Estar grávida no Brasil

Abstract

Pregnancy brings many changes and expectations for women and their families, since it entails new emotional, social, and legal responsibilities that accompany motherhood. Last year in Brazil, only 45% of the pregnancies resulting in births had been planned for the time at which they eventually occurred. Although 97% of pregnant women in Brazil received prenatal care and 99% of births occurred in hospitals, problems persist with the quality of care provided (Lancet 2011; 377:1863-76). A study in Rio de Janeiro focusing on hospitals under the so-called Supplementary Healthcare System (i.e., private services outsourced by the public Brazilian Unified National Health System) showed that during pregnancy, Brazilian women change their minds on the type of delivery they want. In the first trimester, only 30% report they would prefer a cesarean, but by the time they come to the maternity hospital this figure reaches 70%, and only 10% end up having a vaginal delivery. Fear of pain is the main initial reason for wanting to have a cesarean and is also an important factor for women who change their minds during pregnancy. Protective factors against cesareans include being well-informed about the advantages of vaginal delivery and the husband's desire for the wife to choose this birthing modality (Ciênc Saúde Coletiva 2008; 13:1521-34). A cesarean section should not be viewed as a trivial surgical intervention, since it increases the risk of postpartum hemorrhage, ICU admission, mortality, and uterine rupture in subsequent pregnancies with abnormal placentation. For the newborn, potential complications include increased need for ventilatory support at birth and greater use of the neonatal ICU. In public healthcare services in Brazil, pregnant women undergoing vaginal delivery also suffer excessive manipulation, remain confined to bed, are prevented from walking or eating, receive ocytocin, and give birth in the supine position with the aid of an episiotomy. None of these procedures is still recommended by the World Health Organization. The model of care based on appropriate technologies for delivery and birth (also known as humanized childbirth), conducted by midwives and common in nearly all European countries, has shown excellent perinatal results, in stark contrast to the model we have implemented here in Brazil. With a cesarean rate exceeding 50%, more and more Brazilian women give birth under anesthesia, going through labor and delivery without feeling pain, but also without feeling the birth of their children. Meanwhile, the majority of Brazilian infants are removed from the uterus by physicians, thus alienating them from this vital and highly significant human experience. We have no evaluation of the middle and long-term impacts on children born under Brazil's extremely medicalized model for childbirth care, but it takes little effort to recognize that it represents a break with the way previous generations of Brazilians were born, and from the population perspective, it is an experience that has not been evaluated pre...

Estratégia de comunicação e informação em saúde e a percepção de sentir-se preparada para o parto: ensaio aleatorizado por conglomerados (PRENACEL)

“…Brazil adopted a model of care for pregnancy, childbirth, and postpartum with a medical obstetrician as the principal provider of obstetric care. The model of care has been described as highly interventionist and medicalized 10,11,12 , and recent analyses have focused on strengthening the debate on care centered on the women's needs and preferencees 13 . Current population-based data indicate low or varied prevalence of good practices during care for labor (for example, eating and hydration, walking, use of non-pharmacological pain relief methods, completion of the partograph, and presence of an companion of choice) and high prevalence of obstetric interventions during labor and delivery (for example, venous catheter, Oxytocin induction, amniotomy, analgesia, lithotomy position, Kristeller maneuver, episiotomy, and cesarean section).…”

O parto na TV: um olhar sob a perspectiva de Ivan Illich

“…É preciso acentuar que o parto abdominal aumenta os riscos de: hemorragia pósparto, internação em UTI, mortalidade e ruptura uterina em gestações posteriores com placentação anormal. Além disso, também pode gerar maiores complicações para os recém-nascidos, como: o aumento da necessidade de suporte ventilatório no nascimento, maior uso da UTI neonatal, e necessitará de cuidados especiais pelo menos durante a primeira infância 9 . Diante disso, pode-se afirmar, portanto, que a realização exacerbada de cesáreas está relacionada a um aumento na morbidade materna e neonatal.…”

“…Não deve ser visto, portanto, como uma intervenção cirúrgica rotineira, uma vez que aumenta os riscos de hemorragia pós-parto, internação em Unidade de Terapia Intensiva (UTI) e mortalidade. Além disso, também pode gerar maiores complicações para os recémnascidos, como o aumento da necessidade de suporte ventilatório no nascimento e maior uso da UTI neonatal 9 .…”

Fatores associados a cesáreas em um hospital universitário de alta complexidade do sul do Brasil

“…High C-section rates are a great challenge for health policy, since its indiscriminate performance involves unnecessary risks for both mother and child, besides additional costs to the healthcare system (5) . C-sections should not be trivialized, because they increase risks of complications for women, such as postpartum hemorrhage and mortality and, for the newborn, an increased need for mechanical ventilation support at birth and intensive care (6) .…”