Saberes e práticas de enfermeiros e obstetras: cooperação e conflito na assistência ao parto

Abstract

In Brazil, where birthing generally occurs in hospitals and under the care of obstetricians, the incorporation of nurses is a strategy that has been used recently in an attempt to improve obstetric care. This study, conducted in two maternity hospitals in Rio de Janeiro, focuses on representations of obstetricians and nurses regarding teamwork and analyzes how the dimensions of power, cooperation/conflict, and technical autonomy are permeated by dualistic conceptions which influence the quality of health care for women during childbirth. On the one hand, the results show a consensus regarding the advantages of professional cooperation in the improvement of health care, assuming the existence of a clear definition of professional roles. At the same time, conflicts regarding therapeutic conduct during the birth process reflect the professionals' perceptions of autonomy and the influence of professional hierarchies, in which obstetric care is seen to depend on the "objective observation" of the women giving birth. The degree of conflict is differentiated according to the institutional context and related to dualistic conceptions such as objective/subjective, rational/emotional, and male/female.

Humanização do parto: política pública, comportamento organizacional e ethos profissional

“…Assim, de maneira geral, se por um lado os médicos obstetras percebem o parto como um processo potencialmente patológico e que demanda intervenções a fim de se manter o controle sobre a mulher e o nascimento, as enfermeiras o veem como processo fisiológico a ser realizado com pouca ou nenhuma intervenção, no qual o bem-estar geral das parturientes e suas emoções devem ser considerados (Davim & Bezerra, 2002;Angulo-Tuesta et al, 2003;Sodré & Lacerda, 2007). A própria forma como o profissional nomeia a sua assistência ao parto é um importante sinal dessa 72 diferença: o médico "faz" ou "conduz" o parto, enquanto a enfermeira o "assiste" (neste caso, quem faz o parto é a parturiente).…”

Birth Care Providers’ Experiences and Practices in a Brazilian Alongside Midwifery Unit

“…Historically, obstetricians have assumed the main role in birthing care in Brazil. Changes to this hierarchical structure has been described to require agreements, especially in relation to power (Angulo-Tuesta, Giffin, Gama, d’Orsi, & Barbosa, 2003; Diniz & Ayres, 2001). …”

Resultados obstétricos e neonatais de partos assistidos

“…4 However, indiscriminate adherence to technologies, without the proven need in a physiological process, results in risk and possible maternal and neonatal damages. [5][6] In the context of the transformation of childbirth care, there are social movements in defense of women's sexual and reproductive rights and criticisms of the hegemonic biomedical model, characterized by medicalization and intervention. In response to this dissatisfaction, the Ministry of Health (MOH) determines actions that aim to qualify and humanize childbirth care and birth at the time 7 .…”

“…4 The World Health Organization (WHO), in turn, after meeting with the Pan American Health Organization (PAHO) in 1985, lays down guidelines that emphasize good practices of childbirth and birth care based on evidence scientific, and it is a natural event in which there is no need for control, but rather for care. 6 Childbirth care aims to have a mother and child in good health and with as few interventions as possible at the level that ensures safety. To interfere with the natural process of normal birth, there must be a real reason.…”