A violência obstétrica expressa no contexto das enfermeiras de uma maternidade pública do município do Rio de Janeiro

Abstract

This research regards the issue of obstetric violence in the perspective of nurses from a public maternity hospital in Rio de Janeiro city, Brazil. Overall objective: to analyze the perception of the nurses who work at public maternity hospitals regarding obstetric violence. Specific objectives: to identify the perception of nurses who work at maternity hospitals regarding obstetric violence; to characterize obstetric violence in the understanding of these nurses; and to discuss the influential factors in the occurrence of obstetric violence through their perspective. Methodology: a descriptive, exploratory and qualitative study. The participants were 31 nurses and the study field was a public maternity hospital located at Rio de Janeiro city. Data collection occurred between May and July 2016 through semi-structured interviews. Bardin s content analysis technique was used to analyze the content. The ethical principles of Resolution 466/12 were respected. The results pointed to the construction of the category: Expressions of obstetric violence in the perspective of maternity nurses, related to the definitions and characteristics of obstetric violence and its influential factors. The nurses understand obstetric violence as the one committed against women during their puerperal and pregnancy cycles, which occurs inside the institutional environment as well as in domestic/intrafamily and social environment. The nurses have a broad vision of the concept of obstetric violence, however, some of them could not identify obstetric violence in health-care beyond the moment of childbirth, which was most frequently mentioned by the professionals. Women in miscarriage had little visibility. Most participants presented an updated understanding on recommended and not recommended scientific and technical knowledge to be performed during obstetric care, basing their speeches on the principles of humanization programs and policies. With reference to the influential factors in the occurrence of obstetric violence, they mentioned factors related to the professionals/institutions of health care and to women. The influential factors regarding professionals/institutions are directly related to the aspects of the biomedical obstetric care model. Those related to women encompassed socio-cultural aspects, highlighting the social stigma contexts of greater vulnerability to the occurrence of obstetric violence in health settings. Regarding actions to combat obstetric violence in the domestic/intrafamilial and social environment, training and a differentiated look are important to identify possible situations of violence, as well as to act in the formulation of assistance strategies for these women, preventing aggravation in maternal-fetal health. Regarding obstetric violence in health care services, beyond the public policies to combat violence, the implementation and monitoring of reproductive rights in humanized obstetric care stands out, as well as the promotion of professional qualification and training, especially to nurses, which should consider gender issues and the transformation of the traditional obstetrical assistance model, the promotion of coparticipant management and institutional human and material resource adequacy, and also the encouragement of researches in this area. To achieve these goals, health professionals, managers, institutions, government agencies, international organizations, education professionals, civil society and women must be engaged.