Midwifery continuity of care versus standard maternity care for women at increased risk of preterm birth: A hybrid implementation-effectiveness, randomised controlled pilot trial in the UK.

BACKGROUND: Midwifery continuity of care is the only health system intervention shown to reduce preterm birth (PTB) and improve perinatal survival, but no trial evidence exists for women with identified risk factors for PTB. We aimed to assess feasibility, fidelity, and clinical outcomes of a model of midwifery continuity of care linked with a specialist obstetric clinic for women considered at increased risk for PTB. METHODS AND FINDINGS: We conducted a hybrid implementation-effectiveness, randomised, controlled, unblinded, parallel-group pilot trial at an inner-city maternity service in London (UK), in which pregnant women identified at increased risk of PTB were randomly assigned (1:1) to either midwifery continuity of antenatal, intrapartum, and postnatal care (Pilot study Of midwifery Practice in Preterm birth Including women's Experiences [POPPIE] group) or standard care group (maternity care by different midwives working in designated clinical areas). Pregnant women attending for antenatal care at less than 24 weeks' gestation were eligible if they fulfilled one or more of the following criteria: previous cervical surgery, cerclage, premature rupture of membranes, PTB, or late miscarriage; previous short cervix or short cervix this pregnancy; or uterine abnormality and/or current smoker of tobacco. Feasibility outcomes included eligibility, recruitment and attrition rates, and fidelity of the model. The primary outcome was a composite of appropriate and timely interventions for the prevention and/or management of preterm labour and birth. We analysed by intention to treat. Between 9 May 2017 and 30 September 2018, 334 women were recruited; 169 women were allocated to the POPPIE group and 165 to the standard group. Mean maternal age was 31 years; 32% of the women were from Black, Asian, and ethnic minority groups; 70% were in employment; and 46% had a university degree. Nearly 70% of women lived in areas of social deprivation. More than a quarter of women had at least one pre-existing medical condition and multiple risk factors for PTB. More than 75% of antenatal and postnatal visits were provided by a named/partner midwife, and a midwife from the POPPIE team was present at 80% of births. The incidence of the primary composite outcome showed no statistically significant difference between groups (POPPIE group 83.3% versus standard group 84.7%; risk ratio 0.98 [95% confidence interval (CI) 0.90 to 1.08]; p = 0.742). Infants in the POPPIE group were significantly more likely to have skin-to-skin contact after birth, to have it for a longer time, and to breastfeed immediately after birth and at hospital discharge. There were no differences in other secondary outcomes. The number of serious adverse events was similar in both groups and unrelated to the intervention (POPPIE group 6 versus standard group 5). Limitations of this study included the limited power and the nonmasking of group allocation; however, study assignment was masked to the statistician and researchers who analysed the data. CONCLUSIONS: In this study, we found that it is feasible to set up and achieve fidelity of a model of midwifery continuity of care linked with specialist obstetric care for women at increased risk of PTB in an inner-city maternity service in London (UK), but there is no impact on most outcomes for this population group. Larger appropriately powered trials are needed, including in other settings, to evaluate the impact of relational continuity and hypothesised mechanisms of effect based on increased trust and engagement, improved care coordination, and earlier referral on disadvantaged communities, including women with complex social factors and social vulnerability. TRIAL REGISTRATION: We prospectively registered the pilot trial on the UK Clinical Research Network Portfolio Database (ID number: 31951, 24 April 2017). We registered the trial on the International Standard Randomised Controlled Trial Number (ISRCTN) (Number: 37733900, 21 August 2017) and before trial recruitment was completed (30 September 2018) when informed that prospective registration for a pilot trial was also required in a primary clinical trial registry recognised by WHO and the International Committee of Medical Journal Editors (ICMJE). The protocol as registered and published has remained unchanged, and the analysis conforms to the original plan.

The effects of hands on and hands off/poised techniques on maternal outcomes: A systematic review and meta-analysis.

