A prática obstétrica da enfermeira no parto institucionalizado: uma possibilidade de conhecimento emancipatório

Abstract

Pesquisa qualitativa, que objetivou analisar os sentidos atribuídos pelas enfermeiras às mudanças de sua prática obstétrica, utilizando o método produção de sentidos no cotidiano - práticas discursivas, proposto por Mary Spink. Dados coletados por entrevista individual, semiestruturada, com 16 enfermeiras obstétricas, em maternidades públicas - Rio de Janeiro, Brasil. Foram analisadas com os conceitos de travessia de fronteiras e constelações de poder de Boaventura Santos. Os sentidos atribuídos pelas enfermeiras às práticas obstétricas evidenciaram uma transformação em processo no âmbito do conhecimento obstétrico e das práticas na perspectiva da desmedicalização. Fronteira, lugar de transição paradigmática de novas práticas surge em relações emancipatórias com as mulheres. Concluímos que experimentar novas práticas envolve superação dos limites conhecidos para encontrar autonomia, configurando-se um conhecimento e prática com possibilidades emancipatórias. Travessias, nessa direção, se dão pela ousadia de buscar e experimentar o novo, transgredir o limite e aproveitar os espaços abertos na constelação de poderes.

Cuidado de si e relações de poder: enfermeira cuidando de outras mulheres

“…Also, Birthing Centers of Normal Childbirth constitute a stimulus to childbirth physiology, a space of subjectivity and intersubjectivity that aims at women's protagonism regarding their citizenship, rights, and autonomy. The care in this scenario allows freedom of choice through dialogue, education and informational activities, use of the childbirth plan, and support/encouragement during the childbirth process (24,34) . On the other hand, some studies start address power relations as solidified relations that benefit the health professional and the systems they represent, to the detriment of the user of health (13)(14)16,18,29,(32)(33) .…”

“…The technologies of the I are a privileged subjectification field and of this being-with-the-self domain; they consist of a certain number of operations made by individuals regarding their body and soul, thoughts, conduct or any way of transforming oneself, in search of a certain state of happiness, immortality (37)(38)(39) . Some factors involving the care of the self of nurses were mentioned in the studies (14)(15)17,(19)(20)22,24,28,30,34 ): historical constitution of nursing; need for self-reflection; nurse's social position as a woman and health professional, and resistance movements of nurses. The historical constitution of nurses assumes that corporeity, i.e., the body in the world, is formed by historical influence (19) .…”

“…But nurses are also on the move, seeking to study, work, and have financial independence aiming at growth and emancipation. They are in search to be subjects of their lives and bodies in the everyday life, overcoming the limits of power relations, seeking distinction, creating escape routes and resistance (14,34) . Historically, nurses exercised and suffered the action of power, especially the movement of struggle and resistance to the institutionalized power-knowing.…”

“…Escape strategies of nurses aiming at improving the quality of care toward women are highlighted, being based on critical discourse of scientific nature (28) . In this sense, the experience, on the part of nursing, of a transitional period, on the way to another paradigm that questions the various forms of privilege and oppression, is aspired and indicated (23,34) . They live at the borders -balance between what is ancient and still remains and what should be abandoned; confrontation between the biomedical knowledge acquired and the experiences of everyday life; and this confrontation to colonizer knowledge initiates an emancipation process.…”

“…In this exploration of subjectivities, emancipatory practices are formulated considering the female user and sharing with her in a relationship of freedom for both. All emancipating process constitutes self-knowledge; it is not discovered, but created (34) .…”