Utilização das boas práticas no parto e experiência e satisfação materna / Using good delivery practices and maternal experience and satisfaction

Objetivo: Descrever a utilização das boas práticas de atenção ao parto e nascimento e o grau de satisfação e experiência de puérperas com o parto. Métodos: Estudo transversal, realizado no período de julho de 2017 a janeiro de 2018, em uma maternidade de referência em Fortaleza, Ceará. Para coleta de dados utilizou-se o Questionário de Experiência e Satisfação com o Parto e questionário para avaliação dos dados sociodemográficos e obstétricos. Os dados foram analisados no softwareStatistical Package for the Social Science. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Participaram 237 puérperas com média de idade de 26 anos. 168 (70,9%) mulheres estiveram bastante satisfeitas com a estrutura da instituição, 119 (50,2%) com os cuidados profissionais prestados e 160 (67,5%) com o trabalho de parto e parto. Dentre os fatores que estiveram associados à experiência positiva com o parto, destaca-se a realização do contato pele a pele, o estímulo ao aleitamento materno e a utilização dos métodos não farmacológicos de alívio da dor. Conclusão: Para uma experiência mais positiva de parto, ressalta-se a importância de abordagens mais humanizadas que incentivem práticas como contato pele a pele e início precoce do aleitamento materno, além de garantir que profissionais de saúde forneçam cuidados holísticos. Descritores: Satisfação do Paciente; Enfermagem Obstétrica; Trabalho de Parto; PartoNormal; PartoHumanizado.

Objective:To describe the use of good practices in delivery and childbirth care and the satisfaction levels and experiences of puerperal women with their deliveries.Methods:A cross-sectional study conducted from July 2017 to January 2018 in a reference maternity hospital from Fortaleza, Ceará. The Childbirth Experience and Satisfaction Questionnaire and another one to assess the sociodemographic and obstetric data were used for data collection. The data were analyzed in the Statistical Package for the Social Science. The study was approved by the Research Ethics Committee. Results:The participants were 237 puerperal women with a mean age of 26 years old. 168 (70.9%) women were quite satisfied with the institution's structure, 119 (50.2%) with the professional care provided, and 160 (67.5%) with labor and delivery. Among the factors that were associated with positive experiences with delivery, the most important are skin-to-skin contact, stimulating breastfeeding, and using non-pharmacological pain relief methods. Conclusion: For a more positive experience with delivery, it is worth emphasizing the importance of more humanized approaches that encourage practices such as skin-to-skin contact and early breastfeeding initiation, as well as ensuring that health professionals provide holistic care. Descriptors:Patient Satisfaction; Obstetric Nursing; Labor. Normal Delivery; Humanized Delivery.

The perfect birth: a content analysis of midwives' posts about birth on Instagram.

BACKGROUND: There is limited research into how midwives use social media within their professional role. Small pilot studies have explored the introduction of social media into maternity practice and teaching but there is little evidence around how midwives use social media professionally. This is important as 89% of pregnant women turn to social media for advice during pregnancy, and how midwives use social media could be influencing women, their perception of birth and their decision making. METHODS: AIM: To analyse how popular midwives portray birth on the social media platform Instagram. This is an observational mixed methods study using content analysis. Five 'popular' midwives from each country (UK, New Zealand, USA and Australia) were identified and their posts about birth collated from a one-year period (2020-21). Images/videos were then coded. Descriptive statistics enabled comparison of the posts by country. Categorisation was used to analyse and understand the content. RESULTS: The study identified 917 posts from the 20 midwives' accounts, containing 1216 images/videos, with most coming from USA (n = 466), and UK (n = 239), Australia (n = 205) and New Zealand (n = 7) respectively. Images/videos were categorised into 'Birth Positivity', 'Humour', 'Education', 'Birth Story' and 'Advertisement'. Midwives' portrayals of birth represented a greater proportion of vaginal births, waterbirths and homebirths than known national birth statistics. The most popular midwives identified mainly had private businesses (n = 17). Both the midwives and women portrayed in images were primarily white, demonstrating a disproportionate representation. CONCLUSION: There is a small midwifery presence on Instagram that is not representative of the broader profession, or the current picture of midwifery care. This paper is the first study to explore how midwives are using the popular social media platform Instagram to portray birth. It provides insight into how midwives post an un-medicalised, low risk representation of birth. Further research is recommended to explore midwives' motivation behind their posts, and how pregnant and postnatal women engage with social media.

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.

Midwives' Perception Regarding Conditions Influencing the Implementation of the Natural Childbirth Promotion Program in Iran: A Qualitative Study.

