1
PhD in Nur sing, Associat e Pr ofessor ; e- m ail: m er ighi@usp.br ; 2 Under graduat e st udent , e- m ail: t avares_re@yahoo.com .br. Univer sit y of São Paulo at Ribeirão Pret o, School of Nursing, Brazil; 3 Nur sing Mast er st udent ; Assist ant Pr ofessor, School of Nur sing, Univer sit y Cent er of Carat inga, Minas Gerais, Brazil, e- m ail: selisv ane@y ahoo.com .br
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e
CARE NEEDS OF PREGNANT W OMEN W I TH A PRI VATE HEALTH I NSURANCE: A
COMPREHEN SI VE SOCI AL PHEN OMEN OLOGY APPROACH
Mir iam Apar ecida Bar bosa Mer igh i1 Ren at a Tav ar es Fr an co Rodr igu es2 Selisv ane Ribeir o da Fonseca Dom ingos3
Mer ighi MAB, Rodr igues RTF, Dom ingos SRF. Car e needs of pr egnant w om en w it h a pr ivat e healt h insurance: a com prehensive social phenom enology approach. Rev Lat ino- am Enferm agem 2007 set em bro- out ubro; 15( 5) : 914- 21.
This st udy aim ed t o under st and t he m eanings w om en w ho possess healt h plans hold r egar ding pr egnancy and get t o know t heir car e needs in t his phase of t he v it al cy cle. I t w as based on t he qualit at iv e r esear ch of phenom enological inspir at ion. The discour ses analy sis w as based on t he sociologist and fenom enologist Alfr ed Sch u t z’s t h ou gh t . Hav in g h ealt h p lan s an d b ein g at t en d ed in p r iv at e in st it u t ion s w er e d ef in ed as in clu sion cr it er ia. Th e f ollow in g cat egor ies em er ged f r om t h e discou r ses: h av in g n ew r espon sibilit ies; ex per ien cin g a sp eci al si t u at i o n ; ex p er i en ci n g i n secu r i t y , an x i et y an d ex p ect at i o n s; f eel i n g l i m i t ed ; t r u st i n g t h e h eal t h pr ofessional. I t w as found, t hr ough t he analysis of cat egor ies, t hat t he exper ience of t he pr egnant w om en w ho par t icipat ed in t he st udy is sim ilar t o t hose w ho do not possess healt h plans. How ever , in t he cat egor y “ t r ust ing t he healt h pr ofessional” it w as possible t o per ceive t he im por t ance of possessing healt h plan, w hich allow s t he int er subj ect iv it y bet w een t he w om an and t he healt h pr ofessional.
DESCRI PTORS: qu alit at iv e r esear ch ; w om en ’s h ealt h ; pr egn an cy
N ECESI DADES DE CUI DADO DE MUJERES EMBARAZADAS QUE POSEEN SEGURO DE
SALUD: UNA APROXI MACI ÓN COMPRENSI VA DE LA FENOMENOLOGÍ A SOCI AL
Est e est udio t iene com o obj et iv o com pr ender los significados que las m uj er es que poseen segur o de salud at r ibuy en al em bar azo y conocer sus necesidades de cuidado en est a fase del ciclo v it al. El est udio fue f u n dam en t ado en la in v est igación cu alit at iv a de in spir ación f en om en ológica. El pen sam ien t o del sociólogo y fenom enólogo Alfr ed Schut z conduj o el análisis de los discur sos. Com o cr it er io de inclusión, se definió que los in div idu os deber ían ser at en didos en in st it u cion es pr iv adas y poseer segu r o de salu d. De las declar acion es sur gier am las cat egor ías: t eniendo nuev as r esponsabilidades; v iv enciando una sit uación especial; v iv enciando insegur idad, ansiedad y ex pect at iv as; sint iéndose lim it adas; confiando en el pr ofesional de salud. Por m edio del análisis de las cat egor ías, fue const at ado que la v iv encia de las m uj er es em bar azadas que par t icipar on de est e est udio se m ost r ó de for m a sim ilar a la de las m uj er es que no poseen segur o de salud. Sin em bar go, en la cat egor ía “ con f ian do en el p r of esion al de salu d” , f u e posib le per cib ir la im p or t an cia de poseer plan o de salud, hecho que posibilit a la int er subj et iv idad ent r e la m uj er y el pr ofesional de salud.
DESCRI PTORES: inv est igación cualit at iv a; salud de la m uj er ; em bar azo
NECESSI DADES DE CUI DADO DAS MULHERES GRÁVI DAS QUE POSSUEM CONVÊNI O
SAÚDE: ABORDAGEM COMPREENSI VA DA FENOMENOLOGI A SOCI AL
Est e est udo obj et ivou com pr eender os significados que as m ulher es que possuem convênio saúde t êm da gr avidez e conhecer quais as necessidades de cuidado das m ulher es nessa fase do ciclo vit al. Fundam ent ou-se na pesquisa qualit at iv a de inspir ação fenom enológica. O pensam ent o do sociólogo e fenom enólogo Alfr ed Schut z conduziu a análise das falas. Com o cr it ér io de inclusão, definiu- se que os suj eit os dever iam ser at endidos em in st it u ições pr iv adas e possu ir con v ên io saú de. Dos depoim en t os em er gir am as cat egor ias: t en do n ov as r esp on sab ilid ad es; v iv en cian d o u m a sit u ação esp ecial; v iv en cian d o in seg u r an ça, an sied ad e e ex p ect at iv as; sent indo- se lim it ada; confiando no pr ofissional de saúde. Por m eio da análise das cat egor ias, const at ou- se que a v iv ên cia d as m u lh er es g r áv id as q u e p ar t icip ar am d est e est u d o m ost r ou - se d e f or m a sim ilar à d aq u elas m ulher es gr áv idas que não possuem conv ênio saúde. No ent ant o, na cat egor ia “ confiando no pr ofissional de saúde” foi possív el per ceber a im por t ância de possuir conv ênio saúde, fat o que possibilit a a int er subj et iv idade ent r e a m ulher e o pr ofissional de saúde.
