What are the criteria for choosing the ideal motherhood? – 09/13/2023 – Balance and Health

The moment of birth can be magical, but it is also delicate. Therefore, to guarantee the safety of the procedure and happy memories for the future, it is important to have the support of a good maternity hospital. But, when choosing a private institution, there are more important indicators than the thread count of the sheet or the size of the room.

Furthermore, you can also guarantee better care when giving birth in a public maternity hospital with good prior research. This is what obstetrician Mariano Tamura, supervisor of the Medical Residency Program in Gynecology and Obstetrics at Hospital Israelita Albert Einstein, explains.

“Birth is a critical moment in life. It is a celebration, but it is also clearly a moment that is surrounded by fear, it is not a simple moment in the passage of a human being. Any accident that occurs at this time can be very serious, and adverse events exist”, explains Tamura.

On social media, videos about luxury items in maternity wards, such as sheets with thousands of threads and plenty of space for visitors, are successful and generate engagement. But, outside of cell phone screens, the most important thing is not the hotel items or even the physical structure of the maternity ward.

“When a complication occurs, you don’t want to know how many threads the sheet has or what will be served for breakfast, you want to know who is in the ICU [Unidade de Terapia Intensiva] on the side, who are the professionals who will deal with this complication”, warns doctor and professor Rômulo Negrini, medical coordinator of obstetrics at Hospital Israelita Albert Einstein.

A similar warning is made by the National Association of Private Hospitals (Anahp), which commissioned an opinion survey with more than 3 thousand respondents in April 2022. The survey, carried out by Anahp, in partnership with PoderData, showed that the issue structure Physics was highlighted as more important than quality indicators by those interviewed.

In the report, the association recognizes that this is an example of “the population’s lack of knowledge regarding the essential quality criteria for qualified care.” “But it’s not the citizen’s fault, it’s the health sector itself, which does not communicate transparently with the population”, states the report.

To avoid this mismatch, it is important to know the main signs of safety and quality when choosing a maternity hospital.

“The most important aspect to look for is safety. It is necessary to understand what safety items the mother finds in the maternity ward, both for herself and her baby, and make a comparison between the available options”, explains Negrini, who He is also a professor of obstetrics at the Faculty of Medical Sciences of Santa Casa de São Paulo.

“Hotel care shouldn’t be the biggest priority, but it is part of the experience and brings comfort to the patient. I don’t see it as something we need to fight against, but the most important information is related to quality and safety”, agrees Tamura.

Midwife Paloma Ortolani, who has a bachelor’s degree in Obstetrics from the School of Arts, Sciences and Humanities (EACH) at the University of São Paulo (USP), also highlights the importance of looking for maternity wards where there is a concern with the involvement of professionals from different areas.

“Not all maternity wards are used to receiving the most diverse teams that are common in humanized births, such as a midwife and a doula accompanying the obstetrician doctor”, he explains.

“Some hospitals nowadays already understand that the obstetrician is the specialist in normal birth, so they allow a multidisciplinary team to work more in this type of birth”, says Ortolani, who graduated from the only Brazilian college that offers a degree in obstetrics , which is different from the specialization of obstetricians.

What matters?

But, after all, what matters to determine the quality of a maternity hospital? According to doctors interviewed by Agência Einstein, the best way to evaluate health institutions is by observing objective indicators, such as maternal and neonatal mortality, or the percentage of vaginal births and cesarean sections, and comparing these numbers with those recommended by the World Health Organization ( WHO).

“The number is an objective way of providing information, and it translates into reality a series of information, experiences, reports. What is the proportion of vaginal births in patients with no indication of risk? What is the percentage of discharge from Neonatal ICU? From what fetal age do they go home healthily and safely? This is some information that translates very important points”, explains Tamura.

Taking guided tours to get to know the maternity wards also helps to go beyond the numbers and see in person what the service is like in each unit. Nowadays, most private maternity hospitals in São Paulo already work with these visits, which can even be done online and are often encouraged by obstetricians.

“For some women, silence during childbirth is important. Others say they calm down by talking, and ask the team to talk and talk all the time. So, it’s important to understand that each woman is different and meet these expectations as well. “, says midwife Ortolani.

Doctors also remember that, even in public institutions, it is possible to compare data and carry out prior research to ensure better care. Although it is not always possible to choose the desired maternity hospital when the birth is carried out by the Unified Health System (SUS), or to visit the unit’s facilities beforehand, a careful analysis of the main indicators can help the family to have an experience more aligned with the your expectations for this moment.