Background: In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as a component of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage natural childbirth practices and reduce cesarean section rates. The purpose of this qualitative study was to explore the perceptions of midwives about conditions influencing the implementation of NCPP. Methods: In this qualitative study, data were collected through 21 in-depth semi-structured individual interviews with expert midwives who were selected using purposive sampling mainly from one medical university in Eastern Iran from October 2019 to February 2020. Based on the framework method as a thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, we followed Lincoln and Guba's criteria. Results: Data analysis yielded 546 open codes. After the codes were reviewed and similar codes were removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes, 19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristics of the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effective management; Institutional and social context; and Social education. Conclusion: Based on the perceptions of the studied midwives, the success of the NCPP is guaranteed by a set of conditions identified in this study. In practice, these conditions are complementary and interrelated, and they cover a wide range of staff and parturient characteristics to the social context. It seems that effective implementation of the NCPP also calls for the accountability of all stakeholders, from policymakers to maternity care providers.

Vivências das puérperas no centro de parto normal / Vivencias de las puérperas en el centro de parto normal / Experiences of puerperal women in the normal birth center

Objetivos: compreender a vivência das puérperas na parturição no Centro de Parto Normal em um município do Agreste Paraibano. Método: trata-se de estudo descritivo, de abordagem qualitativa, realizado com puérperas, por meio de entrevista semiestruturada. A coleta de dados ocorreu nos meses de janeiro e fevereiro de 2020, em um Centro de Parto Normal. Os dados foram analisados conforme a técnica de análise de conteúdo temática. Resultados: dos dados empíricos emergiram as categorias: O cuidado da enfermeira obstétrica no contexto do Centro de Parto Normal; A presença do acompanhante durante o trabalho de parto. Constatou-se que as mulheres ficaram satisfeitas com o cuidado recebido pelas enfermeiras obstétricas. Foi evidenciado que a fisiologia, as escolhas e os sentimentos das mulheres foram respeitados durante o internamento. Conclusão: os cuidados ofertados proporcionaram vivências positivas, segurança e bem-estar no parto e pós-parto.

Objetivos: comprender la vivencia de las puérperas en el parto en el Centro de Parto Normal en un municipio del Agreste de Paraíba. Método: se trata de estudio descriptivo, de abordaje cualitativa, realizado con puérperas, por medio de entrevista semiestructurada. La recogida de datos ocurrió en los meses de enero y febrero de 2020, en un Centro de Parto Normal. Los datos fueron analizados conforme a la técnica de análisis de contenido temática. Resultados: de los datos empíricos emergieron las categorías: El cuidado de la enfermera obstétrica en el contexto del Centro de Parto Normal; La presencia del acompañante durante el trabajo de parto. Se constató que las mujeres quedaron satisfechas con el cuidado recibido por las enfermeras obstétricas. Se evidenció que la fisiología, las elecciones y los sentimientos de las mujeres fueron respetados durante el internamiento. Conclusión: los cuidados ofrecidos proporcionaron vivencias positivas, seguridad y bienestar en el parto y posparto.

Objective: to understand the experience of puerperal women in childbirth in the Normal Birth Center in a municipality of Paraíba's countryside. Method: this is a descriptive study, with a qualitative approach, conducted with puerperal women, through semi-structured interviews. Data collection occurred in January and February 2020, in a Normal Birth Center. The data were analyzed according to the thematic content analysis technique. Results: the following categories emerged from the empirical data: Obstetric nurse care in the context of the Normal Birth Center; The presence of the companion during labor. Women were satisfied with the care received by obstetric nurses. The physiology, choices and feelings of women were respected during hospitalization. Conclusion: the care offered provided positive experiences, safety and well-being in birth and postpartum.

The Role of Midwives in the Course of Natural Childbirth-Analysis of Sociodemographic and Psychosocial Factors-A Cross-Sectional Study.

BACKGROUND: An important role in the course of natural childbirth is played by midwives, who should effectively work on relieving pain. This study aims to present the opinions of midwives on non-pharmacological methods of relieving labor pain; the frequency of their use and reasons for their abandonment; and the relationship between the use of non-pharmacological methods of relieving labor pain and perceived job satisfaction, burnout, and self-efficacy of the midwife. METHODS: The study was conducted online, with the participation of 135 Polish midwives working in the delivery room. The author's survey questionnaire, the Generalized Self-Efficacy Scale (GSES), the LBQ Burnout Questionnaire, and the Scale of Job Satisfaction were used. RESULTS: Among the surveyed midwives, 77% use vertical positions in work with a patient giving birth. Almost all respondents consider vertical positions as an example of a non-pharmacological method of relieving labor pain; those with master's degree felt more prepared for their use (p = 0.02). The most common reason for abandoning their use was disagreement on the part of co-workers (p = 0.005). An association was observed between the use of vertical positions and the level of burnout (p = 0.001) and a significant correlation between preparation for their use and self-efficacy assessment, burnout, and job satisfaction. CONCLUSION: Our research shows that it would be important to conduct additional training on the use of non-pharmacological methods to relieve labor pain and to present their benefits. In contrast to other research results, our results showed that midwives feel well prepared to use these methods; however, similar to other research, we found that they often feel disagreement from colleagues and a lack of support from their leaders. The use of vertical positions is related to burnout.

