Midwives' experiences with screening for intimate partner violence in Santiago, Chile.

Although intimate partner violence (IPV) is well-established as a highly prevalent global issue, research examining the experience of health providers who screen women at risk for IPV is scarce. We aimed to explore the experience of midwives in primary health care centers in Santiago, Chile, regarding identification of at-risk women and barriers to screening. We highlight the intersection of complex issues of global relevance, such as culture, language, provider-patient relationships, and allocation of time and resources. In our results, we illustrate the importance of providing midwives extended time, interpreter services, and cross-cultural education to address IPV in their transcultural context.

[Prevalence and factors associated with partner violence among pregnant and puerperal women in Santiago, Chile]. / Violencia contra la mujer durante la gestación y postparto infligida por su pareja en Centros de Atención Primaria de la zona norte de Santiago, Chile.

BACKGROUND: Violence against women (VAW) is a violation of women's fundamental rights and special attention must be paid during the gestational and postpartum period. AIM: To determine the prevalence of violence against women attending antenatal and postpartum controls in Primary Health Centers. MATERIAL AND METHOD: The Woman Abuse Screening Tool (WAST) for early detection of VAW was applied to 279 pregnant and 102 puerperal women attending five public primary health centers in metropolitan Santiago. RESULTS: The prevalence ofviolence against pregnant and puerperal women was 5.7 and 5.9%, respectively. In both groups, the factors associated with a greater risk of violence were being immigrants, a history of domestic violence, not having a supportive partner and alcohol consumption by the partner. CONCLUSIONS: Violence against these women is a multifactorial, complex and structural phenomenon, which involves the victim, the abuser and the entire social system. Primary health care level and health professionals can be key elements applying early detection strategies, timely referral mechanisms and bringing emotional support for victims.

Variations in use of childbirth interventions in 13 high-income countries: A multinational cross-sectional study.

BACKGROUND: Variations in intervention rates, without subsequent reductions in adverse outcomes, can indicate overuse. We studied variations in and associations between commonly used childbirth interventions and adverse outcomes, adjusted for population characteristics. METHODS AND FINDINGS: In this multinational cross-sectional study, existing data on 4,729,307 singleton births at ≥37 weeks in 2013 from Finland, Sweden, Norway, Denmark, Iceland, Ireland, England, the Netherlands, Belgium, Germany (Hesse), Malta, the United States, and Chile were used to describe variations in childbirth interventions and outcomes. Numbers of births ranged from 3,987 for Iceland to 3,500,397 for the USA. Crude data were analysed in the Netherlands, or analysed data were shared with the principal investigator. Strict variable definitions were used and information on data quality was collected. Intervention rates were described for each country and stratified by parity. Uni- and multivariable analyses were performed, adjusted for population characteristics, and associations between rates of interventions, population characteristics, and outcomes were assessed using Spearman's rank correlation coefficients. Considerable intercountry variations were found for all interventions, despite adjustments for population characteristics. Adjustments for ethnicity and body mass index changed odds ratios for augmentation of labour and episiotomy. Largest variations were found for augmentation of labour, pain relief, episiotomy, instrumental birth, and cesarean section (CS). Percentages of births at ≥42 weeks varied from 0.1% to 6.7%. Rates among nulliparous versus multiparous women varied from 56% to 80% versus 51% to 82% for spontaneous onset of labour; 14% to 36% versus 8% to 28% for induction of labour; 3% to 13% versus 7% to 26% for prelabour CS; 16% to 48% versus 12% to 50% for overall CS; 22% to 71% versus 7% to 38% for augmentation of labour; 50% to 93% versus 25% to 86% for any intrapartum pain relief, 19% to 83% versus 10% to 64% for epidural anaesthesia; 6% to 68% versus 2% to 30% for episiotomy in vaginal births; 3% to 30% versus 1% to 7% for instrumental vaginal births; and 42% to 70% versus 50% to 84% for spontaneous vaginal births. Countries with higher rates of births at ≥42 weeks had higher rates of births with a spontaneous onset (rho = 0.82 for nulliparous/rho = 0.83 for multiparous women) and instrumental (rho = 0.67) and spontaneous (rho = 0.66) vaginal births among multiparous women and lower rates of induction of labour (rho = -0.71/-0.66), prelabour CS (rho = -0.61/-0.65), overall CS (rho = -0.61/-0.67), and episiotomy (multiparous: rho = -0.67). Variation in CS rates was mainly due to prelabour CS (rho = 0.96). Countries with higher rates of births with a spontaneous onset had lower rates of emergency CS (nulliparous: rho = -0.62) and higher rates of spontaneous vaginal births (multiparous: rho = 0.70). Prelabour and emergency CS were positively correlated (nulliparous: rho = 0.74). Higher rates of obstetric anal sphincter injury following vaginal birth were found in countries with higher rates of spontaneous birth (nulliparous: rho = 0.65). In countries with higher rates of epidural anaesthesia (nulliparous) and spontaneous births (multiparous), higher rates of Apgar score < 7 were found (rhos = 0.64). No statistically significant variation was found for perinatal mortality. Main limitations were varying quality of data and missing information. CONCLUSIONS: Considerable intercountry variations were found for all interventions, even after adjusting for population characteristics, indicating overuse of interventions in some countries. Multivariable analyses are essential when comparing intercountry rates. Implementation of evidence-based guidelines is crucial in optimising intervention use and improving quality of maternity care worldwide.

