Legal abortion requests and outcomes for women when the law is restrictive - experience from a referral centre in south-eastern Brazil.

METHODS: Retrospective cohort study with review of medical records of women assisted between 2015 and 2020. The variables were socio-demographic and SV characteristics, gestational age, reactions towards pregnancy and outcome. We compared outcome groups using the chi-square test, Fisher's exact test and the Kruskal-Wallis test. The significance level was 5%. RESULTS: We evaluated the medical records of 235 women, of which 153(65%) had undergone to abortion; 17(7.2%) had a spontaneous abortion; 19(8%) remained pregnant; 25(10.6%) had an abortion denied; and 21(8.9%) had been lost to follow-up. Out of the total number of women, 44(18.7%) were adolescents, 152(65.2%) were white and 201(88.5%) had an education ≥9 years. Women who remained pregnant had a known aggressor, disclosed the pregnancy (p < 0.001) and were more ambivalent (p < 0.001) than the other groups. Gestational age was higher in the denied abortion group than in the performed abortion group (p < 0.001). CONCLUSION: Feelings related to decision-making about abortion affected all groups, with differences. It is important to give women space to be heard, so they can make their own decisions.

Abortion care is possible in places with restrictive laws; however, women with more vulnerable characteristics did not seek the service. Legal restrictions interfere with women's decision-making about abortion and can promote inequality in gaining access to health services.

Breathing Techniques During Labor: A Multinational Narrative Review of Efficacy.

We conducted a narrative review to assess the use and effectiveness of breathing techniques for pain control as the only non-pharmacological resource during labor and childbirth. A search was conducted using PubMed, PEDro, SciELO, and Scopus with publications between January 2005 and September 2021 in English, Portuguese, or Spanish. Seven publications were selected. Most of the articles reported on the use of slow and deep breathing during contractions in the first stage of labor and breathing associated with pushing-down efforts in the second stage. The information regarding the moment when guidance on the use of the techniques was provided varied across studies. According to the reviewed papers, breathing techniques offer benefits for women in labor without adverse effects on newborns.

Atendimento humanizado no pré-natal de alto risco: percepções de enfermeiros / Humanized care in high-risk prenatal care: nurses perceptions

RESUMO Objetivo desvelar as percepções de enfermeiros sobre assistência humanizada, no pré-natal de alto risco. Métodos pesquisa qualitativa, com seis enfermeiros que atuavam no pré-natal de alto risco. Para coleta de dados, recorreu-se à entrevista semiestruturada. Na análise dos resultados, utilizou-se da técnica de análise de conteúdo. Resultados a humanização do cuidado consistiu de ações relacionadas ao acolhimento, atendimento individualizado, comunicação com gestantes e estabelecimento de relação de confiança. As principais práticas de humanização foram as visitas guiadas nas maternidades; a realização de grupos educacionais; o uso de métodos não farmacológicos para alívio da dor, no trabalho de parto; e o incentivo à atuação de acompanhante. Conclusão os enfermeiros participantes compreenderam o conceito de humanização e atribuíram as práticas de humanização ao acolhimento da gestante, visitas guiadas, atendimento individualizado, orientação sobre uso dos métodos não farmacológicos e promoção de vínculo com as gestantes.

ABSTRACT Objective to unveil nurses' perceptions about humanized care in high-risk prenatal care. Methods a qualitative study, with six nurses who worked in high-risk prenatal care. Data collection took place using semi-structured interviews. To analyze the results, the content analysis technique was used. Results the adoption of humanized care consisted of actions related to user embracement, personalized care, dialogue with pregnant women and the establishment of a trustful relationship. The main humanization practices were guided visits to maternity hospitals; creating educational groups; the use of non-pharmacological methods for pain relief during labor; and encouraging companion support. Conclusion participating nurses understood the humanization concept and associated humanization practices to the embracement of pregnant women, guided visits, personalized care, guidance on the use of non-pharmacological methods and the promotion of connections with pregnant women.

Developing strategies to be added to the protocol for antenatal care: an exercise and birth preparation program.

OBJECTIVES: To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. METHODS: The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18-24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials.gov: NCT01155804. RESULTS: The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. CONCLUSIONS: The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings.