BACKGROUND: Negative maternal outcomes such as perineal trauma and related perineal pain may cause both long-and short- term morbidities. Hands on and hands off/poised technique are two kinds of techniques to protect perineum during the second-stage of labor. Hands on technique has been the routine midwifery practice for a long time; nevertheless, the effects of hands on technique on protecting perineum has been doubted. Hands off/poised as a promising technique seems prevalent in clinical practice. However, there is no consensus on use of hands off/poised technique and hands on technique. The effects of these techniques on maternal outcomes have not been fully investigated. OBJECTIVE: To evaluate the effects of hands on hands off/poised technique on maternal outcomes during the second-stage of labor. DESIGN: Systematic review and meta-analysis of relevant quantitative studies. DATA SOURCES: Seven databases: PubMed, EMBASE, The Cochrane Library, CINAHL, WanFang Data, China National Knowledge Infrastructure (CKNI), SinoMed were systematically searched from inception to July 23,2018 for relevant quantitative studies comparing the effects of hands on and hands off/poised technique on maternal outcomes. REVIEW METHODS: Quantitative studies were retrieved for relevant studies. Two reviewers independently screened the studies, evaluated the methodological quality using JBI appraisal checklist tools and extracted the data. The included studies were divided into two groups for analysis according to study types. RESULTS: Nine RCTs with a total of 7112 participants and eight non-RCTs with 37,786 participants were included for meta-analysis. Based on the results from RCTs, this study did not find difference between hands on and hands off/poised technique regarding the risk of 2nd perineal tears, 3rd /4th degree perineal tears, duration of second-stage labor and incidence of postpartum hemorrhage (PPH>500 ml). The results from 9 non-RCTs were similar with that of RCTs, except for showing less 2nd degree perineal tears in hands off/poised technique than in hands on technique. CONCLUSION: Evidence in the present study indicated that hands off/poised technique may be a promising delivery technique to maintain intact perineum, and reduce perineal pain and episiotomy use among women with low-risk pregnancy undergoing vaginal delivery. In addition, hands off/poised technique might be safe to use as it did not increase the risk of severe perineal trauma, postpartum hemorrhage, and longer duration of second-stage labor when compared with hands on technique. More studies with stringent study design, especially large randomized controlled trial, should be conducted before strong recommendation of the hands off/poised technique.

Gestação e parto em uma comunidade rural amazônica: reflexões sobre o papel da parteira tradicional / Pregnancy and childbirth in a rural community in the Amazon: reflections on the role of traditional midwives / Gestación y parto en una comunidad rural amazónica: reflexiones sobre el papel de la comadrona tradicional

O artigo tem como objetivo a reflexão sobre o papel social das parteiras e sua relação com os serviços de saúde na comunidade rural de Lindoia, município de Itacoatiara, Amazonas. Nessa comunidade, há uma sala de parto onde atua uma auxiliar de enfermagem que se identifica como parteira, sendo que também atua como articuladora entre outras parteiras da localidade. Realizamos 13 entrevistas abertas e dez semiestruturadas para discutir a inserção das parteiras tradicionais na Unidade Básica de Saúde (UBS), buscando analisar as aproximações e os estranhamentos entre parteiras e equipe. Conclui-se que as parteiras da comunidade conquistaram um espaço importante na UBS, mas suas ações são limitadas e reguladas pela gestão e pela equipe de saúde. Entende-se que há necessidade de ampliarmos o diálogo intercultural entre os saberes biomédicos e tradicionais no cotidiano do cuidado em saúde.

This article reflects on the social role of traditional midwives and their relation with health services in the rural community of Lindóia in the State of Amazonas, Brazil. This community has a delivery room and nursing assistant who is acts as a midwife and articulator of other traditional midwives in the area. We conducted 13 open-ended interviews and ten semi-structured interviews to investigate the involvement of traditional midwives in a primary care center, comparing their responses with those of the health team. It was concluded that community midwives play an important role in the care center, although their activities are limited and regulated by the health facility manager and health team. There is a need to broaden intercultural dialogue between biomedical and traditional knowledge in everyday health care practice.

El objetivo de este artículo es la reflexión sobre el papel social de las comadronas y su relación con los servicios de salud en la comunidad rural de Lindóia, municipio de Itacoatiara, Amazonas. En esa comunidad, hay una sala de parto en donde actúa una auxiliar de enfermería que se identifica como comadrona, siendo que ella también actúa como articuladora entre otras comadronas de la localidad. Realizamos 13 entrevistas abiertas y diez semiestructuradas para discutir la inserción de las comadronas tradicionales en la Unidad Básica de Salud (UBS), buscando analizar las aproximaciones y los extrañamientos entre comadronas y equipo. Se concluye que las comadronas de la comunidad conquistaron un espacio importante en la UBS, pero sus acciones están limitadas y reguladas por la gestión y equipo de salud. Se entiende que hay necesidad de que ampliemos el diálogo intercultural entre los saberes biomédicos y tradicionales en el cotidiano del cuidado en salud.

