Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Relatos da pandemia: ser mulher e mãe em tempos de covid-19 / Pandemic reports: being a woman and mother in covid-19 times / Relatos de la pandemia: ser mujer y madre en tiempos del covid-19

Partindo da pergunta "Como tem sido ser mulher e mãe em tempos de pandemia?", o presente estudo convidou mulheres que são mães, em redes sociais virtuais, a partilhar um relato de suas experiências com a readaptação parental em função do distanciamento social causado pela pandemia de covid-19. O objetivo foi refletir sobre a experiência de ser mulher e mãe em tempos de covid-19 e distanciamento social, apontando algumas ressonâncias do cenário pandêmico na subjetividade dessas mulheres. O estudo teve como base o referencial psicanalítico, tanto na construção da pesquisa e análise dos relatos quanto na sua discussão. A análise dos cerca de 340 relatos coletados, os quais variaram de uma breve frase a longos parágrafos, apontou para uma série de questionamentos, pontos de análise e reflexões. A pandemia, e o decorrente distanciamento social, parece ter colocado uma lente de aumento sobre as angústias das mulheres que são mães, evidenciando sentimentos e sofrimentos sempre presentes. Destacaram-se, nos relatos, a sobrecarga das mulheres com as tarefas de cuidado dos filhos e da casa, a culpa, a solidão, a exaustão, e o sentimento de que não havia espaço nesse contexto para "ser mulher", sendo isso entendido especialmente a questões estéticas e de vaidade.(AU)

Starting from the question "How does it feel to be a woman and a mother in pandemic times?", this study invited women who are mothers, in virtual social networks, to share their experiences regarding parental adaptations due to social distancing caused by the COVID-19 pandemic. The objective was to reflect on the experience of being a woman and a mother in the context of COVID-19 and of social distancing, pointing out some resonances of the pandemic scenario in the subjectivity of these women. The study was based on the psychoanalytical framework, both in the construction of the research and analysis of the reports and in their discussion. The analysis of about 340 collected reports, which ranged from a brief sentence to long paragraphs, pointed to a series of questions, analysis topics, and reflections. The pandemic, and the resulting social distancing, seems to have placed a magnifying glass over the anguish of women who are mothers, showing ever-present feelings and suffering. The reports highlighted women's overload with child and house care tasks, the guilt, loneliness, exhaustion, and the feeling that there was no space in this context to "be a woman," and it extends to aesthetic and vanity related questions especially.(AU)

A partir de la pregunta "¿cómo te sientes siendo mujer y madre en tiempos de pandemia?", este estudio invitó por las redes sociales a mujeres que son madres a compartir un relato de sus experiencias sobre la readaptación parental en función del distanciamiento social causado por la pandemia del covid-19. Su objetivo fue reflexionar sobre la experiencia de ser mujer y madre en tiempos del covid-19 y el distanciamiento social, señalando algunas resonancias del escenario pandémico en la subjetividad de estas mujeres. Este estudio se basó en el marco psicoanalítico, tanto en la construcción de la investigación y análisis de los informes como en su discusión. El análisis de los casi 340 relatos, que variaron de una pequeña frase a largos párrafos, generó en las investigadoras una serie de cuestionamientos y reflexiones. La pandemia y el consecuente distanciamiento social parece haber agrandado las angustias de las mujeres que son madres, evidenciando sentimientos y sufrimientos siempre presentes. En los relatos destacan la sobrecarga de las mujeres con las tareas de cuidado de los hijos y del hogar, la culpa, la soledad, el cansancio, así como el sentimiento de que no hay espacio em este contexto para "ser mujer", relacionado principalmente a cuestiones estéticas y de vanidad.(AU)

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Evaluation of an Australian Aboriginal model of maternity care: The Malabar Community Midwifery Link Service.

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.

Music therapy intervention in cardiac autonomic modulation, anxiety, and depression in mothers of preterms: randomized controlled trial.

