Avaliação na gestão dos cuidados de saúde - O caso do método psicoprofiláctico de preparação para o parto/maternidade
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2010
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A preparação para o parto/maternidade adquire uma importância crescente no sistema de saúde, com iniciativas políticas que visam apoiar e promover o parto natural. Foi neste enquadramento que se inseriu o objectivo primordial deste estudo, que consistiu na avaliação para a gestão dos
cuidados de saúde do caso específico do Método Psicoprofiláctico de preparação para o
parto/maternidade.
O presente estudo, de carácter empírico, inscreve-se num paradigma quantitativo, numa amostra de 130 puérperas, igualmente repartida entre mulheres com e sem preparação para o parto/maternidade - Método Psicoprofiláctico, que recorreram ao Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE para o nascimento dos filhos. A recolha de dados foi obtida por um
formulário estruturado em nove blocos temáticos. A média de idades das puérperas era de 28,55 anos, o nível de escolaridade em 60,8% era inferior ou igual a 12 anos e o estado civil da maioria das puérperas (75,4%) era casada.
Dos resultados obtidos, constata-se que para elevado número de puérperas (46,9%) se tratava de primeira gravidez e de um parto de termo (56,9%), predominando um filho para a maioria dos casais. Apesar da maioria das mulheres ter considerado que este acontecimento particular foi
planeado e desejado, não pode deixar de ser mencionado o número de gravidezes não planeadas (23,8%) e não desejadas (22,1%).
A vigilância pré-natal foi efectuada por um número significativo de mulheres (96,2%),
merecendo ser questionado o número de mulheres que não fez uma vigilância adequada da gravidez. A preparação para o parto, contrariamente ao preconizado, ocorreu para a maioria das mulheres (55,4%) depois das 28 semanas de gestação. Durante as sessões de preparação para o
parto/maternidade, a maioria das puérperas obteve informação sobre o trabalho de parto,
analgesia epidural, aleitamento materno e cuidados ao recém-nascido. A frequência de
utilização dos exercícios práticos durante o trabalho de parto e parto foi bastante inferior ao que
seria expectável.
O parto eutócico com episiotomia (40,8%), e distócico com aplicação de ventosa foram mais
frequentes nas puérperas que fizeram preparação para o parto/maternidade. O tempo de
permanência no bloco de partos foi em média muito idêntico nos dois grupos de puérperas. A
opção pela analgesia epidural recaiu com maior expressão nas puérperas que fizeram preparação
para o parto/maternidade e a intensidade da dor durante o trabalho de parto e parto foi
percepcionada com maior intensidade pelas puérperas sem preparação para o parto. No que diz respeito à expressão dos sentimentos de medo e confiança, verificamos que as
mulheres que fizeram preparação para o parto se sentiram mais confiantes e referiram menos
medo. A possibilidade de os pais assistirem e participarem no nascimento dos seus filhos,
verificou-se de forma mais expressiva entre as puérperas que fizeram preparação para o
parto/maternidade.
A maioria dos recém-nascidos (70,8%) foi adaptada à mama na primeira hora de vida, e no segundo dia após o parto, apenas 72,3% das puérperas se encontravam a fazer amamentação
exclusiva, com ligeiro predomínio entre as mulheres que fizeram preparação para o
parto/maternidade. Um número significativo de puérperas que fez preparação para o
parto/maternidade não teve dificuldades relativamente aos cuidados de higiene e conforto, ao coto umbilical e ao sono e repouso.
De uma forma global, constata-se que ocorreram ganhos em saúde no grupo de puérperas que fez preparação para o parto/maternidade - Método Psicoprofiláctico, decorrentes de um maior cumprimento das consultas de vigilância pré-natal, da presença do pai mais frequente durante o trabalho de parto, do reconhecimento das competências do recém-nascido, da menor dificuldade nos cuidados ao recém-nascido, da maior adesão à prática do aleitamento materno e da opção pela analgesia epidural.
