Os avancos tecnologicos e cientificos da Medicina, o respeito a autonomia das gestantes e as indicacoes medicas parecem ter contribuido para o aumento do numero de cesarianas. Nesse contexto, o objetivo desta pesquisa foi identificar a expectativa de gestantes e medicos obstetras quanto a via de parto. Trata-se de pesquisa descritiva e transversal, com enfoque quantitativo. A amostra do estudo foi constituida por 85 (41,87%) gestantes, maiores de 18 anos, cuja gestacao transcorreu entre abril de 2011 e abril de 2012, periodo em que realizavam pre-natal na rede publica de saude do municipio de Joacaba, SC, por 11 medicos obstetras que exerciam sua profissao neste municipio. Foram excluidas as gestantes mentalmente incapacitadas ou de alto risco. Para os medicos obstetras, o unico criterio de exclusao foi de nao consentirem em participar do estudo. A abordagem das gestantes ocorreu em ambiente privativo, sem a presenca do medico, quando foi apresentado o Termo de Consentimento Livre Esclarecido (TCLE) e, posteriormente, um questionario autoaplicavel, contendo perguntas gerais e especificas. Quanto aos medicos obstetras, era feito contato telefonico com posterior apresentacao do TCLE e questionario. Os dados foram armazenados em software Epinfo 3.4.3 e as principais variaveis calculadas pelo Teste Qui-Quadrado, com intervalo de confianca de 95%. A coleta de dados foi realizada nos meses de janeiro a marco de 2012. Para a realizacao do estudo foi solicitada a aprovacao previa do CEP Unoesc. A maioria das gestantes (74,1%) manifestou preferencia pelo parto natural, sobretudo as catolicas e portadoras de ensino superior completo ou medio incompleto. Entre os obstetras, houve preferencia pelo parto cesariano (58,3%), e, se fossem instados a aconselhar, todos (100%) recomendariam parto natural. Caso fossem solicitados a realizar cesariana a pedido, 54,5% dos obstetras concordariam de imediato, porem, somente 27,3% admitiriam este direito para gestantes do sistema publico de saude. Em conclusao, a expectativa da maioria das gestantes foi pelo parto natural e dos medicos obstetras pela cesarea; contudo, eles realizariam parto natural em condicao normal e cesarea, a pedido. Palavras-chave: Cesarea. Parto natural. Obstetricia. Autonomia pessoal.

Escolha da via de parto: expectativa de gestantes e médicos obstetras

Renacimiento del parto: reflexiones sobre la medicalización de la atención obstétrica en Brasil

Collectif, Nouveaux services - emplois jeunes. Le guide du salarié 2002, Ministère de l’emploi et de la solidarité

Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008–2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.

Prenatal care and socioeconomic status: effect on cesarean delivery

Cette recherche doctorale concerne la professionnalisation des masseurs-kinesitherapeutes. Le courrier electronique, une des nombreuses formes de l’ecriture professionnelle, est utilise dans cette recherche comme un analyseur (Lourau, 1969). Les courriels modifient les pratiques professionnelles et en meme temps ils permettent d’observer la professionnalisation des masseurs-kinesitherapeutes, comprise comme institutionnalisation de la profession, dans leur vie quotidienne. En m’appuyant sur une demarche ethnographique et sur le cadre theorique de l’analyse institutionnelle, je releve dans le quotidien des masseurs-kinesitherapeutes salaries les changements de pratiques, de valeurs ainsi que les resistances aux transformations en cours.Le parcours de la chercheuse, ici praticienne-chercheuse, est pris en compte en ce qu’il est lui-meme implique dans l’objet de recherche. L’analyse des implications professionnelles des masseurs-kinesitherapeutes salaries est menee pour comprendre le processus de professionnalisation et d’universitarisation a partir des observations de terrain.En modifiant les pratiques de communication et d’organisation autour du patient, le courriel agit egalement sur la structuration du corps professionnels et sur l’activite quotidienne des masseurs-kinesitherapeutes. Cependant, comme en resistance a la progression du numerique, l’attachement a la centralite du corps dans les implications professionnelles des masseurs-kinesitherapeutes salaries reste central.

Masseurs-kinésithérapeutes salariés à l’ère numérique : Ce que leurs usages du courrier électronique disent de leur professionnalisation.

This is a double titled thesis that aims to analyze the process of institutionalization of cesarean deliveries in Brazil and France from the perspective of institutional social-clinical. The theoretical-methodological framework, in its dialectical character between institute and instituinte, unfolds in the process of institutionalization. Therefore, birth is understood as an analyzer of "maternal and child health" and "health education" institutions. The present research comes from a larger study on births in Canada, France and Brazil. In this thesis, data were produced between 2016 and 2019, in Brazil and France, through focus groups, individual interviews with maternal and child health professionals (and the Brazilian Maternal and Child Death Surveillance Committee), with mothers and fathers who lived the experience of childbirth and the research journal. The focus groups were composed of professionals from traditional and alternative services, parents from different social backgrounds. There were 3 meetings making a total of 12 meetings. The ethical aspects regarding research with human beings were respected. A cross-analysis was carried out between the different types of data, between services, between groups and between countries, on a continuous basis, based on the materials produced. The polished thematic axes were: Birth by cesarean section: an analyzer of the female condition in face of medicalization, of professional practices and discourses, and of the institutionalization of birth. These were arranged in analytical frameworks and organized by group of interviewees and scenarios studied. Afterwards, horizontal summaries of the interviews were carried out, by groups interviewed. The analysis was also produced during the time of restitution to the participants and was based on the thematic analysis approach of the authors Mucchielli and Paille. Brazil and France demarcate distinct processes. Brazil is the champion in surgical deliveries without indication. France, on the other hand, presents another reality, in which births are mostly vaginal. It was possible to learn that although each of the countries studied has its peculiar sanitary and educational structure, they are marked by a sociohistorical-economic construction outlined by the patriarchy and female subjugation. The marks of New Public Management are present in both contexts and reveal a precariousness of offers and actions supported by a discourse of economic fragility. In terms of education and health, in any of the countries, pregnancy is understood as a physiological process and developed with numerous interventions on the female body. There is an appreciation of the technical and organizational dimensions pointed out by an intellectual and social division of work and knowledge in health. The practices and discourses of professionals (in their work process) influence the occurrence (or not) of cesarean delivery. The progression or regression of this is related to the degree of implementation of medical actions in health actions. In this way, in Brazil there is a struggle between the institutionalization of cesarean delivery in comparison with its deinstitutionalization. In France, in relation to cesarean sections, there is a discussion on "active cesarean section". Would this be the movement of institutionalization of cesarean delivery in this country?Keywords: cesarean section; childbirth; health education; health; education

https://tel.archives-ouvertes.fr/tel-02458149/document

Simone Santana da Silva

Papers

The institutionalization of birth by cesariana in Brazil and France : educational and health components