BACKGROUND: Mothers of preterm infants often have symptoms of anxiety and depression, recognized as risk factors for the development of cardiovascular diseases and associated with low rates of heart rate variability (HRV). This study aimed to evaluate the influence of music therapy intervention on the autonomic control of heart rate, anxiety, and depression in mothers. METHODS: Prospective randomized clinical trial including 21 mothers of preterms admitted to the Neonatal Intensive Care Unit of a tertiary hospital, recruited from August 2015 to September 2017, and divided into control group (CG; n = 11) and music therapy group (MTG; n = 10). Participants underwent anxiety and depression evaluation, as well as measurements of the intervals between consecutive heartbeats or RR intervals for the analysis of HRV at the first and the last weeks of hospitalization of their preterms. Music therapy sessions lasting 30-45 min were individually delivered weekly using receptive techniques. The mean and standard deviation of variables were obtained and the normality of data was analyzed using the Kolmogorov-Smirnov test. The paired sample t-test or Wilcoxon test were employed to calculate the differences between variables before and after music therapy intervention. The correlations anxiety versus heart variables and depression versus heart variables were established using Spearman correlation test. Fisher's exact test was used to verify the differences between categorical variables. A significance level of p < 0.05 was established. Statistical analysis were performed using the Statistical Package for the Social Sciences, version 20. RESULTS: Participants in MTG had an average of seven sessions of music therapy, and showed improvement in anxiety and depression scores and autonomic indexes of the time domain (p < 0.05). Significant correlations were found between depression and parasympathetic modulation using linear (r = - 0.687; p = 0.028) and nonlinear analyses (r = - 0.689; p = 0.027) in MTG. CONCLUSION: Music therapy had a significant and positive impact on anxiety and depression, acting on prevention of cardiovascular diseases, major threats to modern society. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (no. RBR-3x7gz8 ). Retrospectively registered on November 17, 2017.

Percepción del cuidado de enfermería durante el trabajo de parto y parto en una Institución de Bogotá / Perception of nursing care during labor and delivery in an institution in Bogotá

Objetivo: Describir la percepción del cuidado de enfermería, que tiene la puérpera durante el trabajo de parto y parto, en un Hospital de Bogotá, mediante la aplicación del instrumento CARE-Q de Patricia Larson. Material y Métodos: Estudio cuantitativo descriptivo, transversal, sobre puérperas que recibieron cuidado de enfermería durante el trabajo de parto y parto en una Institución de cuarto nivel en Bogotá, se realizó un muestreo no probabilístico consecutivo/ secuencial con 108 mujeres mayores de 18 años durante el puerperio, entre las 2 y 24 horas y embarazos entre 36 y 40 semanas. Se incluyeron datos como: edad, ocupación, estado civil, nivel escolaridad, antecedentes ginecoobstétricos. Se describió la percepción aplicando el cuestionario CARE-Q de Patricia Larson, dividiendo los puntajes obtenidos en cuartiles. Resultados: La caracterización de las mujeres muestra que están en edades de 20 y 35 años con 86.1%, nivel educativo técnico y tecnológico 38%, estado civil 82.4% casadas, la ocupación 68.5% son mujeres empleadas, las semanas de gestación de 39, con un 27.8% y como antecedentes gineco- obstétricos un total de 46.3% un parto. La percepción general se encuentra en los cuartiles 3 y 4, por encima de la mediana, con el 57% de participantes. Las sub- escalas de comportamiento con mayor puntuación "accesibilidad" y "monitorea y hace seguimiento" resaltaron actividades de cuidado físico y conocimiento para la práctica, las sub- escalas de menor puntuación: "explica y facilita" y "se anticipa"; requiere mejoramiento en la comunicación terapéutica con la mujer y el equipo de trabajo. Discusión: En relación con otros estudios; sus resultados hacen énfasis en los cuidados físicos que repercuten en el bienestar de la mujer y su hijo y los demás soportan el cuidado en el apoyo espiritual que requiere la mujer durante éste proceso de transición.