Developing strategies to be added to the protocol for antenatal care: An exercise and birth preparation program

OBJECTIVES: To describe the implementation process of a birth preparation program, the activities in the protocol for physical and birth preparation exercises, and the educational activities that have been evaluated regarding effectiveness and women's satisfaction. The birth preparation program described was developed with the following objectives: to prevent lumbopelvic pain, urinary incontinence and anxiety; to encourage the practice of physical activity during pregnancy and of positions and exercises for non-pharmacological pain relief during labor; and to discuss information that would help women to have autonomy during labor. METHODS: The program comprised the following activities: supervised physical exercise, relaxation exercises, and educational activities (explanations of lumbopelvic pain prevention, pelvic floor function, labor and delivery, and which non-pharmacological pain relief to use during labor) provided regularly after prenatal consultations. These activities were held monthly, starting when the women joined the program at 18–24 weeks of pregnancy and continuing until 30 weeks of pregnancy, fortnightly thereafter from 31 to 36 weeks of pregnancy, and then weekly from the 37th week until delivery. Information and printed materials regarding the physical exercises to be performed at home were provided. Clinicaltrials.gov: NCT01155804. RESULTS: The program was an innovative type of intervention that systematized birth preparation activities that were organized to encompass aspects related both to pregnancy and to labor and that included physical, educational and home-based activities. CONCLUSIONS: The detailed description of the protocol used may serve as a basis for further studies and also for the implementation of birth preparation programs within the healthcare system in different settings. .

[Rape-related pregnancy in Brazil: the experience of women seeking legal abortion]. / Gravidez após violência sexual: vivências de mulheres em busca da interrupção legal.

In Brazil, abortion is permitted by law in cases of rape-related pregnancy. This study reports on various aspects in the experience of women that have been sexually assaulted: diagnosis of the pregnancy, seeking legal abortion, and hospitalization in a university hospital. This was a qualitative study that interviewed ten women 18 to 38 years of age, with at least eight years of schooling, one to five years after legal abortion. The women had been previously unaware of their right to a legal abortion, were ashamed about the sexual assault, kept it secret, and had not sought immediate care. The diagnosis of pregnancy provoked anxiety and the wish to undergo an abortion. Women treated through private health plans received either insufficient orientation or none at all. Respectful treatment by the healthcare staff proved relevant for the women to cope with the abortion. The study highlights the need to publicize the right to abortion in cases of rape-related pregnancy and the healthcare services that perform legal abortion, in addition to training healthcare and law enforcement teams to handle such cases.

Gravidez após violência sexual: vivências de mulheres em busca da interrupção legal / Rape-related pregnancy in Brazil: the experience of women seeking legal abortion / Embarazo tras actos de violencia sexual: experiencias de mujeres en búsqueda de la interrupción legal

No Brasil, a realização de interrupção legal de gestação consequente à violência sexual é permitida por lei. O objetivo deste estudo foi relatar vivências de mulheres após a violência sexual, no diagnóstico de gravidez, na busca pelo serviço de interrupção legal da gestação e durante a internação em um hospital universitário. Foi realizada pesquisa qualitativa com entrevistas semiestruturadas em dez mulheres de 18-38 anos e escolaridade ≥ 8 anos, após 1-5 anos da interrupção legal da gestação. As mulheres desconheciam o direito à interrupção legal da gestação, sentiram a violência sexual como experiência vergonhosa, mantiveram segredo e não procuraram qualquer atendimento imediato. O diagnóstico de gravidez provocou sentimentos de angústia e desejo de abortar. Para as mulheres que procuraram o setor de saúde suplementar as orientações foram precárias ou não aconteceram. O atendimento dos profissionais mostrou-se relevante para assimilação da experiência do aborto. É necessário divulgar o direito à interrupção legal da gestação e a existência de serviços que a realizam, e capacitar profissionais de saúde e segurança pública para atender esses casos.