Status of national policy on companion of choice at birth in Latin America and the Caribbean: Gaps and challenges.

The World Health Organization (WHO) recommends a companion of choice during labor and birth, to improve maternal and perinatal outcomes and women's satisfaction with health services. To better understand the status of companion of choice in Latin America and the Caribbean (LAC), an online survey was conducted with members of a midwifery virtual community of practice and with key informants, aiming to identify: 1) existing regulatory instruments related to companion of choice in the countries where the members are practicing; and, 2) key characteristics of implementation of companion of choice, where regulation exists. Responses (n = 112) were received from representatives of 20 of the 43 countries of LAC. Respondents reported existence of a national policy or legislation in seven countries, ministerial norms or institutional protocols in five countries, and no existing policy/protocol in eight countries. Respondents from the same country often provided contradictory responses. Responses differed from information provided by ministries of health in a WHO-led global policy survey in 11 instances. These variations may reflect that midwives were not always aware of the national policy/guideline in their country. We propose that a more robust effort should be undertaken to understand the status of companion of choice for labor and birth in LAC countries, at national, regional, and local level, in public and private facilities. It is important to know if policies exist, at what level of the system, and if key stakeholders, maternity-care health providers, and women are aware of their existence. Efforts should also be made to understand barriers to implementing companion of choice.

La Organización Mundial de la Salud (OMS) recomienda la presencia de un acompañante durante el trabajo de parto y el parto debido a que mejora los resultados maternos y perinatales y la satisfacción de las mujeres con los servicios de salud. Para comprender mejor la situación acerca de los acompañantes en América Latina y el Caribe (ALC) se llevó a cabo una encuesta en línea dirigida a miembros de una comunidad de práctica de partería e informantes clave con el objetivo de identificar: 1) los instrumentos regulatorios existentes relacionados con la presencia de acompañante en los países en los que ejercen las personas encuestadas y 2) las características clave relacionadas con la implementación del acompañante, en los lugares donde existe un marco regulatorio. Se recibieron 112 respuestas de 20 de los 43 países de ALC. Las personas encuestadas informaron la existencia de una política o legislación nacional en siete países, de normas ministeriales o protocolos institucionales en cinco países, y de la inexistencia de una política o un protocolo en ocho países. Las respuestas provenientes del mismo país a menudo fueron contradictorias, y en 11 casos estas difirieron de la información proporcionada por los ministerios de salud en una encuesta mundial sobre políticas dirigida por la OMS. Estas variaciones pueden reflejar que los profesionales de la partería no siempre conocían la política o el protocolo de su país. Debe emprenderse un esfuerzo más firme para comprender la situación relacionada con el acompañante durante el trabajo de parto y el parto en los países de ALC a nivel nacional, regional y local, tanto en instituciones públicas como privadas. Es importante conocer si existen políticas y en qué nivel del sistema y si los principales interesados, los prestadores de servicios de salud materna y las mujeres conocen su existencia. Se deben realizar esfuerzos para comprender los obstáculos que impiden la implementación de la presencia de un acompañante durante el parto.

