Antonia Angulo-Tuesta

Qualidade da atenção ao parto em maternidades do Rio de Janeiro

OBJETIVO: Avaliar a qualidade da atencao durante o processo de trabalho de parto de acordo com normas da Organizacao Mundial de Saude. METODOS: Trata-se de estudo do tipo caso-controle, realizado em duas maternidades: publica e conveniada com o Sistema Unico de Saude, no Municipio do Rio de Janeiro. A amostra foi composta por 461 mulheres na maternidade publica (230 partos vaginais e 231 cesareas) e por 448 mulheres na maternidade conveniada (224 partos vaginais e 224 cesareas). De outubro de 1998 a marco de 1999, foram realizadas entrevistas com puerperas e revisao de prontuarios. Foi construido escore sumarizador da qualidade do atendimento. RESULTADOS: Observou-se baixa frequencia de algumas praticas que devem ser encorajadas, como presenca de acompanhante (1% na maternidade conveniada, em ambos os tipos de parto), deambulacao durante o trabalho de parto (9,6% das cesareas na maternidade publica e 9,9% dos partos vaginais na conveniada) e aleitamento na sala de parto (6,9% das cesareas na maternidade publica e 8,0% das cesareas na conveniada). Praticas comprovadamente danosas e que devem ser eliminadas como uso de enema (38,4%), tricotomia, hidratacao venosa de rotina (88,8%), uso rotineiro de ocitocina (64,4%), restricao ao leito durante o trabalho de parto (90,1%) e posicao de litotomia (98,7%) para parto vaginal apresentaram alta frequencia. Os melhores resultados do escore sumarizador foram obtidos na maternidade publica. CONCLUSOES: As duas maternidades apresentam frequencia elevada de intervencoes durante a assistencia ao parto. A maternidade publica, apesar de atender clientela com maior risco gestacional, apresenta perfil menos intervencionista que maternidade conveniada. Procedimentos realizados de maneira rotineira merecem ser discutidos a luz de evidencias de seus beneficios.

Defining and implementing a National Policy for Science, Technology, and Innovation in Health: lessons from the Brazilian experience

The need for clearly-defined health research policies and priorities has been emphasized in the international scenario. In Brazil, this process began in 2003, when a group appointed by the National Health Council proposed 20 sub-agendas to account for the various health research specificities. The second step was to identify research priorities for each sub-agenda during national seminars involving 510 researchers and policymakers. The 2nd National Conference on Science, Technology, and Innovation in Health was held in July 2004. During the preparatory phase, 307 cities and 24 States organized local conferences, involving 15,000 participants. Some 360 health sector delegates were appointed during the local conferences, in addition to those from the education and science and technology sectors. During the Conference, the national policy was approved and 3 other sub-agendas were introduced and approved. The national policy and the priority agenda are currently guiding investments by the Ministry of Health for research and development, and to a certain extent those from the Ministry of Science and Technology as well. From 2003 to 2005, 24 calls for proposals were launched; as a result, 3,962 research projects were submitted and 1,300 financed.

Representações e experiências das mulheres sobre a assistência ao parto vaginal e cesárea em maternidades pública e privada

This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and womens submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of womens empowerment during childbirth.This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and womens submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of womens empowerment during childbirth.