Alta taxa de cesáreas no Brasil: de quem é o protagonismo na escolha da vida de parto?
Tipo
TCC
Data de publicação
2024-06-13
Periódico
Citações (Scopus)
Autores
Cristo, Julia Duarte Couto de
Figueiredo, Júlia Rafaela
Figueiredo, Júlia Rafaela
Orientador
Biagi, Juliana de
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ISSN da Revista
Título de Volume
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Resumo
Introdução: A violência obstétrica é constituída por práticas que podem ocorrer durante gravidez, parto, pós-parto e abortamento, como negligência, discriminação social e racial, realização de procedimentos sem explicação e/ou consentimento prévio, privar a gestante de alimentar-se, movimentar-se ou escolher a posição de parto, e, inclusive, a realização de cesariana sem indicação. Cesariana é uma intervenção cirúrgica de grande importância na prática médica, com baixa incidência de complicações graves e vantajosa quando indicada corretamente, mas que agrega riscos adicionais e desnecessários ao feto e à mãe quando realizado sem necessidade clínica. A OMS recomenda uma taxa de cesáreas entre 5,0 e 15,0%, e apesar disto, a taxa de cesáreas no Brasil é de 56,7%, a 2ª maior do mundo, refletindo a falta de informação e permitindo desrespeito aos mecanismos fisiológicos do parto normal, impondo posições desconfortáveis e intervenções obstétricas desnecessárias, atribuindo uma visão patológica ao parto vaginal, normalizando experiências de dor, impotência e humilhação, e implantando a crença na cesárea como a melhor opção de dar à luz: indolor, sem riscos e sem medo. As gestantes têm a prerrogativa de exercer seus direitos, o que é possibilitado com conhecimentos acerca do processo, idealmente adquiridos durante o pré-natal. A escolha da via de parto é um direito da parturiente, assim como uma assistência digna, informada, livre de violência e discriminação, prestada por profissionais de saúde compromissados e respeitosos, que informem e incluam a gestante na decisão, permitindo uma escolha baseada em evidências, considerando seus desejos e expectativas para a realização de um parto adequado. Objetivo: Analisar se há interferência na escolha da via de parto das gestantes por parte dos profissionais da saúde. Metodologia: Estudo observacional, transversal e prospectivo, com aplicação de questionário Google forms, adaptado de “Nascer no Brasil: Inquérito Nacional sobre Parto e Nascimento”, da Fiocruz, a 50 puérperas, no período de novembro de 2023 a abril de 2024, no Hospital Universitário Evangélico Mackenzie. Resultados: Em relação ao tipo de parto que queriam ter no início da gravidez, 4,0% (n = 2) afirmaram não ter preferência, 36,0% (n = 18) afirmaram preferir cesárea, e 60,0% (n = 30) afirmaram preferir parto normal. Das que não tinham preferência, ambas fizeram cesárea (100%, n = 2); das que preferiam cesárea, 72,2% (n = 13) realizaram cesárea, 22,2% (n = 4) realizaram parto normal, e 5,6% (n = 1) realizaram parto à fórceps. Finalmente, das que preferiam parto normal, 66,7% (n = 20) fizeram parto normal e 33,3% (n = 10) fizeram cesárea. Analisando comparativamente os dados coletados com o resultado da pesquisa “Nascer no Brasil”, há similaridade entre valores percentuais, como altas taxas de cesárias nos grupos 4 (66,0% na amostra e 61,0% na Nascer no Brasil) e 5 (79,0% e 84,0%). Conclusão: Baseando-se nas informações conciliadas ao longo do projeto, considerando a revisão da literatura, bem como dados coletados na entrevista com puérperas e em seus prontuários, pode-se dizer que não houve evidência significativa de interferência na escolha da via de parto por meio dos profissionais de saúde na amostra analisada.
