Graduate Nursing Program, Nursing School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil.
Health Sciences, Child and Adolescent Health, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte City, Minas Gerais State, Brazil.
BMC Pregnancy Childbirth. 2021 Sep 9;21(1):618. doi: 10.1186/s12884-021-04092-x.
Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it.
Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile.
Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2.
CONCLUSION(S): Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.
分娩过程中的产科干预措施并不能反映产科护理的改善。在分娩过程中常规进行的一些没有任何科学依据的做法，如 Kristeller 手法、常规会阴切开术以及限制产妇活动或进食等，反映了一种不尊重产妇的现实，这种现实在巴西仍然存在。本研究的目的是基于会员等级（GoM）方法评估贝洛奥里藏特市产科医院的产科干预措施的共存和流行情况，并调查与其共存情况相关的社会人口学和产科因素。
这是一项基于横断面设计的观察性研究，数据来自“Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento”（生于贝洛奥里藏特：分娩和出生调查）研究。在此研究中，所调查的干预措施包括：明确有用且应鼓励的措施；明确有害或无效且应消除的措施；以及不恰当地使用与世界卫生组织推荐的方法不一致的措施。所分析的干预措施包括：为产妇提供食物，允许产妇自由活动，使用产程图，采用非药物方法缓解疼痛，灌肠，会阴剃毛，产妇卧位分娩，Kristeller 手法，人工破膜，缩宫素输注，镇痛和会阴切开术。本研究采用 GoM 来识别所采用的产科干预措施的共存情况。在构建患者特征时，考虑了年龄、教育程度、肤色、初产妇、分娩地点的资金来源、产前检查次数、分娩时的胎龄、分娩时是否有产科护士、有偿工作以及分娩时是否有陪伴者等变量。
结果突出了两种对立的产科特征，即：特征 1 包括为产妇提供饮食、自由活动、使用产程图、使用非药物方法缓解疼痛、卧位分娩、不进行 Kristeller 手法、会阴切开术或人工破膜、不给产妇使用催产素输注和镇痛的产妇；特征 2 则包括不给产妇提供饮食、不允许产妇自由活动、不使用产程图或使用非药物方法缓解疼痛、进行灌肠、会阴剃毛、Kristeller 手法、人工破膜和催产素输注的产妇。此外，她们还接受了镇痛和会阴切开术。这一结果强调了存在一种不基于科学证据的产科护理模式。基于对影响产科干预措施共存的因素的分析，产科护士在医疗实践中的存在降低了产妇属于特征 2 的可能性。此外，在公立机构分娩的产妇属于特征 2 的可能性也降低了。
基于对影响产科干预措施共存的因素的分析，分娩医院的资金来源增加了产妇属于特征 2 的可能性。然而，当医院的产房有活跃的产科护士时，产妇属于特征 2 的可能性会降低。本研究有助于讨论产科干预措施，并改善分娩辅助模式。此外，它强调了需要制定策略，专注于遵循和实施基于科学证据的辅助模式。
