Mayara Guimarães Santos a Violência Obstétrica Sob O Olhar De

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Mayara Guimarães Santos a Violência Obstétrica Sob O Olhar De 0 UNIVERSIDADE FEDERAL DE GOIÁS FACULDADE DE ENFERMAGEM PROGRAMA DE PÓS-GRADUAÇÃO EM ENFERMAGEM MAYARA GUIMARÃES SANTOS A VIOLÊNCIA OBSTÉTRICA SOB O OLHAR DE PROFISSIONAIS DE SAÚDE GOIÂNIA, 2017 1 2 MAYARA GUIMARÃES SANTOS A VIOLÊNCIA OBSTÉTRICA SOB O OLHAR DE PROFISSIONAIS DE SAÚDE Dissertação de Mestrado apresentada ao Programa de Pós-Graduação em Enfermagem da Faculdade de Enfermagem da Universidade Federal de Goiás para a obtenção do título de Mestre em Enfermagem. ÁrEa dE concentração: A Enfermagem no cuidado à saude humana. Linha de Pesquisa: Fundamentação teórica, metodológica e tecnológica para o cuidar em saúde e Enfermagem. OriEntador: Prof. Dr. Marcelo Medeiros CooriEntadora: Profa. Dra. Mary Lopes Reis GOIÂNIA, 2017 3 Ficha de identificação da obra elaborada pelo autor, através do Programa de Geração Automática do Sistema de Bibliotecas da UFG. Guimarães Santos, Mayara A violência obstétrica sob o olhar de profissionais de saúde [manuscrito] / Mayara Guimarães Santos. - 2017. 115 f. Orientador: Prof. Dr. Marcelo Medeiros; co-orientadora Dra. Mary Lopes Reis. Dissertação (Mestrado) - Universidade Federal de Goiás, Faculdade de Enfermagem (FEN), Programa de Pós-Graduação em Enfermagem, Goiânia, 2017. Bibliografia. Anexos. Apêndice. Inclui siglas, abreviaturas, lista de figuras, lista de tabelas. 1. Violência contra a Mulher. 2. Saúde da Mulher. 3. Saúde Pública. 4. Parto. 5. Trabalho de Parto. I. Medeiros, Marcelo, orient. II. Título. CDU 616-083 4 5 DEDICATÓRIA A todas as mulheres, de todas as cores, idades e escolaridades, que lutam diariamente para que seus direitos sejam respeitados. 6 a c AGRADECIMENTOS a m i n h Gratidão. Esse é o sentimento que emana após esta caminhada de a dois anos de muitos desafios e perseverança. Trilha essa que não teria d a conseguido percorrer sozinha. Ao meu lado sempre estiveram grandes companheiros dessa jornada chamada vida. Assim, diante da finalização a o da presente dissertação, estou grata a todos que se fizeram presentes nesta construção de conhecimento, em especial: s e A Deus, meu acalento e refúgio, pelo dom da vida e por se mostrar u tão presente em todos os momentos da minha existência. l À minha mãe, Marly, exemplo de perseverança e fortaleza diante a das adversidades da vida. Exemplo de amor puro e sincero. Obrigada por d o me ensinar a percorrer meus sonhos, a ser sempre forte. Obrigada pelo incentivo a sempre ir mais longe! é Ao meu pai, Marcelo, pelo incentivo e apoio incondicional. Meu s modelo de confiança e esforço. e m À minha irmã, Marcela, pelo companheirismo e por estar sempre p disponível. Obrigada por, continuamente, despertar em mim meu lado r e crítico e por me ensinar o valor da união. À Poliana, por tornar a vida mais leve, pelo cuidado, paciência, u m incentivo e compreensão nos momentos de ausência. Obrigada por trazer a a luz nos momentos mais escuros. A caminhada ao seu lado é sempre a uma alegria! l Às minhas amigas, Juliana, Laura, Vittória e Emilly, pela lealdade, e g companheirismo e amizade em todos os momentos. Obrigada pelas r conversas, risadas e pelo apoio sempre. A caminhada com vocês tornou i a minha trajetória menos cansativa! Ao Prof. Marcelo Medeiros, por acreditar neste projeto e na minha capacidade de desenvolvê-lo. Obrigada pela orientação, inspiração e sensibilidade. O aprendizado com você vai além dessa dissertação. Muito obrigada! À Profa. Mary Lopes Reis, minha coorientadora, pelo apoio e acolhimento! 7 Aos membros do Núcleo de Estudos Qualitativos em Saúde e Enfermagem – NEQUASE -, pela troca de experiência e parceria nesta c trajetória. Obrigada por me ensinarem a compartilhar. a m Aos profissionais de saúde, enfermeiras, enfermeiros, médicas e i médicos que participaram da nossa pesquisa, por compartilharem comigo n h suas vidas, percepções e sentimentos. Obrigada por disponibilizarem o a tempo de vocês para a concretude deste projeto! d a Aos membros da banca de qualificação e defesa, pelas valiosas contribuições ao trabalho. a o Ao cNPq, pelo incentivo financeiro. Espero que a Instituição continue forte, impulsionando a produção científica no Brasil. s e u l a d o é s e m p r e u m a a l e g r i a 8 SUMÁRIO LISTA DE ILUSTRAÇÕES ......................................................................... 9 LISTA DE ABREVIATURAS E SIGLAS ................................................... 10 RESUMO ................................................................................................... 12 ABSTRACT ............................................................................................... 13 RESUMEN ................................................................................................ 