JUSTI FI CATI ON AND OBJECTI VES
A
r ev iew of lit er at ur e about t he subj ect iv it y of w om en w h o ex p er i en ce p r eg n an cy r ev eal s t h att h ese st u d ies m ain ly f ocu s on w om en w h o u se t h e
Single Healt h Syst em ( SUS) and ar e at t ended in public
h ospit als. Th ese w om en ar e con dit ion ed t o see an d
act in t he healt h and disease ar ea fr om t he per spect ive
of t heir social inser t ion, char act er ized by t heir liv ing
c o n d i t i o n i t s e l f a n d b y t h e e x p e r i e n c e o f m a n y
eco n o m i c d i f f i cu l t i es( 1 - 5 ). Th er ef o r e, i n i t i al l y, so m e considerat ions are needed about t he result s of st udies
abou t pr egn an cy an d pr en at al car e, aft er w h ich t h e
ex per ience of pr egnancy w ill be addr essed fr om t he
per spect ive of w om en w it h a privat e healt h insur ance,
w ho ar e focused on in t his st udy.
I n a r esear ch car r ied out in Duque de Caxias/
RJ, aim ed at get t ing t o know healt h pr ofessionals’ and
client s’ opinions about pr enat al car e, it w as observed
t hat , in gener al, t he pr egnant w om en w ho used t he
ser v ices u n d er st u d y d id n ot m en t ion a sig n if ican t
c o n t r i b u t i o n b y p r i m a r y c a r e t o f a c i l i t a t e t h e i r
u n d er st an d in g of t h e p r eg n an cy an d b ir t h p r ocess.
Except ions w ere relat ed t o nursing consult at ions, w hich
t ook longer and cont ained m or e infor m at ion, opening
u p a space w h er e t h e w om en ’s af f ect iv e qu est ion s,
d ou b t s, an x iet ies an d cu r iosit y can b e b r ou g h t u p ,
p er m it t in g t h e est ab lish m en t of a r elat ion b et w een
healt h pr ofessionals and client s( 1).
Th e r esu lt s of an et h n ogr aph ic st u dy abou t
t h e c a r e o f f e r e d t o p r e g n a n t w o m e n a t a
p h i l a n t h r o p i c i n s t i t u t i o n r e f l e c t s t h e s e w o m e n ’ s
act u al an x iet y abou t pr en at al car e, besides pr ov in g
t h eir d if f icu lt ies t o g et access t o p r en at al ser v ices,
t h e discon t in u it y of car e an d t h e w om en ’s n egat iv e
assessm en t ab ou t t h e p r en at al car e of f er ed b y t h e
p u b l i c n e t w o r k a n d i n a g r e e m e n t w i t h t h e so ci a l
secu r it y ser v ice( 6 ). Th e au t h or com m en t s t h at , w h en t h e p r eg n a n t w o m en m a n a g e t o g et a t t en d ed b y
t h e p r en at al ser v ice, t h ey ar e con f r on t ed w it h t h e
pr of ession als’ lack of pr epar at ion an d com m it m en t ,
w h o d o n o t g i v e t h em a t t en t i o n , a r e a l w a y s i n a
h u r r y an d , t h er ef o r e, d o n o t m an ag e t o est ab l i sh
in t er act ion w it h t h e w om en w h o, in t u r n , con sid er
t h e ser v ice t oo f ast an d su per f icial. Som e of t h em ,
dissat isf ied, m ov e on t o seek at t en t ion t o t h eir n eeds
e l s e w h e r e . O t h e r s g e t d i s c o u r a g e d a n d , i n a
su b seq u en t p r eg n a n cy, n o l o n g er a t t en d p r en a t a l
ser v ices or do it at a lat e st age, m er ely at t em pt in g
t o gu ar an t ee a place t o giv e bir t h .
A n o t h e r s t u d y a b o u t t h e p r e g n a n c y
ex p er i en ce o f w o m en i n a l o w - i n co m e co m m u n i t y
aim ed t o under st and and descr ibe how t hese w om en
an d t h eir h u sb an d s ex p er ien ce t h e p r eg n an cy. Th e
analy sis of t heir r epor t s show ed t hat , essent ially, t he
p r eg n an t w om en ar e: “ Liv in g an u n cer t ain f u t u r e,
at t em pt ing t o adapt t o t he new sit uat ions em er ging
f r om t h e p r eg n an cy an d ask in g God t o sh ow t h em
t he r ight w ay”. The aut hor consider ed t hat t her e exist s
a lar g e d ist an ce b et w een t h e h ealt h ser v ice u ser s’
needs and w hat t hey ar e offer ed by t he inst it ut ions
and t heir pr ofessionals( 3).
A st u dy car r ied ou t in Ribeir ão Pr et o abou t
access t o pr en at al car e in t h e basic h ealt h n et w or k
ident ified t hat 54. 6% of t he w om en st ar t ed pr enat al
car e i n t h e seco n d t er m o f t h ei r p r eg n an cy, 4 0 %
at t en d ed l ess t h an si x p r en at al ap p oi n t m en t s an d
7 7 . 1 % did n ot h av e an y paid w or k . Th e an aly sis of
t he car e t his gr oup of w om en r eceived evidenced t hat ,
in prenat al care, t he w om en defined t he sociocult ural
access as biological and indiv idual car e, cent er ed on
t h e d o ct o r ’ s a p p o i n t m e n t . Or g a n i za t i o n a l a cce ss
d isp lay ed ob st acles r elat ed t o w ait in g t im e f or t h e
appoint m ent , lack of places and difficult y t o do exam s.
