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Abstract Objectives: to understand the cultural context presented in hospitals and its relation to the obstetric nurse's autonomous practice on low-risk childbirth care. Methods: ethnographic research performed in three public maternities in Rio Grande do Norte, Brazil. Three managers and twenty-three obstetric nurses participated in this research. Results: distinctive on cultural, organizational and structural aspects of the hospital institution interfering directly with the obstetric nurse's autonomous practice. Among these aspects, professional appreciation on low-risk childbirth care contributes for the nurse's autonomy Conclusions: it was noticed that obstetric nurses undergo different contexts of action, which directly interfere with their autonomy on low-risk childbirth care and their decisionmaking abilities. It is necessary, then, to eradicate the relation of dominance and submission that it is still imposed by medical hegemony.

Resumo Objetivos: compreender o contexto cultural da instituição hospitalar e sua relação com a prática autônoma do enfermeiro obstetra na assistência ao parto de risco habitual. Métodos: pesquisa etnográfica desenvolvida em três maternidades públicas do Estado do Rio Grande do Norte, Brasil, com três gestores e 23 enfermeiros obstetras. Resultados: diferentes aspectos de ordem cultural, organizacional e estrutural da instituição hospitalar interferem diretamente na prática autônoma do enfermeiro obstetra. Dentre estes aspectos, a valorização profissional na assistência ao parto de risco habitual contribui para a autonomia do profissional em questão. Conclusões: constatou-se que o enfermeiro obstetra vivencia distintos contextos de atuação, os quais interferem diretamente na sua autonomia na assistência ao parto de risco habitual e no seu poder de decisão. Faz-se necessário, então, desvencilhar-se das relações de domínio e submissão, ainda impostas pela hegemonia médica.

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The objective was to evaluate the childcare actions in the neonatal period from the strategies recommended by the Ministry of Health. Cross-sectional study carried out from the database of the national population-based survey entitled "Chamada Neonatal" (Neonatal Call--in English): assessment of attention to prenatal care and to children under one year in the North and Northeast, which happened in the nine priority municipalities for the Pact of reducing child mortality and Neonatal in Rio Grande do Norte, Brazil with 837 mother/child pairs. The variables were composed by issues/actions regarding the neonatal period, followed by a descriptive and inferential analysis. The whole database sample was used, composed of 57.6% in the capital and 42.4% in all the interiors. The frequency of hospital environment actions ranges from 35% to 96% and those carried out in primary care from 57% to 91.2%. Most are associated with the nature of public hospitals and the state capital, and the actions of care for continuity of care and better economic conditions (p <0.05). Not all actions met the totality of what is advocated in the programs and childcare policies, and reveals regional inequalities in healthcare.

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Resumo O objetivo foi avaliar as ações de atenção à criança no período neonatal a partir das estratégias preconizadas pelo Ministério da Saúde. Estudo transversal realizado a partir do banco de dados da pesquisa nacional de base populacional intitulada “Chamada Neonatal: avaliação da atenção ao pré-natal e aos menores de um ano nas regiões Norte e Nordeste”, que aconteceu nos nove municípios prioritários para o Pacto de Redução da Mortalidade Infantil e Neonatal no Rio Grande do Norte, com 837 pares mãe/filho. As variáveis foram compostas pelas questões/ações referentes ao período neonatal, seguidas de uma análise descritiva e inferencial. Foi utilizada toda a amostra do banco de dados composta por 57,6% na capital e 42,4% no conjunto dos interiores. A frequência das ações de âmbito hospitalar variou de 35% a 96% e as realizadas na atenção básica de 57% a 91,2%. A maioria teve associação com os hospitais de natureza pública e com a capital do estado, e as ações de atenção à continuidade do cuidado com melhores condições econômicas (p < 0,05). Todas as ações não atenderam a totalidade do que é preconizado nos programas e políticas de atenção à criança, e revelam as iniquidades regionais em saúde.

Abstract The objective was to evaluate the childcare actions in the neonatal period from the strategies recommended by the Ministry of Health. Cross-sectional study carried out from the database of the national population-based survey entitled “Chamada Neonatal” (Neonatal Call - in English): assessment of attention to prenatal care and to children under one year in the North and Northeast, which happened in the nine priority municipalities for the Pact of reducing child mortality and Neonatal in Rio Grande do Norte, Brazil with 837 mother/child pairs. The variables were composed by issues/actions regarding the neonatal period, followed by a descriptive and inferential analysis. The whole database sample was used, composed of 57.6% in the capital and 42.4% in all the interiors. The frequency of hospital environment actions ranges from 35% to 96% and those carried out in primary care from 57% to 91.2%. Most are associated with the nature of public hospitals and the state capital, and the actions of care for continuity of care and better economic conditions (p <0.05). Not all actions met the totality of what is advocated in the programs and childcare policies, and reveals regional inequalities in healthcare.

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