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Critérios para a realização de episiotomia: reflexão sobre a ação
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Abstract(s)
O presente relatório tem como objetivo ilustrar as competências do Enfermeiro
Especialista em Enfermagem de Saúde Materna e Obstétrica adquiridas e
desenvolvidas ao longo do estágio de natureza profissional, de acordo com o
Regulamento das competências específicas do enfermeiro especialista em
enfermagem de saúde materna e obstétrica nº. 391/2019, publicado em três de
maio de 2019.
A metodologia descritiva utilizada neste relatório centrou-se na análise crítica e
reflexiva das experiências decorrentes da prática clínica, realizada em três áreas
distintas: bloco de partos, serviço de internamento de grávidas com
complicações e serviço de internamento de puerpério. Esta abordagem foi
orientada pela evidência científica mais atualizada, visando a prestação de
cuidados de excelência e seguros. Ao integrar as melhores práticas e
conhecimentos recentes, foi possível desenvolver uma análise crítica
aprofundada das intervenções realizadas, promovendo a melhoria contínua da
qualidade dos cuidados especializados em Enfermagem de Saúde Materna e
Obstétrica.
Neste relatório irei apresentar uma reflexão crítica de casos clínicos vivenciados
no período de estágio, nomeadamente, quatro casos clínicos do bloco de partos,
um caso clínico da unidade materno fetal e um caso clínico do estágio no
internamento de obstetrícia.
No âmbito do projeto de investigação implementado no bloco de partos, intitulado
“Episiotomia: fazer ou não fazer? Contributos para a tomada de decisão”, este
relatório incluirá um capítulo dedicado à descrição do meu contributo. O foco
principal da minha participação consistiu na transcrição e análise de entrevistas
realizadas aos Enfermeiros Especialistas de Enfermagem de Saúde Materna e
Obstétrica envolvidos, utilizando como referência a metodologia de análise de
conteúdo proposta por Bardin (2011).
De acordo com a literatura e as entrevistas, a episiotomia depende de fatores
como experiência profissional, condições do períneo, paridade e sinais de
sofrimento fetal, visando o bem-estar materno e fetal. Profissionais experientes realizam menos episiotomias, privilegiando intervenções seletivas e o parto
natural, enquanto os menos experientes recorrem mais ao procedimento por
insegurança ou pressões externas. A elasticidade do períneo, a primiparidade e
sinais de sofrimento fetal aumentam a probabilidade de intervenção. Quanto ao
impacto na vida da mulher, a episiotomia está ligada a desconforto, possíveis
complicações e um impacto negativo na qualidade de vida da mulher no período
pós-parto.
Fazendo uma retrospetiva do meu percurso ao longo deste ano, foi possível
adquirir e desenvolver competências como Enfermeiro Especialista de
Enfermagem em Saúde Materna e Obstétrica de forma progressiva, com um
balanço bastante positivo. A elaboração deste relatório permitiu-me adotar, após
o término do estágio, uma postura reflexiva contínua, essencial para a melhoria
da prática clínica. Esta reflexão crítica possibilitou a reformulação de abordagens
e a implementação de estratégias mais eficazes, garantindo, assim, uma
evolução constante na prestação de cuidados, baseada na evidência científica e
focada na segurança e bem-estar das utentes.
