Instructional and didactic support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings: Creation and validation.

OBJECTIVE: To describe the creation and validation process of an instructional, didactic and self-applied support tool for teaching-learning Post-Partum Haemorrhage care in simulated settings. BACKGROUND: Students frequently face difficulties performing the actions in the proper sequence in Post-Partum Haemorrhage simulated cases. Even in a controlled environment, anxiety, nervousness and fear of making mistakes are evident, which render the simulated experience highly stressful. Having a tool with a guideline can help students perform these actions more assertively. DESIGN: A methodological study to develop a didactic tool. METHODS: The creation process of the didactic tool, called Instructional Disk for the Management of Post-Partum Haemorrhage, was divided into five phases: Analysis, Design, Development, Implementation and Evaluation. Nine experts specialised in Obstetrics and Midwifery validated the tool by answering a questionnaire with nine items; in turn, 32 undergraduate Midwifery program students carried out the evaluation using a questionnaire on applicability, functionality, clarity, coherence and usability of the tool in Post-Partum Haemorrhage simulated stations. The data were analysed descriptively, considering absolute agreement when the answers to all questions in the five-point Likert scale corresponded to 5 (I totally agree). The Content Validity Index was calculated for the experts' questionnaires. RESULTS: In the validation stage, the experts agreed or totally agreed with all nine items, reaching a Content Validity Index = 1. In the total scores assigned by the experts, there was a variation between 80.0% and 100% absolute agreement, with a mean of 95.6%. In the students' assessment, the variation was between 87.5% and 100% absolute agreement, with a mean of 97.7%, in the eight items evaluated. The agreement level above 90% among experts and students was considered high. CONCLUSIONS: The Instructional Disk for the Management of Post-Partum Haemorrhage was validated by experts with extensive experience in Obstetrics and Midwifery care and teaching, ensuring that the content included in the guidelines for the management of Post-Partum Haemorrhage adopted in Brazil is covered. The students positively evaluated this support tool for learning the care to be provided in Post-Partum Haemorrhage cases in the simulated stations.

Spiritual Experiences of Portuguese Women Who had a Water Birth.

This study aimed to understand the significance of spirituality to Portuguese women who had a water birth. In-depth interviews, using a semi-structured questionnaire, were conducted with 24 women who experienced water birth at the hospital or home. Results were analyzed from a narrative interpretation perspective. Three spirituality-related categories emerged: (1) Beliefs and connections with the body; (2) Spirituality: integration of being a woman and transformation during birth; and (3) Spirituality as wisdom, intuition, or the sixth sense. Spirituality was perceived in women's faith and beliefs in a superior being that helped them manage the unpredictability and uncontrollability of giving birth.

Perineal outcomes and its associated variables of water births versus non-water births: a cross-sectional study / Desfechos perineais e as variáveis associadas no parto na água e no parto fora da água: estudo transversal

Abstract Objectives: to describe the perineal outcomes of women who had delivered in water and out of water. Methods: a cross-sectional and quantitative study developed in a public hospital in Setúbal, Portugal. The population was of women who participated in the "Water Birth Project" in the period from 2011 to 2014, which gave birth in water and out of water. 104 women were selected according to established inclusion criteria. The groups were compared according to the following variables: demographics, obstetric information, delivery care and perineal outcomes. The data were analyzed in the Stata(r) software, with descriptive and bivariate statistics (chi-square and Fisher's test). Results: the medical records of 73 women who gave birth in water and 31 women who gave birth out of water were studied. Water deliveries were significantly associated with fewer perineal lacerations, lower rates of episiotomy, and shorter delivery time. Conclusions: the results of the study suggest that childbirth in water has a protective effect against severe third or fourth degree perineal tears, during fetal expulsion in water.

Resumo Objetivos: descrever os resultados perineais de mulheres que tiveram parto na água e fora da água. Métodos: estudo transversal e quantitativo desenvolvido em um hospital público de Setúbal, Portugal. A população foi de mulheres que participaram do "Projeto Parto na Água", no período de 2011 a 2014, que deram à luz na água e fora da água. Foram selecionadas para o estudo 104 mulheres de acordo com os critérios de inclusão estabelecidos. Os grupos foram comparados de acordo com as seguintes variáveis: demografia, informação obstétrica, assistência ao parto e resultados perineais. Os dados foram analisados no software Stata(r), com estatísitica descritiva e bivariada (qui-quadrado e teste de Fisher). Resultados: foram estudados os prontuários de 73 mulheres que deram à luz na água e 31 mulheres que deram à luz fora da água. Os partos na água foram significativamente associados a menos lacerações perineais, menores taxas de episiotomia e menor tempo de parto. Conclusão: os resultados do estudo sugerem que o parto na água tem um efeito protetor contra lacerações perineais severas de terceiro ou de quarto grau durante a expulsão fetal na água.

Localização das lacerações perineais no parto normal em mulheres primíparas / Locus of perineal lacerations in vaginal birth among primiparous women / Localización de las laceraciones perineales en el parto normal en mujeres primíparas

Estudo de tipo transversal, cujo objetivo foi analisar a distribuição das lacerações vulvo-perineais e os fatores relacionados à sua localização nas regiões anterior e posterior do períneo no parto normal. A amostra foi constituída por 317 primíparas que tiveram parto normal sem episiotomia e apresentaram laceração perineal. Os dados foram coletados em dois centros de parto normal, nas cidades de São Paulo e Itapecerica da Serra, Estado de São Paulo, no período de 2001 a 2012, e integram o banco de dados de cinco subprojetos vinculados ao projeto Trauma perineal no parto normal: prevenção, morbidade e cuidados. Houve predomínio de lacerações na região posterior do períneo. Não houve diferença estatística significante em relação ao local da laceração perineal e a posição materna no parto, variedade de posição no desprendimento cefálico, circular de cordão umbilical e peso do recém-nascido, porém houve diferença significante em relação ao tipo de puxo.

Cross-sectional study, aiming at analyzing the distribution of vulvo-perineal lacerations and factors related to its location in anterior and posterior region of perineum in spontaneous birth. Sample was comprised of 317 women who had vaginal delivery without episiotomy and with perineal laceration. Data were collected in two centers of normal birth, in the cities of São Paulo and Itapecerica da Serra, in the state of São Paulo, Brazil, from 2001 to 2012. It integrates the database of five subprojects under the Perineal trauma in normal birth: prevention, morbidity and care project. There was predominance of lacerations in the posterior perineum region. There was no statistically significant difference in relation to the location of the perineal laceration and the maternal position during delivery, variety of fetal head position in the detachment, umbilical cord circular, and weight of the new-born, but there was significant difference concerning the kind of pushing.

Estudio transversal, cuyo objetivo fue analizar la distribución vulvo-perineal de las laceraciones y los factores relacionados con su localización en el parto normal. La muestra consistió de 317 mujeres primíparas que tuvieron parto normal sin episiotomía y presentaron laceración perineal. Los datos fueron recolectados en dos centros de parto normal, en las ciudades de São Paulo e Itapecerica da Serra, Estado de São Paulo – Brasil, de 2001 a 2012, y forman parte de la base de datos de cinco subproyectos relacionados al proyecto Trauma perineal en el parto normal: prevención, morbilidad y cuidados. Hubo predominio de laceraciones en la región posterior del perineo. No hubo diferencia estadísticamente significativa en relación a la localización de la laceración perineal y la posición materna durante el parto, variedad de posición en la cabeza fetal en el desprendimiento, circular de cordón umbilical y peso del recién nacido, pero hubo diferencia significativa en relación al tipo de pujo.