O nascimento humanizado: a assistência pré-natal e ao parto na saúde pública do Município de Manaus

Abstract

This master‟s dissertation analyzes the prenatal and parturition assistance offered in the public health system of Manaus. To achieve the proposed objectives, we seek to know the legal advice to the offer of both assistances and we used, priority, primary data obtained at 2015. It is a quantitative and qualitative research made in four public maternity hospitals of Manaus: Ana Braga, Azilda da Silva Marreiro, Balbina Maestrino and Alvorada. It was made semi-structured interviews with twenty mothers who had given birth - five at each maternity hospital – and with three nurses - at the first three hospitals cited. For that, the mothers who were hospitalized in the data survey period and who had already gone through childbirth care process were selected. Nurses were selected as they had direct involvement in labor and delivery. The graduate student contributed with the research as user of the assistance of child-birth. It was not planned, but the opportunity was used to know better the reality of the service, giving birth at one of the public maternity hospitals part of the research. Concerning prenatal assistance, it was evaluated the adequacy of the assistance received by women with what is proposed by legislation – “Portaria 569/2000”, that established the program of humanization of labor and birth. The main results show high coverage, but with expressive access difficulty, which resulted in the impossibility of all pregnant women carry a minimum of six prenatal consultations. It was identified, mainly, the need of enlargement of assistance offer at basic units, priority in North Zone of Manaus. Concerning parturition assistance, was evaluated the use of good obstetric practices throughout labor and birth, which legal orientations are in the technical manual named as “Parto, Aborto e Puerpério: Assistência Humanizada a Mulher”, from 2001. The results show that good practices throughout the labor occurred in less than half of cases and that expressive number of women was submitted to unnecessary and harmful obstetric intervention. In order to improve the parturition assistance quality, the municipality of Manaus must invest in the construction of normal delivery centers, outside the hospital ambience, to cover all usual risk pregnant women. Also, it must reform the maternity hospitals to provide a suitable environment for humanized birth and invest in the training of doctors to have appropriate practices based on scientific evidence and respect the role of women