The purpose of this report is to illustrate the competencies of the Specialist Nurse in Maternal and Obstetric Health Nursing acquired and developed during the professional internship, in accordance with the Regulation on the Specific Competencies of the Specialist Nurse in Maternal and Obstetric Health Nursing No. 391/2019, published on May 3, 2019. The descriptive methodology applied in this report focused on the critical and reflective analysis of experiences arising from clinical practice, carried out in three distinct areas: delivery room, inpatient unit for pregnant women with complications, and postpartum inpatient unit. This approach was guided by the most up-to-date scientific evidence, aiming to deliver excellent and safe care. By integrating best practices and recent knowledge, it was possible to develop an indepth critical analysis of the interventions performed, fostering the continuous improvement of specialized care in Maternal and Obstetric Health Nursing. This report will present a critical reflection on clinical cases encountered during the internship, including four clinical cases from the delivery room, one clinical case from the maternal-fetal unit, and one clinical case from the obstetrics inpatient unit internship. As part of the research project implemented in the delivery room, titled “Episiotomy: To Perform or Not? Contributions to Decision-Making,” this report will include a chapter dedicated to describing my contribution. My main focus was on transcribing and analyzing interviews conducted with Specialist Nurses in Maternal and Obstetric Health Nursing, using Bardin's (2011) content analysis methodology as a reference. According to the literature and interviews, the decision to perform an episiotomy depends on factors such as professional experience, perineal conditions, parity, and signs of fetal distress, always aiming at maternal and fetal well-being. Experienced professionals perform fewer episiotomies, favoring selective interventions and natural birth, while less experienced professionals resort to the procedure more often due to insecurity or external pressures. Factors such as perineal elasticity, primiparity, and signs of fetal distress increase the likelihood of intervention. Regarding its impact on the woman's life, episiotomy is associated with discomfort, potential complications, and a negative effect on the woman's quality of life during the postpartum period. Reflecting on my journey throughout this year, I progressively acquired and developed competencies as a Specialist Nurse in Maternal and Obstetric Health Nursing, achieving a very positive balance. The preparation of this report allowed me to adopt, after completing the internship, a continuous reflective approach essential for improving clinical practice. This critical reflection enabled the reformulation of approaches and the implementation of more effective strategies, ensuring constant evolution in care delivery, grounded in scientific evidence and focused on the safety and well-being of the patients.
The purpose of this report is to illustrate the competencies of the Specialist Nurse in Maternal and Obstetric Health Nursing acquired and developed during the professional internship, in accordance with the Regulation on the Specific Competencies of the Specialist Nurse in Maternal and Obstetric Health Nursing No. 391/2019, published on May 3, 2019. The descriptive methodology applied in this report focused on the critical and reflective analysis of experiences arising from clinical practice, carried out in three distinct areas: delivery room, inpatient unit for pregnant women with complications, and postpartum inpatient unit. This approach was guided by the most up-to-date scientific evidence, aiming to deliver excellent and safe care. By integrating best practices and recent knowledge, it was possible to develop an indepth critical analysis of the interventions performed, fostering the continuous improvement of specialized care in Maternal and Obstetric Health Nursing. This report will present a critical reflection on clinical cases encountered during the internship, including four clinical cases from the delivery room, one clinical case from the maternal-fetal unit, and one clinical case from the obstetrics inpatient unit internship. As part of the research project implemented in the delivery room, titled “Episiotomy: To Perform or Not? Contributions to Decision-Making,” this report will include a chapter dedicated to describing my contribution. My main focus was on transcribing and analyzing interviews conducted with Specialist Nurses in Maternal and Obstetric Health Nursing, using Bardin's (2011) content analysis methodology as a reference. According to the literature and interviews, the decision to perform an episiotomy depends on factors such as professional experience, perineal conditions, parity, and signs of fetal distress, always aiming at maternal and fetal well-being. Experienced professionals perform fewer episiotomies, favoring selective interventions and natural birth, while less experienced professionals resort to the procedure more often due to insecurity or external pressures. Factors such as perineal elasticity, primiparity, and signs of fetal distress increase the likelihood of intervention. Regarding its impact on the woman's life, episiotomy is associated with discomfort, potential complications, and a negative effect on the woman's quality of life during the postpartum period. Reflecting on my journey throughout this year, I progressively acquired and developed competencies as a Specialist Nurse in Maternal and Obstetric Health Nursing, achieving a very positive balance. The preparation of this report allowed me to adopt, after completing the internship, a continuous reflective approach essential for improving clinical practice. This critical reflection enabled the reformulation of approaches and the implementation of more effective strategies, ensuring constant evolution in care delivery, grounded in scientific evidence and focused on the safety and well-being of the patients.
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Keywords
Enfermagem de Saúde Materna e Obstétrica trabalho de parto episiotomia integridade perineal adaptação à parentalidade Relatório de estágio