Transition of the environment model in hospitals that deliver in Rede Cegonha

Pasche, Dário Frederico; Pessatti, Mirela Pilon; Silva, Luiza Beatriz Ribeiro Acioli de Araújo; Matão, Maria Eliane Liegio; Soares, Dianne Barbosa; Caramachi, Ana Paula da Cruz

doi:10.1590/1413-81232021263.45262020

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ARTICLE • Ciênc. saúde coletiva 26 (3) • Mar 2021 • https://doi.org/10.1590/1413-81232021263.45262020 copy

Transition of the environment model in hospitals that deliver in Rede Cegonha

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article analyzes the environment of birth places, considering the presence of PCP room (Prepartum, Childbirth, and Postpartum) in 575 hospitals that deliver in Sistema Único de Saúde (Unified Health System) within the scope of Rede Cegonha. The data were extracted from a survey called Avaliação da atenção ao parto e nascimento nas maternidades da Rede Cegonha (Assessment of childbirth and birth care in the Rede Cegonha maternity units), carried out in 2017 by UFMA and ENSP, in partnership with the Ministry of Health. The PCP room model combines care for parturient women in a single space, favoring the role of women and the exercise of good practices in childbirth and birth care. The information was obtained by direct observation in the services, and assessment considered the presence and adequacy of PCP rooms and their distribution according to the pre-childbirth environment, which were compared with specific characteristics of these hospitals. Collective rooms for childbirths prevail and only 16.8% of beds are PCP rooms. This picture suggests difficulties in resource management, resistance to changes and insufficiencies in institutional support, which have hampered the transition from the childbirth environment model in Brazilian hospitals. The Brazilian obstetric and neonatal field has lived a fertile period, but it is necessary to build and sustain political-institutional disposition to advance the changes.

Key words
“Rede Cegonha”; Childbirth rooms; Childbirth; Humanization; Delivery assistance

	Region
	North	Northeast	Southeast	South	Center-West	Brazil
Hospitals
Number	77	166	215	79	38	575
Percentage	13.4	28.9	37.4	13.7	6.6	100.0
Location in the capital	26.0	30.7	27.9	16.5	63.2	29.2
Legal nature ¹1 Leal MC, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, Bastos MH, Gama SGN. Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. Cad Saude Publica 2014; 30(Supl. 1):17-32.
Public	72.7	60.2	58.1	34.2	63.2	57.7
Private	27.3	39.8	41.9	65.8	36.8	42.3
Management type¹1 Leal MC, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, Bastos MH, Gama SGN. Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. Cad Saude Publica 2014; 30(Supl. 1):17-32.
Municipal	61.0	67.5	72.6	49.4	63.2	65.7
State	33.8	24.1	22.8	24.1	34.2	25.6
Double	5.2	8.4	4.2	26.6	2.6	8.5
Childbirth volume²2 Brasil. Ministério da Saúde (MS). HumanizaSUS: Documento base para gestores e trabalhadores do SUS. Brasília: Editora do MS; 2010.
Up to 999 childbirths	28.6	19.9	20.1	24.1	13.2	21.3
1,000 to 2,999	45.5	47.0	51.9	53.2	52.6	49.8
3,000 and more	26.0	33.1	28.0	22.8	34.2	28.9
With Neonatal Intensive Care Unit ³3 Agência Nacional de Vigilância Sanitária (Anvisa). Resolução RDC nº 36, de 3 de junho de 2008. Dispõe sobre Regulamento Técnico para Funcionamento dos Serviços de Atenção Obstétrica e Neonatal. Diário Oficial da União 2008; 4 jun.	28.6	34.3	69.3	54.4	52.6	50.6
High risk reference ⁴4 Brasil. Ministério da Saúde (MS). Portaria nº 1.459, de 24 de junho de 2011. Diário Oficial da União 2011; 27 jun.	7.8	18.7	28.4	17.7	21.6	20.9

	North		Northeast		Southeast		South		Center-West		Brazil
Prepartum environments	N	%	N	%	N	%	N	%	N	%	N	%
Collective room without separation between beds	38	49.4	76	45.8	37	17.2	16	20.3	7	18.4	174	30.3
Collective room with curtains/shower division	24	31.2	53	31.9	87	40.5	44	55.7	13	34.2	221	38.4
PCP room (prepartum, childbirth, and postpartum)	8	10.4	17	10.2	30	14.0	2	2.5	10	26.3	67	11.7
Two types of environments	3	3.9	15	9.0	59	27.4	16	20.3	6	15.8	99	17.2
Others^* * Surgical center reserved for delivery; double rooms, in the ward itself; observation room	4	5.2	5	3.0	2	0.9	1	1.3	2	5.3	14	2.4

	Region
	North	Northeast	Southeast	South	Center-West	Brazil
Number of maternities	77	166	215	79	38	575
Total labor beds	360	1106	1260	403	229	3358
Average number of labor beds	4.7	6.7	5.9	5.1	6.0	5.8
Total PCP rooms	46	142	275	31	71	565
Number of PCP rooms assessed	45	100	206	28	55	434
Percentage	97.8	70.4	74.9	90.3	77.5	76.8
There is an exclusive bathroom directly connected to the shower room	10	71	196	4	30	311
Percentage	77.8	70.3	95.1	85.7	56.6	73.5
Non-pharmacological pain relief equipment	43	96	184	26	50	399
Percentage	95.6	96.0	89.3	92.9	90.9	91.9

	Maternities with PCP rooms
	No		Yes
Maternity location	Nº	%	Nº	%
Capital	105	62.5	63	37.5
Countryside	333	81.8	74	18.2
Legal nature
Public administration	250	75.3	82	24.7
Business/Non-profit/Individual organization	188	77.4	55	22.6
Childbirth volume
Up to 999 childbirths	104	85.2	18	14.8
1,000 to 2,999	231	80.8	55	19.2
3,000 and more	103	62.0	63	38.0
With Intensive Care Unit
Yes	192	66.0	99	34.0
No	246	86.6	38	13.4
Reference for high-risk pregnant women
Yes	79	65.8	41	34.2
No	359	79.1	95	20.9

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

DF Pasche participated in the conception, elaboration and coordination of the article. MP Pessatti worked on the design and writing and final review of the article. LBRAA Silva worked on the article design, data collection and review. MEL Matão, DB Soares and APC Caramachi worked on the design of the article, participated in data collection and bibliographic review.