Os desafios de enfrentamento da episiotomia no parto: uma revisão de literatura

Abstract

Episiotomy is one of the most performed surgical procedures in Brazil and the world, from its first report until the popularization of the technique, assisting the labor of thousands of women, countless studies were carried out so that its limits, indications and consequences were identified and evaluated. In Brazil, episiotomy was used in almost all vaginal births as a routine procedure in all health units. At the beginning of the 21st century, international and national institutions began to propose ways to reduce its incidence. Despite all efforts, Brazil presents unsatisfactory data on the reduction in the incidence of episiotomy. The work consisted of an integrative literature review, in which searches were carried out in the Scielo and LILACS databases. Its objective was to: identify the factors related to the high rates of episiotomy in Brazil. The specific objective is to: identify and analyze the factors related to the incidence of episiotomy during childbirth; identify and analyze the factors related to coping with episiotomy during childbirth. In the databases used, the following research descriptors were used: obstetric violence, nursing and episiotomy. In total, 1,562 articles were found, of which 57 were identified as duplicates. After applying the inclusion and exclusion criteria (date of publication, location, objectives, completeness of data, presentation of data related to episiotomy), 23 works were selected from the total amount. The relationships that influenced the incidence and those that reduced episiotomy rates were identified based on the elements highlighted by the authors, as well as those taken from the evaluation of their work. These results were grouped by theme: human, physiological, social, political and technical factors. This made it possible to identify the factors: technicality of care, less presence of obstetric nursing, greater presence of medical professionals during childbirth and the relationship of social inequality resulting in high rates of episiotomy during childbirth. Facing episiotomy during childbirth: the presence of obstetric nursing providing more humanized care. Professional experience and training are considered fundamental in the evaluation and decision-making of the use of PPE, identifying the importance of creating and effectively implementing public policies in Brazil