Introduction: Obstetric violence consists of practices that can occur during pregnancy, childbirth, postpartum, abortion, such as negligence, social and racial discrimination, performing procedures without explanation and/or prior consent, depriving pregnant women of food, movement, or the choice of birthing position, and even performing unnecessary cesarean sections. Cesarean section is a major surgical intervention in medical practice, with low incidence of severe complications and advantageous when correctly indicated, but that causes additional and unnecessary risks to the fetus and mother when performed without clinical need. The WHO recommends a cesarean section rate between 5,0 and 15,0%. Despite this, the C-section rate in Brazil is 56,7%, the 2nd highest in the world, reflecting lack of information, hindering the physiological mechanisms of normal childbirth through the imposing routines, uncomfortable positions, and unnecessary obstetric interventions. This contributes to a pathological view of vaginal birth, normalizing experiences of pain, helplessness, and humiliation, instilling in women the belief that cesarean delivery is the best option: painless, risk-free, and without fear. Women have the prerogative to exercise their rights, which is possible with knowledge about the birthing process, ideally acquired during prenatal care. For instance, the choice of delivery is a right of women in labor, as well as a dignified, informed, violence-free, and discrimination-free care by committed and respectful healthcare professionals who inform and involve the pregnant woman in the decision, allowing for an evidence-based choice, considering her desires and expectations for a proper delivery. Objective: To analyze if there is interference in the choice of type of delivery for pregnant women by healthcare professionals. Methodology: Observational, cross-sectional, prospective study, through the application of a Google Forms questionnaire, adapted from "Giving Birth in Brazil: National Survey on Birth and Delivery", made by Oswaldo Cruz Foundation, applied to 50 postpartum women, from November 2023 to April 2024, at Hospital Universitário Evangélico Mackenzie. Results: Regarding the type of delivery they wanted to have in the beginning of pregnancy, 4,0% (n = 2) didn’t have a preference, 36,0% (n = 18) prefered a cesarean birth and 60,0% (n = 30) prefered a vaginal delivery. The ones that didn’t have a preference, both had C-sections; the ones thar prefered a cesarian birth, 72,2% (n = 13) had a C-section, 22,2% (n = 4) had a vaginal delivery and 5,6% (n = 1) had a assisted vaginal delivery (vacum or forceps); finally, 66,7% (n = 20) of the ones that wanted a vaginal delivery had one, and 33,3% (n = 10) had a ceserean birth. Comparing data with results from the survey, there is similarity between the numbers, such as the high average of C-sections on the groups 4 (66,0% in the current group and 61,0% in the survey) and 5 (79,0% e 84,0%). Conclusion: Based in the informations gathered, considering the revised bibliography, as well as the data collected from the postpartum women’ interviews, there was no significative evidence of interference of health care professionals in the choice of type of delivery by women in the current group analyzed.
Introduction: Obstetric violence consists of practices that can occur during pregnancy, childbirth, postpartum, abortion, such as negligence, social and racial discrimination, performing procedures without explanation and/or prior consent, depriving pregnant women of food, movement, or the choice of birthing position, and even performing unnecessary cesarean sections. Cesarean section is a major surgical intervention in medical practice, with low incidence of severe complications and advantageous when correctly indicated, but that causes additional and unnecessary risks to the fetus and mother when performed without clinical need. The WHO recommends a cesarean section rate between 5,0 and 15,0%. Despite this, the C-section rate in Brazil is 56,7%, the 2nd highest in the world, reflecting lack of information, hindering the physiological mechanisms of normal childbirth through the imposing routines, uncomfortable positions, and unnecessary obstetric interventions. This contributes to a pathological view of vaginal birth, normalizing experiences of pain, helplessness, and humiliation, instilling in women the belief that cesarean delivery is the best option: painless, risk-free, and without fear. Women have the prerogative to exercise their rights, which is possible with knowledge about the birthing process, ideally acquired during prenatal care. For instance, the choice of delivery is a right of women in labor, as well as a dignified, informed, violence-free, and discrimination-free care by committed and respectful healthcare professionals who inform and involve the pregnant woman in the decision, allowing for an evidence-based choice, considering her desires and expectations for a proper delivery. Objective: To analyze if there is interference in the choice of type of delivery for pregnant women by healthcare professionals. Methodology: Observational, cross-sectional, prospective study, through the application of a Google Forms questionnaire, adapted from "Giving Birth in Brazil: National Survey on Birth and Delivery", made by Oswaldo Cruz Foundation, applied to 50 postpartum women, from November 2023 to April 2024, at Hospital Universitário Evangélico Mackenzie. Results: Regarding the type of delivery they wanted to have in the beginning of pregnancy, 4,0% (n = 2) didn’t have a preference, 36,0% (n = 18) prefered a cesarean birth and 60,0% (n = 30) prefered a vaginal delivery. The ones that didn’t have a preference, both had C-sections; the ones thar prefered a cesarian birth, 72,2% (n = 13) had a C-section, 22,2% (n = 4) had a vaginal delivery and 5,6% (n = 1) had a assisted vaginal delivery (vacum or forceps); finally, 66,7% (n = 20) of the ones that wanted a vaginal delivery had one, and 33,3% (n = 10) had a ceserean birth. Comparing data with results from the survey, there is similarity between the numbers, such as the high average of C-sections on the groups 4 (66,0% in the current group and 61,0% in the survey) and 5 (79,0% e 84,0%). Conclusion: Based in the informations gathered, considering the revised bibliography, as well as the data collected from the postpartum women’ interviews, there was no significative evidence of interference of health care professionals in the choice of type of delivery by women in the current group analyzed.
Descrição
Palavras-chave
parto normal , cesárea , violência obstétrica , natural childbirth , cesarean section , obstetric violence