14 INTRODUÇÃO .......................................................................................... 15 CAPÍTULO 1 - ASPECTOS CONCEITUAIS E POLÍTICOS DA VIOLÊNCIA OBSTÉTRICA ...................................................................... 21 1. A violência ......................................................................................... 21 1.1 Violência contra a mulher ........................................................................... 23 1.2 A violência obstétrica .................................................................................. 28 1.3 Institucionalização e medicalização do parto .............................................. 36 2. AspEctos Políticos ............................................................................ 41 2.1 Principais marcos político-legais da violência contra a mulher ................... 41 2.2 Políticas públicas na saúde da mulher ....................................................... 44 2.3 Assistência à parturiente ............................................................................. 49 2.4 conduta profissional e código de Ética na assistência obstétrica ............. 53 CAPÍTULO 2 - METODOLOGIA ............................................................... 56 2.1 Delineamento do estudo ............................................................................. 56 2.2 campo de estudo ........................................................................................ 56 2.3 Trabalho de campo ..................................................................................... 57 CAPÍTULO 3 – RESULTADOS E DISCUSSÃO ...................................... 62 3.1 Caracterização dos participantes ................................................................ 62 3.2 Humanização da assistência à parturiente ................................................. 64 3.3 Vivências de violência obstétrica ................................................................ 68 3.3.1 Significados da violência obstétrica ..................................................... 69 3.3.2 Manifestações da violência obstétrica ................................................. 74 3.3.3 Motivos da violência obstétrica ............................................................ 78 3.4 conhecimento sobre o período gravídico-puerperal ................................... 82 CONSIDERAÇŌES FINAIS ...................................................................... 85 REFERÊNCIAS ......................................................................................... 88 APÊNDICE I ............................................................................................ 105 APÊNDICE II ........................................................................................... 107 ANEXO I ................................................................................................. 109 9 LISTA DE ILUSTRAÇÕES QUADRO 1: categorias de desrespeito e abuso durante o nascimento ................. 24 QUADRO 2: categorias de intervenções durante o processo de parturição ........... 28 10 LISTA DE ABREVIATURAS E SIGLAS cAIS – centro de Assistência Integral à Saúde cAPS – centro de Atenção Psicossocial cEM – código de Ética Médica cEPE – código de Ética dos Profissionais de Enfermagem cEVAM – Centro de Valorização da Mulher cFM – conselho Federal de Medicina cIAMS – centro Integrado de Assistência Médico-Sanitária cNDM – conselho Nacional dos Direitos da Mulher cOFEN – conselho Federal de Enfermagem DEAM – Delegacia Especializada de Atendimento à Mulher ENSP - Escola Nacional de Saúde Pública EUA – Estados Unidos da América FPA - Fundação Perseu Abramo IBGE – Instituto Brasileiro de Geografia e Estatística IPEA – Instituto de Pesquisa Aplicada MS - Ministério da Saúde NEQUASE – Núcleo de Estudos Qualitativos em Saúde e Enfermagem OMS - Organização Mundial de Saúde ONG - Organização Não Governamental PAISM – Programa de Assistência Integral à Saúde da Mulher PHPN – Programa de Humanização no Pré-Natal e Nascimento PNAISM – Política Nacional de Assistência à Saúde da Mulher PNPM – Plano Nacional de Políticas par a as Mulheres 11 PSMI – Programa de Saúde Materno-Infantil REHUNA – Rede pela Humanização do Parto e Nascimento SIM – Sistema de Informação de Mortalidade SMS – Secretaria Municipal de Saúde SPM - Secretária de Políticas para as Mulheres SUS – Sistema Único de Saúde TcLE - Termo de consentimento Livre e Esclarecido UABSF – Unidade de Atenção Básica à Saúde da Família UFG - Universidade Federal de Goiás UPA – Unidade de Pronto-Atendimento UTI – Unidade de Terapia Intensiva VO – Violência Obstétrica 12 RESUMO A violência obstétrica é um problema de Saúde Pública no âmbito nacional e internacional. Refere-se a todas as formas de violência originadas durante a assistência ao ciclo gravídico-puerperal ou abortamento, perpetradas por profissionais de saúde em instituições
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