Is a randomized controlled trial of waterbirth possible? An Australian feasibility study.

BACKGROUND: The safety of waterbirth is contested because of the lack of evidence from randomized trials and conflicting results. This research assessed the feasibility of a prospective study of waterbirth (trial or cohort). METHODS: We conducted a prospective cohort study at an Australian maternity hospital. Eligible women with uncomplicated pregnancies at 36 weeks of gestation were recruited and surveyed about their willingness for randomization. The primary midwife assessed waterbirth eligibility and intention on admission in labor, and onset of second stage. Primary outcomes measured feasibility. Intention-to-treat analysis, and per-protocol analysis, compared clinical outcomes of women and their babies who intended waterbirth and nonwaterbirth at onset of second stage. RESULTS: 1260 participants were recruited; 15% (n = 188) agreed to randomization in a future trial. 550 women were analyzed by intention-to-treat analysis: 351 (waterbirth) and 199 (nonwaterbirth). In per-protocol analysis, 14% (n = 48) were excluded. Women in the waterbirth group were less likely to have amniotomy and more likely to have water immersion and physiological third stage. There were no differences in other measures of maternal morbidity. There were no significant differences between groups for serious neonatal morbidity; four cord avulsions occurred in the waterbirth group with none in the landbirth group. An RCT would need approximately 6000 women to be approached at onset of second stage. CONCLUSIONS: A randomized trial of waterbirth compared with nonwaterbirth, powered to detect a difference in serious neonatal morbidity, is unlikely to be feasible. A powered prospective study with intention-to-treat analysis at onset of second stage is feasible.

Waterbirth: current knowledge and medico-legal issues.

Water immersion during labour and birth has become increasingly popular and widespread in many countries, in particular in midwifery-led care settings. Nevertheless, there is a dearth of quality data about waterbirth, with currently available findings mostly arising from observational studies and case series. The lack of high-quality evidence and the controversial results reported by different studies determined a "behavioral gap" without clearly objective, consistent indications allowing for a sound and evidence-based decision making process. Although water immersion in the first stage of labour is generally considered a safe and cost-effective method of pain management for women in labor, concerns still linger as to the safety of immersion during the second stage of labor and delivery, particularly in terms of neonatal risks and medico-legal implications.

Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial.

BACKGROUND: Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth. METHODS: One hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section). RESULTS: It was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome. CONCLUSIONS: An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC. TRIAL REGISTRATION: The Netherlands Trial Register (NTR; 4302 ).

Práticas no parto: análise do cuidado em uma maternidade paraibana / Prácticas en el parto: análisis de la atención en una maternidad en Paraíba / Practices in birth: analysis of care in a maternity in paraiban

Objetivo: Caracterizar as práticas em saúde no período do parto em uma maternidade Paraibana. Método: Pesquisa de origem exploratória, descritiva e quantitativa. O estudo ocorreu em 2018, em uma Maternidade Municipal, localizada no município de Cabedelo, Paraíba. A amostra se deu com a participação de 12 pacientes, que se encontravam no período puerperal. Os dados foram analisados sob estatística descritiva e organizados em duas tabelas. Foi aprovado pelo comitê de ética em pesquisa do Centro Universitário de João Pessoa sob nº CAAE 83170617.8.0000.5176. Resultados: Ocorreu aplicação de ocitocina de rotina; Manobras desnecessárias; Amamentação na primeira hora de vida prejudicada e clampeamento precoce do cordão. Conclusão: Percebe-se a necessidade de investir-se em capacitações para os profissionais, visando quebrar a assistência inadequada e fragilizada que está sendo oferecida para as mulheres, no qual é rodeada de intervenções e cuidados desnecessários ao binômio(AU)

Objective: To characterize health practices during childbirth in a Paraíba maternity hospital. Method: Exploratory, descriptive and quantitative research. The study took place in 2018, in a Municipal Maternity, located in the city of Cabedelo, Paraíba. The sample took place with the participation of 12 patients, who were in the puerperal period. Data were analyzed using descriptive statistics and organized into two tables. It was approved by the research ethics committee of the Centro Universitário de João Pessoa under number CAAE 83170617.80000.5176. Results: Routine application of oxytocin occurred; Unnecessary maneuvers; Impaired breastfeeding in the first hour of life and early cord clamping. Conclusion: It is perceived the need to invest in training for professionals, aiming to break the inadequate and weakened care that is being offered to women, which is surrounded by interventions and unnecessary care for the binomial.(AU)