Geographical/ econom ic access w as r elat ed t o dist ance
f r o m t h e m a t e r n i t y h o sp i t a l , a s w e l l a s f i n a n ci a l
difficult ies for t r anspor t at ion( 5).
Hence, w e believe it is im port ant t o research
on w om en w ho hav e a pr iv at e healt h insur ance and
ar e at t ended at pr ivat e inst it ut ions as w ell. We depar t
fr om t he pr em ise t hat t hey m ay get easier access t o
healt h care. I n public hospit als, t he w om an’s isolat ion,
dur ing pr enat al car e as w ell as in t he deliv er y r oom
a n d i n t h e p u e r p e r a l p h a s e , t h e i n d i f f e r e n c e ,
car elessness, lack of efficient car e and pr ohibit ion of
t h e par t n er ’s or r elat iv e’s pr esen ce ar e f act or s t h at
cont ribut e t o t he feeling of solit ude, helplessness and
panic, m aking t hese w om en feel t hat t hey ar e in t he
hands of fat e( 7).
We also depar t fr om t he pr em ise t hat w om en
w it h a privat e healt h insurance have easier access t o
prenat al services, cont inue receiving care during labor,
deliver y and post par t um , have a guar ant eed place at
an inst it ut ion w hen t hey ar e going t o giv e bir t h and
do n ot ex per ien ce t h e appr eh en sion of n ot k n ow in g
w ho w ill do t he deliver y.
We b e l i e v e t h a t k n o w l e d g e a b o u t o t h e r
per sons in t heir t ot alit y can be obt ained if w e at t em pt
t o under st and t hem as individuals belonging t o a social
collect iv ely con st r u ct ed an d accept ed an d in f lu en ce
t h e w ay t h ei r p er cei v e t h ei r h eal t h p r o b l em s an d
t r eat m ent . Thus, in t his st udy, w e at t em pt t o display
t he exper iences of pr egnancy in a com pr ehensive way,
m ain ly in t er m s of t h e m ean in g s at t r ib u t ed t o t h e
ex p er ien ces an d t o t h e ack n ow led g em en t of t h ese
w om en ’s n eed s b ased on t h eir ex p er ien ces d u r in g
p r eg n an cy.
Wit h a v iew t o unv eiling t he phenom enon of
t h e ex p er i en ce of p r eg n an t w om en w i t h a p r i v at e
h e a l t h i n s u r a n c e , t h i s s t u d y h a d t h e f o l l o w i n g
ob j ect iv es:
- gener al: I dent ify if t he feelings and car e needs of
w o m e n w i t h a p r i v a t e h e a l t h i n su r a n ce , w h o a r e
a t t e n d e d i n p r i v a t e i n s t i t u t i o n s a n d e x p e r i e n c e
p r eg n an cy, d i f f er f r o m u ser s o f t h e Si n g l e Heal t h
Sy st em .
- sp ecif ic: Un d er st an d t h e m ean in g w om en w it h a
pr iv at e h ealt h in su r an ce at t r ibu t e t o t h e pr egn an cy
pr ocess; get t o k n ow t h ese w om en ’s car e n eeds in
t his phase of t he life span.
We b el i ev e t h a t t h i s k n o w l ed g e ca n o f f er
significant cont ribut ions in care delivery t o t his client ele
and add t o t eaching in t he w om en’s healt h ar ea.
THEORETI CAL- METHODOLOGI CAL BASES
The t heor et ical- m et hodological fr am ew or k of
t his r esear ch is based on t he pr inciples of qualit at iv e
r esear ch , w h ich f av or s a d eep er k n ow led g e of t h e
m eanings, beliefs and values of people, w ho at t r ibut e
specific m eanings t o t heir act ions and hum an relat ions.
Th e ph en om en ological per spect iv e w as adopt ed, as
w e consider t hat t his allow s for a bet t er under st anding
as w om en w h o ar e cap ab le of t h in k in g , act in g an d
r ef l ect i n g o n t h ei r l i f e w o r l d an d w h o n eed t o b e
under st ood and helped by t heir car egiv er s.
We u sed t h e r ef er en ce f r am ew or k of social
phenom enology, based on Alfr ed Schut z’ concept ion.
This fr am ew or k st udies t he phenom enon on t he basis
o f w h a t p e o p l e e x p e r i e n c e i n t h e i r d a i l y l i f e ,
consider ing t hem as elem ent s t hat act , int er act and
u n d er st an d on e an ot h er w it h in t h e so- called social
w or ld; it allow s for t he replacem ent of t he obj ect ives
o f t h i n k i n g b y co m m o n sen se, ex em p l i f i ed b y t h e
t y pified act iv it ies for t he st udy quest ions( 8).
