Shifting the paradigm to an obstetric humanized care: the disparities at a tertiary care hospital in the midwest of Brazil

Abstract

Shifting the paradigm to an obstetric humanized care: the disparities at a tertiary care hospital in the midwest of Brazil J.B. Verano 1 , C.D. Rodrigues 2 , M.V.S. Ferreira 2 , S.R. de Oliveira 1 1Department of Gynecology and Obstetrics, Ceilândia Regional Hospital, Brasília; 2Catholic University of Brasília, Brasília (Brazil) Summary Objectives: This study intended to evaluate the overuse of episiotomy as a routine practice at a public referral regional hospital and the changes promoted by the widespread concept of obstetric violence. Materials and Methods: This study was an analytic cross-sectional study with retrospective gathering of data through medical record analyses from women that gave birth from July 2012 and July 2015 at the Birth Center of Ceilândia Regional Hospital. Results: From a sample of 519 births, 47.4% were performed by resident physicians in training. The overall episiotomy rate considering both periods was 41.2% with a significant decrease on the rate between the periods (p < 0.01), with a 53.2% rate in 2012 vs. a 32.3% in 2015. There was no difference in the episiotomy rates amongst obstetricians (p = 0.263). However, in 2012 a 60.2% rate against a 24.6% rate in 2015 was observed among resident physicians (p < 0.001). There was no statistically significant difference among third- and fourth-degree tear rates in the two periods. Perineal integrity was observed in 26.78% of the patients. Conclusion: This study indicates that the referred center is currently facing a paradigm shift motivated by young physicians, with a drop in the episiotomy rates, but still with little reflex on the fully trained obstetricians’ practices. Key words: Obstetric labor; Natural birth; Episiotomy; Humanization of assistance.