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CARE AT THE FIRST POSTNATAL HOUR IN TWO HOSPITALS OF THE ADEQUATE BIRTH PROJECT: QUALITATIVE ANALYSIS OF EXPERIENCES IN TWO STAGES OF THE HEALTHY BIRTH RESEARCH
Author
Gomes, Maysa Luduvice
Nicida, Lucia Regina de Azevedo
Oliveira, Débora Cecília Chaves de
Rodrigues, Andreza
Torres, Jacqueline Alves
Coutinho, Amanda da Trindade Dias
Cravo, Beatriz da Silva Soares de Souza
Dantas, Juliana Guimarães
Oliveira, Thays Basílio
Brandão, Patrick
Domingues, Rosa Maria Soares Madeira
Nicida, Lucia Regina de Azevedo
Oliveira, Débora Cecília Chaves de
Rodrigues, Andreza
Torres, Jacqueline Alves
Coutinho, Amanda da Trindade Dias
Cravo, Beatriz da Silva Soares de Souza
Dantas, Juliana Guimarães
Oliveira, Thays Basílio
Brandão, Patrick
Domingues, Rosa Maria Soares Madeira
Affilliation
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil / Rio de Janeiro State University. Faculty of Nursing. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. National Institute of Women, Children and Adolescents Health Fernandes Figueira. Collective Health. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Public Health at Sérgio Arouca National School of Public Health. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. National Institute of Women, Children and Adolescents Health Fernandes Figueira. Collective Health. Rio de Janeiro, RJ, Brazil.
Institute for Healthcare Improvement. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectology. Laboratory of Clinical Research in STD/AIDS. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. National Institute of Women, Children and Adolescents Health Fernandes Figueira. Collective Health. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Public Health at Sérgio Arouca National School of Public Health. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. National Institute of Women, Children and Adolescents Health Fernandes Figueira. Collective Health. Rio de Janeiro, RJ, Brazil.
Institute for Healthcare Improvement. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Federal University of Rio de Janeiro. Anna Nery School of Nursing. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectology. Laboratory of Clinical Research in STD/AIDS. Rio de Janeiro, RJ, Brazil.
Abstract
Background: The Adequate Childbirth Project (PPA) is a quality improvement project that aims to enhance normal delivery and reduce cesarean sections with no clinical indication in the Brazilian supplementary health care system. This study aims to analyze the care model of the first postpartum hour in hospitals that participated in the PPA. Methods: Qualitative analysis based on the narrative of 102 women attended at two hospitals participating in the evaluative "Healthy Birth" research that analyzed the degree of implementation and the effects of the PPA. We assessed three practices within the first hour after delivery: skin-to-skin contact, breastfeeding and appropriate clamping of the umbilical cord. Data was collected through semi-structured interviews by telephone and submitted to thematic content analysis. Results: The categories that emerged from the analysis of the results were "Dimension of time and care expressed in the lived experience" and "Interferences in care in the first hour of life". In the first category, women reported that in the first hour after delivery the newborn was placed on the mother's chest, but the length of time of the newborn's stay in skin-to-skin contact was less than one hour. This experience, even in a shorter period of time, was said to be positive by the women interviewed. Two barriers were observed: interruption of skin-to-skin contact for neonatal care and the transfer to the recovery room, both separating baby from mother without observing the duration of the "golden hour". It was identified that a process of improvement of the quality of care for childbirth is underway, with a gradual incorporation of recommended practices for care in newborn's first hour of life. Conclusions: Women reported access to the three care practices at two hospitals participating in the PPA quality improvement project. All practices were valued by women as a positive experience and should be promoted. Information during antenatal care to increase women´s autonomy, review of hospital practices to reduce barriers, and support from health care providers during the first hour after birth are needed to improve the implementation of these practices and access to their health benefits.
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