Alfr ed Schut z’ social phenom enology aim s t o
u n d e r s t a n d t h e w o r l d w i t h t h e o t h e r s i n i t s
in t er su b j ect iv e m ean in g . I t s p r op osal is t o an aly ze
s o c i a l r e l a t i o n s , c o n s i d e r e d a s m u t u a l r e l a t i o n s
inv olv ing people. I t is st r uct ur ed on t he m eanings of
t h e in t er su bj ect iv e ex per ien ce of t h e social r elat ion
and seek s t o at t end t o social act ions, w hich hav e a
cont ex t ualized m eaning, configur ed in t he social and
not purely individual sense. I t is t he focus of int erest
t hat can be cont r ibut ed as a t ypical char act er ist ic of a
social group t hat is experiencing a cert ain sit uat ion( 9). This r esear ch aim ed t o get t o know t he r ealit y
of a gr oup of pr egnant w om en at t he end of t he second
t er m of t heir pr egnancy, sit uat ing t hem in t he nat ural
a t t i t u d e a n d , t h e r e f o r e , i n t h e i r l i f e - w o r l d , t o
u n d e r st a n d t h e d i f f e r e n t i n t e r p r e t a t i v e p r a ct i ce s
t h r ou gh w h ich r ealit y is con st r u ct ed in t h e per son al
an d social per spect iv e.
So ci al act i o n i s a co n d u ct d i r ect ed at t h e
achiev em ent of a cer t ain goal and t his act ion, called
m o t i v e f o r can o n l y b e i n t er p r et ed b y t h e act o r ’s
subj ect ivit y, as it is only t he person him - / herself w ho
ca n d e f i n e h i s/ h e r a ct i o n p r o j e ct , h i s/ h e r so ci a l
per for m ance. I n t his sense, t he under st anding of t he
social is orient ed t ow ards t he social behavior in relat ion
t o t he m ot ives, t o t he int ent ions t hat guide t he act ion
an d t o i t s m ean i n g s f o r t h e act o r p er f o r m i n g t h e
act ion( 8).
Mot iv e is con sider ed as: “ a st at e of t h in gs,
t he obj ect ive one int ends t o r each t hr ough t he act ion”.
Hence, m ot ive for is t he orient at ion t ow ards t he fut ure
act ion. I t is, t her efor e, a cont ex t of m eet ing t hat is
co n st r u ct ed o r co n st r u ct s i t sel f o n t h e co n t ex t o f
exper iences available at t he m om ent of t he pr oj ect ion.
This cat egor y is essent ially subj ect iv e. On t he ot her
hand, t he m ot iv e w hy r efer s t o a pr oj ect in funct ion
o f p ast ex p er i en ces an d i s an o b j ect i v e cat eg o r y,
accessible t o r esear cher s. The cont ex t of m eaning of
t h e t r u e r eason w h y is alw ay s an ex plan at ion af t er
t he ev ent( 8).
Schut z dev eloped his st udies out of int er est
in u n der st an din g t h e su bj ect iv e m ean in g of act ion s,
w h i c h w i l l m a k e i t p o s s i b l e t o c o n s t r u c t t h e
e x p e r i e n c e d t y p e . Th e e x p e r i e n c e d t y p e i s t h e
expression of a st ruct ure lived in t he social dim ension,
a char act er ist ic of a social group, a concept expr essed
by int elligence, w hose experienced nat ure is essent ial,
unv ar y ing. The ex per ienced t y pe is r eached t hr ough
t he analy sis of social r elat ions( 8).
I n t h is st u d y, w e u sed t h e m et h od olog ical
r esour ce of t y pology because w e at t em pt ed t o lear n
and apprehend from t he “ social t hings” as significant ,
scene, in t heir t ypical funct ion and not as unique and
singular, but as an exper ienced t ype. I n t he act ion of
g et t in g p r eg n an t , w om en of t en h av e som et h in g in
m ind, t hat is, m ot ives for t he act ion as an int ent ional
pr oj ect t o be accom plished.
METHODOLOGY
Wit h a v iew t o unv eiling t he phenom enon of
“ being a w om an w ho is ex per iencing pr egnancy”, t he
subj ect s’ select ion w as based on cr it er ia est ablished
in f u n ct ion of ou r con cer n s. Th u s, t o p ar t icip at e in
t h i s r e s e a r c h , w e c h o s e t h e f o l l o w i n g c r i t e r i a :
p r e g n a n t w o m e n , o v e r 1 8 , a t t e n d e d a t p r i v a t e
inst it ut ions, w ho had a healt h insur ance and agr eed
t o par t icipat e in t he st udy.
The pr egnant w om en w ho ser ved as r esear ch
su b j ect s sh ou ld also h av e r each ed t h e en d of t h e
s e c o n d t e r m o f p r e g n a n c y a n d , t h e r e f o r e , b e
exper iencing pr egnancy and pr enat al car e. This phase
in t he course of w om en’s life is appropriat e t o collect
t he descr ipt ions as, at t he end of t he second t er m of
pr egnancy, t heir feelings ar e closer t o t he r ealit y t hey
ex per ience and, hence, t hey w ill be able t o ex pr ess
it s m eaning in r icher discour se.
Ther e is no need t o define a place for dat a
collect ion in t h is st u dy, w h ich w as car r ied ou t f r om
Nov em b er 2 0 0 4 t o Mar ch 2 0 0 5 . Th e r eg ion u n d er
analysis w as t he sit uat ion it self w here t he phenom enon
occurs, t he life w orld, t he pr e- r eflexive of w om en w ho
live and suffer t he influences of pregnancy. The cont act
w i t h t h e p r e g n a n t w o m e n d e p e n d e d o n t h e
r esear ch er s’ k n ow led g e an d in f or m at ion f r om t h ir d
p ar t ies ab ou t t h e ex ist en ce of t h ese su b j ect s. Th e
int er v iew s w er e scheduled accor ding t o t he w om en’s
pr efer r ed dat e, t im e and place. Thus, som e t ook place
at t heir hom es and ot her s at t heir w or k place.
