The association between waterbirth and perineal injury or other adverse outcomes among low-risk women with physiological birth: Results from the Nordic Home Birth Cohort Study.

PROBLEM/BACKGROUND: Immersion in water has known benefits, such as reducing pain and shortening the duration of labour. The relationship between waterbirth and perineal injury remains unclear. AIM: To compare the incidence of perineal injury in waterbirth and birth on land among low-risk women. Secondary outcomes were postpartum haemorrhage and 5-minute Apgar scores <7. METHODS: Prospective cohort study of 2875 low-risk women who planned a home birth in Denmark, Iceland, Norway, and Sweden in 2008-2013 and had a spontaneous vaginal birth without intervention. Descriptive statistics and logistic regression were performed. FINDINGS: A total of 942 women had a waterbirth, and 1933 gave birth on land. The groups differed in their various background variables. Multiparous women had moderately lower rates of intact perineum (59.3% vs. 63.9%) and primiparous women had lower rates of episiotomies (1.1% vs. 4.8%) in waterbirth than in birth on land. No statistically significant differences were detected in adjusted regression analysis on intact perineum in waterbirth (primiparous women's aOR = 1.03, CI 0.68-1.58; multiparous women's aOR = 0.84, CI 0.67-1.05). The rates of sphincter injuries (0.9% vs. 0.6%) were low in both groups. No significant differences were detected in secondary outcomes. DISCUSSION: The decreased incidence of intact perineum among multiparous women was modest and inconclusive, and the prevalence of sphincter injury was low. CONCLUSION: Low-risk women contemplating waterbirth should be advised to weigh the risks and benefits detected in this study against previously established benefits of waterbirth and should make an informed choice based on their values.

The significance of paramedic communication during women's birth experiences: A scoping review.

BACKGROUND: Internationally, over one-third of women experience birth trauma, leading to adverse mental health outcomes. Poor communication with healthcare professionals is a primary contributing factor. Paramedics attend various clinical presentations, including childbirth, yet their potential impact on women's birth experiences has been largely overlooked. METHODS: A systematic literature search was conducted following the Joanna Briggs Institute methodological framework. The search identified 1015 potentially suitable articles, and 5 articles met the inclusion criteria. Data was analysed using reflexive thematic analysis from a feminist standpoint. RESULTS: Three themes were generated: 1. First Impressions Count: paramedic demeanour impacted the woman's sense of safety and perception of paramedic clinical competence. 2. Choice as a Pathway to Control: when paramedics involved women in decision-making, it led to empowerment, while non-involvement led to women becoming passive participants. 3. Exposed, Violated and Disempowered: some paramedics disrespected and abused women, treating them solely as objects for the purpose of producing a baby. CONCLUSIONS: This review highlights the influence of paramedic communication on women's birth experiences. While some paramedics communicated respectfully, other paramedics were the perpetrators of Obstetric Violence. Future research should inform paramedic education and improve outcomes for birthing women.

Exploring women's motivations to freebirth and their experience of maternity care: A systematic qualitative evidence synthesis.

BACKGROUND: Freebirth is currently defined as the deliberate decision to give birth without a regulated healthcare professional. Previous reviews have identified factors influencing women's decision to freebirth, yet there is limited evidence on what is the care experience for women who opt to freebirth. AIM: To synthesise the qualitative evidence on women's motivations to freebirth and their experience of maternity care when deciding to freebirth. METHODS: We conducted a qualitative evidence synthesis using a sensitive search strategy in May 2022 and August 2023. Twenty-two publications between 2008 and 2023 and from ten different high-income countries were included. Thematic synthesis, underpinned by a feminist standpoint, was used to analyse the data. FINDINGS: Three main analytical themes were developed in response to each of the review questions. 'A quest for a safer birth' describes the factors influencing women's decision to freebirth. 'Powerful and powerless midwives' describes women's perceptions of their care providers (mostly midwives) and how these perceptions influenced their decision to freebirth. 'Rites of self-protection' describes women's care experiences and self-care practices in the pregnancy leading to freebirth DISCUSSION: Freebirth was rarely women's primary choice but the result of structural and relational barriers to access wanted care. Self-care in the form of freebirth helped women to achieve a positive birth experience and to protect their reproductive self-determination. CONCLUSION: A new woman-centred definition of freebirth is proposed as the practice to self-care during birth in contexts where emergency maternity care is readily available.

Health professionals' perceptions of planned home birth care within the Brazilian health system.

BACKGROUND: The American College of Obstetricians and Gynecologists, in its opinion of the Committee on Midwifery Practice, points out that planned home birth is a woman's and family's right to experience, but also to choose and be informed about, their baby's place of birth. The aim of this study was to understand obstetric nurses' perceptions of planned home childbirth care within the framework of the Brazilian obstetric model. METHOD: A qualitative study, with Snowball Sampling recruitment, totaling 20 obstetric nurses through semi-structured interviews between September 2022 and January 2023, remotely, using the Google Meet application and the recording feature. After the data had been collected, the material was transcribed in full and subjected to content analysis in the thematic modality with the support of ATLAS.ti 8.0 software. RESULTS: Obstetric care at home emerged as a counterpoint to hospital care and the biomedical model, providing care at home based on scientific evidence and humanization, bringing qualified information as a facilitator of access and financial costs as an obstacle to effective home birth. CONCLUSION: Understanding obstetric nurses' perceptions of planned home birth care in the context of the Brazilian obstetric model shows the need for progress as a public policy and for strategies to ensure quality and regulation.