Objective: Describe the perception of nursing care that the postpartum have during the childbirth and its labor, in a hospital from Bogotá by applying the CARE-Q instrument of Patricia Larson. Material and methods: Study with quantitative approach of transversal type, postpartum" were included who received nursing care during the childbird and its labor in a fourth level institution in bogota city, a non-probabilistic/sequential samplingwas made which consisted of 100 women older than 18 years during the postpartum between 2 and 24 intrahospital hours, with term pregnancies with healthy newborn. The signature of the informed consent was made for participación in the study, sociodemographic data about age, occupation, marital status, education level, gynecoobstetric history. the perception of care was described applying the CARE-Q questionnaire of Patricia Larson which consists in 46 questions divided into 6 sub-scales of behavior. Also a factorial analisis was made identifying the total variance explained and the most significant behaviors for each sub-scale vs which had higher scores. Results The demographic characterization ages %, ages between 20 and 35 with a 86.1%, the educational level is about a 38% technician/technologist Marital status is composed by 82.4% of married women .Occupation is composed by 68,5% of employed women. The weeks of gestation were about 39 weeks with a 27.8% and as gynecoobstetric history: a one birth 46.3%. General perception about nursing care is inside the quartile 3, its above average, the sub-scales of behavior with higher punctuation were "accessibility" and "monitoring and follow up" highlighting activities of physical care and knowledge for nursing practice, the sub-scales of less punctuation were "explain and facilitates" and "it is anticipated" where requires improvement in activities as therapy communication with women and her family and between work team. Discussion Regarding with other studies that also speaks about perception, this one shows a big difference due to its results make emphasis in physical care that impacts on women's wellness and her son to be born and others results support the care in spiritual support that a woman requires during this process of transition.

Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health.

BACKGROUND: Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mothers and their infants in the short and long term. There is strong evidence to support treatment for GDM. However, there is uncertainty as to whether or not screening all pregnant women for GDM will improve maternal and infant health and if so, the most appropriate setting for screening. This review updates a Cochrane Review, first published in 2010, and subsequently updated in 2014. OBJECTIVES: To assess the effects of screening for gestational diabetes mellitus based on different risk profiles and settings on maternal and infant outcomes. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (31 January 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (14 June 2017), and reference lists of retrieved studies. SELECTION CRITERIA: We included randomised and quasi-randomised trials evaluating the effects of different protocols, guidelines or programmes for screening for GDM based on different risk profiles and settings, compared with the absence of screening, or compared with other protocols, guidelines or programmes for screening. We planned to include trials published as abstracts only and cluster-randomised trials, but we did not identify any. Cross-over trials are not eligible for inclusion in this review. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of the included trials. We resolved disagreements through discussion or through consulting a third reviewer. MAIN RESULTS: We included two trials that randomised 4523 women and their infants. Both trials were conducted in Ireland. One trial (which quasi-randomised 3742 women, and analysed 3152 women) compared universal screening versus risk factor-based screening, and one trial (which randomised 781 women, and analysed 690 women) compared primary care screening versus secondary care screening. We were not able to perform meta-analyses due to the different interventions and comparisons assessed.Overall, there was moderate to high risk of bias due to one trial being quasi-randomised, inadequate blinding, and incomplete outcome data in both trials. We used GRADEpro GDT software to assess the quality of the evidence for selected outcomes for the mother and her child. Evidence was downgraded for study design limitations and imprecision of effect estimates. Universal screening versus risk-factor screening (one trial) MotherMore women were diagnosed with GDM in the universal screening group than in the risk-factor screening group (risk ratio (RR) 1.85, 95% confidence interval (CI) 1.12 to 3.04; participants = 3152; low-quality evidence). There were no data reported under this comparison for other maternal outcomes including hypertensive disorders of pregnancy, caesarean birth, perineal trauma, gestational weight gain, postnatal depression, and type 2 diabetes. ChildNeonatal outcomes: large-for-gestational age, perinatal mortality, mortality or morbidity composite, hypoglycaemia; and childhood/adulthood outcomes: adiposity, type 2 diabetes, and neurosensory disability, were not reported under this comparison. Primary care screening versus secondary care screening (one trial) MotherThere was no clear difference between the primary care and secondary care screening groups for GDM (RR 0.91, 95% CI 0.50 to 1.66; participants = 690; low-quality evidence), hypertension (RR 1.41, 95% CI 0.77 to 2.59; participants = 690; low-quality evidence), pre-eclampsia (RR 0.80, 95% CI 0.36 to 1.78; participants = 690;low-quality evidence), or caesarean section birth (RR 1.00, 95% CI 0.80 to 1.27; participants = 690; low-quality evidence). There were no data reported for perineal trauma, gestational weight gain, postnatal depression, or type 2 diabetes. ChildThere was no clear difference between the primary care and secondary care screening groups for large-for-gestational age (RR 1.37, 95% CI 0.96 to 1.96; participants = 690; low-quality evidence), neonatal complications: composite outcome, including: hypoglycaemia, respiratory distress, need for phototherapy, birth trauma, shoulder dystocia, five minute Apgar less than seven at one or five minutes, prematurity (RR 0.99, 95% CI 0.57 to 1.71; participants = 690; low-quality evidence), or neonatal hypoglycaemia (RR 1.10, 95% CI 0.28 to 4.38; participants = 690; very low-quality evidence). There was one perinatal death in the primary care screening group and two in the secondary care screening group (RR 1.10, 95% CI 0.10 to 12.12; participants = 690; very low-quality evidence). There were no data for neurosensory disability, or childhood/adulthood adiposity or type 2 diabetes. AUTHORS' CONCLUSIONS: There are insufficient randomised controlled trial data evaluating the effects of screening for GDM based on different risk profiles and settings on maternal and infant outcomes. Low-quality evidence suggests universal screening compared with risk factor-based screening leads to more women being diagnosed with GDM. Low to very low-quality evidence suggests no clear differences between primary care and secondary care screening, for outcomes: GDM, hypertension, pre-eclampsia, caesarean birth, large-for-gestational age, neonatal complications composite, and hypoglycaemia.Further, high-quality randomised controlled trials are needed to assess the value of screening for GDM, which may compare different protocols, guidelines or programmes for screening (based on different risk profiles and settings), with the absence of screening, or with other protocols, guidelines or programmes. There is a need for future trials to be sufficiently powered to detect important differences in short- and long-term maternal and infant outcomes, such as those important outcomes pre-specified in this review. As only a proportion of women will be diagnosed with GDM in these trials, large sample sizes may be required.