À margem da humanização? Experiências de parto de usuárias de uma maternidade pública de Porto Alegre-RS / Apart from humanization? Birth experiences of users of a public maternity hospital in Porto Alegre-RS, Brazil

Resumo O artigo reflete sobre as experiências de mulheres em relação à assistência ao parto numa maternidade pública de Porto Alegre-RS. Adota-se uma perspectiva dos direitos humanos, entendendo a humanização como uma garantia ampla de direitos das mulheres a uma parturição segura, socialmente amparada e prazerosa. Trata-se de um estudo qualitativo exploratório, que utilizou as técnicas de observação participante, entrevista semiestruturada e pesquisa documental. Aceitaram fazer parte da pesquisa 25 mulheres puérperas, com idades entre 18 e 38 anos. Os relatos das participantes e os registros de campo foram examinados por meio da análise de discurso. Como resultados, constatamos uma fragmentação das práticas tidas como "humanizadoras", atreladas a protocolos de procedimentos no manejo do parto e, muitas vezes, à inflexibilidade perante eles. A supervalorização de tecnologias/práticas intervencionistas no corpo da mulher, assim como as hierarquias entre profissionais e usuárias apareceram nos relatos e nas observações. Sentimentos e sensações das mulheres em relação ao parto pareciam não ser contemplados e ficavam à margem do cuidado. Identificaram-se práticas de violência obstétrica, que muitas vezes eram banalizadas pelas próprias mulheres em consonância ao que elas esperavam de um atendimento público. Essas situações parecem reforçar hierarquias reprodutivas, deixando essas gestantes "à margem da humanização".

Abstract This paper reflects on the experiences of women regarding childbirth care in a public maternity hospital in Porto Alegre-RS. It adopts a human rights perspective, understanding humanization as a broad guarantee of women's rights to a safe, socially supported and pleasurable parturition. This is an exploratory qualitative study, using participant observation techniques, semi-structured interviews and documentary research. Twenty-five postpartum women, aged between 18 and 38, took part in the study. Participant reports and field records were examined through Discourse Analysis. As a result, it was identified a fragmented nature of the practices considered as "humanizing", linked to protocols of procedures in the management of childbirth and often linked to inflexibility regarding these protocols. The overrating of interventionist technologies/ practices in women's body, as well as the hierarchies between professionals and users appeared in the reports and the observations. Subjective experiences of motherhood seemed not to be considered and were left on the margins of care. It was identified specific modes of obstetric violence experienced by grassroots women, which are trivialized by the women themselves in accordance with what they expected from a public service. These situations reinforce reproductive hierarchies and end up leaving these pregnant women "on the fringes of humanization".

Health behaviour information provided to clients during midwife-led prenatal booking visits: Findings from video analyses.

OBJECTIVE: to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. DESIGN: quantitative video analyses. SETTING AND PARTICIPANTS: 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS: thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. FINDINGS: our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were usually provided basic and occasionally extensive explanations about these topics. The majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: although additional information was generally provided about folic acid and smoking, when relevant for their clients, the majority of women were provided with little or no information about the other health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Characteristics of patients receiving midwife-led prenatal care in Canada: results from the Maternity Experiences Survey (MES).

