Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses

Abstract

Objective: to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France. Method: a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries. Results: the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health. Conclusion: the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.

The Feminine Condition and Women's Sexual and Reproductive Health in Brazil and France

“…They often report on the existence of an asymmetry in the interaction between women and professionals. Professionals of assistance, in exercising their power, may use practices and speeches to censor, encourage, make invisible, misrepresent, value, or devalue the actions of service users (Silva et al, 2021 ).…”

“…It is possible to say that, in some way, there is a rapprochement between the two countries, in what involves the criticism regarding the monopoly of the discourse on women's bodies and health (Coulm and Blondel, 2013 ; Thomas, 2017 ; Betrán et al, 2018 ; Boerma et al, 2018 ; Grilo Diniz et al, 2018 ; Lansky et al, 2019 ). It is also possible to verify that in both countries there is an ambivalence in the attention to mothers and babies, which is revealed in the existence of a health organization that intends, on the one hand, to protect them through regulation of their behavior materialized in the establishment of an administrative surveillance (Molina, 2014 ; Silva et al, 2021 ).…”

“…In addition to these group discussions, individual interviews were conducted and a research diary was adopted. It was guided by the theoretical and methodological references and the theoretical-methodological framework of institutional analysis (Lourau, 1970 ) the latter of which is in line with the French Institutional Socioclinics that seek to be attentive to the institutional dynamics and to understand the logic of professional practices implemented (Monceau, 2003 , 2018 ; Silva et al, 2021 ).…”

“…The steps of the analytical process were transcription of the individual and group 3 interviews, constitution of the units of meaning and correlation of these with the theoretical references, and reconstitution with the final analyses (Silva et al, 2021 ).…”

“…Such practices are usually justified by the idea of safety. At the same time, this system is worn down by the logic of profit, efficiency of actions, and rationalization of practices (Coulm and Blondel, 2013 ; Césarine, 2017 ; Silva et al, 2021 ).…”