Esta pesquisa teve como objetivo geral investigar como a Assistência Humanizada ao longo do acompanhamento Pré-Natal pode minimizar as consequências causadas pela soropositividade, uma vez que as práticas discriminatórias podem influenciar o ciclo gravídico, tanto na sua relação com seu filho, quanto em seu meio social. A dissociação da AIDS em grupos de risco é favorável a uma nova concepção do soropositivo, ou seja, não apenas homossexuais, prostitutas ou drogados podem se infectar; o quadro epidemiológico é ampliado. Estudos têm mostrado que mulheres, muitas destas monogâmicas, só tomam conhecimento de que são portadoras do HIV ao fazerem o pré-natal, durante ou, em alguns casos, somente após o parto. Além dos anseios comuns à gestação, a grávida soropositiva sofre uma avalanche de medos: o da doença propriamente dita, da discriminação, de ser julgada ou mesmo de transmitir o vírus para o filho. A hipótese de trabalho é de que o cuidado humanizado ou a falta deste configura-se como um fator definidor dos rumos evolutivos de uma gestação de risco, principalmente no caso da soropositividade. Trata-se de uma pesquisa qualitativa agregada ao método fenomenológico, associada à investigação naturalista, obtidas através de coleta e análise de materiais subjetivos de entrevistas. Os sujeitos foram mulheres no ciclo gravídico com diagnóstico de HIV/AIDS atendidas no Centro de Referência de DST/AIDS de uma cidade do Interior da Bahia. A análise dos dados aponta que a presença do vírus HIV na vida das gestantes afeta todos os aspectos da vida destas mulheres. Assim, o cuidado que essas recebem durante a sua gestação torna-se crucial para o seu bom curso, bem como para a relação mãe-filho. Desta forma, pretendo, com este trabalho, advogar a implantação de disciplinas, nos cursos da área de saúde, voltadas para a abordagem do cuidado humanizado, salientando principalmente o combate às práticas discriminatórias acima abordadas. / This research had the general goal of investigating how Humanized Care during Prenatal follow-up can minimize the consequences caused by seropositivity, since discriminatory practices may influence the pregnancy cycle, both in her relationship with her child and her social environment. Dissociation of AIDS in risk groups is in favor of a new conception of the seropositive, that is, not only homosexuals, prostitutes and drug addicts may become infected; the epidemiological picture has been widened. Studies have shown that women, many of these monogamous, only learn that they are HIV-positive when they have a prenatal exam, during or in some cases only after delivery. In addition to the anxieties common to gestation, the seropositive pregnant faces an avalanche of fears: the one of the disease itself, of discrimination, of being judged or even of transmitting the virus to her child. The working hypothesis is that humanized care or its lack appears as a defining factor of the evolutionary courses of a pregnancy at risk, especially in the case of seropositivity. This is a qualitative research joined with the phenomenological method, associated with the naturalistic approach, obtained by collecting and analyzing subjective materials of interviews. The subjects were women in the pregnancy cycle diagnosed with HIV/AIDS and treated at the Reference Center for STD/AIDS in a town in the backland of Bahia. Data analysis shows that the presence of HIV in the lives of pregnant women affects every aspect of their life. Thus, the "care" that they receive during their pregnancy becomes crucial to its proper progress, as well as for the mother-child relationship. Then, with this work I intend to advocate the establishment of disciplines in health care courses, devoted to approaching humanized care, especially highlighting the fight against the discriminatory practices discussed above.

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators’ perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy. / De nombreuses études ont mis l'accent sur le concept de l'humanisation des soins de naissance d’une grossesse normale ou à faible risque obstétrical. Mais, à notre connaissance, aucune étude à ce jour n’a spécifiquement porté sur l'humanisation des soins de la naissance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. La présente étude vise à: 1) définir les composantes spécifiques de l'humanisation des soins qui apportent satisfaction aux femmes qui cherchent des soins obstétricaux dans un hôpital hautement spécialisé; 2) explorer les dimensions organisationnelles et culturelles qui constituent des obstacles ou des facilitateurs pour les pratiques périnatales favorisant l'humanisation des soins dans un centre hospitalier universitaire très spécialisé, au Québec. Une étude de cas unique a été choisie pour notre thèse. Les données ont été recueillies au moyen d'entrevues semi-structurées, de notes de terrain, d’observation des participants, d’un questionnaire auto-administré, et de documents et d’archives pertinents. L’échantillon est composé de : 11 professionnels de différentes disciplines, six administrateurs de différents niveaux hiérarchiques de l'hôpital et 157femmes qui ont accouché à l'hôpital durant la période de l’étude. Une analyse à la fois descriptive quantitative et qualitative déductive et inductive a été réalisée. La thèse comprend trois articles. Dans le premier article, nous proposons un cadre conceptuel fondé sur la théorie de la culture organisationnelle développée par Allaire et Firsirotu (1984). Le but de cet article est d’examiner les tendances d’accouchement en tant que phénomène de culture organisationnelle. Le second article, répond à une question spécifique : quelle est la définition des soins humanisés selon les administrateurs et des professionnels multidisciplinaires oeuvrant dans un hôpital hautement spécialisé, ainsi que celle des femmes soignées dans cet hôpital ? L'analyse des données permet de ressortir les thèmes suivants sur la perception de l'humanisation de la naissance : les soins personnalisés, la reconnaissance du droit desfemmes, des soins humains, des soins centrés sur la famille, la défense des femmes et de leur compagnon, le compromis de sécurité, le confort et l'humanité, et les grossesses non stéréotypées. Les femmes à risque élevé et à faible risque semblent plus satisfaites des soins s'ils sont fournis selon un choix