Gama Silvana Granado Nogueira da, Viellas Elaine Fernandes, Torres Jacqueline Alves, Bastos Maria Helena, Brüggemann Odaléa Maria, Theme Filha Mariza Miranda, Schilithz Arthur Orlando Correa, Leal Maria do Carmo
National School of Public Health, Oswaldo Cruz Foundation (ENSP/Fiocruz), Rio de Janeiro, Brazil.
ESCOLA NACIONAL DE SAÚDE PÚBLICA SERGIO AROUCA - ENSP/FIOCRUZ, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, CEP: 21041-210, Brazil.
Reprod Health. 2016 Oct 17;13(Suppl 3):123. doi: 10.1186/s12978-016-0236-7.
The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections.
Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births.
16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower.
The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.
在巴西，护士和助产士参与阴道分娩护理的情况有限，且没有关于她们参与情况的全国性数据。目标是描述2011年和2012年巴西护士及助产护士在分娩护理中的参与情况，并分析配备护士及助产护士进行分娩护理的医院与良好实践的应用之间的关联，以及它们在减少包括剖宫产在内的不必要干预措施方面的影响。
巴西分娩研究是一项基于全国人口的研究，涉及2011年2月至2012年10月期间在266个医疗机构中的23,894名产后妇女。该研究纳入了所有由医生或护士/助产护士参与的阴道分娩。采用逻辑回归模型来检验分娩期间良好实践和适当干预措施的实施与护理是由医生主导还是由护士/助产护士主导之间的关联。我们构建了另一个模型，以评估分娩期间产科干预措施的使用与负责患者护理的人员之间的关联，将完全由医生做出决策的医院与那些也包括护士/助产护士负责阴道分娩的医院进行比较。
16.2%的阴道分娩由护士/助产护士协助。在由护士/助产护士协助的分娩中，良好实践（随意饮食、分娩期间活动、非药物性止痛方法以及使用产程图）更为常见，而一些干预措施（麻醉、截石位、子宫底加压和会阴切开术）的使用频率较低。在分娩护理中配备护士/助产护士的产科病房，剖宫产的发生率较低。
本研究结果表明医生与护士/助产护士在分娩护理中开展协作工作具有潜在益处。在巴西，采用良好的分娩管理实践可能是迈向更有效的产科和助产护理的第一步。引入新方法可能比消除旧方法更容易，这或许可以解释为何分娩期间不必要干预措施的减少不如新实践的采用那么显著。
