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Violência Obstétrica dói em mulheres e profissionais

É comum que a primeira reação de profissionais obstetras, especialmente da medicina, ao ouvir a expressão VIOLÊNCIA OBSTÉTRICA¹ seja: “mas que raios será isso, gente?!” 

(Eu mesma² tentei disfarçar, mas quase caí dura. Tive taquicardia, sudorese fria, mal estar.

No entanto, aproveitar a oportunidade do questionamento pode desencadear um processo intenso e doloroso – mas compensador – de desconstrução e reconstrução de si. Após ouvir sobre essa tal violência, procurar informações, estudos científicos e refletir pode fornecer subsídios e combustível para ressignificar sua própria prática de atenção e cuidado.

Foto: Marina Santos

Dar-se a oportunidade de conhecer uma nova estética³ de cuidado em saúde, nesse campo da atenção ao parto e nascimento, abre caminho para a percepção de que um outro cenário, muito diferente daquele marcado por cenas de dor e desespero, é possível. Descobrirá que não foi à toa que, um dia, alguém escreveu um livro chamado “Nascer Sorrindo”.

Talvez sem exceções, as trajetórias e os requisitos de graduações e pós-graduações em saúde são extensos e extenuantes, exigindo de aspirantes a obstetras, extrema dedicação de tempo, energia, mente e vida. Após dar-se tanto para, enfim, iniciar uma atuação profissional de fato, não é de se estranhar que, ao receber nos ouvidos o som inédito de “violência obstétrica”, a reação e os sentimentos não sejam exatamente positivos.

(Eu me senti mal, meio indignada, pessoalmente ofendida e ferida. Como assim? Depois de tudo aquilo??? Foi difícil digerir isso, viu?!)

Com coragem, assiste “O Renascimento do Parto”, descobre que essa novidade toda é quase caduca… Existe publicação da Organização Mundial da Saúde (OMS) sobre o tema desde 1985⁶, o Ministério da Saúde instituiu no ano 2000 o PHPN (Programa de Humanização no Pré-natal e Nascimento)⁷ , depois veio a Rede Cegonha⁸, diretrizes nacionais atualizadas⁹, a mais recente publicação da OMS¹⁰ que ratifica esse paradigma de práticas, toda uma discussão de Medicina Baseada em Evidências, partos e nascimentos extra-hospitalares subsidiados por ciência e políticas públicas, a legitimidade ainda maior da atuação de enfermeiras obstetras e obstetrizes nesse cuidado.

Foto: Marina Santos

Decorre de tudo isso o entendimento de que violência obstétrica é institucional, estrutural, atravessada por uma cultura ainda essencialmente patriarcal. Não é o/a médico/a violento/a. Ela é consequência da (de)formação profissional, do modelo inadequado de atenção obstétrica e neonatal, das estruturas defasadas das maternidades, da remuneração incompatível de profissionais, da cultura e da sociedade machista

Transformar isso é bom pra todo mundo! Pra quem presta assistência, pra quem dá à luz e pra quem chega à luz! 

Transformar isso é bom pra todo mundo! Pra quem presta assistência, pra quem dá à luz e pra quem chega à luz! 

Sim, é difícil… mas é bom, necessário, possível e vale a pena. Então… A gente pode começar a pensar diferente e a enxergar o que está diante do próprio nariz.

Foto: Unsplash

Uma mulher em um quarto com outras mulheres, muitas vezes frio por causa do ar condicionado, sem nenhum acompanhante, nenhum rosto familiar, sem nenhuma mão pra segurar, sentindo dores que ninguém ajuda a processar ou tolerar ou ressignificar, que pensa que devia estar vivendo o melhor momento de sua vida, mas que, na verdade, já está se sentindo até meio culpada por não estar exatamente gostando daquilo…

“Ela fica restrita ao leito, sem se movimentar, sem rebolar, sem poder expressar suas emoções, nem gemer, nem vocalizar… não pode contar nem com o “pra descer todo santo ajuda”, porque, afinal, como que alguma coisa desce deitada, de costas, em cima do cóccix que fica angustiado e não amplia a passagem da bacia?

O que esses bebês, vivenciando esse ritual de passagem dessa forma, com medo, frio, solidão e dor, vão registrar em seu cérebro, suas memórias, seu DNA? Como vão nascer bem com pouco retorno venoso e, por consequência, pouco oxigênio (mulher deitada e fazendo valsalva sem parar por causa dos puxos dirigidos e prolongados)?