The num ber of subj ect s w as defined as soon
as w e p er ceiv ed t h at t h e t est im on ies u n v eiled t h e
research phenom enon, t hat is, when our inquiries were
sufficient ly answered. We decided t o st op including new
w om en w ho w er e ex per iencing t he pr egnancy per iod
on t he basis of t he set of collect ed dat a, which evidenced
bot h t he wealt h and range of m eanings cont ained in t he
t est im onies. Thus, t en st at em ent s w er e analyzed and
considered sufficient t o unveil t he phenom enon.
Dat a w er e obt ained t hr ough int er view s, w hich
w er e r ecor ded w it h t he par t icipant s’ aut hor izat ion, and
guided b y a scr ipt w it h t he follow ing quest ions: Tell
m e about your daily life aft er you got pr egnant . How
do you feel? What do you expect fr om t he car e- giving
pr ofession al du r in g pr egn an cy, deliv er y an d bir t h ?
The wom en received furt her inform at ion about
t he st udy obj ect ive, as well as about secrecy, anonym it y
a n d t h e i r r i g h t t o p a r t i ci p a t e o r n o t . Af t e r t h e se
clar ificat ions, t he par t icipant s w er e ask ed t o sign t he
Free and I nform ed Consent Term t o part icipat e in t he
st udy. Wit h a view t o preserving anonym ity, t he wom en
w ere ident ified w it h fict it ious nam es.
CON CRETE CATEGORI ES EM ERGED FROM
THE EXPERI ENCE
To analy ze t he t est im onies, w e at t em pt ed t o
at t ent ively lim it ourselves t o what appeared in com m on,
t hat is, seeking t he reasons for in t he int erviews, which
ident ified t he conv er gences in t he pr egnant w om en’s
desire for t he healt h professionals’ act ions. The wom en’s
feelings and experiences were underst ood t hrough t he
an al y si s of t h e f i v e cat eg or i es i d en t i f i ed af t er t h e
organizat ion of t he st at em ent s, which were: Having new
responsibilit ies; Experiencing a special sit uat ion; Living
insecurit y, anxiety and expect at ions; Feeling lim it ed and
Trust ing t he healt h professional.
Th e con cr et e cat egor ies t h at em er ged f r om
t he ex per ience, w hich w er e const it ut ed on t he basis
of t he m eaning of t he subj ect ive act ion, allow ed us t o
descr ibe t h e ex per ien ced t y pe “ w om an ex per ien cin g
pr egn an cy, w it h h ealt h in su r an ce an d at t en ded at a
pr ivat e inst it ut ion” as w om en w ho, t hr ough pr egnancy,
st ar t s new pr oj ect s and acquir es new r esponsibilit ies,
w ho experiences special sit uat ions, such as insecurit y,
an x iet y an d ex pect at ion , w it h r espect t o pr egn an cy,
deliv er y and bir t h, w ho ex pect s at t ent ion, av ailabilit y
a n d t e c h n i c a l - s c i e n t i f i c c o m p e t e n c e f r o m t h e
pr ofessional and w ho, due t o t he fact t hat t hey had
t he oppor t unit y t o choose t he car e- giving pr ofessional
d u r in g p r eg n an cy, b ir t h an d p u er p er al p er iod , f eel
secu r e an d con fiden t .
CO M P R EH EN S I V E A N A LY S I S O F T H E
EXPERI ENCED TYPE: W OMAN EXPERI ENCI NG
PREGN AN CY, W I TH H EALTH I N SURAN CE
AND ATTENDED AT A PRI VATE I NSTI TUTI ON
This st udy allow ed us t o appr ehend, t hr ough
i n t e r s u b j e c t i v i t y t h a t p e r m e a t e d t h e p r e g n a n t
w om en ’s t est im on ies abou t t h e m ot iv es for an d t h e
m o t i v e s w h y o f t h e p r e g n a n t w o m e n ’ s d a i l y
ex per iences, and of t heir ex pect at ions r elat ed t o t he
act ions of t he care professionals during prenat al care,
pr e- bir t h and bir t h. The collect ed dat a allow ed us t o
get t o know and under st and w hat is t ypical about t he
ex per ien ce of t h ese w om en , w h o ar e pr egn an t an d
hav e a pr iv at e healt h insur ance.
Th e m o t i v e s f o r e x t r a ct e d f r o m t h e d a i l y
exper iences of t hese pr egnant w om en, w ho w er e t he
subj ect s of t his st udy and had a privat e healt h insurance,
appeared in a relevant way in t he following cat egories:
Hav in g n ew r esp on sib ilit ies; Ex p er ien cin g a sp ecial
sit uat ion; Living insecurit y, anxiety and expect at ions and
Trust ing t he healt h professional. The m ot ives why were
revealed t hrough t he cat egory “ Feeling lim it ed”.
I n t he cat egor y Hav ing new r esponsibilit ies,
s o m e p r e g n a n t w o m e n ’ s s t a t e m e n t s s h o w a
b e h a v i o r a l c h a n g e i n t e r m s o f c a r e w i t h t h e i r
m ovem ent s, body, food, car e t hat not only r elat es t o
t h em , b u t also t o t h eir b ab ies. I n t h is sen se, t h ey
hav e new pr oj ect s, show ing gr eat er r esponsibilit y :
. . . I t ’s a feeling of gr eat er r esponsibilit y . We t hink
m ore about t he fut ure and in t he first place about t he child. So we
no longer t hink alone like, for exam ple, I ’m going t o accept anot her
j ob because I need t o m ake m ore m oney. We st art t o t hink about
w hat ’s gonna be safer for t he baby. So t hat changes, because w e
know t hat t her e’s a child w ho depends on us... ( Luciana)
...Everyt hing has changed. My life proj ect has changed.
