Elizabeth Eriko Ishida Nagahama

A institucionalização médica do parto no Brasil

Trata-se de abordar o conceito de institucionalizacao da atencao a saude, em especial da Saude da Mulher, como forma de poder hegemonico na atencao, especificamente na assistencia institucional ao parto. O trabalho descreve as estrategias de implantacao da hegemonia institucional sobre o corpo feminino, exercidas atraves das politicas de saude e das praticas de atencao medica. O poder do Estado na institucionalizacao da atencao e registrado no decurso da reconstrucao historica dos programas de saude materno infantil das decadas de 1920 a 1980, na qual se identificou que o controle ideologico sobre a saude das mulheres traduziu-se em formas de controle da sua sexualidade como veiculo da reproducao. Nas praticas de atencao medica, abordam-se as questoes da hegemonia do poder medico e a medicalizacao do corpo feminino. O processo de hospitalizacao do parto foi fundamental para a apropriacao do saber nesta area e para o desenvolvimento do saber medico, culminando com o estabelecimento da medicalizacao do corpo feminino.

Prenatal care in an university hospital: evaluating the process

The objective of this study was to evaluate the prenatal care process referring to the Prenatal Assistance to Low Risk Pregnant Women Program of the University Hospital of Maringá, Paraná State, Brazil. It was made a selection of quality criteria which evaluate the precocity in the process and the adequacy in the number of consultation during prenatal period, measured by the Humanization Program of Prenatal and Birth of the Health Ministry and the adequacy on the use of the prenatal care. The study showed that 44.5% of pregnant women started late the prenatal care suggest of the low offer and search to better quality care, which is manifested by spontaneous transference of pregnant women to other services to the program. The prenatal consultations were confirmed and the results showed a mean of 9.8 consultations per pregnant woman--higher than the recommended national parameters. The indicators used and developed to the evaluation of process still present some obstacles to the organizational access and need to define strategies which guarantee this fundamental policy of the Brazilian Unified Health System.

Humanização e eqüidade na atenção ao parto em município da região Sul do Brasil

Objectives: To identify the factors associated to the quality of care and possible predisposition to inequities in labor care, as of socialdemographic and obstetrical characteristics of women cared for in two hospitals associated to the Single Health System in the city of MaringaParana. Methods: Cross-sectional study, performed by researching hospital handbooks and by interviewing 569 women in labor. Seven quality indicators classified the assistance into excellent, good, fair and insufficient. The Chi-square test was used to establish the association among variables. Results: The women were young, had fixed partners, full high school education, no paying jobs and a low socioeconomic level. Inequality in care was stressed by the differentiated offer in procedures that qualify care, determined by individual, contextual factors and, in particular, related to assistance practices. Conclusion: Three characteristics made up the profile of the parturients who benefitted from the most qualified healthcare: being under 19 years of age, having full high school education and having had no previous caesarian section.

Parto humanizado e tipo de parto: avaliação da assistência oferecida pelo Sistema Único de Saúde em uma cidade do sul do Brasil

OBJECTIVES: to evaluate the quality of childbirth care in two public maternity referral hospitals in the municipality of Maringa, Parana. METHODS: a cross-sectional study was carried out using medical records and interviews with 569 women. Seven process indicators were used, four relating to labor and three to delivery. By establishing scores for each the indicators, hospital care was classified into four levels: excellent, good, regular and unsatisfactory. The kind of delivery was considered to be a result indicator. Analysis was carried out using the Excel and Statistica software and the results submitted to the chi-squared and Student’s t test. RESULTS: 1.0% of women received excellent care; 28.9% good; 52.7% regular; and 17.4% unsatisfactory. In terms of average scores, hospital 1 performed better than hospital 2. Caesarian birth was prevalent in both hospitals, with rates of over 50%. CONCLUSIONS: the performance of the hospitals was classified as regular and the result of care unsatisfactory, given the high prevalence of caesarian births.

Avaliação da qualidade da atenção à saúde de adolescentes no pré-natal e puerpério

