Article of Research Journal of Pharmacology and Pharmacy
Assistance for mother and child health: challenges for health education
SANTOS, C.B1; SANTOS, F.J1; SOUZA, I.M1; BASTOS, J.L1; JARDIM, R1.
Federal University of Sergipe1
Assistance to maternal and child health and the high prevalence of C-sections associated with care model medicalized represent disturbing factors. The cesarean rate has been used as an evaluation indicator of childbirth care model and according to the normative standard of the World Health Organization, should not exceed 15 %. However, the number of cesarean deliveries has increased exponentially, reaching epidemic levels in both the developed and in the developing countries. In this context, Brazil is the country with the highest cesarean rates in the world. The rapid increase in the number of cesarean sections observed in Brazil since 1970 is a prime example of excessively interventionist assistance model and is strongly influenced by the capitalist system, by convenience of a scheduled intervention, the role of obstetricians in assisted birth and insecurity in the face of variations that occur during the course of vaginal delivery. The cesarean delivery have immediate effect and long-term on maternal and child health, usually associated with infection, bleeding and anesthetic complications and poses a threat to reproductive health. Unfair rates of cesarean deliveries are associated with increased maternal mortality rates and notes are a higher prevalence of maternal deaths in black women. Indeed, most maternal deaths could be prevented by reducing cesarean rates, improving the quality of obstetric care, encouraging natural delivery, facing institutional racism, health education actions and deploying humanized birth in the health services. In this perspective, the Research Project and Extension of the Federal University of Sergipe entitled “Saúde Materno-Infantil: por um nascimento respeitoso” Maternal and Child Health: for a respectful birth it aims to investigate the factors related to childbirth and maternal and child care, encourage the humanized delivery and promote racial equality and equity in health. The present study aims to describe the prevalence of cesarean sections and maternal deaths in Brazil, Sergipe and Lagarto, in total and according to some maternal data: skin color, educational level and age group and highlight the importance of Research and Extension Project “Saúde Materno-Infantil: por um nascimento respeitoso”. Descriptive observational study on the prevalence of cesarean sections in Brazil in the state of Sergipe and the County of Lagarto, based on DATASUS database from 2010 to 2013 period. There was a percentage increase in caesarean section in the investigated period. In Brazil, there was an increase from 52 % to 57 % in Sergipe from 36 % to 43 % and in Lagarto, from 35 % to 42 %. Maternal age group showed a direct relationship with the prevalence of C-sections: 42 % of Brazilian young women, 32 % of Sergipe and 30 % of Lagartenses between 15 and 19 years old, underwent cesarean section in 2013, increasing to 69 %, 52 % and 39 % in women between 40 and 44 years respectively. The degree of maternal education, women with no education level had fewer cesarean deliveries, in total of 26 % in Brazil, 24 % in Sergipe and 14 % in Lagarto. Women with 12 or more years of education had, significantly more cesarean deliveries corresponding to 84 % in Brazil, 79 % in Sergipe and 74 % in Lagarto. Regarding skin color, were carried out in Brazil 45 % of cesarean deliveries in black women, and 41% in Sergipe and Lagarto. Among white women, the database accounted for 68 %, 58 % and 62 %, respectively. There has been a lower prevalence of cesarean sections in the city of Lagarto. Regarding maternal deaths in 2013, it was observed in Brazil that 31 % was related to white women and 63 % to black ones. In the state of Sergipe maternal deaths were also recorded approximately twice as high among women black women (65 %). In Lagarto, the only documented case of maternal death was in a white woman. Studies reveal growth in caesarean section rates. These rates were increased at the advancing of maternal age. The highest prevalence of cesarean sections in women between 40 and 44 years of age may be related to the higher frequency of complications such as hypertension and other chronic diseases, and the fact that women do not wish to have more children and, in due course, request a tubal ligation. The C-section rates