Now, I program m y day, m y night and m y weekend. The financial
side has changed, t he pr ivat e, int im acy, t he fam ily. Ever yt hing
has changed. I t ’s com plet ely different . Each day, t here are changes
and adapt at ions. You st ar t t o m ake new plans... ( Bianca)
...quit e a lot has changed in m y life, even your fut ur e
per spect ive changes, you know , if you w er e only concer ned w it h
your self befor e, or w it h your fam ily, it changes, you ar e m uch
m ore concerned wit h t he baby...( Carolina)
I n t h e ca t e g o r y Ex p e r i e n ci n g a sp e ci a l
sit uat ion, t he r epor t s show how t he pr egnant w om en
def in e t h eir f eelin gs of h appin ess, accom plish m en t ,
p r o j e ct i o n o f f a m i l y co n st r u ct i o n , i n sh o r t , t h e y
e x p e r i e n ce a sp e ci a l si t u a t i o n . Th e p r e g n a n cy i s
influenced by sev er al fact or s. This pr ocess pr ov ok es
bot h int ernal and ext ernal m odificat ions and, t herefore,
becom es a m om ent loaded wit h feelings and sensat ions,
as dem onst rat ed by t he following st at em ent s:
. . . ev er y body is ex per iencing a pr egnancy t hat w as
w ant ed. Oh dear ! I t ’s t ot ally differ ent . Ever ybody is enj oying it
a lot . Ever ybody is ver y happy... ( Bianca)
... The pregnancy is wonderful for m e... I ’m very happy.
I t ’s such a gr eat happiness. . . Ev er y t hing is w onder ful. . . I t ’s
being a divine blessing fr om heaven... ( Kelly)
... I t w as such a gr eat happiness t hat I can’t descr ibe
it . That idea t hat t her e w as a hum an being in m y belly, t hat is,
t hat t hing of car r ying a new life inside you m ade m e feel blessed.
Wh en I f ou n d ou t I w as t h in k in g , I t h ou g h t t h at God h ad
rem em bered m e... ( Giovana)
... it is ver y special w hen you m anage t o car r y a lit t le
being inside your belly... ( Car olina)
I n t he cat egory Living insecur it y, anxiet y and
ex pect at ion s, w e cou ld per ceiv e t h at each pr egn an t
w om an r efer s t o her insecur it y and concer n accor ding
t o t h e ex p er ien ces an d t r an sf or m at ion s t h at occu r
du r in g t h e pr egn an cy. Th e st at em en t s u nv eiled t h e
m ot iv es for t his insecur it y :
... we get like, how will it be and what ’s gonna happen?
Anot her concer n w e have at t he beginning is w it h spont aneous
abor t ion. So, w e get concer ned. Ther e is som e car e... w e feel
insecur e and ar e afr aid of abor t ion . ( Luciana)
... I w as afr aid of feeling cont r act ions and not having
t im e for anest hesia... ( Lílian)
... They t old m e t hat t he doct or does not st ay t here t he
w hole t im e. A nur se st ays and she does t he assessm ent . Then,
I got concer ned if she w ould do t he vaginal exam or t he doct or ...
people are going t o see m e and how m any are going t o t ouch m e.
I n view of t his sit uat ion, I got ver y concer ned because, if it ’s like
t hat her e, can you im agine in ot her places. Aft er all, t his is a
pr ivat e hospit al offer ing t his differ ent iat ed car e. Now , im agine
t he ot her places. ( Cam ila)
... The em ot ional par t t hat is m ost affect ed r eally is
anxiet y. We get kind of anxious t o know if ever yt hing’s alr ight ...
I anxiously w ait ed for t he day of t he ult r asound t o know how she
w as doing... ( Giovana)
The cat egory Feeling lim it ed shows fat igue as
a lim it at ion. Everyt hing t hat used t o be done wit h cert ain
abilit y can no longer be done nat ur ally. The m ot iv es
w hy of feeling lim it ed appear. Som e changes can be
clearly perceived. I ncreased sleep needs are com m on,
as if a n ew , slow er r h y t h m w er e im p r in t ed in t h e
or ganism , including calm ness, ser enit y, t ranquilit y, it
is as if t hey becam e m ore vulnerable and sensit ive( 9).
... I do not m anage t o do ever yt hing I used t o all at
once, I have t o lie dow n som et im es, put m y legs up... ( Gabr iela)
... Ah I feel bad..., it’s not nice when you’re going through
a ser ies of hor m onal changes t hat t ur n your or ganism t ot ally
unpr epar ed, at least in m y pr egnancy r ight , I don’t know , I don’t
know if all pregnancies are like t hat , at least m ine is, so I get very
sad because I don’t have t he ener gy used t o have befor e, t o do
... I t seem s t hat ever yt hing get s a bit m or e difficult ,
m or e t ir esom e, so I have t o r est a bit m or e... in t he physical
sense it ’s only t he fat igue, I feel m or e t ir ed, r ight , I feel a bit of
lack of air , sw elling... ( Adr iana)
I n t h e c a t e g o r y Tr u s t i n g t h e h e a l t h
p r of ession al , w e cou ld p er ceiv e t h e im p or t an ce of
p r o f e s s i o n a l - c l i e n t i n t e r a c t i o n . Th i s b o n d o f f e r s
t r anquilit y, t r ust and secur it y. The ack now ledgem ent
of t he feelings, expect at ions, insecurit ies and anguish
l i v e d b y t h e p r e g n a n t w o m e n c a n d e f i n i t e l y b e
m inim ized t hr ough pr ofessional- client int er act ion, as
t his gr ant s t he w om an fr eedom and pr ov ides for an
im por t ant channel of ex pr ession. Being w ell infor m ed
subst ant ially cont r ibut es t o solve doubt s, anguish and
an x iet y :
... she char ged t o do a C- sect ion and I didn’t t hink t hat
was fair. So I changed t o anot her doct or. This doct or now is m uch
m ore hum ane. I can be m uch freer wit h her. The ot her doct or was
m uch m or e dist ant . I hope and t hink t hat w hat w e alw ays expect
in pr egnancy is gr eat er appr oxim at ion w it h t he doct or ( Luciana)
... Look, I had a fir st appoint m ent t hat w as like t his... I
opened up t he book and looked at a nam e. I had no reference and
did not know t he person. Then I went t o an appoint m ent wit h her,
I didn’t like her . She w asn’t t he kind of pr ofessional I w ant ed t o
follow m e for nine m ont hs. She w as a ver y dist ant per son, of
lit t le words. Kind of, you’re gonna do t his, t hat and t hen you com e
back. You know t hat em pt y t hing. She didn’t offer m e any r oom
for quest ions eit her . I felt inhibit ed. She w as not t he kind of
Pr ofessional I w ant ed...so, t hen I t hought , oh dear , am I gonna
have t o m ake appoint m ent s w it h everyone and screen unt il I find
som eone good. Then t hey ended up indicat ing som e highly
dem anded people. Then I m ade anot her appoint m ent ...( Bianca) .