Birth plan

Another preparation that may be helpful is creating a birth plan before the procedure. In this document, whose use is becoming more common in the SUS, the mother highlights her preferences, intentions and desires for childbirth.

Aspects such as the priority route of delivery, the desired positions during labor and the pregnant woman’s choices in case of emergency measures can be described in this plan, which is recognized by the Ministry of Health and must be accepted by SUS institutions.

“When we talk about public and private maternity hospitals there shouldn’t be a difference in the risk for the mother or the baby, that is, a risk to safety. Today the public maternity hospital is opening up to the birth plan, and many city halls have made a prenatal card with the birth plan inserted in it”, recalls Negrini.

“We have a very different reality in the SUS, but it is always possible to demand better care. We must remember that, as citizens, we are the financiers of the health system, and it needs to reflect this”, adds the obstetrician.

Another aspect to be taken into consideration is the location of the maternity ward. Ideally, the institution should be close to the pregnant woman’s residence, and not in another city or in a very distant neighborhood. This strategy is also used in the SUS and, according to experts, it is repeated in the health systems of several countries around the world.

“In the SUS, people have a little less flexibility when choosing a maternity hospital, but that makes perfect sense. It’s better if you are close to where you live, close to your family, your support network. 20 years ago we had much less maternity hospitals, so it was common for people to have to go further. This dynamic was wrong, and this has improved a lot in Brazil”, comments Tamura.
General hospitals linked to maternity

Even though the physical structure is not the main quality indicator highlighted by Anahp, a tip from experts is to prefer maternity hospitals that are linked to general hospitals, especially in cases of higher-risk pregnancies. This is because hospitals have a more complete multidisciplinary structure, and professionals from other specialties can be called in case of complications during childbirth.

“The support of a large hospital facilitates the acquisition of technology and the participation of professionals who are not pediatricians and obstetricians when pregnancy becomes complex. This could be a cardiologist, an infectious disease specialist, a neurologist. This closer approach to this clinical team more diversity provides us with a more complete treatment”, says Tamura.

Doctor Linus Pauling Fascina, who is manager of the Maternal and Child Department at Hospital Israelita Albert Einstein, agrees that the presence of a general hospital is an advantage in terms of safety during childbirth, whether in the public or private system.

“A maternity ward that is located within a general hospital has much more rigorous security locks than one that is just a maternity ward,” explains Fascina.

The clinical team, in fact, goes far beyond the obstetrician chosen by the pregnant woman to supervise the birth. In many cases, the mother’s contact ends up being more intense with nurses and obstetric nurses than with the doctor herself. Therefore, experts recommend a careful analysis of the clinical staff of each institution before choosing a private maternity hospital.

See below a summary of the experts’ main tips for choosing a private maternity hospital:
Ideal motherhood checklist:

1- Check the main indicators
Percentage of birth complications, maternal mortality, percentage of natural births or cesarean sections: all this data can be good indications of what actually happens in a particular maternity hospital. This information must be made available by the institutions at the request of the family or in their publicity materials. Furthermore, on the Anahp website it is possible to access the performance indicators of the institutions associated with the entity. On the National Supplementary Health Agency (ANS) portal, it is possible to access data from the Health Service Providers Qualification Program (Qualiss).

2 – Prioritize safety and quality
Luxury and comfort may attract likes on social media, but they are less relevant than safety and quality at the time of birth. Experts consulted by Agência Einstein recommend that hotel aspects are not decisive in the search for a maternity ward, and remember that these details do not necessarily imply better service and experience.

3 – Analyze the set
It’s not just the doctor who matters: when choosing a maternity hospital, it’s important to evaluate the quality of the institution’s entire clinical team, especially the obstetric nurses, who play a leading role in caring for pregnant women in labor. . It is also worth paying attention to the infrastructure of each unit, although Anahp reminds us that the physical structure is not the main indicator of quality and safety.

4 – Prefer units with a general hospital
Doctors interviewed by the report state that maternity hospitals that are linked to general hospitals can provide more multidisciplinary care and are important in cases of complications during childbirth. Furthermore, general hospitals have stricter security locks and have adequate equipment for more serious conditions.

5 – Seek foster care
Despite what many people think, the obstetrician is not the protagonist of the birth, but rather the pregnant woman. Therefore, choosing maternity hospitals where mother and baby are considered protagonists can bring more support to the pregnant woman at the time of birth than places where the patient’s wishes are not yet treated as a priority.