1 - Embracement in Obstetrics |
Emphasizes that the embracement in maternity hospitals has particularities specific to the needs and demands related to the pregnancy-puerperal cycle. Common pregnancy complaints can often mask clinical situations that demand rapid action, which requires qualified listening and gain of skill for a judicious clinical judgment. It aims to ensure access to and resolution in health care for women, as well as for newborns throughout the service, involving the reception, assistance spaces, measures to provide a definitive answer and/or responsible referral to other places2828 Notarbartolo di Villarosa F. A estimativa rápida e a divisão do território no Distrito Sanitário: manual de instruções. In: Notarbartolo di Villarosa F. A estimativa rápida e a divisäo do território no Distrito Sanitário: manual de instruções. Brasília: OPS/OMS; 1993. p. 54.. In this sense, the Embracement associated with the Risk Classification tool aims to reorganize the admissionand all the assistance in maternity hospitals. The Embracement and Risk Classification (E&RC) leads to the health professional'sdecision-making basedonqualified listening, associated with clinical judgment founded on a scientifically based protocol, enhancing teamwork through systematic institutional communication2929 Piovesan MF, Padrão MVV, Dumont UM, Gondim GM, Flores O, Pedrosa JI, Lima LFM. Vigilância Sanitária: uma proposta de análise dos contextos locais. Rev Bras Epidemiol 2005; 8(1):83-95.. |
2 - Good Delivery and Childbirth Care Practices |
Theywere based on what Obstetrics produced in terms of the review of scientific studies analyzing a set of practices employed in delivery and childbirth care. Following the methodology that seeks to collect the best available scientific evidence, the WHO published their recommendations, called Good Delivery and Childbirth CarePractices55 Cavalcanti PCS, Gurgel Junior GD, Vanconcelos ALR, Guerrero AVP. Um modelo lógico da Rede Cegonha. Physis 2013; 23(4):1297-1316.,77 Andrade MAC, Lima JBMC. O Modelo Obstétrico e Neonatal que defendemos e com o qual trabalhamos. In: Cadernos HumanizaSUS: humanização do parto e nascimento. Brasília: Editora MS; 2004. v. 4. p. 437-443.,2121 Figueiró AC, Hartz Z, Samico I, Cesse EAP. Usos e influência da avaliação em saúde em dois estudos sobre o Programa Nacional de Controle da Dengue. Cad Saude Publica 2012; 28(11):2095-2105.,2222 Pasche DF, Passos E, Hennington EA. Cinco anos da política nacional de humanização: trajetória de uma política pública. Cien Saude Colet 2011; 16(11):4541-4548..These recommendations were updated in the document published by the National Commission for the Incorporation of Technology (CONITEC / MS), the ¨National Guidelines for Normal Childbirth Care"1717 Brasil. Ministério da Saúde (MS). Comissão Nacional de Incorporação de Tecnologias no SUS. Diretriz Nacional de Atenção ao parto normal. Brasília: Editora MS, 2016.. They are based on the principle of the right to information and women'sempowerment and autonomy during all aspects of this care. They highlight the need to incorporate social and emotional dimensions to prenatal care and childbirth and recommend the abolition of the routine use of several obstetric practices considered inadequate, non-beneficial and harmful in childbirth care, stressing the importance of including good delivery and childbirth care practices and ensure, at the time of delivery, the woman'sintegrity and privacy.Good practices include the provision of a diet during labor, deambulation, continuous support, access to non-pharmacological pain relief methods, verticalized positions during childbirth, skin-to-skin contact and timely umbilical cord clamping. Also described in the document are the practices that should be abolished or reduced, including the routine use of venoclysis and oxytocin to accelerate labor, routine amniotomy, bed restraint and the imposition of the lithotomy position duringdelivery, episiotomy and Kristeller maneuver55 Cavalcanti PCS, Gurgel Junior GD, Vanconcelos ALR, Guerrero AVP. Um modelo lógico da Rede Cegonha. Physis 2013; 23(4):1297-1316.,77 Andrade MAC, Lima JBMC. O Modelo Obstétrico e Neonatal que defendemos e com o qual trabalhamos. In: Cadernos HumanizaSUS: humanização do parto e nascimento. Brasília: Editora MS; 2004. v. 4. p. 437-443.,1717 Brasil. Ministério da Saúde (MS). Comissão Nacional de Incorporação de Tecnologias no SUS. Diretriz Nacional de Atenção ao parto normal. Brasília: Editora MS, 2016.,2121 Figueiró AC, Hartz Z, Samico I, Cesse EAP. Usos e influência da avaliação em saúde em dois estudos sobre o Programa Nacional de Controle da Dengue. Cad Saude Publica 2012; 28(11):2095-2105.,2222 Pasche DF, Passos E, Hennington EA. Cinco anos da política nacional de humanização: trajetória de uma política pública. Cien Saude Colet 2011; 16(11):4541-4548.. For the WHO7, changes in access to and provision of services will only be achieved when women are strengthened in their empowerment and their human rights, including having their right to quality services in childbirth respected. |
