Assistência puerperal no contexto do alto risco obstétrico: uma investigação sobre a relação com fatores sociodemográficos

Abstract

INTRODUCTION: In the context of the emergence of public policies on women's health, high rates of maternal mortality remain a complex difficulty to be overcome, even if faced as a priority. Studies carried out in underdeveloped countries, in addition to Brazil, also reveal a trend that approximately 60% of maternal deaths occur in the postpartum period. OBJECTIVE: To analyze the association between sociodemographic factors and postpartum care in the context of high obstetric risk. METHOD: This is an observational, exploratory, cross-sectional and analytical study with a quantitative approach, developed in two high-risk maternity hospitals. The participants were postpartum women in rooming-in. Data collection took place from January to October 2024 through the application of a semistructured form. The data obtained were entered and tabulated in spreadsheets in Microsoft Excel 2016. Subsequently, descriptive and inferential statistical analyses were performed using the R software, version 4.2.2. The Chi-square test and Fisher's exact test were used. This research was approved by the Research Ethics Committee of UFAL and UNCISAL. RESULTS: 312 forms were applied. There was a higher prevalence of postpartum women in the age group of 20-29 years, self-declared brown race/color, women in stable unions, with complete high school education, predominantly housewives and from the 1st Health Region. Regarding obstetric aspects, most of the women studied were multiparous, with a history of six or more prenatal consultations, hospitalized due to a single associated cause, prevalence of cesarean deliveries and, in cases of normal delivery, care was predominantly conducted by physicians. Most of the participants also did not present complications in the postpartum period, hospitalization time varied between 1 and 3 days, and rooming-in was the main neonatal outcome. Regarding postpartum care, most of the postpartum women did not receive guidance on returning to sexual activity and use of contraceptive methods. Older women presented lower frequency of breastfeeding in the first hour after delivery and lower understanding of the language used by professionals. In contrast, younger women received less encouragement and guidance on breastfeeding. Furthermore, in relation to white and mixed-race women, self-declared black women reported feeling less comfortable expressing their doubts. CONCLUSION: In general, postpartum care was satisfactory in most aspects evaluated, although it presents gaps, especially regarding guidance on sexual and reproductive health. Therefore, it is essential that health professionals recognize the importance of managing care in the postpartum period, considering the direct and indirect impacts on maternal health. In this perspective, it is important to highlight that, by allowing a deeper understanding of postpartum care in the context of high risk, this study can provide a basis for qualifying increasingly respectful, comprehensive and safe care for women.