Abstract
Abstract Objectives: To characterize the practices used by nurse-midwives in a Natural Birth Center (NBC) and to verify the maternal and neonatal outcomes. Method: This was a cross-sectional, documentary, retrospective study with a quantitative approach in which the medical records of 300 parturients who gave birth in a state hospital in the city of São Paulo were analyzed. The categories of the World Health Organization (WHO) composed the criteria adopted for the analysis of the obstetric practices. Fisher's exact test or the likelihood ratio and Student t-test were used. Results: The nurse-midwives mostly used category A practices of the WHO. There were no statistically significant associations between practices and perineal outcomes. There was a statistically significant association between the weight of the newborn and the number of neonatal complications, as well as between the delivery position of the primiparous women and clavicle fractures of the newborns. Conclusion and Implications for the practice: Evidence-based practices were followed by the nurse-midwives in the NBC analyzed. The maternal and neonatal outcomes were adequate. There is a need to improve care in the second stage of the delivery in order to avoid behaviors that reflect in neonatal complications. The study makes it possible to reflect on the importance of the continuous evaluation of the care provided.
Highlights
The results demonstrate that the nurse-midwives mostly used the World Health Organization (WHO) category A recommendations, which has been observed in other studies performed in Natural Birth Center (NBC).[1,2]
The annotations identified in the medical records allowed the conclusion that evidence-based practices are being followed by nurse-midwives in the childbirth care of usual risk in the NBC analyzed
Another limitation is related to the fact that data collected was from the medical records of women accompanied by nurse-midwives throughout the birth and delivery process
Summary
Changing the scenario of obstetric care in Brazil is a challenge and requires structural alterations in the care services, changes in some cultural paradigms and, above all, the qualification of the professionals and the effective inclusion of midwives and nurse-midwives in order to contribute to the reduction of maternal and neonatal morbidity and mortality.[1,2]One of the strategies used by the Brazilian Ministry of Health (MH) to encourage the use of evidence-based practices in the birth and delivery process was the implantation, in 1999, of Natural Birth Centers (NBCs),[3,4] places where preferably nurse-midwives and midwives provide the care.From this perspective, studies[5,6,7,8] comparing the care provided at the Obstetric Center (OC) and the NBC showed an improvement in childbirth care in the second model, since there were fewer perineal traumas and interventions such as analgesia, episiotomy and oxytocin use, as well as a lower number of transfers for operative deliveries.Despite the efforts of the previous 20 years to implement public policies aimed at improving obstetric care, the results are still incipient, as demonstrated by the national survey published in 2014.9 This revealed the priority use of practices not recommended by the scientific evidence, leading the authors to corroborate with publications recommending the inclusion of midwives and nurse-midwives in order to collaborate with the transformation and improvement of the health care.[10,11,12]As the strengthening and expansion of NBCs depend on the successful results of this care model, the present study aimed to characterize the practices used by nurse-midwives in an NBC and to verify the maternal and neonatal outcomes resulting from this care. One of the strategies used by the Brazilian Ministry of Health (MH) to encourage the use of evidence-based practices in the birth and delivery process was the implantation, in 1999, of Natural Birth Centers (NBCs),[3,4] places where preferably nurse-midwives and midwives provide the care From this perspective, studies[5,6,7,8] comparing the care provided at the Obstetric Center (OC) and the NBC showed an improvement in childbirth care in the second model, since there were fewer perineal traumas and interventions such as analgesia, episiotomy and oxytocin use, as well as a lower number of transfers for operative deliveries.
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