Association between receiving information on obstetric complications and institutional delivery: An analysis of the demographic and health survey of Peru, 2019.

Objective: To evaluate the association between receiving information on obstetric complications and institutional delivery in Peruvian women in 2019. Methods: We conducted a secondary analysis of the 2019 Peruvian Demographic and Family Health Survey (ENDES) database. The dependent variable was the type of delivery (institutional or non-institutional). The exposure variable was self-reporting of having received information on obstetric complications during prenatal care. The association of interest was evaluated using binary logistic regression models, obtaining crude odds ratios (cOR) and adjusted odds ratios (aOR) with their respective 95 % confidence intervals (95%CI). Values of p < 0.05 were considered statistically significant. Results: We included a total of 14,835 women in the analysis. Of the total, 14,088 (94.1 %) reported having received information on pregnancy complications. Also, 13,883 (92.5 %) had an institutional delivery in their last pregnancy. The adjusted model showed that women who reported knowing the complications that can occur in pregnancy had a higher probability of presenting an institutional delivery (aOR = 1.47; 95%CI: 1.04-2.08). Conclusions: Receiving information about pregnancy complications was found to be associated with a higher probability of institutional delivery. Ensuring the provision of information to the pregnant woman about pregnancy complications can be a useful strategy to increase institutional delivery.

Determinants of non-institutional childbirth: Evidence from the Peruvian demographic and health survey.

Objective: We aimed to evaluate the determinants of non-institutional delivery among women of childbearing age in Peru. Methods: We conducted a secondary analysis of data from the Peru 2019 Demographic and Family Health Survey (ENDES). This multi-stage survey sampling is representative at the urban-rural, regional, and national levels. The outcome variable was place of delivery, collected by self-reporting. Binary logistic regression models were used to assess the factors associated with non-institutionalized delivery. Thus, we estimated crude and adjusted odd ratios (aOR). For the multivariable model, the manual forward selection method and the Wald test were used to obtain a final parsimonious model. Results: The final sample included 14,061 women of reproductive age between the ages of 15 and 49. The prevalence of non-institutional delivery was 7.8 %. Multivariate regression analysis found that having a secondary education (aOR:0.48; 95 % confidence interval [CI]:0.39-0.58) or higher (aOR:0.57; 95 %CI:0.42-0.78); belonging to the second (aOR:0.26; 95 %CI:0.20-0.33), third (aOR:0.28; 95 %CI:0.21-0.38), fourth (aOR:0.21; 95 %CI:0.13-0.33), or fifth wealth quintile (aOR:0.15; 95 %CI:0.09-0.27); and suffering intimate partner violence (aOR:0.76; 95 %CI:0.64-0.91) were associated with lower odds of non-institutional delivery, while not having some type of health insurance (aOR:3.12; 95 %CI:2.47-3.95), living in a rural area (aOR:1.93; 95 %CI:1.54-2.42), and having had three or more deliveries (aOR:1.36; 95 %CI:1.07-1.72), were associated with higher odds of non-institutional delivery. Conclusions: We found that not having health insurance, residing in a rural area, and having had three or more deliveries were factors associated with non-institutional delivery in women of childbearing age. We propose that should focus public health strategies towards providing education to women about maternal health, and likewise, facilitating access to specialized health centers for rural populations.

Exploring Women's Reasons for Choosing Home Birth with the Help of Their Untrained Family Members: A Qualitative Research.

Background: Home births with the help of untrained family members continue to be women's preference in Indonesia. However, the practice has received very little attention. The purpose of this study was to explore women's reasons for choosing home births with the help of their untrained family members. Methods: This study used an exploratory-descriptive qualitative research approach and was conducted from April 2020 to March 2021 in Riau Province, Indonesia. A total of 22 respondents determined by data saturation was recruited using purposive and snowball samplings. The respondents consisted of 12 women who had at least one planned home birth with the help of their untrained family members, and 10 untrained relatives who had an experience in intentionally assisting their family member's home birth. Data were collected through semi-structured telephone interviews. Nvivo version 11 software was used for data analysis using the Graneheim and Lundman's content analysis. Results: 13 categories and 4 themes emerged. The themes were living with fallacious beliefs in unassisted home childbirths, feeling of socially alienated from the surrounding communities, dealing with limited access to healthcare services, and escaping from childbirth-related stressors. Conclusion: Home birth with the help of untrained family members takes place because of not only limited access to healthcare services, but also women's personal beliefs, values, and needs. Designing culturally sensitive health education, ensuring culturally competent healthcare workers and services, overcoming healthcare access barriers, and improving the community's pregnancy and childbirth literacies are fundamental in reducing unassisted home births and promoting facility childbirths.