In Brazil, abortion is permitted by law in cases of rape-related pregnancy. This study reports on various aspects in the experience of women that have been sexually assaulted: diagnosis of the pregnancy, seeking legal abortion, and hospitalization in a university hospital. This was a qualitative study that interviewed ten women 18 to 38 years of age, with at least eight years of schooling, one to five years after legal abortion. The women had been previously unaware of their right to a legal abortion, were ashamed about the sexual assault, kept it secret, and had not sought immediate care. The diagnosis of pregnancy provoked anxiety and the wish to undergo an abortion. Women treated through private health plans received either insufficient orientation or none at all. Respectful treatment by the healthcare staff proved relevant for the women to cope with the abortion. The study highlights the need to publicize the right to abortion in cases of rape-related pregnancy and the healthcare services that perform legal abortion, in addition to training healthcare and law enforcement teams to handle such cases.

En Brasil, la interrupción legal del embarazo, como consecuencia de actos de violencia sexual, está permitido por la ley. El objetivo de este trabajo es presentar la experiencia de mujeres tras actos de violencia sexual, el diagnóstico de su embarazo, su búsqueda del servicio de interrupción legal del embarazo y su internamiento en un hospital universitario. La investigación cualitativa se llevó a cabo mediante entrevistas semiestructuradas con 10 mujeres de 18-38 años, más de 8 años de escolaridad, tras 1-5 años de la interrupción legal del embarazo. Las mujeres no eran conscientes de su derecho a la interrupción legal del embarazo, sintieron la experiencia de sus violaciones como algo vergonzoso, las mantuvieron en secreto y no buscaron ninguna atención inmediata. El diagnóstico de embarazo les causó sentimientos de angustia y deseo de abortar. Para las mujeres que buscaron atención adicional de salud la información recibida era pobre o no se produjo. La asistencia de profesionales resultó relevante para asimilar la experiencia del aborto. Es necesario promover el derecho a la interrupción legal del embarazo y la existencia de servicios que lo realicen.

Maternidade e formas de maternagem desde a idade média à atualidade / Motherhood and mothering forms since the middle ages to the present

Tradicionalmente a maternidade e a maternagem são vistas como decorrentes de relações biológicas e afetivas estabelecidas entre mãe e filho. Atualmente, com o avanço das tecnologias reprodutivas e as novas configurações familiares, observa-se o desenvolvimento de novas possibilidades de maternidade e maternagem que questionam os vínculos biológicos e os papéis de gênero nos cuidados ao filho. A reflexão sobre a construção social da maternidade e da maternagem ao longo do tempo pode favorecer a discussão sobre as demandas das novas configurações familiares. O objetivo deste artigo é realizar uma reflexão sobre os diferentes valores da maternidade e as diversas formas de maternagem desde a Idade Média até a atualidade, nas sociedades ocidentais...

Traditionally motherhood and mothering are seen as resulting from biological and affective relations between mother and son. Today, with the advancement of reproductive technologies and new family configurations observed the development of new sources of motherhood and maternal bonds questioning the biological and gender roles in the care of child. The reflection on the social construction of motherhood and mothering over time can encourage discussion about the demands of new family configurations. The purpose of this article is a reflection on the different values of motherhood and the various forms of mothering since the Middle Ages to the present, in western societies...

Antenatal education and the birthing experience of Brazilian women: a qualitative study.

BACKGROUND: Information is still scarce on the birthing experience of women who participate in antenatal systematic education programs. The objective of the study was to report the experience of labor as described by nulliparous women who participated and who did not in a systematic Birth Preparation Program (BPP). METHOD: A qualitative study was conducted with eleven women who participated in a BPP and ten women attending routine prenatal care selected through purposeful sampling. The BPP consisted of systematized antenatal group meetings structured to provide physical exercise and information on pain prevention during pregnancy, the role of the pelvic floor muscles, the physiology of labor, and pain relief techniques. A single, semi-structured interview was conducted with each participant. All interviews were recorded, transcribed verbatim and thematic analyses performed. The relevant themes were organized in the following categories of analysis: control of labor, positions adopted during labor, and satisfaction with labor. RESULTS: Women who participated in the systematic educational activities of the BPP reported they maintained self-control during labor and used breathing exercises, exercises on the ball, massage, baths and vertical positions to control pain. Also they reported satisfaction with their birthing experience. Women who did not participate in systematic educational activities referred to difficulties in maintaining control during labor and almost half of them reported lack of control. Also they were more likely to report dissatisfaction with labor. CONCLUSIONS: Women who participated in the BPP reported self-control during labor and used non-pharmacological techniques to control pain and facilitate labor and expressed satisfaction with the birthing experience.