BACKGROUND: The aim of this study was to determine the characteristics of women in Canada who received care from a midwife during their prenatal period. METHODS: The findings of this study were drawn from the Maternity Experiences Survey (MES), which was a cross-sectional survey that assessed the experiences of women who gave birth between November 2005 and May 2006. The main outcome variable for this study was the prenatal care provider (i.e. midwife versus other healthcare providers). Demographic, socioeconomic, as well as health and pregnancy factors were evaluated using bivariate and multivariate models of logistic regression. RESULTS: A total of 6421 participants were included in this analysis representing a weighted total of 76,508 women. The prevalence of midwife-led prenatal care was 6.1%. The highest prevalence of midwife-led prenatal care was in British Columbia (9.8%), while the lowest prevalence of midwife-led prenatal care was 0.3% representing the cumulative prevalence in Nova Scotia, Prince Edward Island, Newfoundland and Labrador, New Brunswick, Saskatchewan, and Yukon. Factors showing significant association with midwife-led prenatal care were: Aboriginal status (OR = 2.26, 95% CI: 1.41-3.64), higher education with bachelor and graduate degree attainment having higher ORs when compared to high-school or less (OR = 2.71, 95% CI: 1.71-4.31 and OR = 3.17, 95% CI: 1.81-5.55, respectively), and alcohol use (OR = 1.63, 95% CI: 1.17-2.26). Age, marital status, immigrant status, work during pregnancy, household income, previous pregnancies, perceived health, maternal Body Mass Index (BMI), and smoking during the last 3 months of pregnancy were not significantly associated with midwife care. CONCLUSIONS: In general, women who were more educated, have aboriginal status, and/or are alcohol drinkers were more likely to receive care from midwives. Since MES is the most recent resource that includes information about national midwifery utilization, future studies can provide more up-to-date information about this important area. Moreover, future research can aim at understanding the reasons that lead women to opt for midwife-led prenatal care.

O cuidado à mulher no contexto da maternidade: caminhos e desafios para a humanização / El cuidado de las mujeres en el contexto de la maternidad: caminos y desafíos de humanizar / The care of women in the context of maternity: challenges and ways to humanize

Objective: to know the perception of mothers about the care received during hospitalization in a public hospital. Methods: Descriptive study, performed at a secondary public hospital in Fortaleza/Ceará. Data were collected through semi-structured interview with 20 mothers, and analyzed using the technique of content analysis. Results: The most part of women realized the attention received as quality, accessible and humane, and emphasizing the reception and good relationship with the health care team. However, difficulties were also observed, as the lack of monitoring of the health team during labor, lack of information and insensitive and rude behavior of some professionals. Conclusion: The study encourages reflection and debate among professionals and managers, points out weaknesses and potentialities and indicates paths to follow in order to improve health care for women in maternity wards.

Objetivo: conhecer a percepção de puérperas acerca da atenção recebida durante a internação em uma maternidade pública. Método: Estudo descritivo, realizado em um hospital público de nível secundário de Fortaleza/Ceará. Os dados foram coletados mediante entrevista semiestruturada a 20 puérperas, e analisados a partir da técnica de análise de conteúdo. Resultados: As mulheres, em sua maioria, perceberam a atenção recebida como de qualidade, fácil acesso e humanizada, além de enfatizarem o acolhimento e o bom relacionamento com a equipe de saúde. Porém, dificuldades também foram evidenciadas, como a falta de acompanhamento da equipe de saúde durante o trabalho de parto, a ausência de informações e o comportamento indelicado e insensível de alguns profissionais. Conclusão: O estudo estimula reflexão e debate entre profissionais e gestores, aponta fragilidades e potencialidades e indica desafios a serem seguidos com vistas a melhorar a assistência à mulher nas maternidades.

Objetivo: conocer la percepción de mujeres en postparto sobre la atención que recibió durante su hospitalización en una maternidad pública. Métodos: Estudio descriptivo, realizado en un hospital públicosecundario en Fortaleza/Ceará. Los datos fueron recolectados a través de entrevistas semiestructuradas a 20 mujeres en postparto y se analizaron mediante la técnica de análisis de contenido. Resultados: Las mujeres, en su mayoría, se dieron cuenta de la atención recibida como la calidad, accesible y humana, y haciendo hincapié en la recepción y la buena relación con el equipo de atención médica. Sin embargo, también se observaron dificultades, como la falta de monitoreo del equipo de salud durante el parto, la falta de información y el comportamiento insensible y grosero de algunos profesionales. Conclusión: El estudio promueve la reflexión y el debate entre profesionales y directivos, señala debilidades y potenciales, indican caminos a seguir con el fin de mejorar la atención de salud para las mujeres en las salas de maternidad.

