The Safety and Feasibility of a Family First Aid Approach for the Management of Postpartum Hemorrhage in Home Births: A Pre-post Intervention Study in Rural Pakistan.

OBJECTIVE: To evaluate the safety and feasibility of a Family First Aid approach whereby women and their families are provided misoprostol in advance to manage postpartum hemorrhage (PPH) in home births. METHODS: A 12-month prospective, pre-post intervention study was conducted from February 2017 to February 2018. Women in their second and third trimesters were enrolled at home visits. Participants and their families received educational materials and were counseled on how to diagnose excessive bleeding and the importance of seeking care at a facility if PPH occurs. In the intervention phase, participants were also given misoprostol and counselled on how to administer the four 200 mcg tablets for first aid in case of PPH. Participants were followed-up postpartum to collect data on use of misoprostol for Family First Aid at home deliveries (primary outcome) and record maternal and perinatal outcomes. RESULTS: Of the 4008 participants enrolled, 97% were successfully followed-up postpartum. Half of the participants in each phase delivered at home. Among home deliveries, the odds of reporting PPH almost doubled among in the intervention phase (OR 1.98; CI 1.43, 2.76). Among those reporting PPH, women in the intervention phase were significantly more likely to have received PPH treatment (OR 10.49; CI 3.37, 32.71) and 90% administered the dose correctly. No maternal deaths, invasive procedures or surgery were reported in either phase after home deliveries. CONCLUSIONS: The Family First Aid approach is a safe and feasible model of care that provides timely PPH treatment to women delivering at home in rural communities.

Factores que influyen en la decisión de tener partos domiciliarios en la localidad de Ironcollo - Cochabamba, gestión 2011 / Factors influencing the decision to have home births in the town of Ironcollo - Cochabamba, management 2011

El alto índice de morbimortalidad materno-infantil es un problema importante de salud pública en los países en los que el parto domiciliario continúa siendo habitual como en Bolivia, motivo por el que el presente estudio pretende identificar los factores influyentes en la decisión de tener partos domiciliarios en la localidad de Ironcollo. El enfoque que encamina la investigación es el enfoque mixto cuali-cuantitativo basada en obtener resultados visibles y puntuales.Los resultados obtenidos muestran que los factores de mayor influencia para decidir tener un parto domiciliario son varios, entre los cuales están las barreas sociales (idioma, grado de instrucción), culturales (malas experiencias y temores de las mujeres a las instituciones y personal de salud, vergüenza, costumbre y la satisfacción de dar a luz en casa); además, la incapacidad de pago por atenciones prestadas en instituciones hospitalarias; factores que llevan a las mujeres a optar por la atención de partos domiciliarios a pesar de que los servicios de salud se están volviendo cada vez más accesibles, no sólo por el aspecto cultural, sino por el presupuesto económico disminuido gracias a las prestaciones del Seguro Universal Materno Infantil (SUMI)

As parteiras / Midwives

As parteiras ajudaram mães aflitas a ganhar seus filhos em locais distantes de qualquer recurso da medicina. a cena se repetiu por décadas: mulheres, munidas de sua maleta, tesoura e muitas vezes levando o rosário e a imagem de nossa senhora do bom parto, percorriam estradas precárias, em cima de carroças ou no lombo do cavalo, enfrentado frio e viagens longas, lutando contra o tempo, a chuva e o vento