Objetivo: Caracterizar las prácticas de salud durante el parto en una maternidad de Paraíba. Método: Investigación exploratoria, descriptiva y cuantitativa. El estudio se realizó en 2018, en una Maternidad Municipal, ubicada en la ciudad de Cabedelo, Paraíba. La muestra se realizó con la participación de 12 pacientes, que se encontraban en el puerperio. Los datos se analizaron mediante estadística descriptiva y se organizaron en dos tablas. Fue aprobado por el comité de ética en investigación del Centro Universitário de João Pessoa con el número CAAE 83170617.80000.5176. Resultados: se produjo la aplicación de rutina de oxitocina; Maniobras innecesarias; Lactancia materna deteriorada en la primera hora de vida y pinzamiento temprano del cordón. Conclusión: Se percibe la necesidad de invertir en la formación de los profesionales, con el objetivo de romper con la atención inadecuada y debilitada que se ofrece a las mujeres, que está rodeada de intervenciones y cuidados innecesarios para el binomio(AU)

Relação de Trabalho entre Enfermeiros Obstétricos e Doulas na Assistência ao Parto / The work relationship between obstetric nurses and doulas in assistance to childbirth / La relación de trabajo entre enfermeros obstétricos y doulas en la asistencia al parto

Objetivo: O estudo objetiva descrever a relação de Enfermeiros Obstétricos e Doulas na assistência ao trabalho de parto e parto. Métodos: Estudo qualitativo, descritivo e prospectivo, realizado no Centro de Parto Normal localizado em Castanhal, com sete Enfermeiras Obstétricas e três Doulas. Os dados foram coletados entre dezembro/2017 e maio/2018, por meio de entrevista semiestruturada e Análise de Conteúdo de Bardin. Resultados: Emergiram as seguintes categorias: Assistência holística à gestante; A Enfermagem Obstétrica e as Doulas: o desafio no entrecruzar de práticas; Associação de práticas na assistência ao parto normal. Conclusão: Apesar dos relatos evidenciados de conflitos entre as Doulas e as Enfermeiras Obstétricas, é possível identificar uma boa relação na associação de práticas proporcionando benefícios à parturiente. (AU)

Objective: The study aims to describe the relationship between Obstetric Nurses and Doulas in assisting labor and delivery. Methods: A qualitative, descriptive and prospective study, carried out with seven Obstetric Nurses and three Doulas. Data were collected between Dec 2017 to May 2018, through a semi-structured interview and Bardin Content Analysis. Results: The speeches were classified into the following categories: Holistic care for pregnant women; Obstetric Nursing and Doulas: the challenge in the intertwining of practices; Association of practices in assisting normal delivery. Conclusion: Despite the evidences of conflicts between the Doulas and the Obstetric Nurses, it is possible to identify a good relation in the association of practices providing benefits to the parturient. (AU)

Objetivo: El estudio objetivó describir la relación de Enfermeros Obstétricos y Doulas en la asistencia al trabajo de parto y parto. Métodos: Estudio cualitativo, descriptivo y prospectivo, realizado en el Centro de Parto Normal ubicado en Castanhal, con siete Enfermeras Obstétricas y tres Doulas. Los datos fueron recolectados entre diciembre/2017 y mayo/2018, por medio de entrevista semiestructurada y Análisis de Contenido de Bardin. Resultados: Se plantearon las siguientes categorías: Asistencia holística a la gestante; La Enfermería Obstétrica y las Doulas: el desafío en el entrecruzar de prácticas; Asociación de prácticas en la asistencia al parto normal. Conclusion: A pesar de los relatos evidenciados de conflictos entre las Doulas y las Enfermeras Obstétricas, es posible identificar una buena relación en la asociación de prácticas proporcionando beneficios a la parturienta. (AU)

Práticas de atenção ao parto realizadas em uma maternidade de um municipio paraibano / Birth care practices carried out in a maternity in a municipality in paraibano / Practices in attention to childbirth accomplished in a maternity of a paraibano municipality

Descrever as práticas de atenção ao parto realizadas em uma maternidade de um município paraibano. Método: Trata-se de um estudo exploratório e descritivo, com abordagem quantitativa realizado no município de Cabedelo, Paraíba. A amostra foi não probabilística por conveniência constituída por 12 puérperas, em março e abril de 2018. Para a coleta dos dados foi utilizado um formulário específico e a análise estatística ocorreu utilizando-se o programa Microsoft Excel. Posteriormente, os dados foram apresentados em tabelas e interpretados a partir da literatura. O presente estudo foi aprovado sob nº CAAE 83170617.8.0000.5176. Resultados: Constatou-se que as práticas prejudiciais ao parto como manobra de Kristeller, episiotomia, utilização de ocitocina de rotina, posição de litotomia e clampeamento precoce do cordão umbilical ainda costumam ser realizadas com frequência. Conclusão: Percebe-se que é de extrema relevância promover cursos de atualização e capacitação baseados em evidências científicas para os profissionais de saúde.(AU)

