A arte de não fazer o errado e fazer o certo!
Cadernos de Saúde Pública
Timely and strategic, Leal et al.'s article "Obstetric Interventions During Labor and Childbirth in Brazilian Low-risk Women", intend to assess on a national level one of the most currently discussed issues: how to assist childbirth, and what should or should not be done for the safety and well-being of the woman and the newborn. Worldwide, this discussion has extreme and opposite impacts: in places with very few human resources and poor infrastructure, where childbirth without any professional
... ut any professional care keeps killing women, and, in the other extreme end, in places where, for the sake of "care", interventions turned childbirth a standardizes process, with "routine" interventions whose evaluation of effectiveness are being the subject of permanent investigations, as mentioned by the authors and other systematic reviews carried out by Cochrane, recently published and mentioned at the end of this comment 1,2,3,4,5,6,7,8 . The results presented in this article disclose, in a summarized way, that the so-called good practices are less frequent then interventions during labor and delivery, which go against the evidences found in the investigations about the effectiveness of such actions. Aside from considerations about regions and other variables, my contribution in this comment seeks to expand the basis necessary to address the so-called obstetric care model for both, the public and the private sector, with the incorporation of evidence-based practices, and, particularly, with the revision of the initial concept that turned childbirth from a natural process into a medicalized procedure, filled with interventions. As well indicated by the authors, a very small proportion, 5.6% of low-risk women, and 3.2% of nulliparous women of this group managed to have a normal vaginal delivery, in a natural way, with no intervention in the physiology of labor. In other countries, such proportion may range from 15% to 35% in Australia to 41.8% to the total births in England. For almost 95% of the women in Brazil, the mere fact of being in a hospital means to be subjected to procedures, most of them expensive and unwarranted. Thus, the basic principle for discussion of the necessary shift in care model is the autonomy of the woman, the ownership of childbirth and its needs. Calling it a model is an approximation, inadequate and categorizing, in the discussion about the unique and always particular experience of giving birth.