Obstetric practices in childbirth care and usual risk birth

cross-sectional, descriptive study with a quantitative approach. Data were collected from 314 Monitoring Sheets of Labor and Childbirth Care of women who had their birth attended at the institution, from July 2017 to July 2018. The study was approved by the research ethics committee, with the embodied opinion number 2.822.707.

Results:

most women in the study were between 20 and 34 years old, coming from the city of Fortaleza, Ceará; had completed high school; and had unpaid work. The prevalence of good practices was identified: umbilical cord clamping in a timely manner (81.5%), immediate skin-to-skin contact (73.9%), breastfeeding in the childbirth room (74.2%), freedom of position and movement (72.3%), completion of the partograph (66.6%), presence of a companion (66.2%), offer of a liquid diet (65%), and non-pharmacological methods for pain relief (54.8%). As for interventional practices, we identified: venoclysis (42.4%), oxytocin infusion (29%), and amniotomy (11.1%).

Conclusions:

advances in the adoption of good practices based on scientific evidence are noteworthy; however, the technocratic model of childbirth care for women at normal risk persists.

Key words
Perinatal care; Normal childbirth; Midwifery

Characteristics	N	%
Age (years)
14-19	79	25.2
20 - 34	214	68.2
35 - 39	18	5.7
40 or more Origin	3	1.0
Fortaleza	251	79.9
Metropolitan region	42	13.4
Countryside	19	6.1
Not informed Education Level	2	0.6
Elementary School	88	28
Incomplete high school	67	21.3
Complete high school	121	38.5
Incomplete university education	11	3.5
Complete university education	4	1.3
Not informed Occupation	23	7.3
Unpaid work activity	207	65.9
Paid work activity	76	24.2
Not informed Prenatal	31	9.9
Yes	308	98.1
No	4	1.3
Not informed Pregnancies	2	0.6
Primiparous	137	43.6
Multiparous	177	56.4
Total	314	100.0

Variables/Categories	N	%
Category A - Confirmedly useful practices that should be encouraged
Freedom of position and movement	227	72.3
Presence of companion	208	66.2
Completion of the partograph	209	66.6
Offer of liquid diet	204	65.0
Use of non-pharmacological methods for pain relief^* * The sample varied due to the possibility that several methods were performed on a parturient.	172	54.8
Massage	115	66.8
Pelvic swing	82	47.6
Breathing exercises	60	34.8
Pelvic exercises	46	26.7
Others	62	36.0
Cord clamping in a timely manner	256	81.5
Breastfeeding in the childbirth room	233	74.2
Skin-to-skin contact Category B - Clearly harmful or ineffective practices	232	73.9
Venoclysis	133	42.4
Oxytocin infusion	91	29.0
Trichotomy	28	8.9
Lithotomy Position	21	6.7
Enema Category C - Practices without sufficient evidence	1	0.3
Amniotomy	35	11.1
Kristeller maneuver Category D - Practices frequently used inappropriately	6	1.9
Episiotomy	22	7.0

	Presence of companion (%)	Completion of the partograph (%)	Freedom of position and movement (%)	Use of non-pharmacological methods for pain relief (%)	Offer of liquid diet (%)
Age (years)
14 to 19	28.4	24.9	28.2	29.0	26.5
20 to 34	67.3	68.4	65.2	65.7	66.7
35 to 39	3.8	5.7	6.2	4.7	5.9
40 or more Origin	0.5	1.0	0.4	0.6	0.9
Fortaleza	80.3	80.9	83.7	79.6	78.4
Metropolitan region	13.5	14.3	12.3	15.7	16.7
Countryside Occupation	6.2	4.8	4.0	4.7	4.9
Unpaid work activity	67.3	68.4	65.2	59.9	65.2
Paid work activity	22.6	21.5	24. 7	28.5	25.0
Not informed	10.1	10.1	10.1	11.6	9.8
Education
Elementary School	23.1	26.8	27.3	23.3	27.9
Complete high school	41.8	38.3	39.2	40.7	40.2
Incomplete high school Complete university	22.6	23.9	23.4	22.1	19.6
education Incomplete university	1.0	1.4	0.4	0.6	1.5
education	4.3	2.4	3.5	5.2	3.4
Not informed Pregnancies	7.2	7.2	6.2	8.1	7.4
Primiparous	52.9	43.1	45.8	51.2	47.6
Multiparous	47.1	56.9	54.2	48.8	52.4
Total	66.2	66.6	72.3	54.8	65.0

	Enema (%)	Trichotomy (%)	Venoclysis (%)	Amniotomy (%)	Kristeller maneuver (%)	Oxytocin infusion (%)	Episiotomy (%)
Age (years)
14 to 19	-	42.8	22.6	25.7	-	22.0	27.3
20 to 34	100.0	53.6	69.9	68.5	100.0	71.4	72.7
35 to 39	-	3.6	6.8	2.9	-	6.6	-
40 or more Origin	-	-	0.7	2.9	-	-	-
Fortaleza	100.0	71.4	81.2	85.7	100.0	82.4	86.4
Metropolitan region	-	17.9	14.3	11.4	-	13.2	4.5
Countryside Occupation	-	10.7	4.5	2.9	-	4.4	9.1
Unpaid work activity	100.0	89.3	64.7	74.3	66.7	67.0	68.2
Paid work activity	-	7.1	27.0	17.1	33.3	23.1	27.3
Not informed Education	-	3.6	8.3	8.6	-	9.9	4.5
Elementary School	-	28.6	23.3	22.9	16.7	22.0	4.6
Complete high school	100.0	35.7	41.4	37.1	66.6	45.0	63.6
Incomplete high school Complete university	-	28.6	20.3	22.9	16.7	20.9	31.8
education Incomplete university	-	3.6	1.5	2.9	-	2.2	-
education	-	3.6	6.0	5.7	-	3.3	-
Not informed Pregnancies	-	-	7.5	8.5	-	6.6	-
Primiparous	-	50.0	45.1	45.7	66.7	47.2	72.7
Multiparous	100.0	50.0	54.9	54.3	33.3	52.8	13.6
Total	0.3	8.9	42.4	11.1	1.9	29.0	7.0

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[1] Author’s contribution

Alcântara NA contributed to the design of the project, analysis, interpretation of the data and writing of the article. Silva TJP contributed to the critical review of intellectual content. All authors approved the final version of the article.