Objective: To describe childbirth care practices carried out in a maternity hospital in a municipality in Paraíba. Method: This is an exploratory and descriptive study with a quantitative approach carried out in the city of Cabedelo, Paraíba. The sample was non-probabilistic for convenience, consisting of 12 postpartum women, in March and April, year 2018. For data collection, a specific form was used and the statistical analysis was carried out using the Microsoft Excel program. Subsequently, the data were presented in tables and interpreted from the literature. This study was approved under CAAE No. 83170617.8.0000.5176. Results: It was found that practices harmful to childbirth such as Kristeller maneuver, episiotomy, routine use of oxytocin, lithotomy position and early clamping of the umbilical cord are still often performed. Conclusion: It is perceived that it is extremely important to promote refresher and training courses based on scientific evidence for health professionals.(AU)

Objetivo: Describir las prácticas de atención al parto realizadas en una maternidad de un municipio de Paraíba. Método: Se trata de un estudio exploratorio descriptivo con enfoque cuantitativo realizado en la ciudad de Cabedelo, Paraíba. La muestra fue no probabilística por conveniencia, conformada por 12 puérperas, en marzo y abril del año 2018. Para la recolección de datos se utilizó un formulario específico y el análisis estadístico se realizó mediante el programa Microsoft Excel. Posteriormente, los datos se presentaron en tablas y se interpretaron a partir de la literatura. Este estudio fue aprobado con el número CAAE 83170617.80000.5176. Resultados: Se encontró que aún se realizan prácticas nocivas para el parto como la maniobra de Kristeller, la episiotomía, el uso rutinario de oxitocina, la posición de litotomía y el pinzamiento temprano del cordón umbilical. Conclusión: Se percibe que es de suma importancia promover cursos de actualización y capacitación basados en evidencia científica para los profesionales de la salud(AU)

Obstetric practices in childbirth care and usual risk birth / Práticas obstétricas na assistência ao parto e nascimento de risco habitual

Abstract Objectives: to analyze the incidence of obstetric practices in labor and childbirth care at usual risk in a tertiary hospital. Methods: cross-sectional, descriptive study with a quantitative approach. Data were collected from 314 Monitoring Sheets of Labor and Childbirth Care of women who had their birth attended at the institution, from July 2017 to July 2018. The study was approved by the research ethics committee, with the embodied opinion number 2.822.707. Results: most women in the study were between 20 and 34 years old, coming from the city of Fortaleza, Ceará; had completed high school; and had unpaid work. The prevalence of good practices was identified: umbilical cord clamping in a timely manner (81.5%), immediate skin-to-skin contact (73.9%), breastfeeding in the childbirth room (74.2%), freedom of position and movement (72.3%), completion of the partograph (66.6%), presence of a companion (66.2%), offer of a liquid diet (65%), and non-pharmacological methods for pain relief (54.8%). As for interventional practices, we identified: venoclysis (42.4%), oxytocin infusion (29%), and amniotomy (11.1%). Conclusions: advances in the adoption of good practices based on scientific evidence are noteworthy; however, the technocratic model of childbirth care for women at normal risk persists.

Resumo Objetivos: analisar a incidência das práticas obstétricas na assistência ao parto e nascimento de risco habitual em um hospital terciário. Métodos: estudo transversal, de caráter descritivo e abordagem quantitativa. Os dados foram coletados em 314 Fichas de Monitoramento da Atenção ao Parto e Nascimento de mulheres que tiveram seu parto assistido na instituição, no período de julho de 2017 a julho de 2018. O estudo obteve a aprovação do comitê de ética em pesquisa, com o parecer consubstanciado nº 2.822.707. Resultados: a maioria das mulheres do estudo encontrava-se na faixa etária de 20 a 34 anos, procedentes do município de Fortaleza-CE, possuíam ensino médio completo e atividade laboral não remunerada. Identificou-se a prevalência de boas práticas: clampeamento do cordão em tempo oportuno (81,5%), contato pele a pele imediato (73,9%), amamentação na sala de parto (74,2%), liberdade de posição e movimento (72,3%), preenchimento do partograma (66,6%), presença de acompanhante (66,2%), oferta de dieta líquida (65%) e métodos não farmacológicos para o alívio da dor (54,8%). Quanto às práticas intervencionistas, identificou-se: venóclise (42,4%), infusão de ocitocina (29%) e amniotomia (11,1%). Conclusões: ressalta-se avanços na adoção das boas práticas baseadas em evidências científicas, no entanto, persiste o modelo tecnocrático de assistência ao parto, frente ao atendimento de mulheres de risco habitual.

