Enfermagem obstétrica: estudo exploratório sobre o cenário do Distrito Federal - Brasil

Abstract

Introduction: Obstetric nursing has consolidated itself as a pillar of humanization, playing a crucial role in the demedicalization of childbirth care. The Health Secretariat of the Federal District incorporated the specialty through a public civil service examination in 2018, but the insertion of these professionals into the State Health Secretariat was impacted by the COVID-19 pandemic. Continuous monitoring of this workforce, its care production, and its working conditions is necessary to evaluate the effectiveness of the model adopted in the public healthcare network. Objective: To analyze the scenario of obstetric nursing practice within the Unified Health System of the Federal District, considering the care production of births assisted by obstetric nurses, the distribution of this workforce across the network, as well as the profile, insertion, and working conditions of these professionals. Methods: This is a quantitative, analytical, and descriptive study comprising three distinct and complementary components. The Care Component utilized secondary data from the Management of Obstetric and Neonatal Nursing to analyze the production of births assisted by obstetric nurses, procedures, best practices, and obstetric-neonatal outcomes that occurred between 2022 and 2025. The Workforce Component characterized the quantity, allocation, and workload of obstetric nurses, based on secondary data extracted from the Federal District Government's Transparency Portal in January 2026. The third component consisted of a survey, conducted via a self-administered online questionnaire (using the REDCap® platform) between January and March 2026. This survey collected primary data from 121 tenured obstetric nurses, including information on sociodemographic profile, health, lived experiences, job satisfaction, interprofessional collaboration, and the intention to leave the specialty. Statistical analysis included association tests and a multivariate logistic regression model (p < 0.05). Results: Regarding care aspects (2022-2025), obstetric nurses assisted 39.8% of vaginal births in the network (n = 22,142). The care provided demonstrates respect for physiology, indicated by low episiotomy rates (0.5%), the adoption of upright positions (58.9%), and skin-to-skin contact (81.9%). Regarding the workforce, the system registered 172 obstetric nurses, but with a heterogeneous distribution: 36.7% were allocated outside Obstetric Centers or Normal Birth Centers, leading to inadequate staffing. The survey (n = 121) revealed a predominantly female (95.8%), young (median age 36 years), and specialized profile. Occupational vulnerability was found among participants: 57% required medical leave in the past year, 32.2% use antidepressants/anxiolytics, 86% reported conflicts with the team, and 74.4% experienced situations of violence. The evaluation of interprofessional collaboration revealed weaknesses: when asked about the existence of a collaborative relationship between obstetric nurses and obstetricians, the median score of professionals on the Likert scale corresponded to only "neutral/sometimes". Alarmingly, 63.6% considered leaving the specialty. In the multivariate logistic regression, the Job Satisfaction Score acted as a statistically significant protective factor against the desire to abandon the profession (OR = 0.963; 95% CI: 0.941–0.986; p = 0.002). Conclusions: The insertion of obstetric nurses is a contributing factor to the qualification of childbirth care in the Federal District, enabling the application of best practices even in the face of structural fragilities. However, the category faces heterogeneous distribution, overload, and a work environment characterized by conflicts and psychological distress. It is necessary to resize the workforce, implement policies for continuing education and mental health protection, as well as strengthen collaborative processes and expand Normal Birth Centers, with the aim of ensuring the retention of these specialists in the network and the quality of maternal and child care.