Did everyone change their childbirth plans due to the COVID-19 pandemic? A web-based cross-sectional survey of Polish pregnant women.

BACKGROUND AND AIM: With the worldwide outbreak of coronavirus, a significant impact has been observed on the functioning of healthcare systems and the process of childbirth. Women probably did not even have a choice to adjust their plans accordingly to the current situation. The aim of the study was to examine how the outbreak of the SARS CoV-2 pandemic state affected the decisions of pregnant women about their childbirth plan. DESIGN: This cross-sectional study was performed using a web-based survey published on social media in Poland. METHODS: The cross-sectional study was performed using web-based questionnaires. The study group included Polish women who changed their childbirth plans, compared to a group of women not sure about delivery plan change and those whose plans had not changed. The data were collected from 4 March 2020 to 2 May 2020, when the first rising count of new infections was observed in Poland and worldwide. Statistical analysis was performed using STATISTICA Software, Inc., 13.3 (2020). RESULTS: Of 969 women who completed the questionnaire and were enrolled into the study, 57.2% had not changed their childbirth plans (group I), 28.4% had changed their plans (group II), and 14.4% of respondents answered "not sure" to this question (group III). The majority of women changed their birth plans during the pandemic because of the potential absence of their partner during labour (56% of women who had changed their plans and 48% of those whose answer was "I am not sure", p < .001). Another reason was the fear of separation from the child after delivery (33% of women who had changed their plans and 30% of those whose answer was "I am not sure", p < .001). CONCLUSION: Restrictions due to the COVID-19 outbreak have influenced the childbirth plans of pregnant women. The changes were independent of women's vision of birth before the pandemic. IMPACT: The restriction on births with accompanying person and the risk of separation from their infant after childbirth significantly influenced the decision-making process. As a result, some women were more likely to opt for a home birth with or even without medical assistance. PATIENT OR PUBLIC CONTRIBUTION: The study participants were women who were pregnant at the time of completing the questionnaire, were over 18 years old and spoke Polish.

Applying Lessons Learned from the COVID-19 Pandemic to Future Threats to the Perinatal Care System.

INTRODUCTION: Health care systems will continue to face unpredictable challenges related to climate change. The COVID-19 pandemic tested the ability of perinatal care systems to respond to extreme disruption. Many childbearing people in the United States opted out of the mainstream choice of hospital birth during the pandemic, leading to a 19.5% increase in community birth between 2019 and 2020. The aim of the study was to understand the experiences and priorities of childbearing people as they sought to preserve a safe and satisfying birth during the time of extreme health care disruption caused by the pandemic. METHODS: This exploratory qualitative study recruited participants from a sample of respondents to a national-scope web-based survey that explored experiences of pregnancy and birth during the COVID-19 pandemic. Maximal variation sampling was used to invite survey respondents who had considered a variety of birth setting, perinatal care provider, and care model options to participate in individual interviews. A conventional content analysis approach was used with coding categories derived directly from the transcribed interviews. RESULTS: Interviews were conducted with 18 individuals. Results were reported around 4 domains: (1) respect and autonomy in decision-making, (2) high-quality care, (3) safety, and (4) risk assessment and informed choice. Respect and autonomy varied by birth setting and perinatal care provider type. Quality of care and safety were described in relational and physical terms. Childbearing people prioritized alignment with their personal philosophies toward birth as they weighed safety. Although levels of stress and fear were elevated, many felt empowered by the sudden opportunity to consider new options. DISCUSSION: Disaster preparedness and health system strengthening should address the importance childbearing people place on the relational aspects of care, need for options in decision-making, timely and accurate information sharing, and opportunity for a range of safe and supported birth settings. Mechanisms are needed to build system-level changes that respond to the self-expressed needs and priorities of childbearing people.

"It could not have been more different." Comparing experiences of hospital-based birth and homebirth in Ireland: A mixed-methods survey.

PROBLEM: Internationally, little is known about the experiences of the minority who have birthed both in hospital and at home. This group are in a unique position to provide experiential evidence regarding perceptions of care under each approach. BACKGROUND: Obstetric care within the hospital setting is the hegemonic approach to birth in western cultures. Homebirth is at least as safe as hospital birth for those with low-risk pregnancies, yet access is strictly regulated. AIM: To explore how those who have experienced both hospital and homebirth maternity care in Ireland perceived the care received, and experienced birth in each setting. METHODS: 141 participants who birthed both in hospital and at home between 2011 and 2021 completed an online survey. FINDINGS: Participants' overall experience scores were significantly higher for homebirth (9.7/10) than hospital birth (5.5/10). In hospital, midwifery-led care scored significantly higher (6.4/10) than consultant-led care (4.9/10). Qualitative data revealed four explanatory themes: 1) Regulation of birth; 2) Continuity of care and/or carer and establishing relationships; 3) Bodily integrity and informed consent; and 4) Lived experiences of labour and birth at home and in hospital. DISCUSSION: Homebirth was perceived far more positively than hospital birth experiences across all aspects of care surveyed. Findings suggest that those who have experienced both models of care have unique perspectives and aspirations about childbirth. CONCLUSION: This study provides evidence regarding the need for genuine choices for maternity care and reveals the importance of care which is respectful and responsive to divergent ideologies about birth.

