Uma etnografia de um serviço extra hospitalar a mulheres em situação de abortamento “humanizado” em uma maternidade pública do nordeste brasileiro.

Abstract

This is an ethnography about Atenas Program - a counter-hegemonic service (to the national current model) and "humanized" care to women undergoing abortion (provoked or spontaneous), in a public maternity hospital in the Northeast of Brazil - and the subjects involved (participants and professionals) in the initiative. The scientific literature points out that the abortion care model proposed by the ministerial Technical Standard 2005/2011 is not being followed by health services. There is emphasis on the technical component, devaluation of the professional-user relationship, little participation of women in decisions about their sexual and reproductive health, and neglect of reproductive planning. Facing this problem, the Atenas Program emerges as an alternative proposal to such a model. Guided by principles of humanization and by the aforementioned technical standard, the Atenas Program proposed a multiprofessional approach (in- and out-of-hospital) to women undergoing abortion in the studied maternity hospital. Between July and September 2018, in addition to participant observation, semi-structured interviews were applied with 16 members of the program and 35 professionals of the institution, of which 10 were in the core team of the "project". For the participants, in addition to the opportunity to elaborate feelings related to the abortion, the initiative provided an opportunity to finalize it in a longer, but safe, discreet way, at home, without removing them from family life and with less impact on the management of their social and work routine. At the same time, the non-immediate resolution of the abortion, characteristic of the methods proposed by the initiative, made evident in them the fear of infection and death due to the permanence of the "dead fetus in the belly". In this context, many suffered pressure from their close support network for uterine curettage. From the professionals' point of view, the Atenas Program represented a strategy of humanized care to these women that, facing the demands of pregnant women and neonates, had little opportunity to be assisted during hospitalization. The core team members praised the nurses' telemonitoring and the multiprofessional approach, which included psychosocial care - peculiarities that favored individualized care, the bond with the participants, and the women's autonomy. For the professionals of the institution, the Atenas Program helped in the turnover of obstetric beds, in reducing hospital costs, and in demystifying compulsory uterine curettage. However, it was observed that the Atenas Program was a recent and fragile initiative that was struggling for consolidation. Silencing about induced abortion was also perceived. By symbolically transforming all participants into "mothers" who lost a "child," the Atenas Program offered women who had spontaneous abortions a space to elaborate their feelings and, for those who induced them, provided moral protection and the opportunity to access integrated care. This silencing also prevented professionals from confronting their personal dilemmas about the issue and not running into the professional purpose of "saving lives" - given that, in the Brazilian social context and in the health field, fetal vitality is still paramount to the woman's well-being. Given the incipience of initiatives to improve abortion care for women, analyzing this experience was relevant.