A Organização Mundial da Saúde (OMS) recomenda a presença de um acompanhante durante o trabalho de parto e parto, já que essa medida melhora os resultados maternos e perinatais e a satisfação da mulher com os serviços de saúde. Para caracterizar a situação dos acompanhantes na América Latina e Caribe (ALC), realizou-se uma pesquisa on-line com membros de uma comunidade de prática de profissionais de obstetrícia e com informantes chaves para identificar: 1) a existência de instrumentos regulatórios relacionados com a presença de acompanhante nos países onde os respondentes atuam e 2) características chaves relacionadas com a implementação das políticas de acompanhantes nos locais onde existe regulamentação. Foram recebidas 112 respostas de 20 dos 43 países da ALC. Os respondentes relataram a existência de uma política ou legislação nacional em sete países, normas ministeriais ou protocolos institucionais em cinco países e nenhuma política ou protocolo em oito países. Respondentes de um mesmo país deram muitas vezes respostas contraditórias. Em 11 casos, as respostas diferiram das informações fornecidas pelos ministérios da saúde em uma pesquisa de políticas globais realizada pela OMS. Essas variações podem indicar que os profissionais nem sempre conheciam a política ou protocolo em vigor no seu país. Propõe-se a necessidade de iniciativas mais robustas para compreender a situação do acompanhante no trabalho de parto em países da ALC, em nível nacional, regional e local, tanto em instituições públicas como privadas. É importante saber se as políticas existem, em que nível do sistema existem e se as principais partes interessadas, os provedores de cuidados de saúde materna e as mulheres estão cientes de sua existência. São necessários esforços para compreender os obstáculos à implementação do sistema de acompanhante de parto.

Dimensions of childbirth care associated with maternal satisfaction among low-risk Chilean women.

The authors of this study aimed to describe the level of maternal satisfaction during labor reported by a national sample of low-risk childbearing women in Chile by identifying the dimensions of intrapartum care most determinant for overall satisfaction. Maternal satisfaction was measured in the postpartum period with an instrument previously validated in Chile. Almost half of the participants (49.4%) reported having optimal satisfaction, 29% adequate, and 22% worse. Treatment of women by professionals and the physical environment were the most important dimension predicting of maternal satisfaction, consistent with findings from developing countries emphasizing patient-provider interaction during labor as a key component of birth care quality.

Clinical nursing and midwifery research in Latin American and Caribbean countries: A scoping review.

AIM: To identify and describe published, nursing-led and midwifery-led, clinical research that has been conducted in Latin America and the Caribbean. BACKGROUND: Peer-reviewed published research may correspond to and elucidate country's realities, priorities, and needs. DESIGN: A 6-stage scoping review methodology was used to search scientific databases using an applied search strategy. DATA SOURCES: Five databases were searched for articles published in English, Spanish, or Portuguese conducted in a Latin American or Caribbean country between January 1, 2006 and June 14, 2016. REVIEW METHODS: Articles were independently considered for inclusion by 2 researchers, data extracted, and study characteristics described. RESULTS: Of 6922 articles identified, 404 were included. The majority were conducted in Brazil (90.6%) followed by Chile (2.5%). Most were nurse-led (95.8%) and were implemented in hospitals (48.6%). Studies frequently explored patient knowledge or characterized patient populations (61.3%) and commonly assessed chronic disease (19.3%) or maternity/child health outcomes (15.9%). CONCLUSION: Findings revealed a large number of publications but an uneven geographical distribution of nurse-led clinical research and an evident gap of midwifery-related research in Latin America and the Caribbean. Results may be used to build research agendas to promote nursing and midwifery research capacity and further establish evidence-based practice.

[Cultural adaptation and translation of the Woman Abuse Screening Tool]. / Adaptación del instrumento WAST para la detección de violencia doméstica en Centros de Salud.

BACKGROUND: The Woman Abuse Screening Tool (WAST) is a screening tool for domestic violence used in Unites States. AIM: To carry out the cultural adaptation of the WAST instrument for early detection of domestic violence in primary health care. MATERIAL AND METHODS: Qualitative techniques for cultural adaptation were used in stages 1 and 2 and quantitative techniques were used in stage 3. The validity of content was assessed using judge tests carried out with experts in the field. Linguistic adaptation was carried out using a focal group technique to ensure semantic and language comprehension. Finally, the culturally adapted instrument was applied to 16 women who were victims of violence and to 28 women without a history of violence. RESULTS: For cultural adaptation, the judges' test added the item of economic violence to the instrument. According to the focus groups, some words were changed to facilitate understanding by the subjects. According to the scores obtained in women with and without a history of violence, a cut-off point of 15 points was defined to determine a history of domestic violence with a sensitivity of 100% and a specificity of 96%. The Cronbach Alpha of the questionnaire was 91%. CONCLUSIONS: WAST is an effective and easily applied instrument for the early detection of domestic violence.