Effects of an educational intervention on Nigerian midwives' intention to provide planned home birth care.

BACKGROUND: The majority of women in Sokoto, Nigeria prefer homebirths, but midwives are reluctant to provide care in the home setting. As such, many women continue to give birth at home alone or assisted by untrained attendants, which is associated with an increased risk for maternal and neonatal morbidity and mortality. METHODS: A randomized controlled trial was conducted among 226 midwives from 10 health care facilities. The intervention group received an educational program on home birth. A validated questionnaire that evaluated knowledge, attitudes, norms, perceived control, and intention to provide planned home birth care was given at baseline, immediately after the intervention, and at three-months follow-up. Data were analyzed using linear mixed-effect model statistics. RESULTS: Following the intervention, the intervention group demonstrated higher knowledge and more positive attitudes, norms, perceived control, and intention to provide planned home birth care compared with the control group (P < 0.05). No significant changes in the scores of the control group were observed during the study duration (P > 0.05). DISCUSSION: Educating midwives on planned home birth increases their willingness to provide planned home birth care. Health system administrators, policymakers, and researchers may use similar interventions to promote skilled home birth attendance by midwives. Increasing the number of midwives who are willing to attend planned home births provides women at low risk for medical complications with safer options for labor, delivery, and postpartum care.

Challenging norms: Making non-normative choices in childbearing. Results of a meta ethnographic review of the literature.

OBJECTIVE: Women have the right to make choices during pregnancy and birth that sit outside clinical guidelines, medical recommendations, or normative expectations. Declining recommended place or mode of birth, routine intervention or screening can be considered 'non-normative' within western cultural and social expectations around pregnancy and childbirth. The aim of this review is to establish what is known about the experiences, views, and perceptions of women who make non-normative choices during pregnancy and childbirth to uncover new understandings, conceptualisations, and theories within existing literature. METHODS: Using the meta-ethnographic method, and following its seven canonical stages, a systematic search of databases was performed, informed by eMERGe guidelines. FINDINGS: Thirty-three studies met the inclusion criteria. Reciprocal translation resulted in three third order constructs - 'influences and motivators', 'barriers and conflict and 'knowledge as empowerment'. Refutational translation resulted in one third order construct - 'the middle ground', which informed the line of argument synthesis and theoretical insights. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The findings of this review suggest that whilst existing literature from a range of high-income countries with similar healthcare systems to the UK have begun to explore non-normative decision-making for discrete episodes of care and choices, knowledge based, theoretical and population gaps exist in relation to understanding the experiences of, and wider social processes involved in, making non-normative choices across the UK maternity care continuum.

Amazon women's motivations to choose planned home childbirth / Motivaciones de mujeres de la región amazónica para elegir parto domiciliario planificado / Motivações de mulheres amazônidas para tomada de decisão do parto domiciliar planejado

ABSTRACT Objective: to understand the meanings attributed by Amazon women regarding their motivation grounds to choose planned home childbirth. Method: a research study of a qualitative nature. The study data collection tool consisted of semi-structured interviews with 20 Amazon women who underwent home childbirths between November 2021 and March 2022, through the Snowball Sampling recruitment technique. After data collection, the interviews followed the content analysis criteria. Results: it was observed that qualified information, support networks and groups produce motivation and a feeling for home childbirth, which contribute to breaking away from the hegemonic model in Obstetrics and, thus, to refusing unnecessary interventions resulting from the established medical knowledge that oftentimes culminates in obstetric violence. Safety also emerged as a central factor to experience home childbirth, such as feelings of freedom, courage and empowerment about their choices and wishes. Conclusion: there is convergence with the current demands on positive care regarding respect for women's choice, which, through support and information, are central aspects to ensure assistance according to Amazon women's expectations, in order to break away from the hegemonic model in obstetric care, as home childbirth effectively guarantees their will, which must be heard and respected.

RESUMEN Objetivo: comprender los significados que atribuyen las mujeres de la región amazónica a sus bases motivadoras para elegir parto domiciliario planificado. Método: investigación de carácter cualitativo. La herramienta de recolección de datos del estudio correspondió a entrevistas semiestructurada con 20 mujeres de la región amazónica que dieron a luz en sus casas entre los meses de noviembre de 2021 y marzo de 2022, por medio de la técnica de reclutamiento Snowball Sampling. Después de recolectar los datos, las entrevistas siguieron los criterios del análisis de contenido. Resultados: se observó que la información calificada y las redes y los grupos de apoyo generan motivación y cierto sentimiento favorable hacia el parto domiciliario, que contribuyen a distanciarse del modelo hegemónico en Obstetricia y, de ese modo, rechazar intervenciones innecesarias resultantes del saber médico instituido que muchas veces culmina en violencia obstétrica. La seguridad también surgió como un factor central para vivir el parto en el domicilio, como ser sentimientos de libertad, coraje y empoderamiento sobre sus elecciones y deseos. Conclusión: se detecta convergencia con las exigencias actuales sobre la atención positiva en términos de respetar las decisiones de las mujeres, las cuales, por medio de apoyo e información, constituyen aspectos centrales para garantizar una asistencia acorde a las expectativas de las mujeres de la región amazónica, a fin de interrumpir el modelo hegemónico en la asistencia obstétrica, puesto que el parto domiciliario garantiza en forma efectiva su voluntad, que debe ser escuchada y respetada.

