Percepções de violência obstétrica e de bem-estar materno no parto [manuscrito]: um estudo no norte de Minas Gerais

Abstract

Since the 1990s, there have been advances in maternal and child health public policies in Brazil towards the humanization of care, aiming to qualify prenatal, delivery, and birth care. However, there is still evidence of practices that violate women's reproductive and health rights. The objective was to investigate obstetric violence (OV) in prenatal care and maternal well-being in childbirth among pregnant and postpartum women. We used data from the ALGE Study - Evaluation of health conditions of pregnant women in Montes Claros-MG: a longitudinal study conducted at three moments. At the first moment (baseline), pregnant women assisted in the municipality's Family Health Strategy (FHS) teams in 2018 and 2019 were eligible. Pregnant women who were in their 1st trimester of pregnancy were invited to participate in the 2nd moment, when they were in the 3rd trimester of pregnancy and in the 3rd moment when they were puerperal women, 40 to 70 days after delivery. The present study refers to the 2nd and 3rd moments of this cohort, carried out in 2019 and 2020. In 2019, data were collected through interviews in the FHS units or in women's homes; In 2020, due to the pandemic of COVID19, an on line form was used. In the 2nd moment of the cohort, the perception of pregnant women regarding the occurrence of OV in prenatal care was evaluated using a questionnaire with 10 items related to physical, sexual, psychological, and institutional OV; In the 3rd moment, maternal well-being in childbirth was investigated using the scale Maternal Well-Being in Childbirth Situation 2 (BMSP2), composed of 47 items distributed in seven domains. Sociodemographic characteristics, obstetric variables, and delivery assistance were analyzed. The statistical treatment used descriptive and bivariate and multiple analysis. A total of 1279 pregnant women participated in the first moment, of which 341 were in their first trimester of pregnancy. Of these, 300 (88.0%) and 183 (53.7%) participated in the second and third moments, respectively. Most of the pregnant women were between 20 and 34 years old, had more than eight years of schooling, and lived with a partner. The estimated prevalences of prenatal OV were: physical (21.7%), sexual (7.0%), psychological (24.3%), and institutional (26.3%). No association was identified between types of OV and sociodemographic characteristics. The Unified Health System was the funding source for 89.6% of deliveries and 55.7% were normal deliveries. Recommended care practices were reported: presence of a companion (95.1%), newborn (NB) stayed with the mother after delivery (85.2%), skin-to-skin contact with the NB after birth (90.7%), breastfeeding (BF) in the first hour (77.6%), support and guidance for BF (88.5%). Some 13 practices that may negatively interfere were reported: Kristeller maneuver (5.5%), repetitive vaginal touches (16.4%) and by different people (10.4%) and parallel conversations among professionals (16.9%). BMSP2 scale scores ranged from 116.0 to 235.0 with a mean equal to 184.7. The domains "Quality of relationship during care", and "Continuous family participation" were the ones that presented the highest indicators of positive experience and the domains "Self-care and comfort" and "Depersonalized care" were the ones that presented the lowest percentages with positive experience. It was found that 45.9% of puerperae experienced malaise, 27.9% experienced adequate wellbeing, and 26.2% experienced optimal wellbeing during labor. Malaise at delivery was associated with cesarean delivery and with the lack of guidance on breastfeeding. In conclusion, an important prevalence of OV in prenatal care was estimated, both in the physical, psychological, sexual, and institutional aspects, regardless of the sociodemographic characteristics of pregnant women, as well as an important prevalence of maternal malaise during delivery. These findings serve as an alert as to the need to review care practices to direct care to national and international recommendations.