Práticas obstétricas e a questão das cesarianas intraparto na rede pública de saúde de São Paulo

Abstract

Aguiar CA. Praticas obstetricas e a questao das cesarianas intraparto na rede publica de saude de Sao Paulo./Obstetric practices and the question of intrapartum caesarean section in public health system of Sao Paulo [dissertation]. Sao Paulo (BR): Faculdade de Saude Publica da Universidade de Sao Paulo; 2011. Background The obstetrical practices have been determined by the notion of risk, resulting in high rates of intrapartum interventions and cesarean sections in the country. The recommendations of this surgery have not followed a wellfounded clinical and obstetric criterion in different assistance scenarios, reducing its protective potential. Objectives – Identify and compare the recommendations for intrapartum caesarean sections in women with low-risk pregnancies from the assistance and the events that preceded the birth, in two models of care (Center for Childbirth and Obstetric Center); and characterize the study sites regarding the health team, protocol practices and the structure to assist the woman and the baby. Methods A cross sectional study carried out by secondary data collection in two public hospitals in Sao Paulo. The study included 158 pregnant women with low-risk pregnancies, submitted to intrapartum cesarean section in 2010. For data analysis, we estimated the Odds Ratio. Results – The findings were discussed from the Evidence-Based Medicine. The best results were associated with a hospital that has a Childbirth Center, with statistical significance in the timely admission of the mother, in the presence of a companion, the use of partogram and non-pharmacological methods for pain relief. There were records of obstetrical practices in a way questionable in both institutions, such as use of oxytocin and amniotomy. As for complications, the most frequent were: fetal distress, meconium, functional dystocia and cephalopelvic disproportion, although part of these records have diverged from findings reported in the course of labor. Conclusion: Weaknesses in obstetric practices were present in both institutions, although the Hospital Childbirth Center has demonstrated a more personalized and less restrictive care to women. It was noted the presence of unnecessary interventions, aiming at the acceleration of labor, which shows resistance of professionals and institutions to the evidence-based medicine, and also to the recommendations and guidelines of the Ministry of Health and World Health Organization. Descriptors: Cesarean Section; Labor; Delivery of Health Care; Delivery Rooms.