RESUMO Objetivo: compreender os significados das mulheres amazônidas quanto às suas bases motivadoras para tomada de decisão do parto domiciliar planejado. Método: pesquisa de natureza qualitativa. O estudo teve como ferramenta de coleta de dados a entrevista semiestruturada, com 20 mulheres amazônidas que tiveram partos em casa, entre os meses de novembro de 2021 a março de 2022, por intermédio do recrutamento Snowball Sampling. Após a coleta de dados, as entrevistas seguiram os critérios de análise de conteúdo. Resultados: observou-se que a informação qualificada, rede e grupo de apoio produzem motivação e sentimento para o parto domiciliar, que contribuem para romper com o modelo hegemônico na obstetrícia, e, assim, recusar intervenções desnecessárias, resultantes do saber médico instituído que, culmina, muitas vezes, na violência obstétrica. A segurança, também, constituiu um fator central para vivenciar o parto no domicílio, como sentimentos de liberdade, coragem e empoderamento sobre suas escolhas e vontades. Conclusão: há convergência com as demandas atuais sobre o cuidado positivo perante o respeito da tomada de decisão feminina que, por meio do apoio e informação, constituem aspectos centrais para garantir uma assistência conforme as expectativas das mulheres amazônidas, a fim de romper com o modelo hegemônico na assistência obstétrica, visto que o parto em casa garante de forma efetiva a sua vontade, que deve ser ouvida e respeitada.

Planned home births in Joinville: epidemiological profile of women and maternal and neonatal outcomes / Partos domiciliarios planificados ocurridos en Joinville: perfil epidemiológico de la mujer y resultados maternos y neonatales / Partos domiciliares planejados ocorridos em Joinville: perfil epidemiológico das mulheres e desfechos maternos e neonatais

ABSTRACT Objective: To identify the epidemiological profile of women who opted for planned home birth in a city in the north of Santa Catarina and to present the main maternal and neonatal outcomes. Method: Quantitative, cross-sectional research, with retrospective and documentary data collection carried out in 66 medical records of women who had planned home births from January 2012 to March 2020, in Joinville. The data were organized in tables and analyzed in a descriptive way. Results: The women who opted for planned home birth have a mean age of 31 years, are mostly white, married, with higher education, multiparous, planned pregnancy and performed prenatal care properly. Maternal and neonatal outcomes were positive, with low transfer rates, none being neonatal, and no cases of maternal morbidity. Conclusion: The evidence found proved to be satisfactory for the implementation of a new model of health care for women and children.

RESUMEN Objetivo: Identificar el perfil epidemiológico de las mujeres que optaron por el parto domiciliario planificado en un municipio del norte de Santa Catarina y presentar los principales desenlaces maternos y neonatales. Método: Investigación cuantitativa, de corte transversal, con recolección de datos retrospectiva y documental, realizada en 66 historias clínicas de mujeres que tenían parto domiciliario planeado de enero de 2012 a marzo de 2020, en Joinville. Los datos fueron organizados en tablas y analizados de forma descriptiva. Resultados: Las mujeres que optaron por el parto domiciliario planificado tienen una edad promedio de 31 años, son en su mayoría blancas, casadas, con estudios superiores, multiparidad, embarazo planificado y realizaron el control prenatal adecuadamente. Los resultados maternos y neonatales fueron positivos, con bajas tasas de transferencia, ninguna neonatal y ningún caso de morbilidad materna. Conclusión: La evidencia encontrada resultó satisfactoria para la implementación de un nuevo modelo de atención a la salud de la mujer y el niño.

RESUMO Objetivo: Identificar o perfil epidemiológico de mulheres que optaram pelo parto domiciliar planejado em um município localizado no norte de Santa Catarina e apresentar os principais desfechos maternos e neonatais. Método: Pesquisa quantitativa, transversal, com coleta de dados retrospectiva e documental, realizada em 66 prontuários de mulheres que tiveram parto domiciliar planejado de janeiro de 2012 a março de 2020, em Joinville. Os dados foram organizados em tabelas e analisados de maneira descritiva. Resultados: As mulheres que optaram pelo parto domiciliar planejado têm média de 31 anos de idade, são, majoritariamente, brancas, casadas, com ensino superior completo, multigestas, planejaram a gestação e realizaram o pré-natal adequadamente. Os desfechos maternos e neonatais foram positivos, com baixa taxa de transferência, sendo nenhuma neonatal, e nenhum caso de morbidade materna. Conclusão: As evidências constatadas demonstraram-se satisfatórias para a implementação de um novo modelo de atenção à saúde da mulher e da criança.

