Práticas de assistência ao parto e nascimento em maternidades de Belo Horizonte,Minas Gerais, Brasil, no contexto da pandemia da COVID-19.

Abstract

Introduction: In recent years, labor and birth care has undergone important changes, such as the increased use of various practices aimed at regulating and monitoring a physiological process. The COVID-19 pandemic highlighted the need for new changes and reorganization in care models. From this perspective, the mother-child binomial may have suffered more and unnecessary interventions during labor, delivery, and birth. Therefore, it is important to discuss childbirth care models and obstetric interventions during the COVID-19 pandemic. Objective: To analyze childbirth care practices in maternity hospitals in Belo Horizonte, Minas Gerais, Brazil, in the context of the COVID-19 pandemic. Methodology: Observational study with a cross-sectional design, nested in a cohort. A total of 1,717 postpartum women were included in this study. To identify the profiles of obstetric practices, Principal Component Analysis (PCA) was performed. The variables used were divided into: Sociodemographic and health factors, Obstetric factors and Obstetric practices. Results: In this study, divergent profiles of coexistence of obstetric interventions were generated in women with analogous obstetric profiles. Considering that women belonging to the profiles formed tended to receive the same set of interventions, the results formed three profiles that may have been influenced by the context of covid-19. They are: profile 1 - formed by interventions that are frequently used inappropriately in labor care, such as oxytocin infusion, use of analgesia and presence of peripheral venous access; profile 2 - use of obstetric practices that are evidently harmful and should be abolished in obstetric care, consisting of non-use of partogram, non-use of non-pharmacological methods for pain relief, birth in the lithotomy position and episiotomy; and profile 3 - practices that are useful and benefit women in the childbirth process, consisting of offering a diet and freedom of movement during labor and delivery. Conclusion: The findings of this study highlighted the existence of different childbirth care practices in the institutions investigated, which differ in terms of the use of good practices in childbirth and birth care, oscillating between respect for physiology and medicalization. Therefore, it is necessary to promote improvements in labor and birth care, including in specific epidemiological moments, such as pandemics, aiming to promote women's autonomy, protagonism and well-being. Such aspects, especially in critical epidemiological scenarios, such as COVID-19, can be decisive in maternal and child outcomes.