The preparation for labour/motherhood has a growing importance in the health system, with political initiatives that aim to support and promote natural delivery. In this context, the main goal of this project has consisted in the evaluation for health care management of the specific case of the Psycoprophylactic Method of preparation for labour/motherhood. The present research, of an empirical nature, registers in a quantitative paradigm, in a sample of 130 pregnant women, equally distributed between women with and without preparation for labour/motherhood – Psychoprophylactic Method, that came to the Hospital Centre of Trás- os - Montes e Alto Douro, EPE, for the birth of their children. The data gathering has been obtained through a formulary structured in nine thematic units. The age average of pregnant women was of 28, 55 years, the schooling average was of 12 years and the status of most of the pregnant women was married (75, 4%). The obtained results show us that for a high number of women in labour (46, 9%) it was their first pregnancy and it was a full term labour (56, 9%), prevailing one child per couple for most couples. Although, for most women this particular event was planned and wanted, the number of not planned (23, 8%) and unwanted pregnancies (22, 1%) must be mentioned. Prenatal vigilance was carried out by a significant number of women (96, 2%), leading us to enquire the number of women that did not have appropriate vigilance during pregnancy. The preparation for labour, opposed to what is recommended, has occurred, for most women (55, 4%) after the 28th week of gestation. During the sessions of preparation for labour/motherhood, most women obtained information about labour, analgesia epidural, breast feeding and care for the newborn. The frequency of use of practical exercises during labour and delivery was quite inferior to what was expected. Eutocic labour with episiotomy (40, 8%) and dystocic labour with the application of cupping glass were most frequent in women that had preparation for labour/motherhood. The time of permanence in the labour room was, in average, identical for both groups of pregnant women. The option of analgesia epidural was taken more expressively by women that had preparation for labour/motherhood and the intensity of pain during labour and delivery was perceivable with higher intensity in women without preparation for labour. In what concerns the expression of feelings of fear and confidence, we have verified that women that had preparation for labour felt more confident and mentioned less fear. The possibility of having the father of the child attending and participating in the birth of their children, was more expressive in women that had preparation for labour/motherhood. Most newborns (70, 8%) were adapted to breast feeding in the first hour of life, and in the second day post labour, only 72, 3% of women were exclusively breast feeding, with a slight predominance amongst women that had preparation for labour/motherhood. A significant number of women that had preparation for labour/motherhood had no difficulties in what concerned hygiene and comfort care, or in what concerned the umbilical stump and sleep and rest. In general, we verified that gains in health were obtained in the group of women that had preparation for labour/motherhood – Pychoprophylactic Method, resulting from a bigger compliance of the prenatal vigilance appointments, from the more frequent presence of the father during labour, from the recognition of the newborn’s competences, from the minor difficulties in caring for the newborn, from the bigger adhesion to breast feeding and from the option of analgesia epidural.
The preparation for labour/motherhood has a growing importance in the health system, with political initiatives that aim to support and promote natural delivery. In this context, the main goal of this project has consisted in the evaluation for health care management of the specific case of the Psycoprophylactic Method of preparation for labour/motherhood. The present research, of an empirical nature, registers in a quantitative paradigm, in a sample of 130 pregnant women, equally distributed between women with and without preparation for labour/motherhood – Psychoprophylactic Method, that came to the Hospital Centre of Trás- os - Montes e Alto Douro, EPE, for the birth of their children. The data gathering has been obtained through a formulary structured in nine thematic units. The age average of pregnant women was of 28, 55 years, the schooling average was of 12 years and the status of most of the pregnant women was married (75, 4%). The obtained results show us that for a high number of women in labour (46, 9%) it was their first pregnancy and it was a full term labour (56, 9%), prevailing one child per couple for most couples. Although, for most women this particular event was planned and wanted, the number of not planned (23, 8%) and unwanted pregnancies (22, 1%) must be mentioned. Prenatal vigilance was carried out by a significant number of women (96, 2%), leading us to enquire the number of women that did not have appropriate vigilance during pregnancy. The preparation for labour, opposed to what is recommended, has occurred, for most women (55, 4%) after the 28th week of gestation. During the sessions of preparation for labour/motherhood, most women obtained information about labour, analgesia epidural, breast feeding and care for the newborn. The frequency of use of practical exercises during labour and delivery was quite inferior to what was expected. Eutocic labour with episiotomy (40, 8%) and dystocic labour with the application of cupping glass were most frequent in women that had preparation for labour/motherhood. The time of permanence in the labour room was, in average, identical for both groups of pregnant women. The option of analgesia epidural was taken more expressively by women that had preparation for labour/motherhood and the intensity of pain during labour and delivery was perceivable with higher intensity in women without preparation for labour. In what concerns the expression of feelings of fear and confidence, we have verified that women that had preparation for labour felt more confident and mentioned less fear. The possibility of having the father of the child attending and participating in the birth of their children, was more expressive in women that had preparation for labour/motherhood. Most newborns (70, 8%) were adapted to breast feeding in the first hour of life, and in the second day post labour, only 72, 3% of women were exclusively breast feeding, with a slight predominance amongst women that had preparation for labour/motherhood. A significant number of women that had preparation for labour/motherhood had no difficulties in what concerned hygiene and comfort care, or in what concerned the umbilical stump and sleep and rest. In general, we verified that gains in health were obtained in the group of women that had preparation for labour/motherhood – Pychoprophylactic Method, resulting from a bigger compliance of the prenatal vigilance appointments, from the more frequent presence of the father during labour, from the recognition of the newborn’s competences, from the minor difficulties in caring for the newborn, from the bigger adhesion to breast feeding and from the option of analgesia epidural.
Descrição
Dissertação de Mestrado em Gestão dos Serviços de Saúde
Palavras-chave
dor , parto , preparação para o parto/maternidade , método psicoprofiláctico