[Stress of men and women seeking treatment for infertility]. / Estresse de homens e mulheres que buscam tratamento para infertilidade.

PURPOSE: To evaluate the level of stress in men and women seeking treatment for infertility and to identify the associated variables. METHODS: A cross-sectional study with 101 men and 101 women consulting for the first time at the Human Reproduction Unit. Participants completed the Brazilian version of the Fertility Problem Inventory (FPI) based on four domains: "social relationships", "life without children"; "marital relationship/sexual" and "maternity/paternity" and a structured questionnaire with socioeconomic and reproductive variables. Bivariate analysis was performed using the Chi-square and Fisher exact tests, considering p<0.05. Afterwards the multivariate correspondence analysis was done with variables with p<0.20. RESULTS: Overall, the participants presented a high level of stress in all domains, except in the "life without children" domain. Multivariate analysis of correspondence showed that variables associated with a high level of stress in the "social relationships" domains were: to be a woman, to have the infertility problem, and to consider the quality of the marital relationship to be regular. In the "life without children" domain the variables that approached the high stress were: to be woman, age between 18 and 24 years, and to have the infertility problem. To be a man, to consider adoption, parents/in-laws and other people knowing about the difficulty to become pregnant, and to consider the quality of the marital relationship to be excellent were the variables associated with high level of stress in "marital/sexual relationship" domain. For "maternity/paternity" domain the variables associated were to be women, consider marital relationship quality regular, age between 25 and 35 years, be evangelical or protestant were the variables associated with a high level of stress. CONCLUSION: Men and women seeking treatment for infertility present a high level of stress and it can be suggested that psychosocial support is important and should be different for men and women.

Evaluation of a birth preparation program on lumbopelvic pain, urinary incontinence, anxiety and exercise: a randomized controlled trial.

BACKGROUND: Antenatal preparation programmes are recommended worldwide to promote a healthy pregnancy and greater autonomy during labor and delivery, prevent physical discomfort and high levels of anxiety. The objective of this study was to evaluate effectiveness and safety of a birth preparation programme to minimize lumbopelvic pain, urinary incontinence, anxiety, and increase physical activity during pregnancy as well as to compare its effects on perinatal outcomes comparing two groups of nulliparous women. METHODS: A randomized controlled trial was conducted with 197 low risk nulliparous women aged 16 to 40 years, with gestational age ≥ 18 weeks. Participants were randomly allocated to participate in a birth preparation programme (BPP; n=97) or a control group (CG; n=100). The intervention was performed on the days of prenatal visits, and consisted of physical exercises, educational activities and instructions on exercises to be performed at home. The control group followed a routine of prenatal care. Primary outcomes were urinary incontinence, lumbopelvic pain, physical activity, and anxiety. Secondary outcomes were perinatal variables. RESULTS: The risk of urinary incontinence in BPP participants was significantly lower at 30 weeks of pregnancy (BPP 42.7%, CG 62.2%; relative risk [RR] 0.69; 95% confidence interval [CI] 0.51-0.93) and at 36 weeks of pregnancy (BPP 41.2%, CG 68.4%; RR 0.60; 95%CI 0.45-0.81). Participation in the BPP encouraged women to exercise during pregnancy (p=0.009). No difference was found between the groups regarding to anxiety level, lumbopelvic pain, type or duration of delivery and weight or vitality of the newborn infant. CONCLUSIONS: The BPP was effective in controlling urinary incontinence and to encourage the women to exercise during pregnancy with no adverse effects to pregnant women or the fetuses. TRIAL REGISTRATION: Clinicaltrials.gov, (NCT01155804).

