Assistência materna na ótica das puerperas usuárias do SUS no município de Dourados - MS

Abstract

Esta pesquisa descreve a assistencia materna prestada as mulheres, tal como expressa nos discursos de puerperas usuarias do SUS no municipio de Dourados, MS. Os objetivos do estudo foram apresentar as formas de organizacao do trabalho no atendimento a mulher, mostrar como esta o acesso as acoes e servicos de saude e conhecer as opinioes que as puerperas expressam a respeito da assistencia materna. O Ministerio da Saude (1994) orienta que a assistencia materna deve ser vista em seus diversos niveis de atencao e de complexidade e nas praticas adotadas pelos modelos assistenciais. Cabe-nos entao constatar a reorganizacao das praticas assistenciais, uma vez que elas estao passando por mudancas rumo a construcao de um novo modelo de atencao a saude. Metodologicamente, foi desenvolvida uma investigacao de corte transversal descritiva, comparativa e com desenho qualitativo, utilizando o Discurso do Sujeito Coletivo de Lefevre, em 66 puerperas que fizeram o pre-natal na rede e que pariram nos meses de junho a agosto de 2005. Nesse municipio, o atendimento necessita de estruturacao e implementacao de estrategias de mudanca do modelo assistencial a partir da organizacao da demanda, uma vez que cada unidade segue uma rotina. O modelo clinico ainda impera, pois esta centrado na atencao as queixas. O trabalho em equipe existe em apenas algumas unidades de saude, com atuacoes isoladas, desarticuladas, sem integracao dos profissionais. As praticas informativas e educativas em grupo nao foram uma constante e, mesmo quando existentes, nao contaram com a participacao da grande maioria das usuarias. Em vez disso, as orientacoes restringiram-se ao simples repasse de informacoes, sendo pouco direcionadas as necessidades do grupo e com utilizacao do material de apoio de forma inadequada. A maioria relatou ter acesso as consultas, aos meios terapeuticos, aos exames laboratoriais de rotina e aos exames complementares, porem na maioria das vezes o tempo de espera foi muito longo; as consultas foram rapidas; nao houve prescricao de medicamentos preconizados; algumas tiveram a resolucao do parto sem conhecer o resultado dos exames laboratoriais, devido a demora na entrega destes; os exames complementares foram garantidos, mas foi demonstrada insatisfacao com essa pratica, havendo demora no agendamento e no atendimento, e surgiu o descredito no exame do SUS. Apesar do acesso garantido, e necessario que se implementem mudancas na forma como organizam esses servicos e tambem nas formas com os profissionais operam tais servicos, redirecionando enfoques e acoes pautados na vigilancia a saude e na ampliacao da cidadania brasileira, concretizando assim o proposito inicial do municipio, que era a reversao do modelo assistencial. Quanto a opiniao das usuarias com o pre-natal, revelaram-se satisfeitas, pois quando nao o estao expressam isso reclamando ou migrando para outras unidades de saude. Ja no parto/pos-parto, a maioria relatou ter sido bem tratada e bem atendida, e uma minoria relatou alguns sentimentos e atos negativos no transcorrer do parto. Portanto, no periodo estudado, as gestantes dirigiram-se ao parto com diferentes opinioes e expectativas, com base nas praticas assistenciais adotadas pelos modelos assistenciais. Por final, a comparacao dos dois modelos assistenciais, na otica das puerperas usuarias do SUS, revelou nao ter havido diferencas significativas nem relevantes na maioria das categorias estudadas. Nao ocorreu, portanto, reestruturacao das praticas assistenciais.

This investigation describes the maternal assistance delivered to women, as expressed in the discourses of postpartum women who are users of the Brazilian Unified Health Care System (SUS) in the county of Dourados, Mato Grosso do Sul, Brazil. The purposes of the study were to describe the forms of work organization in the provision of care to women, to show the current status of access to health actions and services, and to know the opinions of postpartum women on the maternal assistance delivered to them. The Brazilian Health Ministry (1994) advocates that maternal assistance be viewed in its several levels of attention and complexity, taking into account the policies adopted by the assistance models. The reorganization of practices of assistance should be acknowledged, as these are undergoing changes toward the construction of a novel model of health attention. The present cross-sectional, descriptive, comparative investigation of qualitative design, which adopted the Lefevre's Discourse of the Collective Subject, had as subjects 66 postpartum women who received prenatal care and gave birth from June to August 2005. In Dourados, care provision currently requires structuring, as well as the implementation of strategies to change the model of assistance by organizing the demand, since each health unit follows its particular routine. The clinical model still predominates, which is centered on attention to complaints. Team work was found to be conducted only in some of the health units, though with isolated, poorly articulated actions with no integration of the professionals. Informative and educational group practices were not a common feature; even when available, they did not involve the participation of most users. Instead, guidance was limited to the mere transmission of information poorly targeted at the needs of the group, and support materials were inadequately used. Most users reported having had access to medical appointments, therapeutic resources, routine laboratory tests, and complementary exams, but waiting time was usually very long; office visits were brief; recommended medication failed to be prescribed; some users gave birth without knowing the results of their exams, because of delays in forwarding. Although complementary exams were performed, users were not satisfied: appointment arrangements and provision of services were not fast enough, leading to distrust of the services provided by SUS. Although access was ensured, changes are needed in the manner the services are organized and in the way that the professionals operate these services, so that the approaches and actions can be guided by a focus on health vigilance and on an expansion of Brazilian citizenship practices, so as to accomplish the purpose originally set by the city administration, of reverting the model of assistance. Users reported satisfaction with prenatal care received, dissatisfaction being expressed by complaining or by migrating to other health units. In the partum and postpartum period, however, most of them reported being well cared for, whereas few mentioned negative feelings or experiences during parturition. In the period of study, participants who sought pregnancy- and delivery-related services held a range of opinions and expectations, based on the policies adopted by the models of assistance. Finally, the comparison of both models of assistance, as viewed by postpartum women who used the services of SUS, did not reveal any significant or relevant differences in most of the categories investigated. So far, the practices of assistance have failed to be restructured.