Boas práticas de atenção ao parto na perspectiva das puérperas e dos trabalhadores de maternidades da rede cegonha: uma avaliação por meio da teoria de resposta ao item

Abstract

Good labor and birth care practices are defined by actions to humanize the care for the parturient, child and family, which seek better maternal and perinatal care outcomes. The main objective of this thesis was to evaluate the good practices of care in labor and delivery in Brazil, based on the Item Response Theory (IRT), consisting of two articles. The first article defined a scale to measure the level of supply of good practices in labor and delivery, latent trait estimated by the IRT through the three-parameter-one-dimensional logistic model (M3PL). For that purpose, this study used data from 2427 health professionals which participated in the evaluative research “Evaluation of care during labor and birth in maternity hospitals in RC”. As a result, a scale with seven positioned items and three anchor levels was obtained. On the first level are the maternity hospitals that only offered the strategies defined for the reception and always encouraged the pregnant woman to walk around. The second level maternity hospitals, in addition to the items above, guaranteed the pregnant woman the right to freely choose a companion during hospitalization, offered massage and ball and different delivery positions. On the third level are the maternity hospitals which, in addition to the previous items, offered birth stools. It was possible to identify the contribution of each item in measuring the level of supply of good care practices for labor and delivery, allowing the construction of an interpretative scale for the evaluation of maternity hospitals in the Rede Cegonha at three levels. The second article evaluated good practices in labor and delivery in the perception of postpartum women in RC maternity hospitals and identified the factors associated with the offer of good practices. The sample consisted of 3,716 postpartum women participating in the evaluative research. The three-parameter-one-dimensional logistic model (M3PL) was used. The results showed that the items referring to reception better discriminate the puerperal women regarding the application of good practices, and indigenous puerperal women, women with less schooling, primiparous women and those coming from the North Region showed a lower level of adequacy to good practices in labor and delivery. The puerperal women assisted in highly complex maternity hospitals had greater access to good practices during labor and delivery. The methodology used in this study makes it a pioneer among national research. The advantages of using the Item Response Theory in the investigation of good labor and delivery practices were highlighted.