Barriers to the implementation of the national guidelines for assistance to normal childbirth: A prototypical analysis of the social representations of strategic actors

Abstract

This study aims to analyze the social representations of strategic actors involved in health care or management, on issues involving women, childbirth, and birth, seeking to identify and understand barriers to the implementation of the National Guidelines for Assistance to Normal Childbirth. A qualitative, descriptive, cross-sectional study was conducted, based on a word association test with 12 strategic actors. The words-Childbirth; Midwife; Birth; Obstetrician; Mother; Complication; Woman-were selected from a textual analysis of society's contributions to the Public Consultation of the Guidelines, supported by IRaMuTeQ software. The analysis of the word association test result was carried out in the structural approach of Social Representations, with the OpenEVOC and IRaMuTeQ software. Representations about childbirth associated with pain, the obstetrician as an obstructer and the stereotypes that mark the role of women and mothers in society were identified as potential barriers to implementation. Understanding these representations is important to highlight the conventions that underlie the attitudes and practices of professionals and users of services, enabling the definition of specific strategies for each group.