Qualidade do cuidado materno e neonatal em região de saúde do Ceará: visão da puérpera

Abstract

The reduction of maternal and neonatal morbimortality is based on the approach to quality of health care during the pregnancy-puerperal period, with a view to prevention. Maternal and neonatal care quality (QMNC), referential quality of obstetric and neonatal care international gold standard, consists of essential elements for an evaluation of practices and effective care needed for women and newborns. In this perspective, the evaluation of practices currently performed in Rede Cegonha strategy, having as basis the QMNC, it is necessary, given the completeness of the model, for its rigorous process of building and broad theoretical framework. The objective was to evaluate the quality of care of the woman and the newborn from the perspective of the puerperal woman. Evaluative study, carried out in reference maternity for the 10 municipalities belonging to the 18th Health Region of the State of Ceará, located in Iguatu-CE. The sample consisted of 92 puerperae, who were interviewed during the period of October to December of 2016, y adjusting the pre-established inclusion criteria. Statistical analysis and cross-checking of variables were performed in SPSS software, version 22.0. The study was approved by the Assis Chateaubriand School Maternity Research Ethics Committee. In this perspective, it was observed that the puerperae were at the age of 29 years old (76.1%), were primiparous (56.5%), coming from the municipality of the Region (56.5%), with a stable partner ( 79.8%), practiced extra-household activity (50%), had between 5 and 12 years of education (88.8%) and had a monthly family income between a minimum or lower wage (61.9%). In the category education, information and health promotion, a higher prevalence was found between six and nine (64.4%) pre-natal consultations being performed jointly by nurses and physicians (94.5%), with reference to the nurse for most of the guidelines provided in the consultations (60.4%). In the category of evaluation, screening and care planning, low-risk gestation was evidenced (92.3%), with the recommended tests performed at rates above 80%, however, the professional responsible for the delivery of the child was the physician (85,7%), to the detriment of the obstetrician nurse. As for the category promotion of normal processes and prevention of complications, there was a slight overlap of normal delivery (52.2%) to cesarean section (47.8%); however, there was no adequate filling of the partograph (26.1%), stimulation for adhesion of vertical positions during labor(12.0%) and late clamping of the umbilical cord (3.3%), practices considered beneficial for the quality of obstetric and neonatal care. In the category first-line management and treatment of severe complications, the prevalence of urinary tract infection during pregnancy was identified (54.3%), followed by treatment (67.6%), while in the newborn complications were predominant in the puerperium, with a prevalence of respiratory discomfort (42.9%). Furthermore, only the number of abortions was linked to the occurrence of complications. Thus, it is inferred that changes in maternal and child care are happening in this scope, but there is still a need to adapt some unused charitable practices, which can be reversed over time, investment, training of professionals and complete structuring of the health equipment that make up the Rede Cegonha.