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The institutionalization of birth by cesariana in Brazil and France : educational and health components

Abstract : This is a double titled thesis that aims to analyze the process of institutionalization of cesarean deliveries in Brazil and France from the perspective of institutional social-clinical. The theoretical-methodological framework, in its dialectical character between institute and instituinte, unfolds in the process of institutionalization. Therefore, birth is understood as an analyzer of "maternal and child health" and "health education" institutions. The present research comes from a larger study on births in Canada, France and Brazil. In this thesis, data were produced between 2016 and 2019, in Brazil and France, through focus groups, individual interviews with maternal and child health professionals (and the Brazilian Maternal and Child Death Surveillance Committee), with mothers and fathers who lived the experience of childbirth and the research journal. The focus groups were composed of professionals from traditional and alternative services, parents from different social backgrounds. There were 3 meetings making a total of 12 meetings. The ethical aspects regarding research with human beings were respected. A cross-analysis was carried out between the different types of data, between services, between groups and between countries, on a continuous basis, based on the materials produced. The polished thematic axes were: Birth by cesarean section: an analyzer of the female condition in face of medicalization, of professional practices and discourses, and of the institutionalization of birth. These were arranged in analytical frameworks and organized by group of interviewees and scenarios studied. Afterwards, horizontal summaries of the interviews were carried out, by groups interviewed. The analysis was also produced during the time of restitution to the participants and was based on the thematic analysis approach of the authors Mucchielli and Paillé. Brazil and France demarcate distinct processes. Brazil is the champion in surgical deliveries without indication. France, on the other hand, presents another reality, in which births are mostly vaginal. It was possible to learn that although each of the countries studied has its peculiar sanitary and educational structure, they are marked by a sociohistorical-economic construction outlined by the patriarchy and female subjugation. The marks of New Public Management are present in both contexts and reveal a precariousness of offers and actions supported by a discourse of economic fragility. In terms of education and health, in any of the countries, pregnancy is understood as a physiological process and developed with numerous interventions on the female body. There is an appreciation of the technical and organizational dimensions pointed out by an intellectual and social division of work and knowledge in health. The practices and discourses of professionals (in their work process) influence the occurrence (or not) of cesarean delivery. The progression or regression of this is related to the degree of implementation of medical actions in health actions. In this way, in Brazil there is a struggle between the institutionalization of cesarean delivery in comparison with its deinstitutionalization. In France, in relation to cesarean sections, there is a discussion on "active cesarean section". Would this be the movement of institutionalization of cesarean delivery in this country?Keywords: cesarean section; childbirth; health education; health; education
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Simone Santana da Silva. The institutionalization of birth by cesariana in Brazil and France : educational and health components. Education. Université de Cergy Pontoise; Universidade de São Paulo (Brésil), 2019. Portuguese. ⟨NNT : 2019CERG0994⟩. ⟨tel-02458149⟩

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