Biomechanics of Nurse Midwives in the delivery: contribution of Qualitative Research
Work-related musculoskeletal injuries (LMELT) are considered a health problem due to the prevalence of lesions and associated symptomatology (Carneiro, Braga & Barroso 2014; Serranheira & Uva, 2015; Baixinho, Presado, Marques & Cardoso, 2016; Thinkhamrop et al., 2017). The professional activity nature, with the adoption of painful positions at the time of the expulsive period at childbirth, the inability to predict the parturient behavior and the space configuration are considered risk factos (Baixinho et al., 2016; Presado et al., 2017) which contribute to the prevalence of LMELT in the Nurses Midwives (NM). In situations of greater stress, when work is performed with high levels of anxiety and less probability of control, the risk of injury is significantly higher (Abeldu & Offei, 2015).
Regarding the qualitative and descriptive nature, this study has as objectives: to analyze the NM postures during the delivery; understand the influence of nursing interventions during labor on body alignment, posture and balance.
We resorted to film recording of the clinical practices of ESMOs in the accomplishment of 10 euthyogenic deliveries, in a perinatal hospital in Portugal, after authorization from the Board of Directors and the Ethics Committee.
The images were worked by assigning a color code that facilitated the coding and categories definition, in a structured and interconnected way, using WebQdA® software.
In this study participated 10 NM, 9 women and 1 man with an age mean of 47 years, in which they had a mean of 23 years of service from which 13 years as NM.
In the videos analysis, the risk factors were taken into account, especially those related to the activity (358 Observation units) distributed in four categories. Psychosocial risk factors obtained only one category (11 observation units).
The results showed the changes of posture adopted. Body misalignment is evident when alternations of static to dynamic positions arise. They demonstrate that the specificity of specialized nursing interventions during labor influences the posture adopted by NM. The use of video footage enabled a detailed observation, facilitating the analysis of the biomechanics principles, since it allows review and image (Garcez, Duarte, & Eisenberg, 2011).
The results show that non-organization of the work space and the non-anticipation of the movements by the professional constitutes an increased risk in emergency situations.
In addition to the identification of risk factors, the results revealed possibilities for prevention. They facilitate the recommendation of both the adequacy of spaces and equipment in the workplace and the need for training on LMELT prevention, should be inserted not only in school curricula but also in clinical work contexts, using the simulated high fidelity practice.