Professional autonomy in dealing with complications: discourse of obstetric nurses working in planned home births / Autonomía profesional en el enfrentamiento de las complicaciones: discurso de enfermeros obstetras que actúan en partos domiciliarios planificados / Autonomia profissional na condução de intercorrências: discurso de enfermeiras obstétricas atuantes em parto domiciliar planejado

ABSTRACT Objective: to understand the exercise of professional autonomy by obstetric nurses in dealing with complications in planned home births. Methods: this is a qualitative study, supported by the Discourse of the Collective Subject methodological framework, whose data collection took place from January to March 2021, through interviews guided by a semi-structured script, in which seven midwives who are members of a childbirth care collective in northeastern Brazil and who work in the home context participated. Results: four central ideas emerged from the collective discourses related to the exercise of professional autonomy by obstetric nurses: shared decisions; theoretical-practical instrumentalization; professional expertise; and teamwork. Final considerations: obstetric nurses' autonomy in the face of complications reflects the safety of planned home births and is based on collective critical thinking, reinforcing this professional' leading role in obstetrics.

RESUMEN Objetivo: comprender el ejercicio de la autonomía profesional de las matronas en el manejo de las complicaciones en los partos domiciliarios planificados. Métodos: se trata de un estudio cualitativo, sustentado en el marco metodológico del Discurso del Sujeto Colectivo, cuya recolección de datos ocurrió de enero a marzo de 2021, a través de entrevistas guiadas por un guión semiestructurado, en el que participaron siete parteras integrantes de un colectivo de atención al parto en el Nordeste de Brasil y que actúan en el contexto domiciliario. Resultados: surgieron cuatro ideas centrales de los discursos colectivos relacionados con el ejercicio de la autonomía profesional de las matronas: decisiones compartidas; instrumentalización teórico-práctica; experiencia profesional; y trabajo en equipo Consideraciones finales: la autonomía de las enfermeras obstétricas frente a las complicaciones refleja la seguridad de los partos domiciliarios planificados y se basa en el pensamiento crítico colectivo, reforzando el papel de este profesional en obstetricia.

RESUMO Objetivo: compreender o exercício da autonomia profissional de enfermeiras obstétricas na condução de intercorrências em parto domiciliar planejado. Métodos: trata-se de um estudo qualitativo, amparado no referencial metodológico do Discurso do Sujeito Coletivo, cuja coleta de dados se deu no período de janeiro a março de 2021, por meio de entrevistas guiadas por roteiro semiestruturado, das quais participaram sete enfermeiras obstétricas integrantes em um coletivo de assistência ao parto do Nordeste do Brasil e que atuam no contexto domiciliar. Resultados: emergiram dos discursos coletivos quatro ideias centrais relacionadas ao exercício da autonomia profissional de enfermeiras obstétricas: decisões compartilhadas; instrumentalização teórico-prática; expertise profissional; e trabalho em equipe. Considerações finais: a autonomia das enfermeiras obstétricas diante das intercorrências reflete a segurança do parto domiciliar planejado e está pautada no pensamento crítico coletivo, reforçando o protagonismo desta profissional na atuação em obstetrícia.

A vivência da mulher no parto domiciliar planejado: uma jornada transpessoal / The experience of women in planned home birth: a transpersonal journey

Resumo: Algumas mulheres brasileiras vêm, ao longo das últimas décadas, buscando locais e modos alternativos ao hospital de parir e nascer, buscando também a assistência de enfermeiras obstetras. O cuidado prestado por estas profissionais deve unir conhecimentos técnico-científicos e saberes que contemplem as diversas dimensões da existência humana (físicas, emocionais, psíquicas, sociais e espirituais), razão pela qual o presente estudo fundamenta-se no referencial teórico do Cuidado Transpessoal, proposto pela Ciência do Cuidado Unitário de Jean Watson. Para fomentar a reflexão sobre os impactos multidimensionais do Parto Domiciliar Planejado na individualidade e na sociedade, questionou-se "como as mulheres vivenciam seus partos domiciliares planejados?". Da conclusão desta tese foi possível interpretar a vivência de mulheres que tiveram o Parto Domiciliar Planejado, elaborar uma teoria substantiva que explicitasse esta vivência e, por fim, propor contribuições para a prática profissional que fomentem o cuidado e vivências transpessoais no parto e nascimento. A presente tese tratou-se de uma pesquisa qualitativa, do tipo interpretativista, que utilizou como referencial metodológico a Teoria Fundamentada nos Dados. O estudo ocorreu entre dezembro de 2018 a dezembro 2022, sendo a coleta de dados, do grupo-piloto ao quarto grupo amostral, realizada entre outubro de 2020 a março de 2022. Por amostragem teórica, foram entrevistadas vinte e seis mulheres que tiveram seus partos em domicílio, de forma planejada, entre os anos de 2007 a 2021. Como recurso de fonte de dados, utilizaram-se entrevistas audiogravadas, a partir de roteiro semiestruturado composto por questões abertas e orientadoras, além de produções estéticas, recurso inspirado no método criativo sensível e na pesquisa baseada em artes, produzidas pelas mulheres, referentes às suas vivências. Para a análise, foi utilizada a corrente glaseriana, que envolveu codificações substantivas e teóricas, apoiadas pelo uso de memos, diagramas, e do software NVivo® para a organização dos dados. A partir da análise, elaborou-se a teoria substantiva "A vivência da mulher no Parto Domiciliar Planejado: uma jornada transpessoal", composta por um conceito central, três conceitos, seis subconceitos e vinte e cinco unidades de sustentação, que foi validada por pesquisadores experts e mulheres com vivência em parto domiciliar planejado. A partir dessa teoria substantiva, publicaram-se dois ensaios teóricos em periódico científico, e propõe-se sua inclusão na formação profissional obstétrica fundamentada no cuidado transpessoal, bem como utilizá-la como um guia para mulheres que estão iniciando na jornada. Acredita-se que essas contribuições para a prática, quando implementadas, serão capazes de favorecer a melhoria da qualidade prestada e mudança do cuidado ao parto e nascimento, tanto no âmbito institucional como no domiciliar, impactando positivamente pessoas e sociedade por meio das transformações oportunizadas pela vivência de um parto domiciliar planejado.

