Obstetric Violence and the Current Obstetric Model, in the Perception of Health Managers

Abstract

Objectives: to understand the perception of managers of public maternity hospitals in the Metropolitan Region II of the state of Rio de Janeiro regarding obstetric violence and the measures to face it aiming at guaranteeing the quality of care. Method: a descriptive, exploratory study with a qualitative approach, conducted with 16 health managers from five maternity hospitals in Metropolitan Region II in the state of Rio de Janeiro. Data were collected through interviews, applied from May 2017 to May 2018, and submitted to content analysis in the thematic modality. Results: the research pointed out thenon-reception, technocratic principles of childbirth, refusal of the companion, disrespect to humanized practices centered on physiology and the choice of women, the need for health training as a guide for the humanization policy and the management of health units, professional unpreparedness for performance and lack of involvement of professionals with longer service time to modify practices in obstetric care. Thus, the need to break away from obstetric violence at the structural/institutional level was evident in order to guarantee quality care for women. Conclusion: it is the responsibility of the managers to provide training to health professionals regarding performance that respects the scientific evidence, the centrality and the axes of policies and recommendations in the area of sexual and reproductive health, especially to women regarding their autonomy.

Obstetric Violence: A Conceptual Analysis in the Nursing Context

“…Black-skinned women (12,15,17,18,20,23,26,30,32,33) with unfavorable financial conditions (12,15,17,18,20,23,26,27,29,30), lower schooling levels (15,17,20,23,26,27,32), and ethnic minorities (15,18,20,27,32) are targets more prone to violent practices, mainly routine interventions and absence of a companion. In addition, many women of low socioeconomic status with low schooling levels had limited access to prenatal consultations, which further led to disinformation about labor and delivery (34).…”

“…The following stand out among the antecedents related to health professionals and institutions: unqualified professionals (14,15,21,22,26,27,29), work overload (14,20,23,26), the professionals' low wages (14,16), stress/authoritarianism on the part of the professionals (15,23,30), inadequate infrastructure (13-16, 20, 21, 23, 26), precariousness in terms of materials and resources (12,14,15,23,26,33) and impunity of acts (12,16,21). Due to a lack of training and adequate working conditions -especially associated with insufficient materials and resources, obstetric care quality becomes increasingly dehumanized, causing emotional stress and overload in professionals (40).…”

“…Among the attributes included in the category of physical OV, interventions and procedures that are unnecessary or performed without due consent (14,15,17,21,27,28,30,33) stand out, as well as oxytocin use (13, 15, 18, 22-26, 32), episiotomy and episiorrhaphy (13, 14, 17, 18, 20, 22-26, 28, 32), Kristeller maneuver (15,18,22,23,(25)(26)(27)32), constant use of forceps (25,32), denial of any type of pain relief (14,17,18,25,29,30,32) whether by means of non-pharmacological methods or not, restriction to the bed (18, 23, 24-26, 29, 30), prohibition of eating or drinking (23,25,32), enema (15,17,22,25,28), trichotomy (17,22,23,25,26,30,32), which includes unnecessary removal of pubic hair, and mandatory lithotomy position at birth (17, 18, 23-25, 28, 29, 32), which causes increased pain and slows down the delivery process.…”

“…The following attributes stand out in the psychological OV category: humiliation (14,17,18,23,25,27,28,31,32), teasing (15,17), providing false information or omitting information (15,18,19,23,24,29,30,32), yelling (14,16,18,25,31,32), threats (16,18,25,28,(30)(31)(32), disqualification of women's decisions (18,30), denial of care (18,26), abandonment (18,20,24,26,32), embarrassment (18), imposition of decisions/ values (15,18,19,26), trivialization of women's suffering or needs (18,20), reproaches…”

O aprimoramento para enfermeiras obstétricas: protocolo de uma scoping review

“…Dados apontam que, em 2016, 55,5% dos partos ocorreram via cesariana (Brasil, 2017), o que traz também evidentes desdobramentos na razão da mortalidade materna que, em 2018, registrou 59,1 óbitos para cada cem mil nascidos vivos, meta distante daquela definida pelos Objetivos do Desenvolvimento Sustentável para 2030 (Brasil, 2020). Este é um reflexo da qualidade da assistência oferecida e do tradicional modelo de atenção obstétrico brasileiro configurado por ações de cunho individualizado, biologicista, tecnocrático, com baixa adesão às boas práticas de atenção ao parto e nascimento, as quais valorizam o cuidado ao corpo feminino e sua fisiologia (Paula et al, 2020).…”