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Print version ISSN 0104-1169
Rev. Latino-Am. Enfermagem vol.16 no.1 Ribeirão Preto Jan./Feb. 2008
SHORT COMMUNICATIONS / CASES ACCOUNTS
Collective prenatal consultation: a new proposal for comprehensive health care
Lucia Helena Garcia PennaI; Joana Iabrudi CarinhanhaII; Raquel Fonseca RodriguesIII
IPh.D. in Child and Woman's Health, Adjunct Professor, e-mail: email@example.com
IIMaster's Student, Assistant Professor, Severino Sombra University, Brazil, e-mail: firstname.lastname@example.org. Rio de Janeiro State University School of Nursing, Brazil
IIIRN, Fernandes Figueiras Institute, Oswaldo Cruz Foundation, Brazil, e-mail: email@example.com
This article describes the Collective Prenatal Consultation as a new healthcare methodology, which is performed according to government standards, but collectively. Relaxation and sensitization techniques are used, as well as group dynamics, including a collective exam of the pregnant women. The Collective Consultation is carried out in a welcoming environment, which provides clarification and socialization of experiences and information, centered on those women. The healthcare professional records every obstetric parameter and behavior in the patient's prenatal card and history file. Priority is given to the principle of integrality and citizenship, with the aim to break the biomedical care paradigm, thus favoring humanized and comprehensive care to the women.
Descriptors: comprehensive health care; obstetrical nursing; pregnant women
The present study describes a methodological innovation in health care involving women: the Collective Prenatal Consultation.
It is tradition that most prenatal consultations follow the biomedical model(1). Despite its acknowledged contribution, this model requires critical analyses regarding the process of transformation of reality. Considering the quality of prenatal care, the Health Ministry points at educational actions as the best way to provide pregnant women with health care and promote health(2). Yet, the reality reveals overcrowded public health services, which force health care professionals to reduce the time they would dedicate to educational activities and approach women's subjectivity. Research has shown there are failures in service organization, in addition to the thought that this is an "inhumanizing" situation(3-5).
In this sense, we sought to base this study on the thought that the collective environment is the best opportunity to experience participation and the production of collective knowledge(6). We understand that, this way, it is possible to intervene more effectively in individual and collective issues, considering health as a historical and social process.
DESCRIBING THE COLLECTIVE CONSULTATION
The proposal of this new methodology is having a collective prenatal consultation based on the standards of an individual consultation(2). Its main goal is to help women to construct their motherhood and live their citizenship, breaking the biomedical care paradigm.
The collective consultation makes use of the following strategies: it takes place in a special office with surround sound; the activities are initiated with relaxation exercises; women participate in group dynamics about their perceptions regarding pregnancy, changes of the maternal organism, and the evolution in arranging the baby's room; there are discussions on the subjects that emerge about any problems they had since their last consultation, or about instructions about delivery, the companion of their choice to prenatal visits, marital relationships or any other subject that they wish to obtain clarification, according to the groups' need and interest; and, finally, the pregnant women's collective exam, which includes their self-examination and examining one another. The collective exam is restricted to the obstetric palpation, measuring uterine height, and listening to the fetal heartbeat (FHB). This moment causes great excitement among the women, because it assigns them the appropriation over their own bodies and over the development of their child. It should be clarified that breasts and genitalia are examined in the individual consultation. The collective consultation has the same value as an individual consultation, since all parameters and obstetric behaviors (and any additional data about the woman) are registered on the pregnant woman's card and history file, all of which are recommended for prenatal care.
It is also worth stating that the Collective Consultations are performed after the women had at least one individual consultation. Moreover, they receive previous information about the Collective Consultation, and have the right of refusing to participate.
DISCUSSING THE COLLECTIVE CONSULTATION
In this consultation, women are able to reinforce their self-esteem, develop self-care, know their body better, and learn more about their rights; exchange experiences and feelings; feel safe, realize that everyone has problems and that they are not alone(6-7).
This way of thinking and acting when caring for pregnant women directs us to another thought: "everything you know, you learn it little by little through many different situations when something is shared or exchanged with other people, with your body, with your consciousness, with body-and-consciousness. People live together and knowledge flows..."(8).
We believe that the Collective Consult will allow women to have a new view about their social role, see their sexuality as pleasure and not merely as a means for reproduction or as a consumption object, but as an object to transform reality. At the same time, the Collective Consult intends to contribute to humanizing prenatal care, by understanding it as a rich context of interpersonal relationship, and not a mere technical procedure(4,9-10).
The Collective Consultation is characterized as a methodological innovation that presupposes humanized practice based on valuing women's knowledge, on the socialization of experiences and knowledge (popular and scientific), and on breaking social hierarchy. Hence, group participants are treated as equals, encouraging equality and solidarity among them. At the same time, there is a concern to focus this care process on those women, assigning them the lead roles. Another point that should be highlighted is the need for health care professionals to know themselves and become interested in each woman's context and experiences, helping her to construct her motherhood and health.
It is considered that the Collective Consultation is closely linked to the principle of integrality, which, according to the Program for Comprehensive Health Care to Women [Programa de Assistência Integral a Saúde da Mulher -PAISM] means a practice that meets each and every need of the involved group or individual, favoring collective health prevention and promotion. Therefore, the Collective Consultation, combined with the individual consultation, contributes with expanding prenatal care coverage, and with providing women with comprehensive care. We believe that this methodological innovation contributes with the process of breaking the biomedical care paradigm and putting humanized care into practice, which truly and effectively values women integrally.
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Recebido em: 29.4.2007
Aprovado em: 7.11.2007