Fortalecimiento de la mujer en la decisión de un parto en domicilio en Chile

[spa] INTRODUCCIÓN: El nacimiento humano es un fenómeno social y cultural que por siglos ha estado expuesto a transformaciones. La profesionalización de la partería, la incorporación de médicos hombres a la obstetricia y la aplicación de tecnologías, por mencionar algunas, han generado una serie de consecuencias en la socialización actual del nacimiento. Frente a esto, el aumento de la medicalización del parto ha develado importantes complicaciones en la salud mental, emocional, física y social de las mujeres. En su respuesta han emergido diversos colectivos interpelando el rol que juegan las instituciones sanitarias en la atención del nacimiento, visualizando el parto en domicilio acompañado por una profesional como alternativa posible frente a sus demandas. OBJETIVOS: Por lo expuesto, surge la necesidad de (1) Explorar las representaciones sociales y sanitarias del parto en domicilio, (2) Analizar el concepto de seguridad del parto en domicilio; y (3) Analizar los significados sociales que las mujeres le otorgan al parto en domicilio en el contexto chileno. METODOLOGÍA: Para responder a los objetivos de este estudio se estructuró la investigación en 3 fases con uso de la metodología idónea para abordar cada uno de ellos. Es así como para responder al primer objetivo general, se utilizó una revisión integradora de la literatura permitiendo explorar las representaciones sociales y sanitarias del parto en domicilio. A su vez, para responder al segundo objetivo general, se realizó un scoping review lo que permitió analizar el concepto de seguridad que rodea al parto en domicilio. Por último, para responder al tercer objetivo general, se utilizó un enfoque cualitativo, fenomenológico feminista y situado, a partir de entrevistar a 30 mujeres habitantes de las zonas norte, centro y sur de Chile, que habían dado a luz en sus domicilios. RESULTADOS: De este modo y en base al compendio desarrollado, se presentan los principales hallazgos de esta investigación a través de la publicación de tres artículos científicos. Por su parte y en respuesta al primer objetivo, emergieron cuatro dimensiones centrales de análisis: (1) Dimensión de empoderamiento en el nacimiento; (2) Dimensión comparativa de estudios sociosanitarios del nacimiento; (3) Dimensión institucional del parto; (4) Dimensión cultural del parto. Y nueve subdimensiones: (1.1) Empoderamiento de la mujer; (1.2) Soberanía del cuerpo; (1.3) Políticas contra-hegemónicas; (2.1) Domicilio versus hospital; (2.2) Costos versus efectividad; (2.3) Seguridad versus inseguridad; (3.1) Profesionales de la salud; (3.2)[eng] INTRODUCTION: The human birth is a social and cultural phenomenon that for centuries has been exposed to transformations. The professionalization of midwifery, the incorporation of male doctors to obstetrics and the application of technologies, to name a few, have generated a series of consequences in the current socialization of birth. Faced with this, the increase in the medicalization of childbirth has revealed important complications in the mental, emotional, physical, and social health of women. In their response, various groups have emerged questioning the role played by health institutions in birth care, visualizing home delivery accompanied by a professional as a possible alternative to their demands. AIMS: (1) Explore the social and health representations of home delivery, (2) Analyze the concept of home delivery safety; and (3) Analyze the social meanings that women give to home birth in the Chilean context. METHOD: The research was structured in 3 phases. Thus, to respond to the first general aim, an integrative review of the literature was used to explore the social and health representations of home birth. In turn, to respond to the second general aim, a scoping review was carried out, which allowed analyzing the concept of safety surrounding home delivery. Finally, to respond to the third general aim, a qualitative, feminist and situated phenomenological approach was used, based on interviewing 30 women living in the northern, central, and southern areas of Chile, who had given birth at home. RESULTS: The main findings of this research are presented through the publication of three scientific articles. For its part, and in response to the first objective, four central dimensions of analysis emerged: (1) Dimension of empowerment at birth; (2) Comparative dimension of social and health studies of birth; (3) Institutional dimension of childbirth; (4) Cultural dimension of childbirth. In response to the second objective, three central categories of analysis emerged: (1) Risk of death; (2) Delivery setting; (3) Consensus model. Finally, in response to the third research objective, a central category of analysis emerged: (1) Home birth trajectories. Two subcategories: (1.1) Making the decision to deliver at home; (1.2) The moment of childbirth: (re)born. CONCLUSION: In relation to the social and health representations of home birth, it is evident that, from a health and institutional perspective, home birth is not widely accepted as a valid and safe alternative. However, social representations indicate a certain interest in returning to home birth as a response to the excessive medicalization and institutionalization of birth. In turn, the scientific literature that addresses the concept of home birth safety is permeated by notions of risk and mortality. Both are decisive when making the decision and decreeing an ideal place for the birth. However, scientific evidence determines compliance with safety standards to carry it out at home. In their response, the social meanings that Chilean women give to home birth reveal a series of positive and negative feelings in their trajectories, the latter a product of the sociocultural resistance that surrounds them. Even so, they mean home birth as a political act, positively valuing the presence of midwives and their partners