Seguridad y destreza autoreportadas en la formación de competencias clínicas obstétricas en estudiantes de obstetricia / Self-reported confidence and skills in training for clinical-obstetric competences on Obstetrics students

Introducción: la educación en ciencias de la salud ha requerido adaptaciones de acuerdo a necesidades de la población, y así muchos programas de estudios han adoptado el modelo de competencias. Se hace necesario demostrar la adquisición del conocimiento práctico desarrollándose actividades con seguridad y destreza que permita la atención clínica efectiva. Objetivo: analizar niveles de destreza y seguridad autoreportados y rendimiento obtenido por estudiantes de la carrera de Obstetricia y Puericultura de la Universidad de Concepción, Chile, que entrenan competencias obstétricas, además con simulación clínica. Métodos: se realizó estudio no experimental, analítico y relacional, en 127 estudiantes de la carrera de Obstetricia y Puericultura de la Universidad de Concepción, en el año 2014. Se aplicó encuesta para medir destreza con escala tipo Likert posterior al entrenamiento de competencias obstétricas en modalidad preclínica, y la seguridad en modalidad clínica y se relacionó con el rendimiento obtenido. Se realizó análisis descriptivo y relacional. Resultados: 119 estudiantes respondieron las encuestas para destreza y 115 para seguridad. Las competencias obstétricas fueron 30, de complejidad variable, con resultados diversos. Las destrezas altas se relacionan con seguridad alta, sin embargo no todas las competencias siguen este curso. La destreza no se relaciona con rendimiento. Conclusiones: las competencias obstétricas son diversas en complejidad, con diferentes niveles de destreza y seguridad, algunas muy altas y otras más bajas, sin embargo algunas importantes presentan niveles más bajos que los esperados. Es necesario ordenar los niveles de complejidades. La evaluación de los estudiantes no se relaciona con el logro de competencias, se hace necesario establecer instrumentos adecuados(AU)

Introduction: The education of health sciences has required adjustments according to the needs of the general population and therefore most programs have adopted models based on competencies. It is necessary to demonstrate the acquisition of practical knowledge developed with regards to safety and skill that allows for more effective clinical care. Objective: To analyze the self-reported levels of skill and safety and the assessments obtained by students of midwifery at University of Concepcion, Chile. They train in obstetric skills mainly via clinical simulation. Method: Analytical and relational, non-experimental study with non-probabilistic by 119 volunteer midwifery students at the university at the University of Concepcion in 2014. A Likert type scale survey was administered post practical trainings in preclinical and clinical settings which was correlated with the student's performances. A descriptive and relational analysis was executed. Results: 119 students completed the surveys for skill level and 115 for security of procedures. There were 30 obstetric skills practical trainings, all of varying degrees of complexity with mixed results. High levels of skill are related to high levels of security but not all of their competencies follow this pattern. The level of skill does not relate to performance. Conclusions: Obstetric skills are diverse in terms of complexity, with diferent levels of skill and safety, mostly high for both, but some are not important. It is necessary to sort the levels of complexity. The evaluation of students is not related to the achievement of competencies. It is necessary to establish appropriate measuring instruments(AU)

The increasing cesarean rate globally and what we can do about it.

Cesarean sections sometimes save the lives of mothers and babies; however, they are excessively used compared to medical necessity, which is influenced by various factors that are explored in this article. Since, in most cases the risks of cesarean sections are greater than the benefits, particularly in cesareans that are not medically indicated, it is astonishing that cesarean surgery is the most common surgical procedure, taking away resources from medically necessary care. While economic incentive is counted among the reasons for the increasing cesarean trend, the situation is not so simple since many factors interact to cause the trend. Since reversal of the vaginal birth after cesarean (VBAC) trend downward is correlated with revised policy statements by e.g. American College of Obstetricians and Gynecologists (ACOG), which have since been partially moderated, it became much more difficult for medical institutions to provide VBACs due to concerns about liability. Although whether to give birth by cesarean delivery is a matter for informed consent, yet childbearing women are influenced significantly by their health service providers' opinions. Even though the World Health Organization (WHO) recommends the most peripheral level of maternity care for normal pregnancy and childbirth that is safe using midwives, yet the percentage of midwife deliveries is low. Among other things, it has been suggested that more childbirth by midwife delivery and in out-of-hospital settings can reduce medically unnecessary cesareans and the undue risks associated with them, and free up medical resources for those in need.

Daughter of time: the postmodern midwife (Part 2)

Any effort to make sense of the complexities of contemporary midwifery must deal not only with biomedical and governmental power structures but also with the definitions such structures impose upon midwives and the ramifications of these definitions within and across national and cultural borders. The international definition of a midwife requires graduations from a government-recognized educational program. Those who have not are not considered midwives but are labeled traditional birth attendants. Since there are myriad local names for midwives in myriad languages, the impact of this naming at local levels can be hard to assess. But on the global scale, the ramifications of the distinction between midwives who meet the international definition and those who do not have been profound. Those who do are incorporated into the health care system. Those who do not remain outside of it, and suffer multiple forms of discrimination as a result.

