A arte de não fazer o errado e fazer o certo!

Abstract

Timely and strategic, Leal et al.'s article "Obstetric Interventions During Labor and Childbirth in Brazilian Low-risk Women", intend to assess on a national level one of the most currently discussed issues: how to assist childbirth, and what should or should not be done for the safety and well-being of the woman and the newborn. Worldwide, this discussion has extreme and opposite impacts: in places with very few human resources and poor infrastructure, where childbirth without any professional care keeps killing women, and, in the other extreme end, in places where, for the sake of "care", interventions turned childbirth a standardizes process, with "routine" interventions whose evaluation of effectiveness are being the subject of permanent investigations, as mentioned by the authors and other systematic reviews carried out by Cochrane, recently published and mentioned at the end of this comment 1,2,3,4,5,6,7,8 .The results presented in this article disclose, in a summarized way, that the so-called good practices are less frequent then interventions during labor and delivery, which go against the evidences found in the investigations about the effectiveness of such actions. Aside from considerations about regions and other variables, my contribution in this comment seeks to expand the basis necessary to address the so-called obstetric care model for both, the public and the private sector, with the incorporation of evidence-based practices, and, particularly, with the revision of the initial concept that turned childbirth from a natural process into a medicalized procedure, filled with interventions.As well indicated by the authors, a very small proportion, 5.6% of low-risk women, and 3.2% of nulliparous women of this group managed to have a normal vaginal delivery, in a natural way, with no intervention in the physiology of labor. In other countries, such proportion may range from 15% to 35% in Australia to 41.8% to the total births in England. For almost 95% of the women in Brazil, the mere fact of being in a hospital means to be subjected to procedures, most of them expensive and unwarranted. Thus, the basic principle for discussion of the necessary shift in care model is the autonomy of the woman, the ownership of childbirth and its needs. Calling it a model is an approximation, inadequate and categorizing, in the discussion about the unique and always particular experience of giving birth.

Satisfaction of companions with the experience of supporting the parturient at a university hospital

“…24 The right to information is a basic premise of the relationship of the health care professional with the user, fundamental to cause changes in obstetric care. 25 The type of approach of the health care professional can also influence the companions' experience because, as shown by the results of this investigation, the companions who did not receive instructions from the physician about their role were more satisfied with care received in the OC. This finding is contrary to other studies in which instruction during labor was one of the aspects associated with greater satisfaction of the partu-rients.…”

Da Tecnocracia Ao Protagonismo Da Mulher No Cenário Da Parturição

“…A estratégia para que ocorram as mudanças deve compreender melhor o porquê da não implementação de algumas boas práticas ou da permanência de intervenções sabidamente sem evidência. Assim torna-se fundamental escutar como os profissionais de saúde se sentem diante dessa transformação (SERRUYA, 2014).…”