are more frequent in women with higher education and white, as seen in this study. The highest socioeconomic level of women are exposed to unnecessary interventions, however, socioeconomically disadvantaged women undergo painful procedures such as the acceleration of labor and the low use of obstetric analgesic. The lower prevalence of cesarean sections observed in Lagarto may be due to underreporting. Concerning skin color, according to the Ministry of Health, 60 % of maternal mortality occurs among black women and 34 % among white women. These differences are highlighted in prenatal care in the Unified Health System (SUS), in which 56 % of black mothers had less prenatal care than white ones, as well as guidance on breastfeeding, considering the women attended by SUS, black women were less often orientated than white ones (62 % versus 78 %). The worst outcomes of our country are represented by women with little education, being black and poor and living in the Northeast and North of Brazil. The database shows a diagnostic function of planning and proposals as they reveal the urgent need for intervention. In this sense, the research project and the aforementioned extension works in conjunction with pregnant women, family members, managers and health professionals, by promoting regular meetings in all health units in the city discussing and disseminating the importance of using birth plan as how to empower mothers and their families, with a focus on black women, more vulnerable to obstetric violence and thus promote changes in the logic of local births and reduce racial inequities related to maternal and child care in Lagarto, county in the middle South region of the State of Sergipe. It should be noted that the database from this study may be underestimated, given the underreporting. However, the reported percentage portrays and justifies the concerne over the strong culture of cesarean sections in the health system and its effects on maternal and child health. There are challenges to avoid unnecessary surgeries, promote health education, autonomy and empowerment of women, especially among the most vulnerable. Such projects represent a coping strategy to these challenges to improve the quality of maternal and child care.
Keywords: Humanized birth; maternal and child health services, maternal mortality.
1. Barbosa, G. P et al. Parto cesáreo: quem o deseja? Em quais circunstâncias? Cad. Saúde Pública, vol.19, n.6, p. 1611-1620. 2013.
2. Béhague, D P, et al. Consumer demand for caesarean section in Brazil: informed decision making, patient choice, or social inequality? A population based birth cohort study linking ethnographic and epidemiological methods. BMJ;324(7343):942-5. DOI:10.1136/ bmj.324.7343.942. 2002.
3. Carvalho, L. E. C. et al. Esterilização cirúrgica voluntária na Região Metropolitana de Campinas, São Paulo, Brasil, antes e após sua regulamentação. Cad. Saúde Pública, vol.23, n.12, p. 2906-2916.2007.
4. Fabri, R. H.; Murta, E.F.C. Tipos de Parto e Formas de Assistência Médica em Uberaba-MG. Rev. Bras. Ginecol. Obstet, vol.21, n.2, p. 99-104. 1999.
5. Faundes, A. et al. Opinião de mulheres e médicos brasileiros sobre a preferência pela via de parto. Rev. Saúde Pública, vol.38, n.4, p. 488-494.2004.
6. Freitas, P. F. et al. Desigualdade social nas taxas de cesariana em primíparas no Rio Grande do Sul. Rev. Saúde Pública, vol.39, n.5, pp. 761-767. 2005.
7. Leal, M. C. et al. Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. Cad. Saúde Pública, Rio de Janeiro, 30 Sup:S17-S47, 2014.
8. Moraes, M. S.; Goldenberg, P. Cesáreas: um perfil epidêmico. Cad. Saúde Pública, vol.17, n.3, p. 509-519. 2001.
9. Nagahama, E.E.I; Santiago, S. M. Parto humanizado e tipo de parto: avaliação da assistência oferecida pelo Sistema Único de Saúde em uma cidade do sul do Brasil. Rev. Bras. Saude Mater. Infant, vol.11, n.4, pp. 415-425. 2011.
10. Potter, JE, et al. Frustrated demand for postpartum female sterilization in Brazil. Contraception. 67(5):385-90. DOI:10.1016/ S0010-7824(03)00039-8. 2003.
11. Silva, JLCP; Surita, F.G.C. Idade materna: resultados perinatais e via de parto. Rev Bras Ginecol Obstet; 31(7):321-5. 2009.
12. Silva, L.M; Barbieri, M; Fustinoni, S.M. Vivenciando a experiência da parturição em um modelo assistencial humanizado. Rev. Bras. Enferm. vol.64, n.1, p. 60-65. 2011.
13. Velho, M.B. et al. Vivência do parto normal ou cesáreo: revisão integrativa sobre a percepção de mulheres. Texto Contexto – Enferm, vol.21, n.2, p. 458-466. 2012.