Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2021 Mar;26(3):919-929. doi: 10.1590/1413-81232021263.28482020. Epub 2020 Aug 5.
This study aimed to assess whether nurses' presence in delivery care in maternity hospitals linked to the Rede Cegonha program promotes access to best obstetric practices during labor and delivery. We conducted an evaluative study in 2017 in all 606 SUS maternity hospitals that joined this strategic policy in all Brazilian states. We collected data from maternity hospital managers and puerperae. The analysis was performed at two levels: hospital with or without a nurse in delivery care; and professionals that attended vaginal delivery, whether doctors or nurses. We used best practices and interventions for vaginal deliveries and cesarean section rates as dependent variables. We included 5.016 subjects for analyses of vaginal deliveries and 9.692 to calculate cesarean section rates. Multiple regressions were adjusted for geographic region, maternity hospital size, and puerperae skin color and parity. Maternity hospitals with nurses in delivery care used more the partograph and less oxytocin, lithotomy, episiotomy, and cesarean section. Deliveries attended by nurses had more frequent use of the partograph and a lower likelihood of lithotomy and episiotomy. The inclusion of nurses in vaginal delivery care has successfully brought women closer to a more physiological and respectful delivery.
本研究旨在评估助产士在参与 Rede Cegonha 项目的产科医院中的存在是否能促进产妇在分娩和分娩期间获得最佳产科实践。我们于 2017 年在巴西所有州参与这一战略政策的所有 606 家 SUS 产科医院中进行了一项评估性研究。我们从产科医院管理者和产妇那里收集数据。分析分为两个层次进行：有或没有助产士参与分娩护理的医院；以及参与阴道分娩的专业人员，无论是医生还是护士。我们将阴道分娩的最佳实践和干预措施以及剖宫产率作为因变量。我们纳入了 5016 名接受阴道分娩分析的受试者和 9692 名接受剖宫产率计算的受试者。多元回归调整了地理区域、产科医院规模以及产妇的肤色和产次。有助产士参与分娩护理的产科医院更多地使用产程图，较少使用催产素、截石位、会阴切开术和剖宫产术。由护士照顾的分娩更频繁地使用产程图，而截石位和会阴切开术的可能性较低。将护士纳入阴道分娩护理成功地使妇女更接近更自然和更尊重的分娩。
