Autonomia profissional da enfermeira obstétrica / Professional autonomy of the nurse-midwife

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

The model of healthcare during labor in Brazil is strongly associated to the physician care, and the majority of deliveries occur in hospitals: in 2004, 94% of the deliveries took place in hospitals and 43% of them were cesarian sections, something that implies medical care. In the private health system in the city of São Paulo, the incidence of cesarian section deliveries reaches around 84%. Since the end of the 1990-decade, some political initiatives have been trying to change this model. Some of the proposals favor the insertion of nurse-midwives in the assistance team, recognizing the importance of this professional in the promotion of normal delivery. In that context, the professional autonomy of the nurse-midwife and collaborative work in the delivery assistance are essential for a qualified care. However, the role of the nurse-midwife in the delivery assistance is defined not only by official guidelines, but also by the institutionspolicies. The way she can live professional autonomy and collaborative work depends on the type of hospital, its rules and norms, on the distribution of work among the teams members and on the hierarchical relationships. This study had the objective of describing the nurse-midwifes perception of her insertion in the assistance team and of her professional autonomy in private hospitals. This was a qualitative study, with nurse-midwives working in private institutions in São Paulo that assist members of health care insurance plans. Data were collected by means of semi-structured interviews, registered in a tape recorder, with 15 nurse-midwives who work in 9 private hospitals. Content analysis was used and the qualitative data collected was discussed based on the themes: autonomy, factors that facilitate autonomy or factors that make autonomy more difficult, facilitators of collaborative work and factors that make it more difficult, the composition and coordination of the delivery health care team and the perception of the nurse-midwife of her insertion in the team. We observed that, despite the legal support and the recognition of official and international organizations about the role of the nurse-midwife, her actual work in the private hospitals in São Paulo is restricted and are not in accordance with her competence and skills. The nurse-midwives pointed out that obstetricians do not recognize their responsibilities in the health care team, and this restricts her autonomy and plays against the collaborative work in the patients benefit

ASSUNTO(S)

private sector comportamento cooperativo setor privado enfermeiras obstétricas cooperative behavior nurse midwives autonomia profissional professional autonomy

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