... and she’s a ver y kind per son and com panion. I f I
need her , I call her and she’s alw ays t her e and available, she
t ransm it s great t ranquilit y t o m e...she m akes m e feel very secure,
w hich I find fundam ent al, she is alw ays r eady t o at t end m e and
alw ays ver y pr esent , and she’s gonna be m y obst et r ician, she’ll
be t her e on t he day of bir t h, w hen it ’s t im e. That is excellent for
m e, as t he person who accom panied you t he whole t im e, I believe
she has t o be inside t he r oom ... She’s a per son I t r ust . I t hink
t his is a ver y delicat e m om ent and it ’s not good for you t o have
m any sur pr ises... ( Giovana)
I t sh o u l d b e h i g h l i g h t e d t h a t w e v e r i f i e d
t hr ough lit er at ur e t hat t he pr esent ed cat egor ies, t hat
is, w hat is t y pical about t he ex per ience of pr egnant
w om en w it h a p r iv at e h ealt h in su r an ce, sh ow ed t o
t a k e t h e s a m e f o r m a s f o r w o m e n w i t h o u t t h i s
in su r an ce( 3 - 4 , 1 0 ). How ev er, in t h e cat egor y : “ Tr u st in g t he healt h pr ofessional”, t he im por t ance of hav ing a
healt h insurance and bonding w it h t he professional is
per ceived, as t her e exist s int er subj ect ivit y and m ut ual
i n t e n t i o n s b e t w e e n t h e w o m a n a n d t h e h e a l t h
pr ofessional. The r esult of t his st udy does not r ev eal
difficult ies t o at t end t o t he search for professional care,
as t he client - healt h pr ofessional int er act ion allow s for
a posit iv e ex per ien ce of t h e pr egn an cy per iod. Th is
is differ ent fr om ot her st udies about t he ex per ience
o f p r e g n a n t w o m e n w h o d o n o t h a v e a h e a l t h
in su r an ce, w h o w er e at t en d ed in t h e con t ex t of a
pr en at al car e ser v ice an d sh ow t h e discon t in u it y of
car e and t heir negat iv e assessm ent of t he car e t hey
w er e offer ed( 1, 3, 5, 10).
Th e w or k ov er load in h ealt h p r of ession als’
daily realit y can oft en result in a m echanic, t echnicist
an d n on - r ef lex iv e car e. Th e m ix t u r e of scien ce an d
ar t is w hat dist inguishes a good pr ofessional fr om a
m er e com pet ent t echnician. Good car e only becom es
p o ssi b l e w h en t h e p r o f essi o n al act s n o t o n l y w i t h
t ech n i ca l p r ep a r a t i o n , b u t a l so w i t h i n t u i t i o n a n d
em pat hy( 1 1 ).
... Mainly, I t hink t hat it ’s t he at t ent ion... Being list ened
t o... A bit of kindness...We really want t o be list ened t o... ( Adriana)
... All I expect from t he professional is at t ent ion, because
we need at t ent ion, it is a m om ent of great fragilit y... ( Carolina)
Tak in g car e of a pr egn an t w om an does n ot
m ean t aking car e of a “ belly” but of a pr egnant w om an.
Dialogue is t he m ost im por t ant act in pr enat al car e.
I t is essent ial t hat all professionals act ive in w om en’s
healt h have a pr ofound know ledge of pr egnancy as a
h u m an dev elopm en t ph ase( 2 ).
The r ole of pr ofessionals w ho at t end w om en
in p r en at al car e is b r oad er, sh ou ld g o b ey on d t h e
biological. Th e su bj ect iv e aspect s sh ou ld be v alu ed,
and t he socioeconom ic and cult ur al cont ex t needs t o
b e sy st em at ically k n ow n w it h a v iew t o of f er in g a
bet t er qualit y car e t o pr egnant w om en( 4).
Fo r p r e g n a n t w o m e n w h o h a v e a h e a l t h
in su r an ce an d ar e at t en d ed at p r iv at e in st it u t ion s,
analy zed in t his st udy, w e per ceive t he possibilit y of
being able t o count on and som et im es ev en choose
t he healt h pr ofessional w ho w ill deliv er car e t o t hem
d u r i n g t h e i r p r e g n a n cy, b e p r e se n t a n d st r o n g l y
cont ribut e t o t heir securit y, t ranquilit y and w ell- being.
