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Fatores inerentes à implementação do modelo midwife-led care na vigilância pré-natal da gravidez de baixo risco no Serviço Nacional de Saúde
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Advisor(s)
Abstract(s)
O modelo midwife-led care é centrado na mulher e tem como ponto basilar a premissa de que a gravidez e o parto são eventos normais da vida (ICM, 2017). Este modelo proporciona à mulher formação, aconselhamento, cuidados pré-natais adaptados às suas necessidades específicas e continuidade de cuidados, defendendo a minimização de intervenções e, encaminhando as mulheres em caso de complicações.
Os Enfermeiros Especialistas em Saúde Materna e Obstétrica são profissionais com formação especializada, capazes de prestar cuidados durante toda a gestação, parto e pós-parto (WHO, 2018).
Vários estudos, entre os quais o de Sandall et al. (2016), sugerem que o modelo está associado a múltiplos benefícios tanto para as mães como para os bebés, não tendo sido identificados efeitos adversos em comparação com modelos de assistência médica ou de cuidados partilhados.
Este estudo tem como finalidade contribuir para um projeto que visiona a implementação do modelo midwife-led care na vigilância da gravidez de baixo risco em Portugal, tendo sido definidos como objetivos o desenvolvimento e validação de um instrumento que permita analisar a perspetiva dos stakeholders sobre a implementação do modelo em Portugal, assim como testar o instrumento na identificação das barreiras e fatores facilitadores à implementação do modelo.
Trata-se de um estudo piloto, exploratório de natureza qualitativa. A população consiste em indivíduos / grupos que podem ser afetados ou afetar a implementação do modelo e o instrumento de recolha de dados um guião de entrevista semiestruturada. A análise de dados foi realizada através da análise de conteúdo segundo Bardin, para análise qualitativa de dados.
De modo geral, o guião de entrevista desenvolvido capta a informação que se pretende. Os entrevistados compreenderam as perguntas e foi possível através do estudo piloto identificar algumas barreiras e facilitadores ao modelo midwife-led care em Portugal percebidas pelos entrevistados. Os entrevistados percecionam uma aceitabilidade social positiva na implementação do modelo, enquanto a aceitabilidade profissional pode variar, sugerindo alguma resistência, principalmente dos médicos especialistas. Os fatores facilitadores incluem a formação e a presença de Enfermeiros Especialistas em Saúde Materna e Obstétrica, estrutura física dos serviços, recursos disponíveis, existência de evidências positivas e melhoria no acesso aos cuidados. As principais barreiras mencionadas são a resistência à mudança por parte de grávidas e alguns profissionais de saúde, necessidade de superar mentalidades enraizadas e conscientização da população sobre o modelo e o papel dos Enfermeiros Especialistas em Saúde Materna e Obstétrica, desafios logísticos e políticas de saúde. Vários entrevistados referiram potenciais benefícios, como menor intervenção médica, melhores resultados maternos e perinatais e redução de custos. A legislação existente parece oferecer uma base sólida para a implementação do modelo. No entanto, a criação de protocolos específicos e diretrizes de atuação seria essencial para orientar a prática.
Estes resultados parecem demonstrar preliminarmente que a implementação do modelo midwife-led care em Portugal seria bem-sucedida, dependendo da coordenação entre as diferentes partes interessadas, educação pública adequada e consideração cuidadosa dos desafios e oportunidades específicos de cada região do país.
