From Prenatal to Postpartum Care: Changes in Obstetric Health Services During the Covid-19 Pandemic

Abstract

Objective: to analyze changes in maternal health care during the Covid-19 pandemic, according to reports by health professionals. Method: qualitative research, conducted with managers, physicians, nurses, residents and nursing technicians working in a prenatal outpatient clinic, obstetric emergency department, delivery center and obstetric inpatient ward of a high complexity federal public hospital in the Northeast of Brazil. Data were collected from December 2020 to August 2021. The sample, chosen intentionally, sought the diversity of characteristics and situations, was closed by the criterion of saturation of meaning. A structured questionnaire and a semi-structured interview script were used for data collection. The interviews were recorded and transcribed. Content analysis was used in the thematic modality. Results: 28 professionals were interviewed. Changes in the dynamics of obstetric care were identified and categorized as: prenatal care; and childbirth/postpartum. In prenatal care, there was a decrease in elective consultations; increased time between consultations; delayed care due to paramentation; implementation of new hygiene protocols; limitation of the number of companions; creation of new environments such as the Covid-19 isolation room for symptomatic pregnant women; teleservice and work overload due to the increased demand coming from Primary Health Care. In childbirth/postparum, the reports indicated a reduction in the number of beds; testing and isolation of symptomatic patients; limitating walking, restriction of companions and mandatory use of mask by pregnant woman. Conclusion: the restructuring of services and the creation of new spaces to care for patients with Covid-19 led to a reduction in the availability of vacancies for prenatal and postpartum consultations. The changes were accompanied by new service rules, with setbacks regarding the guarantee of rights.

Prenatal Qualification Course: Interprofessional Constructions and Reconstructions

“…Studies have shown across Brazil persistent gaps related to low coverage, late initiation and the discontinuity of pregnant women attending prenatal consultations, access to diagnosis and treatment centers, in addition to the unpreparedness of health professionals to conduct of quality prenatal care [10][11] . Other studies show, in the same direction, that the quality of prenatal care is directly associated with theoretical-practical intervention approaches, that is, with the expanded and contextualized understanding of biological, psychological and sociocultural aspects by the interprofessional health team [12][13] .…”

Immediate Puerperium During the Pandemic: Women’s Oral History in the Light of Obstetric Care Models

“…To avoid contamination, practices that valued women's protagonism were neglected, which caused suffering to parturients, family members and professionals. These observed that isolation and the fact of preventing the presence of a companion produced intense suffering in women 4 .…”

“…In April 2020, pregnant and postpartum women were part of the risk group for COVID-19, intensifying protective measures and developing institutional protocols that reorganized obstetric care 3 . In this context, the Brazilian reality was perceived in reduction in the offer of prenatal consultations, in new protocols related to hygiene, in implementation of telecare, in professional burden, in complications for mother and baby due to lack of prenatal care and increased perinatal and fetal mortality 4 .…”

Rooming-in Practices and Satisfaction With Care According to Discharge on Exclusive Breastfeeding

“…On the other hand, the COVID-19 pandemic exerted a significant impact on the dynamics of maternity-related health services, which resulted in access barriers and difficulties in prenatal, delivery and postpartum follow-up. In addition to that, the environmental and behavioral changes resulting from the pandemic also exerted impacts on the quality of the services provided 34 .…”