Baldisserotto Marcia Leonardi, Theme Filha Mariza Miranda, da Gama Silvana Granado Nogueira
National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Reprod Health. 2016 Oct 17;13(Suppl 3):124. doi: 10.1186/s12978-016-0233-x.
The World Health Organization recommends good practices for the conduct of uncomplicated labor and birth, with the aim of improving the quality of and assessment by women of childbirth care. The aim of this study was to evaluate the association between adoption of good practices according to WHO's recommendation for normal labor and birth and assessment by women of the care received.
Birth in Brazil is a national hospital-based study with countrywide representation consisting of 23,894 mothers and their newborns, conducted between February 2011 and October 2012. The present study analysed a subsample of this national survey. Postpartum women classified as low risk during pregnancy who had experienced either spontaneous or induced labor were included in this study, totalling 4102 mothers. To estimate the association between assessment by women of the childbirth care received (dependent variable) and good practices according to WHO's recommendation during normal labor and birth (independent variables), a multinomial logistic regression analysis was used and crude and adjusted odds ratios calculated with their 95 % confidence intervals.
The good practices associated with positive assessment of the care received by women during labor and birth included the partner's presence, privacy in the birthing place, time available to ask questions, clarity of information received, and empathic support from caregivers during labor and birth. Freedom of movement, free nutrition offered, choice of companions, nonpharmacological analgesia, skin-to-skin contact and breastfeeding in the childbirth room were not associated with the assessment by women of the care received.
Our findings reveal the importance to mothers of their relationship with the team of caregivers during labor and birth. Therefore, caregiver teams must be qualified within a more humanistic vision of childbirth health care.
世界卫生组织推荐了正常分娩的良好做法，目的是提高分娩护理的质量以及产妇对其的评价。本研究的目的是评估按照世界卫生组织关于正常分娩的建议采用良好做法与产妇对所接受护理的评价之间的关联。
巴西出生情况研究是一项基于全国医院的研究，具有全国代表性，涵盖23894名母亲及其新生儿，于2011年2月至2012年10月进行。本研究分析了这项全国性调查的一个子样本。本研究纳入了孕期被归类为低风险且经历了自然分娩或引产的产后妇女，共计4102名母亲。为了估计产妇对所接受的分娩护理的评价（因变量）与正常分娩期间按照世界卫生组织建议的良好做法（自变量）之间的关联，使用了多项逻辑回归分析，并计算了粗比值比和调整后的比值比及其95%置信区间。
与产妇对分娩期间所接受护理的积极评价相关的良好做法包括伴侣在场、分娩场所的私密性、有提问时间、所获信息的清晰度以及分娩期间护理人员的共情支持。活动自由、提供免费营养、同伴选择、非药物镇痛、母婴皮肤接触以及在分娩室进行母乳喂养与产妇对所接受护理的评价无关。
我们的研究结果揭示了分娩期间母亲与护理团队关系对母亲的重要性。因此，护理团队必须在更具人文主义的分娩保健视野内具备资质。