'Partnerships are crucial': an evaluation of the Aboriginal Family Birthing Program in South Australia.

OBJECTIVES: To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families across South Australia (SA). METHODS: Analysis of births to Aboriginal women in SA 2010-2012; interviews with health professionals and AFBP clients. RESULTS: Around a third of all Aboriginal women giving birth in SA 2010-2012 (n=486) attended AFBP services. AFBP women were more likely to be more socially disadvantaged, have poorer pregnancy health and to have inadequate numbers of antenatal visits than Aboriginal women attending other services. Even with greater social disadvantage and higher clinical complexity, pregnancy outcomes were similar for AFBP and other Aboriginal women. Interviews with 107 health professionals (including 20 Aboriginal Maternal and Infant Care (AMIC) workers) indicated differing levels of commitment to the model, with some lack of clarity about AMIC workers and midwives roles. Interviews with 20 AFBP clients showed they highly valued care from another Aboriginal woman. CONCLUSIONS: Despite challenges, the AFBP reaches out to women with the greatest need, providing culturally appropriate, effective care through partnerships. Implications for Public Health: Programs like the AFBP need to be expanded and supported to improve maternal and child health outcomes for Aboriginal families.

[Ethical dilemmas in medicine. The interruption of pregnancy in woman]. / Dilemas éticos en medicina. La interrupción del embarazo en la mujer.

Pregnancy interruption or abortion may be spontaneous or induced for medical, legal, demographic, and personal reasons. Different events that are present during the woman´s gravid period were described, paying attention to the differences in between fertilization and conception. These issues are very important because people or institutions mix these concepts and posit that pregnancy or conception starts at fertilization in opposition to the actual medical and scientific knowledge. In Mexico there are several millions of spontaneous and induced abortions without medical care, responsible for the high maternal-infant mortality rates. To avoid this undesirable situation, it has been proposed to follow the established WHO guidelines and adopt national health policies to re-orientate population goals on life quality, gender equity, universal public health services, and to promote the new holistic concepts of reproductive and sexual health such as: family planning, use of anti-fertility methods, adolescent reproductive health, sexually transmitted diseases, maternal and newborn health, peri- and post-menopausal women's health, and prevention, diagnosis, and opportune treatment of mammary, cervical-uterine, and ovarian cancers. Finally, it is recommended to revise our national health policies and existing laws on abortion de-penalization.

