O modelo de atenção ao parto domiciliar planejado no Brasil

Abstract

Planned home birth is internationally recognized as a safe model of care when attended by qualified professionals and supported by structured health systems. In Brazil, however, its consolidation still faces challenges related to social recognition, integration with the obstetric care network, and the absence of specific national guidelines. This study aimed to analyze the model of planned home birth care in Brazil, with the purpose of supporting the development of guidelines for its organization, qualification, and integration into the health care network. The research was conducted in three stages: a scoping review, carried out according to JBI and PRISMA-ScR recommendations, which included 13 studies published between 2012 and 2023; an observational quantitative study, conducted through a questionnaire administered to 90 PHB teams from different Brazilian regions; and the development of a national guideline grounded in scientific evidence and the empirical data produced. The scoping review revealed womancentred practices, well-defined eligibility criteria, the use of clinical protocols, and challenges related to standardisation, logistics, and coordination with the hospital network. The quantitative stage showed that most teams were composed of nurse-midwives and midwives with more than 10 years of experience, working in pairs or groups of three, using clinical protocols (75.6%) and providing antenatal care themselves (98.9%). The care practices observed followed national and international recommendations, with emphasis on rigorous postpartum monitoring and newborn care. However, important weaknesses remain, such as difficulties in accessing supplies (76.7%) and the absence of formal coordination during hospital transfers. As a final product, the National Guideline for Planned Home Birth Care was developed, containing recommendations for all stages of care, from risk screening to the postpartum period, in addition to the creation of a means of disseminating the research findings. It is concluded that this study contributes to the technical and political recognition of PHB in Brazil, providing support for the strengthening of public policies, the qualification of practice, and the expansion of safe and equitable access to this model of care.