éclairé et qu’elles ont participé au processus décisionnel, tout en étant entourées par des fournisseurs de soins compétents, qui soignent de façon humaine et font des interventions médicales lorsque requises. Les perceptions des professionnels et des administrateurs à propos de la naissance humanisée mettent principalement l'accent sur des soins personnalisés et centrés sur la famille. Dans notre troisième article, nous traitons les composantes internes et externes d'une institution, qui prédisposent ou qui empêchent un hôpital spécialisé et universitaire affilié au Québec d'adopter des soins humanisés de naissance. Les résultats révèlent qu’à la fois des dimensions externes d'un hôpital hautement spécialisé, -son histoire, son affiliation, et ses contingences - ainsi que des dimensions internes- sa culture, sa structure et ses individus - peuvent tous influer sur l'humanisation de la pratique des soins de naissance dans un tel établissement, que ce soit séparément, simultanément ou en interaction. Nous avons donc conclu que l'humanisation des soins de naissance dans un l'hôpital hautement spécialisé doit répondre à tous les aspects physiologiques et psychologiques des soins périnatals dont le respect des craintes, des croyances et des valeurs et besoins des femmes et de leur famille. L'intégration de professionnels compétents et attentionnés utilisant la technologie obstétrique améliore le niveau de certitude et d'assurance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. Enfin, l'humanisation de l'approche de la naissance dans un centre hospitalier très spécialisé et universitaire affilié requiert des nouvelles politiques de système de santé. Une telle politique garantit, pour une femme enceinte dès le début de sa grossesse, une place dans une institution, un professionnel de la santé de son choix et la possibilité de faire des choix éclairés tout au long du processus de la naissance.

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators’ perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy. / De nombreuses études ont mis l'accent sur le concept de l'humanisation des soins de naissance d’une grossesse normale ou à faible risque obstétrical. Mais, à notre connaissance, aucune étude à ce jour n’a spécifiquement porté sur l'humanisation des soins de la naissance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. La présente étude vise à: 1) définir les composantes spécifiques de l'humanisation des soins qui apportent satisfaction aux femmes qui cherchent des soins obstétricaux dans un hôpital hautement spécialisé; 2) explorer les dimensions organisationnelles et culturelles qui constituent des obstacles ou des facilitateurs pour les pratiques périnatales favorisant l'humanisation des soins dans un centre hospitalier universitaire très spécialisé, au Québec. Une étude de cas unique a été choisie pour notre thèse. Les données ont été recueillies au moyen d'entrevues semi-structurées, de notes de terrain, d’observation des participants, d’un questionnaire auto-administré, et de documents et d’archives pertinents. L’échantillon est composé de : 11 professionnels de différentes disciplines, six administrateurs de différents niveaux hiérarchiques de l'hôpital et 157femmes qui ont accouché à l'hôpital durant la période de l’étude. Une analyse à la fois descriptive quantitative et qualitative déductive et inductive a été réalisée. La thèse comprend trois articles. Dans le premier article, nous proposons un cadre conceptuel fondé sur la théorie de la culture organisationnelle développée par Allaire et Firsirotu (1984). Le but de cet article est d’examiner les tendances d’accouchement en tant que phénomène de culture organisationnelle. Le second article, répond à une question spécifique : quelle est la définition des soins humanisés selon les administrateurs et des professionnels multidisciplinaires oeuvrant dans un hôpital hautement spécialisé, ainsi que celle des femmes soignées dans cet hôpital ? L'analyse des données permet de ressortir les thèmes suivants sur la perception de l'humanisation de la naissance : les soins personnalisés, la reconnaissance du droit desfemmes, des soins humains, des soins centrés sur la famille, la défense des femmes et de leur compagnon, le compromis de sécurité, le confort et l'humanité, et les grossesses non stéréotypées. Les femmes à risque élevé et à faible risque semblent plus satisfaites des soins s'ils sont fournis selon un choix éclairé et qu’elles ont participé au processus décisionnel, tout en étant entourées par des fournisseurs de soins compétents, qui soignent de façon humaine et font des interventions médicales lorsque requises. Les perceptions des professionnels et des administrateurs à propos de la naissance humanisée mettent principalement l'accent sur des soins personnalisés et centrés sur la famille. Dans notre troisième article, nous traitons les composantes internes et externes d'une institution, qui prédisposent ou qui empêchent un hôpital spécialisé et universitaire affilié au Québec d'adopter des soins humanisés de naissance. Les résultats révèlent qu’à la fois des dimensions externes d'un hôpital hautement spécialisé, -son histoire, son affiliation, et ses contingences - ainsi que des dimensions internes- sa culture, sa structure et ses individus - peuvent tous influer sur l'humanisation de la pratique des soins de naissance dans un tel établissement, que ce soit séparément, simultanément ou en interaction. Nous avons donc conclu que l'humanisation des soins de naissance dans un l'hôpital hautement spécialisé doit répondre à tous les aspects physiologiques et psychologiques des soins périnatals dont le respect des craintes, des croyances et des valeurs et besoins des femmes et de leur famille. L'intégration de professionnels compétents et attentionnés utilisant la technologie obstétrique améliore le niveau de certitude et d'assurance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. Enfin, l'humanisation de l'approche de la naissance dans un centre hospitalier très spécialisé et universitaire affilié requiert des nouvelles politiques de système de santé. Une telle politique garantit, pour une femme enceinte dès le début de sa grossesse, une place dans une institution, un professionnel de la santé de son choix et la possibilité de faire des choix éclairés tout au long du processus de la naissance.