Avaliação da qualidade da assistência à mulher e ao filho durante o parto normal
The practices developed in the everyday life of obstetric services are sometimes out of step with the recommendations of the public health policies. Accordingly, this research had the objective of assessing the quality of the care provided to women and children during cases of natural childbirth...
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Formato: | Dissertação |
Idioma: | por |
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Universidade Federal do Rio Grande do Norte
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Endereço do item: | https://repositorio.ufrn.br/jspui/handle/123456789/19437 |
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Resumo: | The practices developed in the everyday life of obstetric services are sometimes out of
step with the recommendations of the public health policies. Accordingly, this research
had the objective of assessing the quality of the care provided to women and children
during cases of natural childbirth in municipal public maternity wards of the city of
Natal/RN, Brazilian Northeast. We developed a cross-sectional and quantitative study in
two maternity wards that provide care actions to pregnant women at regular risk
(maternity wards A and B). The participants were 314 puerperal women who were treated
during the period between April and July 2014, whose children were born alive, through
transpelvic way, with spontaneous or induced beginning of labor and that showed
physical and emotional conditions to respond to the proposed questions. The data
collection instrument was constructed on the basis of the recommendations of the World
Health Organization focused on the care of normal childbirth and validated by skilled
judges, and the final version has obtained optimum agreement (k = 0,96; IVC = 0,99).
Associated with these recommendations, we used three indicators: percentage of women
with induced labor or subjected to elective cesarean section (Indicator A); percentage of
women served by a qualified health professional during labor and childbirth (Indicator B);
and Bologna Index (Indicator C). The research obtained a favorable opinion of the
Research Ethics Committee from the Federal University of Rio Grande do Norte, under
the nº 562.313 and Certificate of Presentation for Ethics Appreciation:
25958513.0.0000.5537. The analysis of categories related to the recommendations of
the World Health Organization was conducted by means of absolute and relative
frequency and the Chi-square Pearson’s and Fisher’s exact tests made the comparison
of the differences observed between the two maternity wards. Furthermore, we
calculated the percentage of the indicators A and B and with the results of the Indicator
C, the quality was assessed as follows: the closer to 5, the better will be the quality, and
the closer to 0, the worst will be the quality, and the Mann-Whitney U test was used to
compare the differences of the obtained averages. The significance level of 5% was
considered in all statistical tests. The differences between the maternity wards were
identified with regard to the provision of liquids orally (p=0,018), stimulus for non-supine
positions (p=0,002), existence of partograph (p=0,001), support or welcoming by health
professionals (p= 0,047), intravenous infusion (p<0,001), supine position (p<0,001), use
of oxytocin (p<0,001), food and liquid restriction (p= 0,002) and, lastly, the fact of the
touch is performed by more than 1 examiner (p=0,011). The indicators A and B showed
percentages of 13,09% and 100%, respectively. The overall average of the Indicator C
was equal to 2,07 (± 0,74). There was a statistically significant difference between the
averages of the maternity wards (p<0,001). The care actions provided during the process
of labor and childbirth is inappropriate, especially in the maternity ward B. It is necessary
to implement improvements and redesign the obstetric model in force |
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