Proposta de intervenção com enfoque na capacitação de profissionais de enfermagem sobre as boas práticas do parto e nascimento

Abstract

The present study aimed to implement the Good Practices of Attention to Childbirth and Birth (GPACB) in a Municipal Maternity, based on the training of nursing professionals.It was made an intervention study with application of pre and post questionnaire, which followed the following phases: Phase 1 - Application of a questionnaire based on GPACB. Phase 2 - Training through the focal group technique. Phase 3 - Reapplication of the questionnaire of BPPN. The training consisted of the participation of eighteen professionals, with twelve nurses, three auxiliaries and three nursing technicians. The activities were carried out during the month of September to November 2017. The results in relation to category A, regarding the practices that are demonstrably useful and that should be stimulated, showed that there was improvement in the results regarding: respect for the mother's choice of place of birth, respect for women's rights to privacy on the spot of delivery, respect for the choice of the woman about her companions, provision of all the information and explanations, supply of oral fluids, non-invasive and non-pharmacological methods of pain relief, such as massage and relaxation techniques, freedom of position and movement, among others. Regarding category B, clearly harmful or ineffective practices that should be avoided, better results were obtained in variables such as: routine use of tricotomy, routine intravenous infusion in labor, routine use of the supine position (dorsal decubitus) during work labor and rectal examination. The items administration of oocytes at any time before delivery and prolonged and directed pulling effort (Valsalva maneuver) during the second stage of labor also had better post-test rates, however, a significant portion of the professionals still reported using it. This fact requires other interventions for its correction. In category C, practices without sufficient evidence to support a clear recommendation and that should be used with caution, referring to the items routine early amniotomy in the first stage of labor, background pressure during labor and active manipulation of the fetus in the time of childbirth have passed and become less used. The maneuvers related to protection of the perineum to the management of the cephalic pole at the time of delivery, routine use of routine oxytocin, controlled traction of the cord, or their combination during the third stage of labor and early clamping of the umbilical cord became more used by professionals. Finally, concerning category D, frequently used inappropriately, most of the items had better results in the post-test. However, attention is drawn to the persistence of a large number of professionals to perform the correction of dynamics using oxytocin, the routine transfer of the parturient to another room at the beginning of the second stage of labor, stimulation of the pull when diagnosing dilation complete or nearly complete cervical before the woman feels the involuntary pull, rigid adherence to a stipulated duration of the second stage of labor and liberal and routine use of episiotomy. In short, it was noticed during the moments with the professionals that there was facility in the implementation of the practices of category A, however, although the categories B and D were discussed in detail, it was noticed a resistance by some professionals to abdicate of the habits they have been carrying out over the years. This fact leads to the need to readdress these issues at other times in order to trigger further changes in the municipal obstetric scenario