Conformidade da assistência de enfermeiras obstétricas às recomendações para o parto normal: estudo em duas maternidades

• Autor(a) principal: Guida, Natasha Faria Barros
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/11391
• topic: Nurse-Midwifery; Labor; Humanized Birth; Nursing Care; Saúde da mulher; Enfermagem obstétrica; Trabalho de Parto; Parto humanizado; Assistência de enfermagem; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

This work aimed to evaluate the compliance of care practices in normal births attended by nurse-midwives with existing recommendations and technical standards; and compare the compliance of such practices between two teams of nurse-midwives from two public hospitals. Cross-sectional, retrospective, comparative study, based on secondary data from two public maternity hospitals, with teams of nurse-midwives with a predominance of different educational and training backgrounds. The study included the record of the assistance provided by nurse-midwives during labor and normal birth of women with normal or low-risk pregnancies, with a single fetus in vertex presentation, and gestational age between 37 weeks and 41 weeks and 6 days. In Maternity A, 266 attendances of nurse-midwives during normal birth were analyzed versus 254 attendances in Maternity B. Data collection occurred through a questionnaire elaborated following the WHO recommendations for normal birth care. The following assessment categories were adopted: 100-75% - adequate compliance; 74-50% - partial compliance; and below 50% - no compliance. The two-tailed Z-test was applied, with a 95% confidence interval, = 0.05 and p-value0.025, to check the statistically significant difference between the proportions of compliance with recommended practices in the investigated samples. Nurse-midwives assist predominantly primiparas who had seven or more prenatal consultations. In relation to the WHO Category A care practices, all variables tested in Maternity A presented adequate compliance. In Maternity B, the only practice that obtained partial compliance was timely cord clamping and the others showed adequate compliance as well. Maternity A showed a higher proportion of records regarding three recommended care parameters compared with Maternity B: the partner s presence before labor, the partner's presence during childbirth and timely cord clamping, while in Maternity B there was a higher percentage of records regarding the use of partograph and auscultation of fetal heart rate. The number of women attended by nurse-midwives who had complications after birth was low, 7.1% in Maternity A and 5.1% in Maternity B. With regard to newborns, resuscitation maneuvers were used in 0.8% of the babies in the Maternity A and 6.3% in Maternity B. Newborns referred to the neonatal unit accounted for 0.8% in Maternity A and 4.3% in Maternity B. There were no reports of stillbirth, neonatal or maternal death at both institutions. The results seem to favor Maternity A, where the team of nurse-midwives has a higher quantity of graduates from residency training programs. However, there are still inappropriate practices, such as zero diet prescription and oxytocin to accelerate labor for most of the parturients, which shows the need to improve the compliance of some assistance parameters for low-obstetric-risk parturients in both hospitals.