Birth Care Providers’ Experiences and Practices in a Brazilian Alongside Midwifery Unit

Abstract

The implementation of a new birthing facility in a country such as Brazil requires an extensive in-depth analysis of the challenges faced. The aim of this study was to explore beliefs, values, experiences, and practices related to the provision of birthing and neonatal care with the implementation of a new birth care facility structure called alongside midwifery units in Brazil. The study utilizes an ethnographic method to evaluate members of a Brazilian public hospital’s midwifery unit. The ethnographic study focuses on the cultural theme of “between the proposed and the possible”: the following birthing care guidelines require overcoming numerous obstacles, and four other cultural subthemes toward revealing the analyzed birth care team’s perspectives. The study found that prior training and preparation of all members of the care team, as well as the provision of adequate institutional infrastructure are essential for the implementation of a new and innovative birthing care center.

‘No other alternative than to compromise’: Experiences of midwives/nurses providing care in the context of scarce resources

“…Nurses and midwives expressed difficulty in maintaining privacy during vaginal examinations and delivery due to the absence of screens and overcrowding. Similar studies across low‐income countries have reported several violations of women's privacy and attributed it to poor hospital infrastructure, overcrowding and lack of resources such as screens and partitions (Macdonald et al, 2019; Mselle et al, 2018; Munabi‐Babigumira et al, 2019; Narchi et al, 2017; Nunes et al, 2016).…”

“…Narrative of frequent shortages of delivery kits, oxygen, intravenous fluid, oxytocic agents, blood products, resuscitation kits, beds, and malfunctioning equipment was reported to significantly constrained the delivery of care to childbearing women (Adolphson et al, 2016; Boakye et al, 2021; Macdonald et al, 2019; Mothiba et al, 2019; Mselle et al, 2013; Munabi‐Babigumira et al, 2019; Nabirye et al, 2014; Uwajeneza et al, 2015). Others described inadequate spacing and poor infrastructure created precarious working conditions and overcrowding, thereby compromising the delivery of humanized care (Macdonald et al, 2019; Mselle, Kohi, & Dol, 2018; Munabi‐Babigumira et al, 2019; Narchi et al, 2017; Nunes et al, 2016). Maintaining a safe and ethical practice in the face of profound shortage of medical supplies and health personnel may undermine the moral agency and generate ethical dilemmas for midwives.…”

“…Others described inadequate spacing and poor infrastructure created precarious working conditions and overcrowding, thereby compromising the delivery of humanized care (Macdonald et al, 2019;Mselle, Kohi, & Dol, 2018;Munabi-Babigumira et al, 2019;Narchi et al, 2017;Nunes et al, 2016). Maintaining a safe and ethical practice in the face of profound shortage of medical supplies and health personnel may undermine the moral agency and generate ethical dilemmas for midwives.…”

Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey

“…of items of peer-reviewed literature (references) No. of items of grey literature (references) Survey indicated MLBC(s) Strong evidence (from two or three of the data source types) Afghanistan – n=2 ( Jobs.Af, 2021 ; Summers, 2021 ) ✓ Bangladesh n=2 ( Mahmood et al., 2019 ; Wallace, 2019 ) n=6 ( Amin et al., 2020 ; Begum, 2019 ; Every Mother Counts, 2022 ; Goodbirth.net, 2021 ; Jahan, 2018 ; Michel-Schuldt et al., 2020a ) ✓ Brazil n=10 ( Caldas Nicacio et al., 2016 ; da Silva et al., 2013 ; 2012 ; Freitas et al., 2019 ; Nunes et al., 2016 ; Progianti et al., 2013 ; Rodrigues Duarte et al., 2019 ; Santos et al., 2015 ; Schneck et al., 2012 ; Viana et al., 2012 ) n=2 ( Goodbirth.net, 2021 ; Silva, 2019 ) nr Ecuador – n=2 ( Goodbirth.net, 2021 ; New Life Ecuador, 2020 ) ✓ Fiji – n=2 ( United Nations Population Fund, 2019 ; Vula, 2018 ) ✓ Gambia – n=2 ( Sheikh Tihami I Nyass Foundation, 2022 ; Tripadvisor, 2015 ) ✓ Ghana – n=2 ( Goodbirth.net, 2021 ; United Nations Population Fund, 2021b ) ...…”

Ampliando vozes sobre violência obstétrica: recomendações de advocacy para enfermeira(o) obstetra

“…Pesquisas brasileiras documentaram tal violência 22 por meio de procedimentos não explicados e não autorizados (27,3%) 23 , recusa de permissão para acompanhantes (9,3%) [24][25] , e elevada taxa de cesarianas e nascimentos prematuros 26 , registrando o impacto na saúde de indivíduos, famílias, comunidades e sociedades 25 . O ativismo político latino-americano, com destaque ao movimento brasileiro de humanização do parto, ainda é insuficiente para coibir tal violência 27 .…”