Qualquer esforço para dar sentido à complexidade do processo reprodutivo na vida contemporânea se depara não só com o modelo biomédico e as estruturas governamentais de poder, mas também com as definições que tais estruturas impõem às parteiras e obstetrizes e à sua denominação, considerando-se os limites nacionais e culturais. A definição internacional de parteira demanda a formação em instituições de ensino reconhecidas pelo governo. As parteiras tradicionais não podem ser consideradas parteiras, mas são denominadas parteiras tradicionais. Há uma gama enorme de denominações para as parteiras em diversos locais, nas diversas línguas e ao longo do tempo, que torna difícil nomear este profissional. Entretanto, em escala global, pode-se reconhecer que há duas ramificações de parteira: a que está incorporada ao sistema de saúde e a que está fora dele.

Cualquier esfuerzo para dar sentido a la complejidad del proceso reproductivo en la vida contemporánea se depara no solamente con el modelo biomédico y las estructuras gubernamentales de poder, sino con las definiciones que estas estructuras imponen a las parteras y matronas y su denominación considerándose los límites nacionales y culturales. La definición internacional de partera demanda formación en instituciones de enseñanza reconocidas por el gobierno. Las parteras tradicionales no pueden ser consideradas parteras, pero son denominadas parteras tradicionales. Hay una gama enorme de denominaciones para las parteras, en diversos locales, en las diversas lenguas y a lo largo del tiempo, y por eso es difícil nombrar a este profesional. No obstante, en escala global se puede reconocer que hay dos ramificaciones de partera: la que está incorporada al sistema de salud y la que está fuera de él.

Daughter of time: the postmodern midwife (Part 1)

This article presents the notion of the postmodern midwife, defining her as one who takes a relativistic stance toward bio-medicine and other knowledge systems, alternative and indigenous, moving fluidly between them to serve the women she attends. She is locally and globally aware, culturally competent, and politically engaged, working with the resources at hand to preserve midwifery in the interests of women. Her informed relativism is most accessible to professional midwives but is also beginning to characterize some savvy traditional midwives in various countries. Thus the concept of the postmodern midwife can serve as a bridge across the ethnic, racial, and status gaps that divide the professional from the traditional midwife, and as an analytical focal point for understanding how the members of each group negotiate their identities and their roles in a changing world.

Este artigo busca conceituar a parteira pós-moderna, definindo-a como aquela que tem uma postura realista em relação à bio-medicina e a outros sistemas de conhecimento, movendo-se fluidicamente entre eles para ajudar as mulheres que assiste. É consciente, culturalmente competente e politicamente engajada. Trabalha com recursos do seu conhecimento específico, aliados aos interesses da mulher. Seu relativismo informado é mais acessível para as parteiras profissionais, mas o que se observa, ao redor do mundo, é que esta atitude está atingindo as parteiras tradicionais, em diversos países. Assim, o conceito de parteira pós-moderna representa uma ponte para as brechas étnicas, raciais e de status, que separam as parteiras profissionais das tradicionais, e um ponto focal e analítico para a compreensão da forma de negociação de identidades e papéis de cada um dos membros no grupo, no mundo em transformação.

Este artículo busca conceptuar la partera pos-moderna, definiéndola como aquella que tiene una postura en relación a la biomedicina y a otros sistemas de conocimiento, moviéndose fluidificado entre ellos para ayudar a las mujeres que asiste. Es consciente, culturalmente competente y políticamente enganchada. Trabaja con recursos de su conocimiento específico, aliados a los intereses de la mujer. Su relativismo informado es más accesible para las parteras profesionales, pero lo que se observa, alrededor del mundo, es que esta actitud está atingiendo las parteras tradicionales, en diversos países. Así, el concepto de partera pos-moderna representa una puente para las brechas étnicas, raciales y de status, que separan las parteras profesionales de las tradicionales, y un punto focal y analítico para la comprensión de la forma de negociación de identidades y papeles de cada uno de los miembros en el grupo, en el mundo en transformación.