Exploring historical conflicts between midwives and nurses: a perspective from Chile.

This article explores issues of historical disputes between nurses and midwives based in Chile. The interaction of these two professions in that country has become an arena of competition which leads to conflicts periodically, such as those related to the ownership of the care of new-borns, and that of projects aimed at relieving nurse shortages by enhancing midwives' nursing skills. Specifically, this article aims to build on historical and contemporary resources analysed from a sociological perspective, and present comparatively a rationale concerning nursing/midwifery jurisdictional conflicts through a social history account. Our analysis suggests that nurses/midwives interaction has been shaped by social-historical transformations and the continuous evolution of the healthcare system as a whole, resulting in a race towards technologisation. These interprofessional conflicts can be explained partly by mechanisms of boundary expansion within an organisational/interpretive domain, as well as varying degrees of medicalisation; and partly by a competition possibly originating from a middle-class consciousness. An eventual merger of the two professions might lead to the enhancement of the political power of the caring professions and integrated care.

Assessment of professional empowerment among midwives in selected LAC: A multisite descriptive study.

OBJECTIVE: to identify the perception of professional empowerment among midwives in selected Latin American countries (LA). Specifically, this study aimed to compare i) the global level of empowerment among midwives in different LA countries, ii) the scores according to the different dimensions of the scale, and iii) scores according to area the of expertise. DESIGN: A quantitative, observational, analytical, cross-sectional and multisite study using an adaptation of the Perceptions Midwifery Empowerment Scale (PEMS). SETTINGS: Clinical, educational and managerial midwifery positions in 5 LA countries belonging to a Latin American Research Network in Midwifery. All the participating countries reported a similar profile regarding type of education, association and regulation procedures. PARTICIPANTS: A total of 1127 responses from midwives with different professional backgrounds were included in the study. FINDINGS: A total mean score of 73.28 (74.23-72.03) points was reported. Chile reported the lowest score of empowerment compared to the other countries, while Argentina reported the highest. Midwives' perceptions of empowerment within their area of expertise, primary health care (PHC) was the area of reference, and gynaecology reported a significantly lower score. Midwives working in management were significantly more empowered compared with those in other areas. Midwives who had continuous education and postgraduate studies were the most empowered. Regarding the provision of woman-centred Care, Chile and El Salvador differed significantly from Argentina (reference), while Uruguay reported a significantly higher score in this dimension. Midwives working in hospital wards reported significantly lower scores compared to those working in PHC. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study suggests that midwifery programmes in the LA countries would benefit from prioritising professional empowerment, especially in the areas of hospital practice, where midwives' perceptions of empowerment were most limited.

Autonomy in labour and delivery in a Latin American urban centre: a qualitative phenomenological analysis.

The medicalisation of childbirth has diminished the role of labouring people. We conducted an exploratory phenomenological qualitative study, using purposive sampling, and then conducted 17 semi-structured interviews between December 2016 and October 2017 with people who had recently given birth in a public hospital in the Northern Metropolitan area of Santiago, Chile. The sufficiency of the study group was determined according to saturation criteria. Triangulated content analysis was applied to explore the clinical relationship and processes of autonomy and decision-making. The predominant clinical relationship observed was paternalism. The participation of labouring people in decision-making is scarce, with no evidence of ethically valid processes of informed consent.

"We are always asked; 'where are you from?'": Chilean women's reflections in midlife about their health and influence of migration to Sweden.