Abstract: Over the last decades, some Brazilian women have been searching for places and alternative ways, rather than a hospital, to labor and delivery, also seeking for the obstetric nurses' assistance. The care provided by these professionals must join technical-scientific knowledge, as well as knowledge that contemplates the various dimensions of human existence (physical, emotional, psychological, social, and spiritual), which is why the present study is based on the theoretical framework of the Transpersonal Care, proposed in Jean Watson's Unitary Caring Science. To encourage reflection on the multidimensional impacts of Planned Homebirth on individuals and society, the question asked was "how do women experience their planned home births?". From the conclusion of this thesis, it was possible to interpret the experience of women who had Planned Homebirth, to elaborate a substantive theory that explained this experience and, finally, to propose contributions to professional practice that promote care and transpersonal experiences in labor and delivery. This thesis was an interpretive qualitative research, which used the Grounded Theory as a methodological framework. The study took place between December 2018 and December 2022, and data collection, from the pilot group to the fourth sample group, was carried out between October 2020 and March 2022. By theoretical sampling, twenty-six women were interviewed, who had planned home births between 2007 and 2021. As a data source, audio-recorded interviews were used, by means of a semi-structured questionnaire with open, guiding questions, and art productions, a resource inspired by the sensitive creative method and art-based research, performed by the women, regarding their lived experiences. For the analysis, the Glaserian approach was used, which comprised substantive and theoretical coding, supported by memos, diagrams, and the NVivo® software for data organization. Based on the analysis, the substantive theory "Women's experience in Planned Home birth: a transpersonal journey" was elaborated, entailing one core concept, three concepts, six subconcepts and twenty-five supporting units, which was validated by expert researchers and women with experience in planned home birth. Based on this substantive theory, two theoretical essays were published in a scientific journal, and its inclusion in a professional obstetric training course grounded in the transpersonal care has been proposed. Its use has also been proposed as a guide for women who are starting their labor and delivery journey. It is believed that these contributions to practice, when implemented, will be able to favor the improvement of the quality provided and change of care during labor and birth, both institutional and home settings, positively impacting on people and society through the transformations provided by the experience of a planned home birth.

Experiências de partos não planejados fora do ambiente hospitalar / Experiences of unplanned deliveries outside the hospital environment

Objetivo: identificar as experiências das mães em partos não planejados fora do ambiente hospitalar. Metodologia: Foi realizada revisão integrativa nas bases de dados Medline e SciVerse Scopus. Foram incluídas publicações em inglês e em português, no período entre 2000 e 2021. A amostra final foi composta de quatro artigos. Resultados: As experiências vividas se mostram ambíguas, com relatos de vulnerabilidade, estresse e culpa, mas, também, sensações de sorte, alívio e orgulho após o nascimento. Ainda, o tempo de deslocamento até uma instituição de saúde é determinante na realização de partos fora do ambiente hospitalar. Outros fatores que influenciam na ocorrência dizem respeito às mães solo, baixa escolaridade e falta de assistência pré-natal. Conclusões: O nível de desenvolvimento socioeconômico do país é um fator decisivo, no qual mães procedentes de países desenvolvidos sentiam-se mais seguras com a experiência do que as mães de países em desenvolvi-mento. Além disso, a educação médica baseada em um atendimento humanizado potencializou a promoção de uma vivência positiva em relação ao parto não planejado fora do ambiente hospitalar para as mulheres. (AU)

Objective: This study aims to identify the experiences of mothers that gave an unplanned out-of-hospital birth. Design: An integrative review was performed in Medline and SciVerse Scopus databases. Publications in English and Portuguese, covering the period between 2000 and 2021, were included. The final selection consisted of four articles. Results: The experiences are ambiguous, showing vulnerability, stress, and guilt, but also feelings of good fortune, relief, and pride after labor. Furthermore, the time spent traveling to a health institution is a determinant of births out of the hospital. Other factors influencing the occurrence are related to single mothers, insufficient education, and lack of prenatal care. Conclusion: It is acknowledged that the country's socio-economic develop-ment level is a decisive factor, in which mothers from developed countries felt more secure with the experience than mothers from developing countries. In addition, medical education based on humanized care has enhanced the promotion of a positive experience concerning unplanned childbirth in an out-of-hospital environment for women. (AU)

Smooth Transitions: Enhancing Interprofessional Collaboration when Planned Community Births Transfer to Hospital Care.

