Report on the midwives' experiences in the Brazilian National Health System: A qualitative research

Objective: to describe the experiences of midwives who graduated from the University of Sao Paulo's midwifery program and the characteristics of their work within the Brazilian National Health System ( SUS). Design: a descriptive, qualitative field study. Setting: interviews were scheduled by telephone or e-mail and were held with the midwives outside their work environment. Interviews lasted for up to one hour and were recorded. Participants: ten midwives who had graduated from the University of Sao Paulo's midwifery program and were working or had worked in the SUS at the time of the study. Ethical issues: the study protocol was approved by the internal review board of the School of Arts, Sciences and Humanities, University of Sao Paulo. All pertinent ethical principles were followed. Measures and Findings: data were collected at interviews focussing on the participants' work and their experiences while working in the SUS. The dialogues during the interview sessions allowed the participants to build on and extend the proposed topics. After the data had been transcribed and read, the discourses were grouped in accordance with the similarity of their content, resulting in four thematic categories: the inclusion of midwives into the obstetric team; dealing with contradictions: challenges of the profession; working in the SUS: between precariousness and guaranteeing access to health services; and making a difference. The findings provoke reflection on the challenges faced by midwives in their work within the SUS: challenges associated with the difficulties in working in the public healthcare sector, difficulties in their relationships with other healthcare professionals, difficulties related to a general lack of knowledge on this specific occupation in Brazil, the absence of a midwifery model of care, difficulty in dealing with obstetric abuse, and the dilemmas facing the midwives during their daily practice of midwifery. Key conclusion: despite the difficulties encountered, the midwives consider the care they provide to be differentiated. They perceive gradual changes in the care offered to women by the healthcare facilities and by other professionals, and believe that they make a difference in their workplaces. In addition, they want to work in the SUS and are committed to transforming the quality of care provided to women in Brazil. Practical implications: the experiences related by midwives reflect the midwifery scenario nationwide, highlighting the perspectives for change. The emphasis placed by midwives on their social role and their commitment to changing current midwifery care models and to consolidating the SUS is noteworthy.