Estresse de homens e mulheres que buscam tratamento para infertilidade / Stress of men and women seeking treatment for infertility

OBJETIVO: Avaliar o nível de estresse de homens e mulheres que buscavam tratamento para infertilidade e identificar variáveis associadas. MÉTODOS: Estudo transversal com 101 homens e 101 mulheres que se consultavam pela primeira vez em um Ambulatório de Reprodução Humana. Os participantes responderam à versão brasileira do Inventário de Problema de Fertilidade (IPF) com base nos quatro domínios: "relacionamentos sociais", "vida sem filhos"; "relacionamento conjugal/sexual" e "maternidade/paternidade" e também a um questionário com características socioeconômicas e reprodutivas. Realizou-se análise bivariada através dos testes qui-quadrado e exato de Fisher, considerando p<0,05. Posteriormente realizou-se análise multivariada de correspondência, na qual foram incluídas as variáveis com p<0,20. RESULTADOS: De modo geral, os participantes apresentaram alto nível de estresse em todos os domínios, exceto no domínio "vida sem filhos". A análise multivariada por correspondência apontou que as variáveis que se aproximaram do estresse alto no domínio "relacionamentos sociais" foram: ser do sexo feminino, ter o problema da infertilidade, e considerar a qualidade do relacionamento conjugal regular. No domínio "vida sem filhos" as variáveis que se aproximaram do estresse alto foram: ser do sexo feminino, ter idade entre 18 e 24 anos, e ter o problema da infertilidade. Ser do sexo masculino, considerar a adoção, pais e/ou sogros e outras pessoas saberem da dificuldade para engravidar, e considerar a qualidade do relacionamento conjugal ótimo aproximaram-se do alto nível de estresse no domínio "relacionamento conjugal/sexual". Para o domínio "maternidade/paternidade" evidenciou-se que as variáveis ser do sexo feminino, considerar a qualidade do relacionamento conjugal regular, ter idade entre 25 e 35 anos, e praticar religião evangélica ou protestante aproximaram-se do alto nível de estresse. CONCLUSÃO: Homens e mulheres que buscam tratamento para infertilidade apresentam alto nível elevado de estresse, sugerindo que o apoio psicossocial é importante e deve ser diferenciado para homens e mulheres.

PURPOSE: To evaluate the level of stress in men and women seeking treatment for infertility and to identify the associated variables. METHODS: A cross-sectional study with 101 men and 101 women consulting for the first time at the Human Reproduction Unit. Participants completed the Brazilian version of the Fertility Problem Inventory (FPI) based on four domains: "social relationships", "life without children"; "marital relationship/sexual" and "maternity/paternity" and a structured questionnaire with socioeconomic and reproductive variables. Bivariate analysis was performed using the Chi-square and Fisher exact tests, considering p<0.05. Afterwards the multivariate correspondence analysis was done with variables with p<0.20. RESULTS: Overall, the participants presented a high level of stress in all domains, except in the "life without children" domain. Multivariate analysis of correspondence showed that variables associated with a high level of stress in the "social relationships" domains were: to be a woman, to have the infertility problem, and to consider the quality of the marital relationship to be regular. In the "life without children" domain the variables that approached the high stress were: to be woman, age between 18 and 24 years, and to have the infertility problem. To be a man, to consider adoption, parents/in-laws and other people knowing about the difficulty to become pregnant, and to consider the quality of the marital relationship to be excellent were the variables associated with high level of stress in "marital/sexual relationship" domain. For "maternity/paternity" domain the variables associated were to be women, consider marital relationship quality regular, age between 25 and 35 years, be evangelical or protestant were the variables associated with a high level of stress. CONCLUSION:Men and women seeking treatment for infertility present a high level of stress and it can be suggested that psychosocial support is important and should be different for men and women.

Sexual function of women with premature ovarian failure.

OBJECTIVE: The aim of this study was to evaluate the sexual function of women with premature ovarian failure (POF). METHODS: A cross-sectional study was performed to evaluate 58 women with a diagnosis of POF compared with a control group composed of 58 women of reproductive age with normal ovarian function, paired for age (±2 y). Sexual function was evaluated in the two groups using the Female Sexual Function Index (FSFI). RESULTS: The mean ± SD age of the women in the POF and control groups was 39.4 ± 6.5 and 39.0 ± 6.8 years, respectively. Mean ± SD FSFI score was 24.0 ± 6.0 and 27.3 ± 4.8 in the POF and control groups, respectively. The prevalence of sexual dysfunction (total FSFI score ≤ 26.55) in the POF group was 62.1% (n = 36) compared with 37.8% (n = 22) in the control group (P = 0.0093). In the analysis of domains, the only domain in which no statistically significant difference was found between the two groups was desire. For the domains of arousal, lubrication, orgasm, satisfaction, and pain, scores were significantly lower, hence poorer, in the group of women with POF compared with the control group. Belonging to the POF group increased a woman's likelihood of having sexual dysfunction by 2.8-fold (OR = 2.78, IC 1.29 to 5.98, P < 0.05). CONCLUSIONS: Women with POF had a higher prevalence of sexual dysfunction compared with women with normal gonadal function and more difficulties in relation to satisfaction, lubrication, orgasm, pain, and arousal; however, there were no differences between the two groups with respect to desire.

