Condições de nascimento e desigualdade social / Conditions of birth and social inequality

O presente trabalho toma como objeto de estudo as relações existentes entre condições de nascimento de crianças de baixo peso e não baixo peso ao nascer, condições de assistência e condições de classe. Busca reter as possibilidades e os limites para o emprego do conceito de classes sociais em pesquisas empíricas no campo da Saúde Pública e Coletiva tendo em vista as mudanças operadas no capitalismo atual pelo processo de globalização...

Practices related to postpartum uterine involution in the Western Highlands of Guatemala.

BACKGROUND: Guatemala has the third highest level of maternal mortality in Latin America. Postpartum haemorrhage is the main cause of maternal mortality. In rural Guatemala, most women rely on Traditional Birth Attendants (TBAs) during labour, delivery, and the postpartum period. Little is known about current postpartum practices that may contribute to uterine involution provided by Mam- and Spanish-speaking TBAs in the Western Highlands of Guatemala. METHODS: a qualitative study was conducted with 39 women who participated in five focus groups in the San Marcos Department of Guatemala. Questions regarding postpartum practices were discussed during four focus groups of TBAs and one group of auxiliary nurses. RESULTS: three postpartum practices believed to aid postpartum uterine involution were identified: use of the chuj (Mam) (Spanish, temazcal), a traditional wood-fired sauna-bath used by Mam-speaking women; herbal baths and teas; and administration of biomedicines. CONCLUSIONS: TBAs provide the majority of care to women during childbirth and the postpartum period and have developed a set of practices to prevent and treat postpartum haemorrhage. Integration of these practices may prove an effective method to reduce maternal morbidity and mortality in the Western Highlands of Guatemala.

A review of cultural influence on maternal mortality in the developing world.

OBJECTIVE: identify research examining the effect of culture on maternal mortality rates. DESIGN: literature review of CINAHL, Cochrane, PsychInfo, OVID Medline and Web of Science databases. SETTING: developing countries with typically higher rates of maternal mortality. PARTICIPANTS: women, birth attendants, family members, nurse midwives, health-care workers, and community members. MEASUREMENTS AND FINDINGS: reviews, qualitative and mixed-methods research have identified components of culture that have a direct impact on maternal mortality. Examples of culture are given in the text and categorised according to the way in which they impact maternal mortality. KEY CONCLUSIONS: cultural customs, practices, beliefs and values profoundly influence women's behaviours during the perinatal period and in some cases increase the likelihood of maternal death in childbirth. The four ways in which culture may increase MMR are as follows: directly harmful acts, inaction, use of care and social status. IMPLICATIONS FOR PRACTICE: understanding the specifics of how the culture surrounding childbirth contributes to maternal mortality can assist nurses, midwives and other health-care workers in providing culturally competent care and designing effective programs to help decrease MMR, especially in the developing world. Interventions designed without accounting for these cultural factors are likely to be less effective in reducing maternal mortality.

ACNM essential documents: a midwife's suit of armor.

As the oldest professional midwifery organization in the United States, The American College of Nurse Midwives (ACNM) represents the profession of midwifery in the United States and sets standards for education, certification, and practice. The ACNM has generated and revised several critical documents that provide guidance for the scope of midwifery practice, individually and collectively. This article reviews essential ACNM documents and their role in supporting professional midwifery.

Jidda: the traditional midwife of Yemen?

Contrary to what is assumed, traditional birth attendants (TBAs) do not appear to be a clearly defined category of women with specialized knowledge and experience of assistance at deliveries in the local cultural situation at village level in the Anis region of the central highlands in Yemen. In the actual design of training for TBAs in Yemen, this results in problematic provision of basic mother and child health care, in particular safe and clean deliveries to all women at village level.

Malay midwives and witches.

This paper attempts to analyse professional rivalry and dissonance amongst traditional Malay midwives (bidan kampung) in the Northwest areas of Peninsular Malaysia. It elucidates how techniques of symbolic and ritual communication are carefully monitored by these female specialists, to develop regular clientele and professional credibility over time. However, since an integral element of Malay midwifery is protection from and mastery over mystical forces in nature and evil spirits harboured by witches, a midwife is also an exorcist with skills rather similar to the Malay bomoh (traditional medical practitioner, usually male) except that her range of knowledge of witchcraft is limited to diagnostic and curative rituals of spirit-possession, in infants and children, young unmarried women and pregnant mothers. Within a restricted population area, professional rivalries and competition amongst midwives regularly surface in oblique attacks of witchcraft accusations where the accused strives to maintain her credibility while her accuser gradually wins over her clientele. Significantly, codes of professionalism in traditional Malay midwifery are not only determined by skill and experience, but also religiousness (faith in Islam), benevolence, virtue, diligence and a sense of equality and fair-play in the practice of the trade. These qualities are seemingly lacking in witches who are conceived to be anti-Islamic, uncompromising, manevolent and destructive. Thus, government midwives who threaten the popularity of traditional midwives by being particularly active in their work or supervising and controlling midwives in an authoritarian way, are also labelled as witches. Generally, while midwifery and witchcraft reflect two forms of knowledge that are structurally opposed, in ideology and morality, they exist within the same sphere of ritual and symbolic communication where the practitioners aided by their clients, shift from one state of dissonance to another in an attempt to regulate behaviour.