Las Matronas de la Beneficencia Municipal y su atención a las mujeres pobres de Málaga (1900-1956) / As Parteiras de Assistência Municipal e atenção às mulheres pobres de Málaga (1900-1956) / The Municipal Welfare Midwives and attention to the poor women of Malaga (1900-1956)

El objetivo de este estudio consiste en conocer las características del desarrollo profesional y la práctica clínica de las Matronas de la Beneficencia Municipal Malagueña en el período de 1900-1956. Material y Método: Se ha realizado un estudio histórico descriptivo. La recogida de información se ha realizado a través de fuentes primarias y secundarias. Resultados: El proceso para instalar las casas de socorro en la ciudad de Málaga, se inició en 1862 por orden del Gobernador Civil que urgió al Ayuntamiento para que las estableciese. Conclusiones: La incorporación de la Matrona al escenario sanitario permitió una cobertura durante el proceso reproductivo a las mujeres pobres de Málaga a través de la Beneficencia Municipal (AU)

The aim of this study was focused on knowing professional development characteristics and Clinical Practice of Midwives in the Municipal Charity of Malaga in 1900-1956. Method and Materials: This was descriptive and historic study. The collection of information has been made through primary and secondary sources. Results: The process to install the relief houses in the City of Malaga, started in 1862 by Order of the Civil Governor. Conclusions: The incorporation of the healthcare scenario allowed Midwives coverage during the reproductive process of poor women of Malaga through the Municipal Welfare (AU)

O objetivo deste estudo é compreender as características do desenvolvimento profissional e prática clínica das Parteiras Municipal de Assistência Malagueña no período 1900-1956. Material e Métodos: Foi realizado um estudo descritivo histórico. A coleta de informações foi realizada por meio de fontes primárias e secundárias. Resultados: O processo para a instalação de casas de socorro na cidade de Malaga, começou em 1862 por ordem do Governador Civil instou o Conselho da Cidade de estabelecer. Conclusões: A adição do cenário da saúde permitiu a cobertura matrona durante o processo reprodutivo de Málaga mulheres pobres através da Previdência Municipal (AU)

Factores asociados con la anemia en niños menores de tres años en Perú: análisis de la Encuesta Demográfica y de Salud Familiar, 2007-2013 / Factors associated with anemia in children under three years of age in Perú: analysis of the Encuesta Demográfica y de Salud Familiar, ENDES, 2007-2013

Introducción. A pesar de la disminución de la pobreza en Perú, la prevalencia de la anemia infantil en el país continúa siendo alta. Objetivo. Determinar los factores sociodemográficos y las características del cuidado materno-infantil asociadas con la anemia en niños de seis a 35 meses de edad en Perú. Materiales y métodos. Se hizo un estudio observacional que incluyó los datos sobre hemoglobina sanguínea registrados en la Encuesta Demográfica y de Salud Familiar (ENDES), 2007-2013, en niños entre los seis y los 35 meses de edad. Mediante un análisis multivariado de regresión logística, se identificaron los factores asociados con la anemia, definida como una hemoglobina corregida por altitud, menor de 11 mg/dl. Resultados. La prevalencia de anemia fue alta (47,9 %). Se identificaron doce factores asociados con la anemia: factores sociodemográficos como vivir fuera de Lima y Callao; en un hogar con bajo nivel socioeconómico; tener una madre adolescente y con bajo nivel educativo; ser de sexo masculino con edad menor de 24 meses y antecedentes de fiebre reciente, y factores relacionados con el cuidado materno-infantil como la falta de control prenatal en el primer trimestre, la falta de suplemento de hierro durante el embarazo o administrado durante un periodo breve, parto en el domicilio, diagnóstico de anemia en la madre en el momento de la encuesta y ausencia de tratamiento antiparasitario preventivo en el niño. Conclusiones. La ENDES proporcionó información valiosa sobre los factores asociados con la anemia en niños de seis a 35 meses, cuyo conocimiento debe mejorar la cobertura y la efectividad de prácticas adecuadas de cuidado materno-infantil.

