RESENHA
Qualification of midwives for delivery assistance: a proposal of the federal health department
Anna Maria Hecker Luz
Enfermeira. Professora do Curso de Enfermagem da Universidade do Vale do Rio dos Sinos e da Pós-Graduação, Mestrado em Enfermagem da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul. Doutoura em Educação pela PUCRS
The objective of the present review is to divulge two books published in 2000 by the Brazilian Federal Health Department and Grupo Curumim (Curumim Group), Women's Health Technical Area in Brasilia. The two books "Livro da Parteira" (The book of the Domiciliar Midwife) and "Trabalhando com Parteiras Tradicionais" (Working with Domiciliar Midwives) represent the intentions of the Federal Health Department in improving obstetric assistance as well as the qualification and supervision of domiciliar midwives.
Although the majority of the deliveries in Brazil take place in hospitals, overcoming maternal death rate is a challenge for the Federal Health Department. In order to combat this problem, the Health Department has taken measures which promote pre-natal assistance, special care for high risk pregnancy, incentive to normal deliveries and reduction on the number of cesarean sections.
In the last decades, there has been a rapid development of a variety of practices which aim at triggering and correcting the uterine dynamic; accelerating, regulating or monitoring the physiological process of delivery; and anticipating or postponing childbirth. Although the objective of these measures is the well-being of mothers and newborns, they are, many times, used to standardize hospital assistance and increase the "culture of cesareans" which should only be done in case of delivery complications.
Considering that these practices have resulted in negative effects, some of which with serious implications, it has been put into question if these interventions are really necessary. The lack of criteria for the adoption of inappropriate and unnecessary interventions has put maternal assistance under risk.
In Brazil, domiciliar delivery is the only option for those women who live under specific geographical, economical and social situation (especially in rural and fishing areas). In this case, they can only count on domiciliar midwives that live in their communities and that usually do not have technical training as well the appropriate conditions to carry out the delivery.
The approach which favors normal delivery and a secure maternity implies that the person who is assisting the delivery should have adequate training and obstetric ability. These abilities should enable the assistant to acknowledge risk factors and complications of the delivery; to observe the health conditions of the mother, fetus and newborn; and to refer the pregnant woman to a specialist when needed. Likewise, it is important that the assistant be patient and empathic with the parturient and her family.
The publications which the Federal Health Department and Grupo Curumim have done together are hereby summarized to provide a previous knowledge of its content. Nevertheless, we recommend the reading of the full text considering that it is an important technical manual to guide health, and specially nursing professionals on the training and supervision of domiciliar midwives.
The book "Livro das Parteiras" is a pedagogical support for the education and qualification of midwives. The text is concise and has visual resources (photographs and illustrations). Its characteristics facilitate the understanding of normal delivery procedures even for those midwives who are not literate. The book is divided in eleven chapters: 1. Woman's body, 2. Pre-natal exams the midwife should do, 3. Labor and positions, 4. Newborn care, 5. Equipment for a hygienic delivery, 6. The experience of a domiciliar delivery, 7. Problems with pregnancy, delivery, post-delivery and the newborn, 8. Equipment for a hygienic delivery, 9. How to refer to a specialist in case of problems, 10. Breastfeeding, and 11. Medicinal plants are developed by the popular health movement and women's movement. These techniques were created, adapted and used as an instrument of sensitization for gender issues and also for the The book "Trabalhando com as Parteiras Tradicionais" aims at qualifying domiciliar can help on the discussion of a variety of themes. Many of the techniques suggested in this manual recycling of technical knowledge. The book proposes a participatory methodology (lucid and creative) through which personal experiences are valued and the distance between the teacher/ student educational roles are reduced.
The workshops deal with seventeen different themes. Besides the themes proposed by the book, the workshops work with group integration, personal value, gender, sexuality and reproductive rights, delivery notice and evaluation of the qualification.
The activities proposed include corporal techniques that aim at amplifying the internal potential of the participants through the process of integrating body and mind. The activities consist of the presentation of the objectives, techniques, hints (number of participants, duration and recommendations to the instructor) and application (equipment and task).
The book is not only useful for those in charge of training midwives, but also for nursing professionals who are involved with education and deal with groups such as: nursing students, elderly, pregnant women and hypertensive patients.
The objective of the Federal Health Department through these publications is to qualify domiciliar midwives so that they can give the appropriate assistance to the mother and the newborn in normal deliveries. It also stimulates team work, integrating midwives and nurses and facilitating the access of pregnant women to health services when needed and referred by the midwives.
The initiative of the Federal Health Department and Grupo Curumim represents the possibility of sharing women's personal and life experiences. It also promotes a reflection which can be profound and meaningful regarding "assisting the childbirth". This contribution can promote a qualitative advancement, professional growth and self-reflection for those involved with the assistance of regular deliveries.
Through the sharing of experience between nursing professionals and midwives, the former can learn how to assist delivery in a more humanistic way. They can also rescue the fundamental knowledge of intimacy in the childbirth. The recuperation of the magic and enchantment of birth are part of a symbology which implies in more respect and humanism regarding delivery and the care for the mother and the newborn.
Publication Dates
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Publication in this collection
30 June 2014 -
Date of issue
Dec 2001