In Washington state, planned community births are attended by direct entry licensed midwives (LMs) and certified nurse-midwives (CNMs). The most recently published vital statistics data from 2018 reported that 3.6% of the 84,648 births in Washington occurred at home or in freestanding birthing centers. Approximately 16.2% of planned home birth and birth center clients experience intrapartum or early postpartum transfer to the hospital, while 1.8% of their newborns do. The safety of and satisfaction with these types of referrals depends on multisystem processes performed by a variety of health care professionals. Smooth Transitions is a quality improvement (QI) initiative in Washington state that was developed to enhance interprofessional collaboration between community-based midwives, emergency medical services (EMS), and hospital personnel to improve the quality of hospital transfers from planned community settings. Key interventions to date have included (1) information sharing to dispel misconceptions and provide context regarding community births and midwives; (2) co-creation of transfer guidelines; (3) regularly held interprofessional meetings to review transfers and build relationships; and (4) ongoing review of qualitative feedback that captures the perspectives of all involved. Responses on questionnaires and audits indicate that Smooth Transitions has had a positive impact on provider, staff, and patient experiences with hospital transfers. Future endeavors will include strengthening quantitative data collection processes to measure safety indicators, expanding relationships with EMS, and building a case review process that is legally protected. By engaging representatives of all stakeholder groups and addressing community-to-hospital transfers as a multisystems issue, replication of the Smooth Transitions QI Program nationally could promote increased community midwifery integration by enhancing the referral experience for both patients and caregivers.

Traditional birth attendant-assisted versus unassisted births: a comparison of neonatal deaths in Nigeria, 2008-2018.

PURPOSE: to directly compare the risk of neonatal death between traditional birth attendant (TBA)-assisted and unassisted deliveries in Nigeria. METHODS: Using data on live births from the 2008, 2013, and 2018 Nigeria Demographic and Health Surveys, this cross-sectional study compared risk of neonatal death for TBA-assisted versus unassisted births. We used survey-featured logistic regression to estimate the odds of neonatal death. Survey year-stratified and propensity score-matched (PSM) estimates were obtained. Multivariate imputation by chained equation (MICE) for missing data was conducted. RESULTS: A total of 28, 922 births were included. Regression and PSM analysis of pooled data showed that unassisted births had lower odds of neonatal death compared to TBA-assisted births, (aOR 0.81, 95% CI: 0.65,1.00) and (aOR 0.80, 95% CI: 0.64,1.00), respectively. Regression analysis by survey year yielded non-significant higher odds of neonatal death for TBA-assisted births. Pooled estimates from MICE showed non-significant higher odds of death for TBA-assisted births. CONCLUSIONS: These findings indicate that birth care by TBAs do not necessarily lead to better neonatal survival. Jurisdictions seeking to allow continued operation of TBAs need to consider measures such as training, supervision, and regulation to ensure the safety of newborns.

Characteristics of Homebirth in Hungary: A Retrospective Cohort Study.

Homebirth is legal and has been regulated by law in Hungary since 2012. Despite the obvious advantages of homebirth, it has not yet been broadly accepted, due to various opinions related to safety and risks associated with giving birth outside of a hospital. Our study aimed at exploring both real maternal and feto-neonatal characteristics associated with Hungarian homebirths. A total of 2997 cases were considered in support of our retrospective cohort study. In the examined period, there was a significant, continual rise in the number of homebirths by a rate of 0.22% on average per year. Aggregated maternal complications (primary uterine inertia, prolonged second stage labour, and third stage haemorrhage) were prevalent among homebirth cases (1.29% vs. 0.72%, p < 0.05) and were associated with an average of 11.77% rate of transfer to a health care institution. On the other hand, the rate of operative (vaginal or caesarean) delivery was 26.31% among institutionalized births. A slightly better Apgar score and relatively high rate (20%) of caesarean deliveries were correlated with institutionalized births (p < 0.05). However, the overall intervention rate was lower among homebirths (0.11% vs. 42.57%) than institutional birth cases (p < 0.001). Overall, homebirth is a reliable option for childbirth for healthy and low-risk mothers with uncomplicated pregnancies, which is reflected in the increasing number of deliveries at home in Hungary. Furthermore, utilizing the experiences of countries where homebirth is a long-established method may further improve the outcome of homebirths in Hungary.