3 - Care monitoring and maternal and neonatal mortality surveillance |
It points to the fact that monitoring, through the use of indicators, allows the evaluation of the performance of health services and the planningof improvement actions, therefore beinga fundamental action for service qualification3030 Carneiro FF, Hoefel MG, Silva MAM, Nepomuceno AR, Vilela C, Amaral FR, Carvalho GPM, Batista JL, Lopes PA. Mapeamento de vulnerabilidades socioambientais e de contextos de promoção da saúde ambiental na comunidade rural do Lamarão, Distrito Federal, 2011. Rev Bras Saude Ocup 2012; 37(125):143-148.,3131 Brasil. Ministério da Saúde (MS). Acolhimento nas práticas de produção de saúde. Brasília: Editora MS; 2010..At the same time, maternal and neonatal mortality surveillance provides knowledge, detection or prevention of the determinants of these deaths, with the purpose of recommending and adopting measures to prevent new deaths.Care monitoring and surveillance of maternal and neonatal death allow health professionals and managers to identify weaknesses in the work process, promote discussion, reassessment and reorganization of care, care flows and assistance processes3030 Carneiro FF, Hoefel MG, Silva MAM, Nepomuceno AR, Vilela C, Amaral FR, Carvalho GPM, Batista JL, Lopes PA. Mapeamento de vulnerabilidades socioambientais e de contextos de promoção da saúde ambiental na comunidade rural do Lamarão, Distrito Federal, 2011. Rev Bras Saude Ocup 2012; 37(125):143-148.,3131 Brasil. Ministério da Saúde (MS). Acolhimento nas práticas de produção de saúde. Brasília: Editora MS; 2010.. |
4 - Participative and shared management |
It discusses the idea that traditionally, health services organize their work processes based on the knowledge of professions and categories, and not on common objectives. This type of organization has not guaranteed that the practices of the several workers are complementary, or that there is solidarity in care, nor that the actions are effective in termsof offering dignified, respectful treatment, with quality, embracement and bond. This has led to a lack of motivation among workers and little incentive to involve users in the health production processes. Therefore, the participative management is a valuable tool to build changes regardinghealth management and care methods. This management model is one of collective construction (those who plan are those who perform it) and occurs in collective spaces that ensure that power is in fact shared, through analyses, decisions and evaluations built together3232 Brasil. Ministério da Saúde (MS). Comissão Nacional de Incorporação de Tecnologias no SUS. Manual de acolhimento e classificação de risco em obstetrícia: relatório de recomendação. Brasília: Editora MS; 2017..Mechanisms that guarantee the active participation of users and family members in the daily lives of health units are essential in this model, both for maintaining the social bonds of hospitalized users and for their inclusion and that of their families in the treatment. |
5 – Environment |
It points out that the environments intended for the care of women and newborns during delivery and childbirth can favor or hinder their physiology. From the entrance door to the joint accommodation, these environments must be welcoming and organized aiming to include the woman's companion duringthe entire process. Good delivery and childbirth care practices recommend that a private and comfortable environment should be ensured during labor, with an area for ambulation and access to non-pharmacological pain reliefmethods, especially the warm water shower and/or bathtub.RDC 36/2008 of Anvisa8 regulates the delivery and childbirth care environments considering that they are family, social, cultural and predominantly physiological events. It establishes changes from the traditional model of pre-delivery and delivery room to the PPP Room model (where the woman is in the same environment during labor, delivery and postpartum), ensuring freedom and conditions for choosing different positions during labor.If an at-risk baby needs to be hospitalized, the parents'free access to and permanence at the neonatal unit must be ensured, as they are essential people in the care process. Comfort, noise and light intensitycontrol must be ensured, aiming to reduce the stress inherent to this situation.In addition to the guidelines, issues related to sexual and reproductive health were included in the assessment to broaden the view and encourage change in maternity practices. Therefore, important issues were also analyzed regarding the effectiveness of the National Policy for Integral Care to Women's Health - PNAISM33 such as: reproductive planning actions and humanized care for women in situations of miscarriage and sexual violence. |