Resumen It is an evaluative study aimed to assess the quality of prenatal and postpartum for adolescents with children born alive in a public health institution in Teresina, Piauí. Two parameters were used to evaluate the prenatal care: an international index (Adequacy of Prenatal Care Utilization) and a national one, based on recommendations from the Ministry of Health. The quality of care was categorized as more appropriate, adequate, intermediate and inadequate. It was noticed that more than half of the women began the prenatal care at an early stage and the number of visits for prenatal care was inadequate. Most of them performed the ordinary prenatal exams, 75% had their breasts examined and 88.6% were advised about breastfeeding. The postpartum care was intermediate to 38.6% of women, 52.3% did not return to the health unit, nor received home visit, 70.5% were advised about contraceptive methods and 93.2% on breastfeeding. Efforts should be undertaken to ensure the quality of care in pregnancy up to the puerperium.It is an evaluative study aimed to assess the quality of prenatal and postpartum for adolescents with children born alive in a public health institution in Teresina, Piaui. Two parameters were used to evaluate the prenatal care: an international index (Adequacy of Prenatal Care Utilization) and a national one, based on recommendations from the Ministry of Health. The quality of care was categorized as more appropriate, adequate, intermediate and inadequate. It was noticed that more than half of the women began the prenatal care at an early stage and the number of visits for prenatal care was inadequate. Most of them performed the ordinary prenatal exams, 75% had their breasts examined and 88.6% wereadvised about breastfeeding. The postpartum care was intermediate to 38.6% of women, 52.3% did not return to the health unit, nor received home visit, 70.5% were advised about contraceptive methods and 93.2% on breastfeeding. Efforts should be undertaken to ensure the quality of care in pregnancy up to the puerperium.

Evaluación de la calidad de atención a la salud de adolescentes en el prenatal y en el puerperio

Resumen It is an evaluative study aimed to assess the quality of prenatal and postpartum for adolescents with children born alive in a public health institution in Teresina, Piauí. Two parameters were used to evaluate the prenatal care: an international index (Adequacy of Prenatal Care Utilization) and a national one, based on recommendations from the Ministry of Health. The quality of care was categorized as more appropriate, adequate, intermediate and inadequate. It was noticed that more than half of the women began the prenatal care at an early stage and the number of visits for prenatal care was inadequate. Most of them performed the ordinary prenatal exams, 75% had their breasts examined and 88.6% were advised about breastfeeding. The postpartum care was intermediate to 38.6% of women, 52.3% did not return to the health unit, nor received home visit, 70.5% were advised about contraceptive methods and 93.2% on breastfeeding. Efforts should be undertaken to ensure the quality of care in pregnancy up to the puerperium.It is an evaluative study aimed to assess the quality of prenatal and postpartum for adolescents with children born alive in a public health institution in Teresina, Piaui. Two parameters were used to evaluate the prenatal care: an international index (Adequacy of Prenatal Care Utilization) and a national one, based on recommendations from the Ministry of Health. The quality of care was categorized as more appropriate, adequate, intermediate and inadequate. It was noticed that more than half of the women began the prenatal care at an early stage and the number of visits for prenatal care was inadequate. Most of them performed the ordinary prenatal exams, 75% had their breasts examined and 88.6% wereadvised about breastfeeding. The postpartum care was intermediate to 38.6% of women, 52.3% did not return to the health unit, nor received home visit, 70.5% were advised about contraceptive methods and 93.2% on breastfeeding. Efforts should be undertaken to ensure the quality of care in pregnancy up to the puerperium.

Evaluation of quality of health care for adolescents in the prenatal and puerperium

Resumen It is an evaluative study aimed to assess the quality of prenatal and postpartum for adolescents with children born alive in a public health institution in Teresina, Piauí. Two parameters were used to evaluate the prenatal care: an international index (Adequacy of Prenatal Care Utilization) and a national one, based on recommendations from the Ministry of Health. The quality of care was categorized as more appropriate, adequate, intermediate and inadequate. It was noticed that more than half of the women began the prenatal care at an early stage and the number of visits for prenatal care was inadequate. Most of them performed the ordinary prenatal exams, 75% had their breasts examined and 88.6% were advised about breastfeeding. The postpartum care was intermediate to 38.6% of women, 52.3% did not return to the health unit, nor received home visit, 70.5% were advised about contraceptive methods and 93.2% on breastfeeding. Efforts should be undertaken to ensure the quality of care in pregnancy up to the puerperium.It is an evaluative study aimed to assess the quality of prenatal and postpartum for adolescents with children born alive in a public health institution in Teresina, Piaui. Two parameters were used to evaluate the prenatal care: an international index (Adequacy of Prenatal Care Utilization) and a national one, based on recommendations from the Ministry of Health. The quality of care was categorized as more appropriate, adequate, intermediate and inadequate. It was noticed that more than half of the women began the prenatal care at an early stage and the number of visits for prenatal care was inadequate. Most of them performed the ordinary prenatal exams, 75% had their breasts examined and 88.6% wereadvised about breastfeeding. The postpartum care was intermediate to 38.6% of women, 52.3% did not return to the health unit, nor received home visit, 70.5% were advised about contraceptive methods and 93.2% on breastfeeding. Efforts should be undertaken to ensure the quality of care in pregnancy up to the puerperium.