| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 625.25 KB | Adobe PDF |
Advisor(s)
Abstract(s)
Introdução: O parto no domicílio designa-se pelo trabalho de parto realizado no domicílio
da grávida quando acompanhado por médicos e enfermeiros especializados. Consiste numa
alternativa legal de tipo de parto cujas evidências científicas parecem indicar que é seguro
para gestações de baixo risco. No entanto, em Portugal ainda não existem critérios que
orientem os casais que optem por esta opção, ou mesmo os profissionais que o praticam.
Cada vez mais é ressalvada a imperatividade de regaste do protagonismo e da autonomia da
mulher para poderem estar em controlo e decidir as condições como desejam que se proceda
o seu trabalho de parto. Estas ambicionam uma experiência prazerosa, íntima, familiar e o
menos instrumentalizada possível em que sejam evitados processos estereotipados sem
sensibilidade e individualidade. Na atualidade afigura-se oportuno discutir a relevância do
parto no domicílio devido ao desejo crescente por parte dos casais da autonomia, da
individualidade, do respeito e do poder de decisão sobre as suas próprias escolhas. No
entanto, uma escolha informada exige a disponibilização de informação fidedigna e
completa para que o parto no domicílio decorra com cautela e de forma segura.
Objetivo: Com esta dissertação tenciona-se reunir a atual evidência científica sobre o parto
no domicílio relativamente a como se procede, os critérios de aptidão, os motivos que
incentivam à escolha, a opinião do parceiro, quais os principais riscos, como são resolvidos
os imprevistos e complicações, e refletir sobre a sua segurança.
Metodologia: A pesquisa bibliográfica foi realizada na PubMed entre outubro de 2022 e
setembro de 2023.
Resultados e Conclusões: Para que o parto no domicílio seja seguro é importante que: seja
minuciosamente planeado; haja a existência de critérios de aptidão específicos que têm de
ser cumpridos à risca; se tenha em atenção o histórico de saúde da grávida; as
contraindicações absolutas sejam respeitadas e excluídas as gestações de alto risco; haja
uma rede robusta e bem estruturada de transferência com protocolos bem estabelecidos
com atenção aos recursos, à distância e ao tempo médio de transferência; seja realizada uma
gestão adequada com base no Modelo dos “Três Atrasos”; o tempo médio de transferência
seja reduzido; se identifique precocemente as complicações, as situações que requerem
transferência hospitalar e as condições que apresentam maior risco de a vir a necessitar; a
transferência hospitalar seja realizada atempadamente; a parteira tenha treino em
emergências obstétricas e seja capaz de estabilizar qualquer situação até ao transporte
chegar; haja obstetra, anestesista e bloco operatório disponível 24h por dia no hospital de receção assim como uma boa articulação entre a parteira e a equipa hospitalar. Portanto, só
se forem cumpridos estes critérios e estiver bem integrado no sistema de saúde, é que se
torna seguro e se reduz significativamente as taxas de morbimortalidade materna e infantil
assemelhando-se às dos partos hospitalares. Assim, o parto no domicílio não deve ser
combatido, mas sim regulado.
Introduction: Home birth is defined as the labor carried out at the pregnant woman’s home when accompanied by specialized doctors and nurses. It consists of a legal alternative type of birth whose scientific evidence seems to indicate that it is safe for low-risk pregnancies. However, in Portugal there are still no criteria that guide couples who opt for this option, or even professionals who practice it. Increasingly, emphasis is placed on the imperativeness of restoring women’s protagonism and autonomy so that they can be in control and decide the conditions in which they wish their labor to proceed. They aim for a pleasurable, intimate, familiar, and as little instrumentalized experience as possible avoiding stereotypical processes without sensitivity and individuality. Nowadays it seems opportune to discuss the relevance of home birth due to the growing desire on the part of couples for autonomy, individuality, respect, and decision-making power over their own choices. However, an informed choice requires the provision of reliable and complete information so that home births can take place cautiously and safely. Objective: With this dissertation we intend to bring together the current scientific evidence on home birth regarding to how it’s carried out, the aptitude criteria, the reasons that encourage the choice, the partner’s opinion, what the main risks are, how unforeseen events and complications are solved and reflect on its safety. Methodology: The bibliographic search was carried out on PudMed between October 2022 and September 2023. Results and Conclusions: Home birth to be safe must: be thoroughly planned; have specific eligibility criteria that must be strictly met; take into account the pregnant woman’s health history; respect absolute contraindications and exclude high-risk pregnancies; have a robust and well-structured transfer network with well establish protocols with attention to resources, distance and time of transfer; have an adequate management based on the Three Delays Model; have a reduced time of transfer; be early identify complications, indications that require transfer to a hospital and conditions that present a greater risk of requiring it; performed the transference to a hospital in a timely manner; have midwives trained in obstetric emergencies and able to stabilize any situation until transport arrives; have an obstetricians, anesthesiologist and operating room available 24 hours a day at the receiving hospital; and have good coordination between the midwife and the hospital team. Only if these criteria are accomplished and it is well integrated into the health care system, will it become safe and significantly reduce maternal and child morbimortality rates, like those in hospital birth. Therefore, home birth should not be fought, but rather regulated.
Introduction: Home birth is defined as the labor carried out at the pregnant woman’s home when accompanied by specialized doctors and nurses. It consists of a legal alternative type of birth whose scientific evidence seems to indicate that it is safe for low-risk pregnancies. However, in Portugal there are still no criteria that guide couples who opt for this option, or even professionals who practice it. Increasingly, emphasis is placed on the imperativeness of restoring women’s protagonism and autonomy so that they can be in control and decide the conditions in which they wish their labor to proceed. They aim for a pleasurable, intimate, familiar, and as little instrumentalized experience as possible avoiding stereotypical processes without sensitivity and individuality. Nowadays it seems opportune to discuss the relevance of home birth due to the growing desire on the part of couples for autonomy, individuality, respect, and decision-making power over their own choices. However, an informed choice requires the provision of reliable and complete information so that home births can take place cautiously and safely. Objective: With this dissertation we intend to bring together the current scientific evidence on home birth regarding to how it’s carried out, the aptitude criteria, the reasons that encourage the choice, the partner’s opinion, what the main risks are, how unforeseen events and complications are solved and reflect on its safety. Methodology: The bibliographic search was carried out on PudMed between October 2022 and September 2023. Results and Conclusions: Home birth to be safe must: be thoroughly planned; have specific eligibility criteria that must be strictly met; take into account the pregnant woman’s health history; respect absolute contraindications and exclude high-risk pregnancies; have a robust and well-structured transfer network with well establish protocols with attention to resources, distance and time of transfer; have an adequate management based on the Three Delays Model; have a reduced time of transfer; be early identify complications, indications that require transfer to a hospital and conditions that present a greater risk of requiring it; performed the transference to a hospital in a timely manner; have midwives trained in obstetric emergencies and able to stabilize any situation until transport arrives; have an obstetricians, anesthesiologist and operating room available 24 hours a day at the receiving hospital; and have good coordination between the midwife and the hospital team. Only if these criteria are accomplished and it is well integrated into the health care system, will it become safe and significantly reduce maternal and child morbimortality rates, like those in hospital birth. Therefore, home birth should not be fought, but rather regulated.
Description
Keywords
Complicações Critérios de Segurança Hemorragia Pós-Parto Infeção Intraparto Infeção Puerperal Morbimortalidade Neonatal Mortalidade Perinatal Opinião do Parceiro