Procedimentos de fertilização in vitro: experiência de mulheres e homens / In vitro fertilization procedures: women and men’s experience / Procedimientos de fertilización in vitro: experiencias de mujeres y hombres

Homens e mulheres com diagnóstico de infertilidade, ante a impossibilidade de conceber um filho, veem a fertilização in vitro (FIV) como a última alternativa. Para o presente estudo foi realizada uma análise qualitativa de entrevistas previamente realizadas com mulheres e homens que estavam iniciando procedimentos de FIV e se haviam submetido ao procedimento sem obter sucesso 4 a 6 anos antes de serem entrevistados. Os principais achados mostraram que a decisão de participar dos procedimentos foi baseada mais no anseio das mulheres que no dos homens, e que os questionamentos e dificuldades das diferentes etapas do procedimento foram minimizados durante sua realização e começaram a se manifestar após o fracasso. Todos os entrevistados consideraram uma experiência válida ter participado dos procedimentos da FIV. O conhecimento das vivências de mulheres e homens nos distintos momentos pode ser útil para a elaboração de estratégias de apoio.

Women and men with a diagnosis of infertility that confronts them with the impossibility of conceiving a child perceive In vitro fertilization (IVF) as their last chance. In this study a qualitative analysis of interviews previously conducted with women and men who were initiating IVF procedures and women and men 4-6 years after unsuccessful IVF was performed. The main findings showed that the decision to participate in IVF procedures had been based principally on women’s desire to have a baby, doubts and difficulties of the different phases of IVF were minimized during procedure and gained importance over time after unsuccessful procedure. All participants considered their participation in IVF a positive experience. The comprehension of the meaning of these procedures at different stages for women and men may contribute for the elaboration of support strategies.

Mujeres y hombres con un diagnóstico de infertilidad que los confronta con la imposibilidad de concebir un hijo ven la Fertilización in vitro (FIV) como la última alternativa. Para el presente estudio fue realizado un análisis cualitativo de entrevistas previamente realizadas con mujeres y hombres que estaban iniciando procedimientos de FIV y de mujeres y hombres que habían participado de estos procedimientos sin obtener suceso 4 a 6 años antes de ser entrevistados. Los principales resultados indicaron que la decisión de participar de los procedimientos estaba basada en el deseo de las mujeres más que de los hombres, y que, cuestionamientos y dificultades de las diferentes etapas del procedimiento habían sido minimizadas durante la realización del mismo y comenzaron a perfilarse como inquietud después del fracaso. Todos los entrevistados consideraron una experiencia valida participar del procedimiento. El conocimiento de las experiencias de mujeres y hombres en distintos momentos de esta técnica puede ser útil para la elaboración de estrategias de apoyo.

The vertical position during labor: pain and satisfaction / Posição vertical durante o trabalho de parto: dor e satisfação

OBJECTIVES: to evaluate the vertical position adopted by nulliparous women during labor in terms of pain and satisfaction with the position. METHODS: the study was based on a secondary efficacy analysis of data from 107 nulliparous women enrolled in a randomized controlled trial in which the vertical position adopted during the dilation phase of labor was evaluated. The analysis involved comparing the median percentages of the duration for which women remained in the vertical position for each of the variables studied . The Kruskal-Wallis and Mann-Whitney tests were used to determine the difference s betwee n th e groups. Statistical significance was set at p<0.05. RESULTS: at 4cm of dilation , the women with a pain score < 5 remained longer in the vertical position during labor compared to those with a score > 7 (p=0.02) . At 4 and 6 cm of dilation , the women who reported greater satisfaction remained more than 50 percent of the time in the vertical position (p=0.0 2 an d p=0.03 , respectively). CONCLUSIONS: the vertical position helped relieve labor pain and increased comfort and patient satisfaction.