AIM: This study explored how Chilean immigrant women living in Sweden perceived and related their life situations and health status during midlife to their migration experiences. METHOD: Three focus group discussions (FGDs) were performed with 21 middle-aged Chilean women (40-60 years) who had lived in Stockholm for at least 15-20 years. In-depth interviews were held with three key informants. A combination of manifest and latent content analysis was performed to structure and categorize the tape-recorded and transcribed data. FINDINGS: Three main themes emerged from the data: (i) Chilean women's reflections about migration and resettlement; (ii) Health during midlife; perceptions of Chilean women living in Sweden; and (iii) Strategies to manage their lives and to gain social acceptance and position. The Chilean women reflected about the discrimination they had met in the Swedish society and within the health care system along with health changes they had had during midlife. They connected some of their health related problems to their hardships of migration. They also expressed confusion about the health care they had received in Sweden including conflicting and mistrusting relationship with some health care providers. Important for their way of coping with their own health seemed to be a recognition of their own space, level of independence, self-acceptance and awareness of power relationships. CONCLUSION: The results illuminate the importance of awareness of influence of gender and socio-cultural aspects, power relationships and communication skills among health care providers on women's health. Complementary interventions to the biomedical paradigm are needed and should be addressed in Swedish health staff educational programmes as well as in clinical training.

Chilean women's reflections about womanhood and sexuality during midlife in a Swedish or Chilean context.

In order to learn about Chilean women's reflections about womanhood and sexuality during midlife, we held focus group discussions (FGDs) with middle-aged Chilean women living in Stockholm, Sweden, or in Santiago, Chile. We used thematic content analysis for the qualitative data. Emerging themes follow; societal expectations on women, perceptions about sexual relationships, and women's social stigmatization. The women had since childhood been strongly influenced by a gender-imbalanced world, which had made them socially, economically, and biologically at higher risk for exploitation during life. More focus should be directed to middle-aged women's life situation and promotion of gender equity in society.

Comparison of bio-sociodemographic, obstetric and perinatal characteristics among immigrant and native women in the Metropolitan Region in Chile.

BACKGROUND: International migration is an increasing public health concern, particularly regard to maternal and neonatal health. OBJECTIVE: To compare obstetric and neonatal variables among native and immigrant childbearing women in a clinical hospital in Santiago, Chile. METHOD: A cross-sectional, analytic study with 2598 childbearing women and their newborn examined between January and July 2015. Data were collected from clinical records by students who had previously been trained. Ethical approval was obtained from the local Ethics Committee at the hospital. All participants signed an informed consent form. A descriptive and comparative analysis was performed. For comparison, a Chi-square test was used for categorical variables, and Student t-test was used for quantitative variables. RESULTS: Among the included women, 41.5% (n = 1078) were immigrants. The immigrants' mean age was 28.1 ±â€¯6.4 years, and that of natives was 26.8 ±â€¯6.9 (p < 0.001). Among natives, the obesity rate was 38.3%, as compared to 19.3% among immigrants (p < 0.001). A significantly higher rate of caesarean section was seen among natives (36.8%) than among immigrants (31.7%). Obstetric morbidity, pre-eclampsia, gestational diabetes and prematurity were significantly higher among natives. There was no difference regarding low birth weights. CONCLUSION: In general, immigrants present better maternal and neonatal indicators than native women. Controversially, this is known as the 'healthy immigrant' phenomenon in the literature.

Variations in childbirth interventions in high-income countries: protocol for a multinational cross-sectional study.

INTRODUCTION: There are growing concerns about the increase in rates of commonly used childbirth interventions. When indicated, childbirth interventions are crucial for preventing maternal and perinatal morbidity and mortality, but their routine use in healthy women and children leads to avoidable maternal and neonatal harm. Establishing ideal rates of interventions can be challenging. This study aims to describe the range of variations in the use of commonly used childbirth interventions in high-income countries around the world, and in outcomes in nulliparous and multiparous women. METHODS AND ANALYSIS: This multinational cross-sectional study will use data from births in 2013 with national population data or representative samples of the population of pregnant women in high-income countries. Data from women who gave birth to a single child from 37 weeks gestation onwards will be included and the results will be presented for nulliparous and multiparous women separately. Anonymised individual level data will be analysed. Primary outcomes are rates of commonly used childbirth interventions, including induction and/or augmentation of labour, intrapartum antibiotics, epidural and pharmacological pain relief, episiotomy in vaginal births, instrument-assisted birth (vacuum or forceps), caesarean section and use of oxytocin postpartum. Secondary outcomes are maternal and perinatal mortality, Apgar score below 7 at 5 min, postpartum haemorrhage and obstetric anal sphincter injury. Univariable and multivariable logistic regression analyses will be conducted to investigate variations among countries, adjusted for maternal age, body mass index, gestational weight gain, ethnic background, socioeconomic status and infant birth weight. The overall mean rates will be considered as a reference category, weighted for the size of the study population per country. ETHICS AND DISSEMINATION: The Medical Ethics Review Committee of VU University Medical Center Amsterdam confirmed that an official approval of this study was not required. Results will be disseminated at national and international conferences and published in peer-reviewed journals.

