Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership

Abstract

Background Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it. Methods Observational study, based on a cross-sectional design, carried out with data deriving from the study “Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento” (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of–delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients’ profile. Results Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2. Conclusion(s) Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

Obstetric and Neonatal Adverse Events and Association With Care Models: A Cohort Study

“…Regarding care models, the best results were obtained in the application of good practices, in the exclusive care of nursing-midwifery, in all aspects, when compared to the two other services. Other studies presented similar results, showing that nursing-midwifery uses fewer interventions in care 17 , respecting the role of women in childbirth, assisting them with a greater amount of good practices 7,18 , which highlights the importance of this professional's role in the childbirth and birth scenario.…”

Tecnologias não invasivas de cuidado utilizadas por enfermeiras obstétricas: contribuições terapêuticas

“…Assim, nota-se que esses princípios da assistência obstétrica estão alinhados com a concepção de desmedicalização, que pressupõe incorporar premissas do modelo humanístico e saberes de diferentes campos do conhecimento, para compreender a parturição como um fenômeno natural da vida, valorizar o protagonismo feminino, apresentar opções de cuidado e compartilhar as decisões [2][3][4][5]7 .…”

“…O modelo obstétrico brasileiro se caracteriza pela medicalização que, historicamente, vem apresentando resultados maternos e perinatais desfavoráveis. Nesse contexto, destacam-se iniciativas de qualificação e humanização da assistência ao parto, as quais impulsionam a redução de intervenções desnecessárias e o incentivo ao uso de tecnologias apropriadas e a atuação da enfermagem obstétrica [1][2][3] .…”

“…A inserção das enfermeiras obstétricas no processo de parturição se associa com cuidados desenvolvidos na perspectiva humanística, que promovem autonomia e bemestar, com satisfação das parturientes e desfechos positivos em comparação com o modelo medicalizado. Ademais, verifica-se a ampliação do acesso das mulheres às práticas consideradas benéficas, como presença do acompanhante, oferta de métodos não farmacológicos para alívio da dor, liberdade de movimentos e alimentação [2][3][4][5][6] .…”

“…Frente ao exposto, o presente artigo objetivou descrever as contribuições terapêuticas da utilização de tecnologias não invasivas de cuidado, oferecidas por enfermeiras obstétricas, durante o trabalho de parto. Essa pesquisa se faz relevante, pois as publicações científicas comumente se referem às TNICE como métodos não farmacológicos para o alívio da dor; entretanto, acredita-se que a intencionalidade do seu oferecimento durante a parturição ultrapassa o objetivo de minimizar a sensação dolorosa, visto que as práticas dessas especialistas apresentam diversos benefícios e, por isso, são mundialmente reconhecidas como estratégicas para impulsionar a mudança do modelo assistencial obstétrico 2,3,5,7 .…”