Fatores intervenientes no comportamento da musculatura perineal em parturientes de centro de parto normal / Intervening factors in perineal outcomes in parturient women in a normal childbirth center / Factores intervenientes en resultados perineales en parturientas en un centro de parto normal

Objetivo: conhecer a frequência e os tipos de traumas perineais em partos vaginais, bem como verificar a associação da paridade, posição do parto e peso do recém-nascido com a situação perineal, após o nascimento. Método: Estudo observacional, retrospectivo, de corte transversal, realizado em Centro de Parto Normal, no município de São Paulo, Brasil. A população foi constituída pelos registros de partos vaginais, no período de janeiro de 2017 a janeiro de 2018. Resultado: dos 2.367 partos registrados, em 1.629 (68,7%) houve traumatismo perineal, sendo as lacerações de primeiro grau as mais prevalentes (43,9%). Nas primíparas e nos partos em posição litotômica e semi-sentada, constataram-se maiores percentuais de episiotomia (<0,0001). Quando o peso do recém-nascido era menor do que 2500 gramas, foi maior o percentual de períneo íntegro e, nos maiores de 4000 gramas, foi maior o percentual de lacerações de segundo grau (<0,0001). Conclusão: houve influência das variáveis estudadas na situação do períneo após o nascimento. O trauma perineal continua a ser uma preocupação, devido à prevalência e às consequências futuras às mulheres. Conhecer os fatores que podem influenciar sua ocorrência é essencial para melhoria da assistência obstétrica.(AU)

Objectives: to determine the frequency and types of perineal trauma in vaginal deliveries, and to verify the association between parity, birth position, and newborn weight and perineal outcomes after birth. Methods: an observational, retrospective, and cross-sectional study was carried out at the Normal Childbirth Center of the city of São Paulo, Brazil. The population consisted of vaginal birth records from January 2017 to January 2018. Results: from 2,367 births recorded, in 1,629 (68.7%) there was perineal trauma, with first-degree lacerations being the most prevalent (43.9%). Higher percentages of episiotomy were found in primiparous women and in deliveries in the lithotomic and semi-seated positions (<0.0001). When the newborn's weight was less than 2500 grams, the percentage of intact perineum was higher and, in those over 4000 grams, the percentage of second-degree lacerations was higher (<0.0001). Conclusion: there was an influence of the studied variables on perineal outcomes after birth. Perineal trauma remains a concern due to the prevalence and future consequences for women. Knowing the factors that can influence its occurrence is essential for improving obstetric care.(AU)

Objetivos: determinar la frecuencia y los tipos de trauma perineal en partos vaginales y verificar la asociación entre paridad, posición del parto y peso del recién nacido y resultados perineales después del nacimiento. Métodos: se realizó un estudio observacional, retrospectivo y transversal en el Centro de Parto Normal de la ciudad de São Paulo, Brasil. La población estuvo constituida por registros de partos vaginales de enero de 2017 a enero de 2018. Resultados: de 2.367 nacimientos registrados, en 1.629 (68,7%) hubo traumatismo perineal, siendo las laceraciones de primer grado las más prevalentes (43,9%). Se encontraron mayores porcentajes de episiotomía en primíparas y en partos en posición litotómica y semisentada (<0,0001). Cuando el peso del recién nacido era menor de 2500 gramos, el porcentaje de perineo intacto era mayor y, en los mayores de 4000 gramos, el porcentaje de laceraciones de segundo grado era mayor (<0,0001). Conclusión: hubo influencia de las variables estudiadas en los resultados perineales después del nacimiento. El trauma perineal sigue siendo una preocupación debido a la prevalencia y las consecuencias futuras para las mujeres. Conocer los factores que pueden influir en su ocurrencia es fundamental para mejorar la atención obstétrica.(AU)

Uso de métodos não farmacológicos durante o trabalho de parto / Use of non-pharmacological methods during childbirth / Uso de métodos no farmacológicos durante el trabajo de parto

Objetivos: identificar a prevalência e descrever o uso dos métodos não farmacológicos para o alívio da dor em parturientes durante o trabalho de parto em maternidades públicas. Método: trata-se de um estudo quantitativo, descritivo, transversal, realizado com 344 parturientes, por meio da análise de prontuários. Realizou-se a análise descritiva com frequências absolutas e relativas. Resultados: registra-se que a prevalência do uso de métodos não farmacológicos foi de 95,4%. Ofereceram-se cinco métodos para 35,5% das parturientes: o apoio profissional (86,6%), método mais oferecido; respiração (80,2%); banho morno (72,4%); bola (57,3%) e massagem (50,0%). Conclusão: conclui-se que a maior parte das parturientes recebeu métodos não farmacológicos para o alívio da dor durante o trabalho de parto, porém, esta prática deve ser aplicada a todas as mulheres, pois é uma ação baseada em evidências e incorporada como uma das estratégias prioritárias de assistência às parturientes.(AU)

Objectives: to identify the prevalence and describe the use of non-pharmacological methods for pain relief in pregnant women during childbirth in public maternity wards. Method: this is a quantitative, descriptive, cross-sectional study, carried out with 344 parturients, through the analysis of medical records. The descriptive analysis was carried out with absolute and relative frequencies. Results: it is recorded that the prevalence of the use of non-pharmacological methods was 95.4%. Five methods were offered to 35.5% of the parturients: professional support (86.6%), the most offered method; breathing (80.2%); warm bath (72.4%); ball (57.3%) and massage (50.0%). Conclusion: it is concluded that most women in labor have received non-pharmacological methods for pain relief during labor, however, this practice should be applied to all women, as it is an evidence-based action and incorporated as one of the priority strategies for assisting women in labor.(AU)