Que primeira impressão (não é a que fica?) bebês vão ter ao serem recebidos dessa forma, separados de suas mães logo ao nascer, tendo coisas esquisitas enfiadas goela abaixo assim, de supetão? 

Sim, o nome disso tudo é violência. E é possível dar as mãos e tomar consciência e mudar. E para mudar, é preciso considerar que aquilo que eu aprendi ou que eu acho melhor podem não estar mais corretos ou atuais.

  • Existe mesmo indicação de episiotomia?
  • Existe mesmo esse cordão enrolado no pescoço que é arriscado para a vida?
  • Parto é mesmo esse evento extremamente perigoso? Se é, como a humanidade existiu até aqui?
  • Será que doulas são aquelas que querem parto normal a qualquer custo e cesárea só em último caso?
  • Será que a cirurgia é a única opção para bebês pélvicos (de bumbum pra baixo)?
  • Ainda é a ética da beneficência (profissionais sabem o que melhor para “pacientes”) que deve nortear o cuidado? Ou será que a autonomia tem seu lugar, assim como o compartilhamento de responsabilidades e decisões?
  • Será mesmo que profissionais da medicina são melhores para assistir partos e nascimentos de mulheres e bebês saudáveis?
  • De onde vem a recomendação da OMS sobre uma ideal taxa de cesariana de 15%?¹¹

E tantas outras perguntas poderosas… 

Talvez essa seja a principal:

– Trabalho de parto é mesmo sofrimento? Em mim, existe ainda essa crença: “pra que ficar sofrendo se existe a cesária?” 

É imprescindível também ouvir as mulheres. Ouvi-las chacoalha, cutuca, incomoda e transforma. Saber de suas vivências de situações de violência na gestação e no parto amolece o coração, não tem jeito. Passamos a sentir na pele essa dor… Nossa urgência em mudar cresce, se fortalece.

As mulheres também nos contam que, para além de toda a segurança e de todos os benefícios do parto normal corroborados pela ciência, a dor de parto não é sofrimento, é uma dor com um propósito, um sentido, que é possível e gostoso acolher o processo e dar seus filhos à luz com prazer, alegria e muito amor ocitocinado naturalmente. Sentimos também essa alegria e esse amor, ressignificamos também o que é ser profissional nesse cenário. Vem!

¹http://www.sentidosdonascer.org/wordpress/wp-content/themes/sentidos-do-nascer/assets/pdf/controversias/Violencia-obstetrica.pdf
²Renata Reis, médica obstetra.
³“A dimensão estética aposta na invenção de percursos, modos de fazer, produzindo novas formas de subjetivação e realidades, em um compromisso com o movimento contínuo, com o fluxo criativo. A vida é entendida como ‘obra de arte’, aberta para a reinvenção do ser, do estar e do sentir, a partir de modos mais efetivos de produzir saúde.” VERDI, Marta; FINKLER, Mirelle; MATIAS, Maria Claudia Souza. A dimensão ético-estético-política da Humanização do SUS: estudo avaliativo da formação de apoiadores de Santa Catarina (2012-2014). Epidemiol. Serv. Saúde,  Brasília ,  v. 24, n. 3, p. 363-372,Sept.2015.Available from <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S2237-96222015000300363&lng=en&nrm=iso>. access on  12  Nov.  2020.  https://doi.org/10.5123/S1679-49742015000300003.
⁴Nascer Sorrindo, de Frédérick Leboyer, autor e médico obstetra francês 
⁵https://www.netflix.com/br/title/80995575
⁶https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2018/01/1-s2.0-S0140673685927503-main.pdfhttp://bvsms.saude.gov.br/bvs/saudelegis/gm/2000/prt0569_01_06_2000_rep.htmlhttp://bvsms.saude.gov.br/bvs/folder/rede_cegonha.pdfhttps://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_nacionais_assistencia_parto_normal.pdf
¹⁰https://portaldeboaspraticas.iff.fiocruz.br/wp-content/uploads/2018/04/9789241550215-eng.pdf
¹¹https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_por.pdf;jsessionid=A4130C5DAB902ABA8A555806A24BF4AE?sequence=3

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