The midwife led care model is woman centered and is based on the premise that pregnancy and childbirth are normal life events (ICM, 2017). This model provides women with education, counseling, prenatal care tailored to their specific needs, and continuity of care, advocating for the minimization of interventions and referring women in case of complications. Midwives are professionals with specialized training capable of providing care throughout pregnancy, childbirth, and the postpartum period (WHO, Several studies, including the one by Sandall et al. (2016), suggest that the model is associated with multiple benefits for both mothers and babies, with no adverse effects identified in comparison to medical led or shared care models. The purpose of this study is to contribute to a project that envisions the implementation of the midwife led care model in the care of low risk pregnan t women in Portugal. The objectives have been defined as the development and validation of an instrument that allows the identification of stakeholders' perspectives on the model's implementation in Portugal as well as testing the instrument in identifying barriers and facilitators to the model's implementation. This is a pilot study, exploratory, and qualitative in nature. The population consists of individuals/groups that may be affected by or affect the implementation of the model, and the data collection instrument is a semi structured interview guide. Data an alysis was carried out using content analysis by Bardin, for qualitative data analysis. In general, the developed interview guide captures the desired information. Respondents understood the questions, and it was possible through out the pilot study to identify some barriers and facilitators to the midwife led care model in Portugal as perceived by the interviewees. Respondents perceive positive social acceptability in the model's implementation, while professional acceptability may v ary, suggesting some resistance, especially from specialist doctors. Facilitating factors include midwifery trai ning and the presence of midwives , the physical structure of services, available resources, the existence of positive evidence, and improved access to care. The main barriers mentioned are resistance to change from pregnant women and some healthcare professionals, the need to overcome entrenched mindsets, public awareness of the model and the role of the midwife , logistical challenges, and healthcare policies. Several interviewees mentioned potential benefits, such as reduced medical intervention, improved maternal and perinatal outcomes, and cost reduction. Existing legislation seems to provide a solid foundation for the model's implementation. However, the creation of specific protocols and guidelines for action would be essential to guide practice. These results preliminarily suggest that the implementation of the midwife led care model in Portugal would be successful, depending on coordination among various stakeholders, appropriate public education, and careful consideration of the specific challen ges and opportunities in different regions of the country.
The midwife led care model is woman centered and is based on the premise that pregnancy and childbirth are normal life events (ICM, 2017). This model provides women with education, counseling, prenatal care tailored to their specific needs, and continuity of care, advocating for the minimization of interventions and referring women in case of complications. Midwives are professionals with specialized training capable of providing care throughout pregnancy, childbirth, and the postpartum period (WHO, Several studies, including the one by Sandall et al. (2016), suggest that the model is associated with multiple benefits for both mothers and babies, with no adverse effects identified in comparison to medical led or shared care models. The purpose of this study is to contribute to a project that envisions the implementation of the midwife led care model in the care of low risk pregnan t women in Portugal. The objectives have been defined as the development and validation of an instrument that allows the identification of stakeholders' perspectives on the model's implementation in Portugal as well as testing the instrument in identifying barriers and facilitators to the model's implementation. This is a pilot study, exploratory, and qualitative in nature. The population consists of individuals/groups that may be affected by or affect the implementation of the model, and the data collection instrument is a semi structured interview guide. Data an alysis was carried out using content analysis by Bardin, for qualitative data analysis. In general, the developed interview guide captures the desired information. Respondents understood the questions, and it was possible through out the pilot study to identify some barriers and facilitators to the midwife led care model in Portugal as perceived by the interviewees. Respondents perceive positive social acceptability in the model's implementation, while professional acceptability may v ary, suggesting some resistance, especially from specialist doctors. Facilitating factors include midwifery trai ning and the presence of midwives , the physical structure of services, available resources, the existence of positive evidence, and improved access to care. The main barriers mentioned are resistance to change from pregnant women and some healthcare professionals, the need to overcome entrenched mindsets, public awareness of the model and the role of the midwife , logistical challenges, and healthcare policies. Several interviewees mentioned potential benefits, such as reduced medical intervention, improved maternal and perinatal outcomes, and cost reduction. Existing legislation seems to provide a solid foundation for the model's implementation. However, the creation of specific protocols and guidelines for action would be essential to guide practice. These results preliminarily suggest that the implementation of the midwife led care model in Portugal would be successful, depending on coordination among various stakeholders, appropriate public education, and careful consideration of the specific challen ges and opportunities in different regions of the country.
Description
Keywords
Qualidade de Cuidados Modelo Midwife-Led care Enfermeiro Especialista em Saúde Materna e Obstétrica Relatório de estágio