Obstetric violence: theme approach in the training of Certified Nurse-Midwives

This is a descriptive and qualitative study carried out at a University Center in Teresina, PI. Twenty nurses participated, graduate students in obstetric nursing. Data collection took place through guided interviews using a semi-structured questionnaire. The data were processed using the software IraMuTeQ and the Descending Hierarchical Classification. The data were analyzed using the Discourse of the Collective Subject technique.

Results:

Through the Descending Hierarchical Classification, six classes were obtained from which the speeches emerged. It was possible to confirm the importance of training nurses in the face of obstetric violence. The main key expressions identified in the speeches were academic training, knowledge in educational practice, quality assistance, scientific, technological and humanistic mismatches, strengthening of the care model, strategic planning in the health sector, humanist base and professional clinical view.

Conclusion:

Through the Discourse of the Collective Subject, it was possible to partially observe the importance of training nurses, since they enable the contribution of comprehensive care, corroborating a physiological process, which can reduce obstetric violence.

Keywords
Violence; Violence against woman; Pregnant women; Nurse midwives; Students, nursing; Humanizing delivery

Key Elements	Central Ideas	Discourses of the Collective Subject
Academic training knowledge in educational practice. Assistance in the pregnancy cycle. Importance of nurses.	Importance of the obstetric violence theme in the academic education of nurses as an educational practice in the pregnancy cycle.	Obstetric violence, characterized by the dehumanization of birth and the misappropriation of health professionals in the reproductive process of women, in the training of nurses, is of great value and importance. It is essential to assist in the pregnancy cycle as a preventive strategy to combat this phenomenon to obtain a harmonic relationship, minimizing possible errors of obstetric complications. Progress in the valorization of professionals is also crucial, as is the support of a public policy network, enabling a better working condition in SUS, better financial or structural performance, in order to awaken a new scientific view on educational practice, developing a thought critical and avoiding this “disentanglement”.
Risks from lack of care. Financial valuation. Quality assistance.	The profile of the Certified Nurse-Midwife in humanized care.	The term “qualified provider” emphasizes exclusively the individual with skill in professional birth care, able to accompany the care of the puerperal woman, from her interaction in the family environment to her mental state. When asked about the care commitment, most professionals and the entire multidisciplinary team are giving more value to the economic sector, that is, they are valuing the currency more than humanization itself. Professionals must prioritize quality service with comfort, responsibility and credibility. The profile of an Obstetric expert is that of an adjunct, and the protagonist is the pregnant woman herself. This means having professional ethics, empathy with others and human dignity.
Quality of care provided. Scientific, technological, and humanistic neglect. Rights to parturient women.	The role of the Certified Nurse-Midwife in caring for women during prenatal care.	The Certified Nurse-Midwife aims to assist the pregnant woman with quality, wishing to primarily reach the poorest parts of society. We observe a neglect and even the absence of integrality when deepening its scientific, technological and humanistic aspects in this context. It is important for pregnant women to receive guidance, knowing the procedures and their rights in this parturition, especially teenage mothers, so that they are prepared to enter this setting.
Strengthening the care model. Risks in the birth process.	The importance of nurses in humanized prenatal care to reduce postpartum complications.	Humanization implies changes in the routine, with the purpose of making the moment of delivery as “medicalized” as possible. One of the main objectives of prenatal care is to know the patient's medical history. It is necessary that the nurse plays a role of total strengthening in the care model, providing early assistance, as the risks evolve into a series of problems that can put the life of both the mother and the newborn at risk.
The importance of scientific knowledge. Maternal and neonatal well-being. Scientific improvement in academic training. Strategic planning in the health sector.	Applicability of scientific knowledge as a strategy in women's health care.	When analyzing institutional violence, we realize that, with regard to combining practice with scientific knowledge, there is a high complexity in the women's health care network, which serves as a gateway to maternal and neonatal care and well-being. Knowledge is an information tool focused on the learning process. Primary care is of great relevance in professional development, as it comprises a detailed - that is, a holistic view - in the field of women's health care, which provides conditions for health promotion and improvement in physical and emotional control. In view of the high level of demand for services, strategic planning in the health sector is necessary, aiming at the elaboration of actions such as assistance restructuring.
Humanist base. Birth interventions. Clinical look of the professional.	Obstetric violence in the view of the health team, in the current context of humanized care.	Humanization would be a strategy in the production of health, understood by a humanist base, capable of transforming the professional's vision. To make a birth satisfactory, it is necessary to reduce interventions and implement good therapeutic obstetric practices, which were previously based on the understanding that birth was associated with the disease, biologically. Today, it becomes a model of expanded care, which makes it possible to discourage unnecessary conduct in labor and delivery. Professionals must have a clinical view so that it is possible to analyze and interpret violence to reduce evils that cause so much suffering and affect the health of women and newborns.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Kayo Henrique Jardel Feitosa Sousa, E-mail: kayohenriquejardel@hotmail.com