OBJETIVOS: avaliar a posição vertical , adotada por mulheres nulíparas durante o trabalho de parto , em relação à dor e satisfação com a posição. MÉTODOS: abordagem analítica distinta, complementar e de eficácia de 107 nulíparas, secundária aos dados de um ensaio controlado randomizado, que avaliou a posição vertical em nulíparas durante a fase de dilatação do trabalho de parto. A análise foi realizada pela comparação das porcentagens medianas do tempo de permanência na posição vertical para cada categoria das variáveis estudadas. Para testar as diferenças entre as variáveis foram utilizados os testes de Kruskal-Wallis e de Mann-Whitney. A significância foi estabelecida em p<0.05. RESULTADOS: aos 4 cm de dilatação , as mulheres que apresentaram escore de dor < 5 permaneceram maior tempo do trabalho de parto na posição vertical quando comparadas às que tiveram escore > 7 (p=0.02). As mulheres mais satisfeitas, aos 4 e 6 cm de dilatação, permaneceram mais de 50 por cento do tempo na posição vertical (p=0.0 2 e p=0.03, respectivamente). CONCLUSÕES: a posição vertical auxiliou no alívio da dor , melhorou o conforto e satisfação das parturientes.

[Alcohol and illicit drug use and its influence on the sexual behavior of teenagers from Minas Gerais State, Brazil]. / Uso de álcool e drogas e sua influência sobre as práticas sexuais de adolescentes de Minas Gerais, Brasil.

This article summarizes the findings of a survey including 5,981 students from public schools in Minas Gerais State, Brazil. The analysis assessed the influence of drug use on sexual practices. Among the boys engaged in relationships with casual partners who stated having used illicit drugs, 55.7% reported consistent condom use, as compared to 65.4% among those not reporting such habits. Among boys engaged in relationships with stable partners who reported illicit drug use, consistent condom use was reported by 42.7%, versus 64.1% among those not reporting such habits. In the subgroup of boys engaged in stable relationships who did not report illicit drug use, consistent condom use was less frequent among those that used alcohol/cigarettes, compared to those who did not drink or smoke (60.7% vs. 71.1%). Girls were less likely than boys to use condoms consistently, regardless of the nature of their relationships, without a noticeable influence of drug use. Policies to prevent drug abuse, sexually transmitted diseases, and unplanned pregnancy should be fully integrated.

Changes in sexual behavior following a sex education program in Brazilian public schools.

This paper describes an evaluation of possible changes in sexual behavior in adolescents who participated in a school-based sex education program in selected public schools in four municipalities in the state of Minas Gerais, Brazil. The program is inserted within the context of reproductive rights, deals with risks involved in unsafe sexual practices and focuses on the positive aspects of sexuality. A quasi-experimental design with pre and post-tests and a non-equivalent control group was used to evaluate the intervention. A total of 4,795 questionnaires were included in this analysis. The program succeeded in more than doubling consistent condom use with casual partners and in increasing the use of modern contraceptives during last intercourse by 68%. The intervention had no effect on age at first intercourse or on adolescents' engagement in sexual activities. The sex education program was effective in generating positive changes in the sexual behavior of adolescents, while not stimulating participation in sexual activities.

Uso de álcool e drogas e sua influência sobre as práticas sexuais de adolescentes de Minas Gerais, Brasil / Alcohol and illicit drug use and its influence on the sexual behavior of teenagers from Minas Gerais State, Brazil

Os achados provêm de um estudo transversal de 5.981 estudantes de escolas públicas de Minas Gerais, Brasil. Avaliou-se a influência do uso de drogas sobre as práticas sexuais. Dos rapazes com relacionamento casual que referiram ter utilizado drogas ilícitas, 55,7 por cento disseram usar preservativos de forma consistente (em todas as relações sexuais), enquanto entre os que nunca fizeram uso de tais substâncias, esse percentual foi de 65,4 por cento. Entre os rapazes com relacionamento fixo, que utilizaram droga ilícita, o uso consistente de preservativos foi referido por 42,7 por cento, ao passo que, para os que nunca fizeram uso dessas substâncias, esse percentual foi de 64,1 por cento. No subgrupo dos rapazes com parceria fixa que nunca utilizaram drogas ilícitas, o uso consistente do preservativo foi menos freqüente entre os que utilizaram cigarro e/ou álcool do que entre os que não referiram este uso (60,7 por cento vs. 71,1 por cento). As moças apresentaram menor proporção de uso consistente do preservativo do que os rapazes, independentemente do tipo de parceria, sem influência aparente dos padrões de consumo. Os achados sugerem a necessidade de integrar a prevenção do uso de drogas à de infecções sexualmente transmissíveis/gravidez indesejada.

