Artículo 10 – Notas de campo en salud mental perinatal: una breve experiencia latinoamericana

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RESUMEN

El Ministerio de Salud Pública de Ecuador ha promulgado 25 normativas para la atención del COVID-19, creadas de manera interdisciplinaria, procurando establecer, entre todas las aristas que la pandemia ha abierto, las recomendaciones que los profesionales de la salud perinatal deben seguir para el manejo y cuidado de la salud de las mujeres y sus neonatos con sospecha o confirmación de COVID-19, durante los ciclos vitales de la gestación, el nacimiento (vaginal o cesárea), posparto inmediato y lactancia.

Además de estas recomendaciones, Ecuador cuenta con la Normativa ESAMYN que, a través de sus 24 pasos, busca garantizar el buen nacer y buen parir, legado importante para una sociedad cuya Constitución basa sus fundamentos en el saber ancestral y el Sumak Kawsay. Sin embargo, la realidad de las mujeres en toda su diversidad, y particularmente en el ámbito perinatal, no llega a tener la relevancia necesaria para que los tomadores de decisiones entiendan y atiendan la emergencia social que propiciará la pandemia. Los efectos secundarios del aislamiento y la inequidad del acceso a salud y educación rebotarán en la salud integral de nuestros bebés, niños y niñas.

«Esta pandemia ha hecho que se intensifiquen todas las barreras de desigualdad presentes en la salud materna en la región», asegura Carmen Martínez, gerenta regional para América Latina y el Caribe del Centro de Derechos Reproductivos. Muchas veces estas barreras están condicionadas por el ánimo, criterio personal (incluso religioso) y formación del profesional que atiende. La atención está limitada a un paradigma reduccionista, que parece desconocer que somos seres integrales, bio-psico-socio-espirituales, que necesitamos afecto y contención para crecer y estar sanos. El devenir madre requiere un entorno especial, con características puntuales. El acompañamiento y tratamiento (psicológico y emocional) tanto para la madre, el padre y el bebé, son una necesidad antes, durante y después de este evento único. Sin embargo, no está adecuadamente comprendido e interiorizado por los profesionales y redes de atención a la infancia y familia. Y es que la salud mental materna y paterna son indicadores claves para la crianza saludable y salud mental del bebé. La familia es la base de la sociedad, la madre es la base de la familia.

Las siguientes notas de campo buscan informar sobre las realidades de las mujeres gestantes y de los neonatos, previo y pos-pandemia, evidenciar la necesidad de acompañamiento emocional e información antes, durante y después del nacimiento, y el impacto de estos en el desarrollo de la maternidad.

FIELD NOTES ON PERINATAL MENTAL HEALTH: A BRIEF LATIN AMERICAN EXPERIENCE

ABSTRACT

The Public Health Ministry of Ecuador issued 25 interdisciplinary regulations in order to manage COVID-19 appropriately, created in an interdisciplinary way, trying to establish, among all the edges that the pandemic has opened, recommendations that perinatal health professionals must follow to adequately care for women and newborns with suspected or confirmed COVID-19 contagion, monitoring the vital signs during gestation, birth (natural or cesarean), immediate postpartum care, and breast-feeding.

In addition to these recommendations, Ecuador follows ESAMYN regulations that, whose 24 articles seek to ensure optimal conditions for babies to be born and mothers to give birth. This is an important legacy for a society that follows a national constitution based on principles of ancestral knowledge and Sumak Kawsay. Nonetheless, the reality women face with their vast diversity, and particularly in the perinatal area, is not given the sufficient attention for decision-makers to understand and act on the social emergency that the pandemic will bring. Quarantine and the unequal access to health services and education will have knock-on effects on the comprehensive health of our babies, boys and girls.

«All of the existing barriers to equal access to maternal healthcare have grown as a consequence of the pandemic», affirms Carmen Martinez, regional chief of the Center for Reproductive Rights for Latin America and the Caribbean. These barriers are often affected by the emotional state, personal and even religious criteria, as well as the academic training of the professional in charge of these patients health. Assistance given by health professionals is reduced to a reductionist, biological perspective, which would seem to overlook the fact that we are comprehensive, bio-psycho-socio-spiritual beings that need affection and containment to grow with optimal health. Becoming a mother requires a special environment with specific characteristics. The psychological and emotional treatment and care for the mother, father, and newborn, are a primary necessity before, during and after the birth itself. However, they are not given priority by groups of infant and family health professionals. Maternal and paternal mental health are key indicators of what is to be a healthy upbringing for the infant and his or her emotional stability throughout it. The family is the bedrock of society and mothers are the foundation of the family structure.

The following field notes are intended to provide information about the reality that pregnant women and newborns face, before and after the pandemic, and to act as proof of the need for emotional and informative guidance before, during and after birth, as well as the impact this guidance has on the development of maternity.

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