Crenças e crendices sobre as atuais intervenções durante o trabalho de parto e parto no Brasil

Abstract

The study Birth in Brazil represents a real landmark for the field of scientific research on the topic of maternal and perinatal health. It arose from a specific Brazilian research call (Edital 057/2009 from CNPq/Decit) which asked for a nationwide survey on the consequences of mode of delivery for the health of both mother and child. At that time I led another proposal also submitted to this call. The winning proposal, this that the article currently under debate refers to, was led by Leal et al. I want to congratulate her and her team on the excellent work they performed. This indicates that the decision the examining committee took at that time was appropriate. To the best of my knowledge this is the first comprehensive assessment of childbirth conditions for a sample representative of the Brazilian population to which we have access.Among the countless possibilities for analytically approaching the huge amount of data they have, we are now focusing on "Obstetric Interventions during labor and childbirth in Brazilian low-risk women" as highlighted in this issue of the journal. This research used the full sample from the original study with information on 23,894 women and then selected those that could be classified as low risk by excluding diagnosis of hypertension, diabetes, obesity, HIVpositive, gestational age outside the 37-41 week range, multiple pregnancy, non-vertex presentation, birth weight below 2,500g or above 4,500g, and inadequate birth weight for gestational age, remaining with around 57% of low risk women in the sample. Additionally, depending on the topics focused in analysis regarding labor and vaginal birth, women who did not enter into labor and those who had cesarean section were also excluded. Although following a framework design typical for a cross sectional study, some information from these women was gathered at 45 days and six months postpartum through telephone interviews. This could be a weak point of the study considering we have no information on dropout rates for these two additional data collection periods and this could have introduced a selection bias, taking into account the practical difficulties and the usual relatively high rates of unsuccessful contacts at least in Brazil 1 .The article deals with practices during childbirth, not all of them with strong evidence to support its use or recommendation for non-use, as well as with the unnecessary use of technologies and interventions that could even cause harm to both mother and fetuses, and the excessively high rates of cesarean section among these low risk women, and hypothesizes that in spite of the high coverage of hospital deliveries in Brazil, the quality of obstetrical care is generally low. It showed that among those recognized as best practices in labor among low risk women, including eating and mobility during the first stage of labor (dilation period), use of non-pharmacological methods for pain relief and the appropriate use of partograph to monitor the evolution of labor were poorly implemented countrywide, and ...

Good practices according to WHO’s recommendation for normal labor and birth and women’s assessment of the care received: the “birth in Brazil” national research study, 2011/2012

“…To assess the outcome of interest (i.e., assessment by women of the care received during labor and birth), only postpartum women classified as low risk during pregnancy who had experienced either spontaneous or induced labor and whose birth had occurred in the Southeast region of Brazil were included. This geographical delimitation has been chosen because the Southeast has the highest prevalence of adoption of the good practices in care during normal labor and birth recommended by WHO [ 13 ]. Women were defined as low-risk according to the following criteria used by Dahlen et al [ 14 ]: absence of pre-existing or pregnancy-related hypertension or diabetes; body mass index <30 (above which the person is considered obese); HIV negative; gestational age between 37 and 41 weeks; singleton pregnancy with cephalic presentation and birth weight between 2500 and 4499 g (between the 5th and 95th centiles of birth weight for gestational age).…”

Caesarean birth rates in public and privately funded hospitals: a cross-sectional study

“…However, CS rates are increasing globally 2 . This rise has been particularly significant in Brazil, where the overall CS rate increased from 33% in 1991 3 to 51.9% in 2012 4 . The high number of CS births in the privately funded healthcare sector makes a significant contribution to the high overall rates in Brazil, with CS rate as high as 80% in these settings 3 , 5 , independent of maternal or fetal complications during pregnancy or labour 5 .…”

Retrato Das Práticas Obstétricas Em Uma Maternidade Pública

“…Outras práticas como amniotomia, o uso de ocitocina e a utilização de acesso venoso periférico devem ser eliminadas na assistência ao parto, entretanto foram ações frequentemente utilizadas, com taxas superiores às aceitas na literatura (22) . Estas práticas são resquícios da formação obstétrica dos anos 80, quando era recomendado amniotomia e ocitocina para todas as parturientes (23) .…”