Acesso de gestantes ao pré-natal de alto risco em uma maternidade de referência para a rede cegonha: uma investigação avaliativa

Abstract

Rede Cegonha is a thematic network, established in 2011, through ordinance number 1,459, dated June 24, 2011 (BRAZIL 2011), as an innovative strategy of the Ministry of Health, within the scope of the Unified Health System (SUS). This network was created to face the issue of maternal mortality, which, at the time, had worrying rates. This study deals with the Rede Cegonha (RC) strategy and has, as research object, the evaluation of the prenatal component of that referred Network, taking as reference the study location the Maternity reference for Rede Cegonha. The objective of the study was to evaluate the access of pregnant women to high-risk prenatal care in a reference maternity for Rede Cegonha. To provide elements for the configuration of the Cegonha Network, its trajectory was described, starting with the Basic Health Unit (UBS) until access to high-risk prenatal care at the reference maternity. This study was developed a qualitative social research with quantitative contributions, circumscribed in tables and graphs. The research was carried out with 100 pregnant women, who had access to high-risk prenatal care at the reference maternity hospital and 27 professionals, 17 of whom worked at the maternity hospital and 10 from the Health Secretary of the Municipality of Fortaleza. To outline the profile of pregnant women who had access to high-risk prenatal care, socioeconomic and demographic elements were delimited, plus the obstetric profile and data on routes and access. The fieldwork revealed that one of the greatest difficulties faced by pregnant women is the waiting list, a fact recognized by the pregnant women themselves and by the professionals. In fact, 74% of pregnant women were on the waiting list, 27.6% of whom arrived at the screening in one week, 33, 7% in two to three weeks, 23.5% waited from two months to three months. The quality of maternity care was considered excellent by a percentage of 65.3% of pregnant women, 10.2% very good, 23.5% good and only one pregnant woman had a negative evaluation, because her expectations did not correspond to reality. Among other elements raised by the speech of professionals about the difficulty of access of pregnant women to high-risk prenatal care were: the turnover of medical professionals in primary care; demand for pregnant women greater than the offer of places; overcrowding in neonatal intensive care units (ICU); restriction of criteria in the reference maternity hospital; and inadequate referrals to referral services.