This article summarizes the findings of a survey including 5,981 students from public schools in Minas Gerais State, Brazil. The analysis assessed the influence of drug use on sexual practices. Among the boys engaged in relationships with casual partners who stated having used illicit drugs, 55.7 percent reported consistent condom use, as compared to 65.4 percent among those not reporting such habits. Among boys engaged in relationships with stable partners who reported illicit drug use, consistent condom use was reported by 42.7 percent, versus 64.1 percent among those not reporting such habits. In the subgroup of boys engaged in stable relationships who did not report illicit drug use, consistent condom use was less frequent among those that used alcohol/cigarettes, compared to those who did not drink or smoke (60.7 percent vs. 71.1 percent). Girls were less likely than boys to use condoms consistently, regardless of the nature of their relationships, without a noticeable influence of drug use. Policies to prevent drug abuse, sexually transmitted diseases, and unplanned pregnancy should be fully integrated.

Changes in sexual behavior following a sex education program in Brazilian public schools / Mudanças no comportamento sexual de adolescentes de escolas públicas no Brasil após um programa de educação sexual

This paper describes an evaluation of possible changes in sexual behavior in adolescents who participated in a school-based sex education program in selected public schools in four municipalities in the state of Minas Gerais, Brazil. The program is inserted within the context of reproductive rights, deals with risks involved in unsafe sexual practices and focuses on the positive aspects of sexuality. A quasi-experimental design with pre and post-tests and a non-equivalent control group was used to evaluate the intervention. A total of 4,795 questionnaires were included in this analysis. The program succeeded in more than doubling consistent condom use with casual partners and in increasing the use of modern contraceptives during last intercourse by 68%. The intervention had no effect on age at first intercourse or on adolescents' engagement in sexual activities. The sex education program was effective in generating positive changes in the sexual behavior of adolescents, while not stimulating participation in sexual activities.

Este artigo descreve a avaliação de possíveis mudanças no comportamento sexual de adolescentes que participaram de um programa de educação sexual implementado em escolas públicas selecionadas em quatro municípios de Minas Gerais, Brasil. O programa está inserido no contexto dos direitos reprodutivos, discute os riscos de práticas sexuais inseguras e enfoca os aspectos positivos da sexualidade. Utilizou-se um desenho quase-experimental com pré e pós-teste e grupo controle não-equivalente. Foram incluídos 4.795 questionários na análise dos resultados. O programa conseguiu dobrar o uso consistente do preservativo com parceiro casual e aumentar em 68% o uso de métodos anticoncepcionais modernos na última relação sexual. A intervenção não teve efeito sobre a idade da primeira relação sexual ou na prática de atividades sexuais. Concluindo, o programa foi eficaz em gerar mudanças positivas no comportamento sexual de adolescentes sem antecipar ou estimular a prática sexual.

Upright position during the first stage of labor: a randomised controlled trial.

BACKGROUND: Evaluation of the upright position during the first stage of labor on pain, patient satisfaction, obstetrical and perinatal outcomes in nullipara women. METHODS: This prospective, randomised, controlled trial included a group of 54 women who were informed and encouraged to adopt the upright position, and a control group of 53 women who were not given this information. The difference between groups was evaluated using the chi2, Wilcoxon and Fisher's Exact tests. Significance was defined as p<0.05. Risk ratios and 95% confidence intervals were calculated. RESULTS: No statistically significant differences were found between the groups in baseline characteristics, obstetrical and perinatal outcomes; however, there was a preference among women in both groups for the upright position. CONCLUSIONS: The upright position during the first stage of labor did not contribute towards a shorter duration of labor; however, it proved to be a safe and well-accepted option for the women of this study.