Profile of high-risk pregnant women and co-management of the decision on the routh of birth delivery between doctor and pregnant woman

ABSTRACT Cross-sectional study carried out with survey data in four large Brazilian cities. This research analyzes data from Campinas (SP), aiming at characterizing the profile of high-risk pregnant women followed-up at specialized public outpatient clinics, as well as to verify and discuss aspects related to collaborative care in the decision on the route of birth delivery during the specialized prenatal care. The sample was calculated considering the prevalence of the high-risk pregnancy, morbidity profile and coverage of specialized services. Questionnaires were applied to 405 pregnant women of these services, and a descriptive analysis was performed based on the frequency distribution of the questions. The profile of pregnant women is mainly composed of young, black women, who have completed high school and without health insurance. There was a statistical association between variables: when women choose their own route of birth individually, the majority opts for normal birth; when only the doctor decides, the majority indicates cesarean section; and, when a joint decision is made the cesarean section prevails, but, in a lower percentage than when the doctor decides alone. It is necessary to discuss the power asymmetry between doctors and users in the care management as a fundamental component to qualify health work.

摘要：本研究为横断面研究，基于巴西四座大城市的调查数据开展。本研究以坎皮纳斯（圣保罗州）的相关数据为分析对象，旨在刻画在专科公立门诊接受随访的高危妊娠孕妇群体特征，并验证、探讨专科产前保健期间分娩方式决策相关的协同照护议题。本研究的样本量基于高危妊娠患病率、疾病谱及专科服务覆盖率测算得出。研究向上述专科门诊的405名孕妇发放问卷，并基于问卷问题的频次分布开展描述性分析。受访孕妇群体以年轻黑人女性为主，她们大多完成高中学业且无医疗保险。变量间存在统计学关联：孕妇自主选择分娩方式时，多数倾向自然分娩；仅由医生决定时，多数选择剖宫产(cesarean section)；若为共同决策，剖宫产仍占多数，但占比低于医生单独决策的情况。有必要探讨照护管理中医师与服务对象之间的权力不对称问题，将其作为优化医疗服务工作的核心要素。