Caracterização do cuidado obstétrico em hospitais de ensino de alto risco: um estudo de coorte retrospectivo

Abstract

Objective: to analyze obstetric care in teaching hospitals in the city of Maceió for the care of high-risk pregnancies. Method: an observational epidemiological study characterized as a retrospective cohort performed with 291 women who received assistance with vaginal delivery, cesarean section or abortion process in selected hospitals as the setting for this study. Data collection took place between June and November 2018, through an interview form containing questions that allowed the sociodemographic and obstetric characterization of the interviewed women, as well as the analysis of the assistance provided to these women and their relationship with the obstetric violence, the descriptive and analytical statistics being the basis for the interpretation of the data. Results: 69.8% of the interviewed women were submitted to cesarean section, 29.5% of the women experienced vaginal delivery, and only 0.7% were hospitalized as a result of abortion care. Regarding the characterization of obstetric care: 18.9% did not feel comfortable to present complaints or doubts; 16.5% had hands, arms or legs tied; 13.1% failed to understand the information they received; 10.3% did not feel safe before the care received; 9.6% did not receive information about the procedures developed by health professionals; 7.9% did not feel welcomed and / or supported; 4.5% believe they did not have privacy respected; 4.5% experienced non-consented procedures; 4.1% do not stay with companions of their choice; 4.1% were cried during the care and 3.1% were asked to stop crying or screaming. With respect to women receiving labor assistance, it was observed that 72.1% of them did not feed; to 54.4% were not offered non-pharmacological methods for pain relief; 46.3% did not ingest liquids; 32.0% were submitted to consecutive vaginal touches by different people; 31.3% received synthetic oxytocin through venous access; 28.6% underwent amniotomy; 21.8% were not free to wander and / or change positions; 6.1% underwent trichotomy and 4.8% underwent gastric lavage. Regarding the assistance to the expulsion period, 91.9% of the women gave birth in non-supine positions; 72.1% received induction of pulls; 15.1% were submitted to episiotomy and 5.8% to the Kristeller Maneuver. Regarding the care received by postpartum women and newborns (vaginal deliveries and cesarean deliveries), in 56.4% there was no encouragement to breastfeed in the first hour of life of the newborn; in 47.8% the binomials did not establish skin-to-skin contact with the mother; in 39.8% there was no late clamping of the umbilical Cord and 38.8% the woman could not remain with her child. Conclusion: the characterization of the assistance provided by the teaching hospitals translates into obstetric violence as institutional and gender violence, distancing itself from the principles of safe motherhood and autonomy of women and the family.