Objetivos: identificar la prevalencia y describir el uso de métodos no farmacológicos para el alivio del dolor en parturientas durante el trabajo de parto en maternidades públicas. Método: se trata de un estudio cuantitativo, descriptivo, transversal, realizado con 344 parturientas, mediante el análisis de historias clínicas. El análisis descriptivo se realizó con frecuencias absolutas y relativas. Resultados: se registra que la prevalencia del uso de métodos no farmacológicos fue del 95,4%. Se ofrecieron cinco métodos al 35,5% de las parturientas: el apoyo profesional (86,6%), el método más ofrecido; respiración (80,2%); baño tibio (72,4%); pelota (57,3%) y masaje (50,0%). Conclusión: se concluye que la mayoría de las parturientas recibieron métodos no farmacológicos para el alivio del dolor durante el trabajo de parto, sin embargo, esta práctica debe ser aplicada a todas las mujeres, ya que es una acción basada en la evidencia e incorporada como una de las estrategias de atención prioritaria a las parturientas.(AU)

'They follow the wants and needs of an institution': Midwives' views of water immersion.

BACKGROUND: A midwife's ability to fully support women's autonomy and self-determination with respect to midwifery care is often challenging. This is particularly true of water immersion for labour and birth. However, the woman's agency over what happens to her body and that of her unborn baby should be key considerations for maternity care provision. OBJECTIVES: A three phased mixed-methods study was undertaken to examine how water immersion policies and guidelines are informed. Phase three of this study captured the knowledge and experiences of Australian midwives, their support for water immersion and their experiences of using policies and guidelines to inform and facilitate the practice. METHODS: Critical, post structural, interpretive interactionism was used to examine more than 300 responses to three open-ended questions included in a survey of 233 midwives. Comment data were analysed to provide further insight, context and meaning to previously reported results. FINDINGS: Findings demonstrated a complex, multidimensional interplay of factors that impacted on both the midwife's ability to offer and the woman's decision to use water immersion under the themes 'the reality of the system', 'the authoritative 'others'' and 'the pseudo decision-makers'. Multiple scaffolded levels were identified, each influenced by the wider macro-socio-political landscape of Australian midwifery care. CONCLUSIONS: The insight gained from examining midwives' views and opinions of water for labour and birth, has aided in contextualising previously reported results. Such insight highlights the importance of qualitative research in challenging the status quo and working towards woman-centred practice and policy.

Beliefs and Perspectives of Women and Obstetrical Providers in Northern Ontario on Water Births.

OBJECTIVE: This study sought to understand the beliefs and perspectives of women in northern Ontario and their obstetrical providers with respect to water birthing as access to this service is limited in this region METHODS: All midwives, family physicians (FPs), and obstetricians providing labour and delivery services in northern Ontario were surveyed, as were a sample of labour and delivery nurses in the region and convenience samples of regional women. RESULTS: Of the 362 women who completed the survey (a 90.5% response rate), 81.8% (95% CI 77.5-85.4) believed water births to be safe, 40.9% (95% CI 35.9-46) were interested in having a water birth, and 76.5% (95% CI 71.8-80.5) wanted to have the option of a hospital-based water birth. Perceptions of water birth safety varied significantly by provider type (χ2P < 0.001) with 100% (95% CI 89.6-100) of midwives but 0% (95% CI 52.3-94.9) of obstetricians considering them to be safe. Perceptions of the specific risks and benefits of water birth also varied significantly by provider type, as did understanding of consumer interest. Reflecting these perceptions, 97.1% (95% CI 85.1-99.5) of midwives and 0% (95% CI 0-27.8) of obstetricians would consider assisting in or providing hospital-based water births. CONCLUSIONS: Women in northern Ontario are interested in water birth and in having this service available in hospitals. However, given the widely divergent views of the professional groups providing labour and delivery care in the region, hospitals should be strongly encouraged to explore interprofessional development opportunities to enable patient-centred care in this context.