Th e st at em en t b elow sh ow t h at , af t er m ak in g t h is
choice, t he w om an feels secure because she can count
on t he pr ofessional in case of doubt s and pr oblem s.
The m ot iv es w hy appear in t heir discour se.
... she’s a ver y kind per son and com panion. I f I need
her, I call her and she’s always t here and available, she t ransm it s
We b eliev e t h at t h e w om en ’s con cer n w it h
t h e b a b y ’s w el l - b ei n g , o r t h e t y p e o f d el i v er y, o r
t h e ca r e r e ce i v e d a t t h i s m o m e n t ca n b e cu r e d ,
p a r t i a l l y t h r o u g h p r o f e s s i o n a l - c l i e n t i n t e r a c t i o n ,
w h ich w ill d ef in it ely g r eat ly con t r ib u t e t o p r om ot e
t r a n q u i l i t y d u r i n g t h i s p h a s e o f t h e p r e g n a n c y
-p u er -p er a l -p er i o d .
I t sh o u l d b e r e m i n d e d t h a t t h e w a y t h e
w o m a n e x p e r i e n c e s p r e g n a n c y, t h e w a y t h i s
ex per ience is per ceiv ed, t he infor m at ion she r eceiv es
about pr egnancy t hr oughout her life, can dir ect ly affect
h e r p e r c e p t i o n a n d b e l i e f w i t h r e s p e c t t o t h e
experienced event s, in com binat ion w it h ot her fact or s.
Th e a v a i l a b l e k n o w l ed g e b a g g a g e i s “ a d ep o si t ed
st r u ct u r e o f t h e i n d i v i d u a l ’ s p r e v i o u s su b j e ct i v e
ex p er ien ces, acq u ir ed t h r ou g h ou t h is lif e, t h r ou g h
ex per ien ces h e liv ed or t h at w er e com m u n icat ed t o
him by ot her people”( 11).
GENERAL CONSI DERATI ONS
Th e u s e o f A l f r e d S c h u t z ’ s o c i a l
Phenom enology allow ed us t o r ev eal t he ex per iences
of p r eg n an t w om en w it h a h ealt h in su r an ce, w h ich
ex p lan at or y r esear ch an d casu al r elat ion s h ad n ot
u n v eiled y et .
Th e w ay t h ey l i v e t h e p r eg n an cy an d t h e
r eason s an d m ot iv es for each ex per ien ce ar e based
on t heir values and beliefs, w hich are socially acquired.
Th e pr egn an t w om en ’s st at em en t s r ev ealed
w hat pr egnancy m eans t o t hem as know ledge of social
or igins and socially appr ov ed. I t is socially appr ov ed
because it is being accept ed as t he t r ut h not only by
t hese w om en, but also by t heir cont em por ar ies. Based
on t h is p r em ise, w e u n d er st an d t h e im p or t an ce of
k n ow led g e acq u ir ed ab ou t p r eg n an cy. Ev en if it is
passed fr om gener at ion t o gener at ion of w om en, w it h
m odificat ions over t im e, t his know ledge m aint ains t he
st r u ct u r e of ear lier gen er at ion s.
Th e p r e g n a n t w o m e n d e p a r t f r o m t y p i ca l
act ions t o solve t ypified problem s in t heir daily social
r elat ions, using t he know ledge invent or y t o under st and
a n d p r o j e ct t h e i r d e l i v e r y a n d b i r t h a ct i o n s a n d
ex pect at ion s abou t car e.
I n t h is sen se, w e con sid er t h at t h is st u d y
l o o k ed f o r a n sw er s b a sed o n a m et h o d o l o g y t h a t
allow ed t o r eflect t h e car e t o pr egn an t w om en w h o
cannot affor d a healt h insur ance, developing a crit ical
at t it u de t ow ar ds t h e car e deliv er ed t o at t en d t h ese
clien t s’ n eed s, in clu d in g t h e p ossib ilit y t o t u r n t h e
k now ledge lear ned int o act ions.
The cat egor ies Liv ing insecur it y , anx iet y and
expect at ions and Tr ust ing t he healt h pr ofessional w ere
show n in t heir cont ext , allow ing us t o reflect on t heir
cont ent w hen w e per for m our act ions.
U s i n g t h e c o m p r e h e n s i v e a p p r o a c h , w e
believe t hat t he obt ained answ er s can cont r ibut e t o a
d ig n if ied car e, w h ich in clu d ed in f or m at ion an d t h e
capacit y t o m ak e t he Best of it , t he im pr ov em ent of
w or k con d it ion s at h ealt h ser v ices an d of t h e u ser
populat ion’s liv ing condit ions. A r ight t hat w e, healt h
professionals and users, should conquer lit t le by lit t le.
Th e d i m e n si o n t h a t v a l u e s i n t e r p e r so n a l
r elat ions t ak es us t o t he et hical dim ension, in w hich
v alu e, f r eed om , r esp ect an d d ig n it y ar e essen t ial.
Th u s, t h e h u m an ex per ien ce con t ain s elem en t s lik e
r elat ionship, shar ing of ideas, em ot ions and feelings
in t he w orld of life. People are w ort h m ore t han t hings;
t hey hav e a v alue in t hem selv es and not because of
t heir posit ion, as t hey hav e an inher ent dignit y, due
t o t he fact t hat t hey ar e hum an beings( 12).
I f p r e g n a n t w o m e n w e r e c o n s i d e r e d a s
a g e n t s i n s t e a d o f p a t i e n t s , p r e n a t a l c a r e c o u l d
p o si t i v e l y a f f e ct e p i d e m i o l o g i ca l i n d i ca t o r s i n t h e
m at er nal and per inat al healt h ar eas.
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