Labor and Birth Care Satisfaction Associated With Medical Interventions and Accompaniment During Labor Among Chilean Women.

INTRODUCTION: Satisfaction with care during labor and birth has been associated with various obstetric variables. The purpose of this study was to determine which labor and birth procedures are significant predictors of maternal patient satisfaction in a large cross-sectional sample. METHODS: An observational, cross-sectional study of 1660 women giving birth in Chilean public hospital facilities was conducted from 2012 to 2013. Data were collected from 9 different hospitals in 8 regions of Chile using 2 instruments, including the American College of Nurse-Midwives Intrapartum Care Data Set and a locally validated measure of maternal well-being. Women were eligible if they arrived at the labor and delivery unit during early labor (2-3 centimeters dilated) and spent at least 4 hours in labor at the facility. In the current analysis, odds ratios were calculated using ordinal logistic regression for association with a less optimal well-being score (possible outcome values were optimal, adequate, and minimal). Odds ratios were adjusted for age, education, single status, and parity (nulliparous vs multiparous). Stepwise regression was used to identify the procedural factors that were significantly associated with labor and birth care satisfaction. RESULTS: Factors significantly associated with lower satisfaction were cesarean birth (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.7), pharmacologic pain management (OR, 1.3; 95% CI, 1.02-1.7), continuous fetal heart rate monitoring (OR. 1.4; 95% CI, 1.2-1.8), and episiotomy (OR, 1.4; 95% CI, 1.1-1.7). Nulliparity was also associated with minimal maternal satisfaction (OR, 1.3; 95% CI, 1.0-1.5). Greater satisfaction was associated with accompaniment by a companion of choice during labor (OR, 0.49: 95% CI, 0.40-0.60). DISCUSSION: This study is one of the first to provide empirical evidence that maternal patient satisfaction is negatively affected by many common obstetric procedures in the Latin American context. These findings are consistent with World Health Organization recommendations regarding judicious and necessary, rather than routine, use of obstetric interventions.

Assessment of the implementation of the model of integrated and humanised midwifery health services in Chile.

OBJECTIVE: in 2010, a pilot study was conducted among women who were attended by midwives in the public sector in Santiago, Chile. The purpose of that study was to evaluate the implementation of the 'Model of Integrated and Humanized Health Services', and the Clinical Guide for Humanized Attention during Labour and Childbirth. Results of that study indicated 92.7% of women had medically augmented labours (artificial rupture of the membranes, oxytocin and epidural analgesia). One third of the women reported discontent with the care they received. This study replicated the pilot study (2010) and was conducted in seven regional hospitals across Chile. The objectives were to : (i) describe selected obstetric and neonatal outcomes of women who received care according to this new guide, (ii) identify the level of maternal-neonatal well-being after experiencing this modality of attention, and (iii) explore professionals' perceptions (obstetricians and midwives), as well as consumers' perceptions of this humanised assistance during labour and childbirth. DESIGN: this is a cross sectional and descriptive, mixed methods study, conducted in two phases. The first phase was quantitative, measuring midwifery processes of care and maternal perceptions of well-being in labour and childbirth. The second phase was qualitative, exploring the perceptions of women, midwives and obstetricians regarding the discrepancy between the national guidelines and actual practice. SETTING: maternity units from seven regional hospitals from the northern, central and southern regions and two metropolitan hospitals across Chile. PARTICIPANTS: 1882 parturient women in the quantitative phase (including the two Metropolitan hospitals published previously). Twenty-six focus groups discussions (FGD) participated from the regional and metropolitan hospitals for the qualitative phase. MEASUREMENTS/FINDINGS: all women started labour spontaneously; 74% of women had spontaneous vaginal childbirth. Caesarean section was the outcome for 20%, and 6% had childbirth assisted with forceps. A high number of medical interventions continued to be performed in all regions, deviating widely from adherence to the national clinical guidelines. Most of the women did not receive any oral hydration, almost all received intravenous hydration; most were under continuous foetal monitoring and medically augmented labour. The majority of women received artificial rupture of membranes, epidural anaesthesia and episiotomy. Most delivered in the lithotomy position. Two thirds of women surveyed perceived adequate well-being in labour and childbirth. Findings from focus group discussions of women (FGD=9; n=27 women), midwives (FGD=9; n=40) and doctors (FGD=8; n=29) indicated lack of infrastructure for family participation in birth, inadequate training and orientation to the national guidelines for practice, and lack of childbirth preparation among women. Some women reported mistreatment by personnel. Some midwives reported lack of autonomy to manage birth physiologically. KEY CONCLUSIONS: birth is managed by midwives across the public sector in Chile. Despite evidence-based guidelines published in 2007 by the Ministry of Health, birth is not managed according to the guidelines in most cases. Women feel that care is adequate, although some women report mistreatment. IMPLICATIONS FOR PRACTICE: efforts to provide midwife-led care and include women in participatory models of antenatal care are recommended to promote women-centred care in accordance with the Chilean national guidelines.