Perfil da assistência ao parto normal em uma maternidade escola federal / Natural childbirth care profile at a maternity hospital of a federal school / Perfil de la asistencia al parto normal en una maternidad escuela federal

Objetivo: Caracterizar a assistência ao parto normal em uma Maternidade Escola Federal, no município do Rio de Janeiro. Método: Pesquisa descritiva, de abordagem quantitativa. Os dados foram coletados a partir dos registros de partos normais locais no período de julho a dezembro de 2018. No total foram realizados 466 partos, sendo 97 excluídos pelos critérios estabelecidos, dessa forma, foram analisados 369 registros. Para a análise dos dados foi utilizado o programa Microsoft Excel 2013 com a descrição dos dados absolutos e relativos. Resultados: a assistência ao parto normal contou com práticas baseadas em evidências científicas, como a garantia do acompanhante no trabalho de parto e parto, com 90,79% e estímulo ao aleitamento materno, em 78,32%, mas também, fez-se presente práticas desaconselhadas rotineiramente tais como: amniotomia, em 30,08% e episiotomia em 20,87%. Conclusão: observou-se que a assistência na referida maternidade se baseou, predominantemente, nas boas práticas assistenciais (AU).

Objective: This study aimed to characterize the care to natural childbirth at the maternity hospital of a federal school located in the city of Rio de Janeiro. Method: This is a quantitative descriptive study. Data were collected from the records of local natural childbirths from July to December 2018. In total, 466 births were performed, 97 of which were excluded according to the inclusion criteria; then 369 records were analyzed. Data were analyzed using Microsoft Excel 2013 with the description of absolute and relative data. Results: Care to natural childbirth was provided with evidence-based practices, including the presence of a companion during labor and delivery in 90.79% of the cases, and encouraging breastfeeding in 78.32%. Practices that are not usually recommended were also observed, like amniotomy in 30.08% and episiotomy in 20.87%. Conclusion: Care in the studied maternity was predominantly based on good care practices (AU).

Objetivo: Caracterizar la asistencia al parto normal en una Maternidad Escuela Federal, en la ciudad de Rio de Janeiro. Método: Investigación descriptiva, con enfoque cuantitativo. Se recolectaron datos de los registros de partos normales locales de julio a diciembre de 2018. En total se realizaron 466 partos, de los cuales 97 fueron excluidos por los criterios establecidos, por lo que se analizaron 369 registros. Para el análisis de los datos se utilizó Microsoft Excel 2013 con la descripción de datos absolutos y relativos. Resultados: En la asistencia al parto normal se realizaron prácticas basadas en evidencia científica, como garantizar un acompañante en el trabajo de parto y parto en el 90,79% de los casos y fomentar la lactancia materna en el 78,32%, pero también se realizaron prácticas que no se aconsejan habitualmente como: amniotomía en el 30,08% y episiotomía en el 20,87%. Conclusión: Se observó que la asistencia en la maternidad referida se basó predominantemente en buenas prácticas de cuidado (AU)

Barreiras à implementação das Diretrizes Nacionais de Assistência ao Parto Normal: uma análise prototípica das representações sociais de atores estratégicos / Barriers to the implementation of the National Guidelines for Assistance to Normal Childbirth: a prototypical analysis of the social representations of strategic actors

Resumo Este estudo tem por objetivo analisar as representações sociais de atores estratégicos envolvidos na assistência ou gestão em saúde, sobre as questões que envolvem a mulher, o parto e o nascimento, buscando identificar e compreender barreiras à implementação das Diretrizes Nacionais de Assistência ao Parto Normal. Realizou-se estudo qualitativo descritivo, de corte transversal, baseado num teste de associação livre de palavras, com 12 atores estratégicos. As palavras - Parto; Enfermeira obstétrica; Nascimento; Médico obstetra; Mãe; Complicação; Mulher - foram selecionadas a partir de uma análise textual das contribuições da sociedade na Consulta Pública das Diretrizes, com o software IRaMuTeQ. A análise do resultado do teste de associação de palavras foi realizada na abordagem estrutural das Representações Sociais, com os softwares OpenEVOC e IRaMuTeQ. Foram identificadas como potenciais barreiras à implementação as representações sobre parto associado a dor, o médico obstetra como obstrutor e os estereótipos que marcam o papel da mulher e da mãe na sociedade. Compreender essas representações é importante para evidenciar as convenções que subjazem nas atitudes e práticas de profissionais e usuárias, possibilitando a definição de estratégias específicas para cada grupo.

Abstract This study aims to analyze the social representations of strategic actors involved in health care or management, on issues involving women, childbirth, and birth, seeking to identify and understand barriers to the implementation of the National Guidelines for Assistance to Normal Childbirth. A qualitative, descriptive, cross-sectional study was conducted, based on a word association test with 12 strategic actors. The words - Childbirth; Midwife; Birth; Obstetrician; Mother; Complication; Woman - were selected from a textual analysis of society's contributions to the Public Consultation of the Guidelines, supported by IRaMuTeQ software. The analysis of the word association test result was carried out in the structural approach of Social Representations, with the OpenEVOC and IRaMuTeQ software. Representations about childbirth associated with pain, the obstetrician as an obstructer and the stereotypes that mark the role of women and mothers in society were identified as potential barriers to implementation. Understanding these representations is important to highlight the conventions that underlie the attitudes and practices of professionals and users of services, enabling the definition of specific strategies for each group.