Implementation of the national guidelines for assistance with normal delivery at the Hospital State of Santana, Amapá, Brazil

Introduction: The predominant model of childbirth care in Brazil is characterized by the abusive or inappropriate use of interventions in all clinical periods of childbirth. It is known that these interventions can be prevented or reduced through the adoption of practices recommended by the National Childbirth Assistance Directives of the Ministry of Health. However, although these Guidelines are even subsidized by the World Health Organization recommendations on intrapartum care for a positive delivery experience, in our reality, most obstetrical practices do not follow these recommendations. Objectives: To evaluate practices and outcomes in normal delivery care; Implement the practices of the National Guidelines for Assistance to Normal Birth; Evaluate the impact of implementing the practices at the study site. Method: longitudinal, quasi-experimental, before-and-after study using audit tools, from action research, and was carried out at Hospital State of Santana, Amapá, Brazil. The study population consisted of four nurses and eight physicians who assist in childbirth at the study site. Phases of the study: 1) pre-audit and basic audit; 2) implementation of practices; 3) post-implementation audit. Data collection: data were collected with the professionals, through a questionnaire with 32 questions and five options of responses type "Likert scale", ranging from "never" to "always", with a score of 1 to 5. In addition, a intentional sample of 126 charts of women who gave birth at the study site was also used. Data analysis: descriptive and inferential (comparing the results of phases 1 and 3), with a significance level of 5%. Ethical aspects: The research was approved by the Research Ethics Committee of the Federal University of Amapá, under the opinion 2,853,419, observing the guidelines and norms of Resolution no. 466/12, of the National Health Council. Results: In stage 1, ambulation, supply of liquids or food in the first phase of labor, and the use of oxytocin as post-partum hemorrhagic prophylaxis were the most common practices in the registries; the use of the anesthetic before the episiotomy or before the repair of lacerations and the active behavior in the third period of the delivery were the practices most reported by the professionals, however, the positions of horizontal birthing are the most recommended compared to vertical and there is little perineal care. Phase 2 will be a seminar scheduled to take place in June 2019 with the purpose of presenting to the participants the results of the basic audit performed at the study site and to present the National Guidelines for Assistance to Normal Labor of the Ministry of Health. Phase 3 will be held in August this year. Conclusion. In phase 1, there was a poor quality of the records in the medical records. There is an urgent need for educational intervention to improve the quality of records in records and childbirth care recommended by the National Birth Assistance Guidelines.