Violencia contra la mujer durante la gestación y postparto infligida por su pareja en Centros de Atención Primaria de la zona norte de Santiago, Chile / Prevalence and factors associated with partner violence among pregnant and puerperal women in Santiago, Chile

Background: Violence against women (VAW) is a violation of women's fundamental rights and special attention must be paid during the gestational and postpartum period. Aim: To determine the prevalence of violence against women attending antenatal and postpartum controls in Primary Health Centers. Material and Method: The Woman Abuse Screening Tool (WAST) for early detection of VAW was applied to 279 pregnant and 102 puerperal women attending five public primary health centers in metropolitan Santiago. Results: The prevalence ofviolence against pregnant and puerperal women was 5.7 and 5.9%, respectively. In both groups, the factors associated with a greater risk of violence were being immigrants, a history of domestic violence, not having a supportive partner and alcohol consumption by the partner. Conclusions: Violence against these women is a multifactorial, complex and structural phenomenon, which involves the victim, the abuser and the entire social system. Primary health care level and health professionals can be key elements applying early detection strategies, timely referral mechanisms and bringing emotional support for victims.

Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean.

OBJECTIVE: over the past three decades there has been a social movement in Latin American countries (LAC) to support humanised, physiologic birth. Rates of caesarean section overall in Latin America are approximately 35%, increasing up to 85% in some cases. There are many factors related to poor outcomes with regard to maternal and newborn/infant health in LAC countries. Maternal and perinatal outcome data within and between countries is scarce and inaccurate. The aims of this study were to: i) describe selected obstetric and neonatal outcomes of women who received midwifery care, ii) identify the level of maternal well-being after experiencing midwifery care in 6 Latin America countries. DESIGN: this was a cross sectional and descriptive study, conducted in selected maternity units in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay. Quantitative methods were used to measure midwifery processes of care and maternal perceptions of well-being in labour and childbirth through a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardized antepartum and intrapartum data set. SETTING: Maternity units from 6 Latin American countries. PARTICIPANTS: the final sample was a convenience sample, and the total participants for all sites in the six countries was 3009 low risk women. FINDINGS: for the countries reporting, overall, 82% of these low risk women had spontaneous vaginal deliveries. The rate of caesarean section was 16%; the Dominican Republic had the highest rate of Caesarean sections (30%) and Peru had the lowest rate (4%). The use of oxytocin in labour was widely variable, although overall there was a high proportion of women whose labour was augmented or induced. Ambulation was common, with the lowest proportion (48%) of women ambulating in labour in Chile, Uruguay (50%), Peru (65%), Brazil (85%). The presence of continuous support was highest in Uruguay (93%), Chile (75%) and Argentina (55%), and Peru had the lowest (22%). Episiotomies are still prevalent in all countries, the lowest rate was reported in the Dominican Republic (22%), and the highest rates were 52 and 53% (Chile and Peru, respectively). The Optimal Maternal well-being score had a prevalence of 43.5%, adequate score was 30.8%; 25% of the total sample of women rated their well-being during labour and childbirth as poor. KEY CONCLUSIONS: despite evidence-based guidelines and recommendations, birth is not managed accordingly in most cases. Women feel that care is adequate, although some women report mistreatment. IMPLICATIONS FOR PRACTICE: More research is needed to understand why such high levels of intervention exist and to test the implementation of evidence-based practices in local settings.