Introduction: Despite the reduction of poverty in Perú, the prevalence of anemia in the country remains high. Objective: To identify socio-demographic, child and maternal-child care factors associated with anemia in children between 6 and 35 months in Perú. Materials and methods: We conducted an analytical and descriptive study that included registered data from the national survey on demography and family health, 2007-2013, on children between 6 and 35 months old, including the measurement of blood hemoglobin. Anemia was confirmed by hemoglobin-altitude corrected values below 11 mg/dl. We used multivariate logistic regression models to assess potential associated factors for anemia. Results: Anemia prevalence was high (47.9%). Twelve factors were independently associated with anemia in children: Socio-demographic factors such as living outside Lima and Callao, in a low socioeconomic household, and having an adolescent mother with low education level; child-related factors as being male, younger than 24 months of age, and having fever in the previous two weeks, and maternal-child care factors such as lack of prenatal control in the first trimester of pregnancy, lack or short period of iron supplementation during pregnancy, house delivery, anemia detection at the moment of the survey, and lack of intestinal anti-parasite preventive treatment in the child. Conclusions: The analysis of survey data provided valuable information about factors associated with anemia in children between 6 and 35 months, which can be used to increase the coverage and effectiveness of maternal-child care practices.

Village midwives and their changing roles in Brunei Darussalam: A qualitative study.

BACKGROUND: There are lay midwives worldwide, interchangeably and universally called traditional birth attendants or traditional midwives by organisations such as the World Health Organization and the International Confederation of Midwives. AIM: This study aimed to explore the history of lay midwives (village midwives) in Brunei, describe the evolution from their previous to current roles and determine if they are still needed by women today. METHODS: This qualitative, descriptive study included in-depth, semi-structured interviews with eight women who had received care from village midwives. Data analysis was based on the principles underpinning thematic analysis and used a constant comparative method. FINDINGS: Village midwives have been popular in Brunei since the 1900s, with their major role being to assist women with childbirth. However, since the 1960s, their roles and practices have changed to focus on pre-conception, antenatal, postnatal and women's general healthcare. Traditional practices were influenced by religion, culture and the social context of and within Brunei. DISCUSSION: The major changes in village midwives' roles and practices resulted from the enforcement of the Brunei Midwives' Act in 1956. Village midwives' traditional practices became juxtaposed with modern complementary alternative medicine practices, and they began charging a fee for their services. CONCLUSION: Brunei village midwives are trusted by women, and their practices may still be widely accepted in Brunei. Further research is necessary to confirm their existence, determine the detailed scope and appropriateness of their practices and verify the feasibility of them working together with healthcare professionals.

Biopsychosocial obstetrics and gynaecology - a perspective from Australia.

Prior to and throughout the twentieth century, biomedical understandings of health predominated. Australian obstetrician and gynaecologist, Professor Derek Llewellyn-Jones responded to frustrations with the limitations of this narrow approach from both within and beyond the medical profession. His pioneering research, education and writings re-conceptualised the discipline as encompassing the social and psychological contexts and profoundly influenced women's own understanding of their health and the practice of obstetrics and gynaecology. The biopsychosocial model has replaced biological determinism and is now pervasive in education and clinical practice in many parts of the world. Widespread acceptance of the model has until now been associated with under-recognition of the importance of biology. Recent findings from epigenetics and neuroscience are enabling integration of body, mind and society and enhanced understanding and practice of psychosomatic obstetrics and gynaecology.

Antenatal GBS screening: an Australian perspective.

Women in Australia are offered a variety of options for screening and treatment of group B streptococcus (GBS), depending on which health service they are engaged with, including a risk-based approach or universal screening. The difficulty for midwives when addressing the evidence supporting these differing policies is that there is no unified national policy on GBS screening in Australia. Furthermore, the Australian population is a discerning one, questioning the implications of procedures and exploring all options. This paper discusses the varying evidence and limitations that midwives need to be aware of in order to inform women, empower their decision-making and provide holistic woman-centred care.

Providing hope: midwifery teaching in Bangladesh.

Bangladesh is recognised as a resource-poor country that has made some very positive steps to reducing maternal mortality over the last decade. However the death rate of women directly caused by pregnancy and childbirth still remains much higher than countries such as the UK, often due to lack of access to good quality and affordable basic health care. In this article, Anna Kent writes of her experiences teaching obstetric emergency clinical skills to Bangladesh's first ever student midwives. The students were recruited from rural villages to complete a three-year fully funded Midwifery Diploma Programme at one of seven education centres across the country. The goal of the programme is for the students to eventually return and practise as midwives in their home communities, enabling greater access for women to good quality basic health care, directly reducing maternal mortality across Bangladesh.