Labor and birth care by nurse with midwifery skills in Brazil

Abstract

BackgroundThe participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections.MethodsBirth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births.Results16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower.ConclusionsThe results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0236-7) contains supplementary material, which is available to authorized users.

Obstetric Nursing in best practices of labor and delivery care

“…Regarding the freedom of movement and position, in this study it was observed greater proportions in the presence of Obstetric Nursing. The findings resemble recent studies (3,(20)(21) .…”

“…This study demonstrated that the presence of Obstetric Nursing substantially reduces the rates of interventions performed and that, possibly, their presence is directly related to higher rates of vaginal deliveries. A recent study showed that the presence of Obstetric Nursing in LA care and delivery in maternity hospitals has a positive impact, including the reduction of cesarean sections (20) . The process of performing the delivery offered by Obstetric Nursing is centered on the promotion of practices based on scientific evidence seeking to rescue the protagonism of women in the process of giving birth (21) .…”

Perceptions of Nurse-Midwives of Their Residency Training and Professional Practice

“…24 Essa fase transicional do campo obstétrico brasileiro confere um desafio adicional a ser enfrentado pelo ensino na modalidade de residência, considerando que 80% da carga horá-ria total do curso ocorre no serviço, sobretudo nos hospitais, e requer vigilância do corpo docente-assistencial para a formação de enfermeiras críticas, reflexivas e com atitudes políticas para superarem essas adversidades e atuarem como agentes de transformação desse modelo dominante.…”

O processo de aprendizagem das discentes no bloco prático da residência em enfermagem obstétrica [The learning process of students in practical activities of residency in obstetric nursing]

“…Esse modo de produzir o cuidado em saúde se opõem ao modelo médico dominante, centrado no trabalho instrumental, ou seja, em tecnologias duras 21 . Sob essa ótica, a utilização das tecnologias leves conferiu novos sentidos ao cuidado obstétrico prestado pelas discentes e produziu representações acerca do modelo assistencial desmedicalizado, o qual vem conferindo distinção e poder às enfermeiras obstétricas na atenção ao parto e nascimento, principalmente no município do Rio de Janeiro 7,18,20,22,23 .…”

“…Tais práticas obstétricas são comumente desenvolvidas por profissionais adeptos do modelo medicalizado, ainda que as recomendações oficiais e as evidências científicas as considerem como prejudiciais ou de uso criterioso 23 . Ainda, as atitudes impositivas das preceptoras evidenciam a posição dessas agentes em relação as residentes e o exercício de uma violência simbólica para legitimar suas concepções medicalizadas.…”