title: Exercise of essential competencies for midwifery care by nurses in São Paulo, Brazil.
abstract: GENERAL OBJECTIVE: to analyse the exercise of essential competencies for midwifery care by nurses and/or midwives in the public health system of São Paulo (eastern zone), Brazil.
  
  
  OBJECTIVE
  to develop a profile of the public health institutions and of the nurses and/or midwives who care for women before, during and following childbirth; to identify the activities performed in providing such care, as well as their frequency; and to specify the possible obstacles or difficulties encountered by them when exercising their competencies.
  
  
  METHODS
  a descriptive and exploratory research design, using a quantitative approach.
  
  
  METHODS
  the study was conducted in all public health services of São Paulo (eastern zone), Brazil, namely 59 basic health-care units and six hospitals, during the period of October 2006-December 2007.
  
  
  METHODS
  the study population consisted of 272 nurses and/or midwives who provide care for pregnant women and newborns at the primary health-care units and maternity hospitals of the public health system. Participants comprised 100% of hospital nurse coordinators (n=6), 61% of hospital maternity nursing and/or midwifery staff (n=62) and 64% (n=204) of nursing and/or midwifery staff working at primary health-care units.
  
  
  RESULTS
  the data collection was based on a single form given to the coordinators and two questionnaires, one handed out to antenatal and postnatal nursing and/or midwifery staff and another handed out to labour and birth nursing and/or midwifery staff. The results showed that nurses and/or midwives providing care for women during pregnancy, labour, birth and the postnatal period did not put the essential competencies for midwifery care into practice, because they encountered institutional barriers and personal resistance, and lacked protocols based on best practice and on the exercise of essential competencies needed for effective midwifery care.
  
  
  CONCLUSIONS
  the model of care in the public health services of São Paulo (eastern zone) is based much more on hierarchical positions than on professional competencies or on the recommendations of the scientific community. As a result, health authorities need to review their midwifery policies to improve maternal-infant care by nurses and/or midwives in order to ensure the implementation of best midwifery practice.
  
  
  CONCLUSIONS
  the results of this study support actions to improve the quality of care delivered to women and their families, while integrating nursing and midwifery care in São Paulo, Brazil.
authors.affiliation: School of Arts, Sciences and Humanities of the University of São Paulo, Avenida Arlindo Bettio, 1000, São Paulo, Brazil. nzn@usp.br
authors.forename: Nadia Zanon
authors.initials: NZ
authors.lastname: Narchi
mesh_terms: D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008429:Maternal Welfare / Q000706:statistics & numerical data; D008875:Middle Aged; D008880:Midwifery / Q000458:organization & administration* / Q000706:statistics & numerical data; D009721:Nurse Midwives / Q000458:organization & administration* / Q000706:statistics & numerical data; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult