Impacto de la implementación de un método de traspaso de información estandarizada interdisciplinar en sala de partos y unidad de cuidados obstétricos intermedios / Impact of the implementation of a standardised interdisciplinary information transfer method in the Delivery room and Intermediate Obstetric Care Unit

Objetivo Este estudio tiene como objetivo describir la implementación de la metodología estandarizada en la transferencia de información en sala de partos y unidad de cuidados obstétricos intermedios en un hospital de tercer nivel de Barcelona e identificar el impacto de esta implementación en los factores que actúan como facilitadores y barreras en el procedimiento. Método Estudio cuasiexperimental tipo pretest-postest sin grupo control en la unidad de cuidados obstétricos intermedios y sala de partos del servicio de Medicina Maternofetal de un hospital de tercer nivel de Barcelona. El personal sanitario autocumplimentó un cuestionario ad hoc antes y después de implementar la metodología estandarizada IDEAS en el servicio durante 2019 y 2020. Se evaluó la autopercepción personal en el procedimiento de transferencia de información. El test de Wilcoxon por pares se utilizó para la comparación antes y después. Resultados El uso de una metodología estandarizada ha mostrado un impacto en la mejora de la transmisión de la información. Se detectaron diferencias significativas antes y después de la intervención en las siguientes dimensiones: ubicación, personas implicadas, periodo de tiempo del procedimiento, estructurada ordenada y clara y tiempo suficiente para preguntas (p<0,001); mientras que no se observaron diferencias en transmisión al profesional referente, actuaciones bien definidas y realización de un resumen. Conclusiones Existen factores, como aspectos estructurales, organizativos y falta de tiempo, que dificultan la comunicación efectiva, por tanto, actúan como barreras en la transferencia de información. La implementación de una metodología con las personas implicadas, el tiempo y el espacio adecuado permite mejorar aspectos en la comunicación en el equipo multiprofesional y, por tanto, la seguridad del paciente. (AU)

Aim This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. Method Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. Results The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p<0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. Conclusions There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety. (AU)

Birth environments for women with complex pregnancies: A mixed-methods systematic review.

BACKGROUND: Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. AIM: To investigate the impact of the birth environment for women with complex pregnancies. METHODS: This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently. FINDINGS: 30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues. DISCUSSION: Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies. CONCLUSION: Further research is needed investigating different users' needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.

Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia.

BACKGROUND: Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. METHODS: A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. RESULTS: Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% - 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). CONCLUSION: Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.

Autonomy for obstetric nurse on low-risk childbirth care / Autonomia do enfermeiro obstetra na assistência ao parto de risco habitual

Abstract Objectives: to understand the cultural context presented in hospitals and its relation to the obstetric nurse's autonomous practice on low-risk childbirth care. Methods: ethnographic research performed in three public maternities in Rio Grande do Norte, Brazil. Three managers and twenty-three obstetric nurses participated in this research. Results: distinctive on cultural, organizational and structural aspects of the hospital institution interfering directly with the obstetric nurse's autonomous practice. Among these aspects, professional appreciation on low-risk childbirth care contributes for the nurse's autonomy Conclusions: it was noticed that obstetric nurses undergo different contexts of action, which directly interfere with their autonomy on low-risk childbirth care and their decisionmaking abilities. It is necessary, then, to eradicate the relation of dominance and submission that it is still imposed by medical hegemony.

Resumo Objetivos: compreender o contexto cultural da instituição hospitalar e sua relação com a prática autônoma do enfermeiro obstetra na assistência ao parto de risco habitual. Métodos: pesquisa etnográfica desenvolvida em três maternidades públicas do Estado do Rio Grande do Norte, Brasil, com três gestores e 23 enfermeiros obstetras. Resultados: diferentes aspectos de ordem cultural, organizacional e estrutural da instituição hospitalar interferem diretamente na prática autônoma do enfermeiro obstetra. Dentre estes aspectos, a valorização profissional na assistência ao parto de risco habitual contribui para a autonomia do profissional em questão. Conclusões: constatou-se que o enfermeiro obstetra vivencia distintos contextos de atuação, os quais interferem diretamente na sua autonomia na assistência ao parto de risco habitual e no seu poder de decisão. Faz-se necessário, então, desvencilhar-se das relações de domínio e submissão, ainda impostas pela hegemonia médica.

O uso de óleos essenciais no trabalho de parto e parto: revisão de escopo / The use of essential oils in labor and childbirth: scope review / El uso de aceites esenciales en el nacimiento y en el trabajo de parto: revisión de su alcance

OBJETIVO: descrever o estado atual dos conhecimentos sobre o uso de óleos essenciais no trabalho de parto e parto. MÉTODO: realizou-se revisão da literatura com o método scoping review, nas bases CINAHL, PubMed e Scopus, entre agosto de 2008 e agosto de 2018. Incluíram-se estudos experimentais, quasi-experimentais, controlados randomizados, não randomizados controlados, antes e depois de estudos e séries temporais interrompidas. Além disso, estudos observacionais analíticos, incluindo estudos prospectivos e retrospectivos de coorte, estudos caso-controle e estudos analíticos transversais foram considerados. Esta revisão também considerou projetos de estudos observacionais descritivos, incluindo séries de casos, relatos de casos individuais e estudos descritivos de corte transversal para inclusão. Foram também considerados estudos qualitativos de diferentes desenhos de pesquisa. RESULTADOS: a revisão abrangeu oito estudos publicados entre 2010 e 2018, com enfoque na publicação pelo Oriente. Da análise, diversos óleos essenciais foram citados, bem como sua forma de aplicação, em destaque para a lavanda. A utilização dos óleos essenciais resumiu-se nas seguintes finalidades: diminuição da dor e da ansiedade, melhora da satisfação materna e diminuição da duração do trabalho de parto, náusea e vômito. CONCLUSÃO: os óleos essenciais podem ser uma alternativa adicional para as parturientes, pela sua eficácia para aliviar a dor, ansiedade, melhora da satisfação, simplicidade de uso, baixo custo e por não serem invasivos.(AU)

Objective: to describe the current state of knowledge about the use of essential oils in labor and childbirth. Method: a literature review was performed using the scoping review method in the CINAHL, PubMed, and Scopus databases between August 2008 and August 2018. We included experimental, quasi-experimental, randomized controlled, nonrandomized controlled trials before and after the study, and interrupted time series. In addition, observational analytical studies including prospective and retrospective cohort studies, case-control studies and cross-sectional analytical studies were considered. This review also considered descriptive observational study designs, including case series, individual case reports, and descriptive cross-sectional studies for inclusion. Qualitative studies of different research designs were also considered. Results: the review covered eight studies published between 2010 and 2018, focusing on publication by the Orient. From the analysis, several essential oils were cited, as well as their application, especially for lavender. The use of essential oils was summarized for the following purposes: decreased pain and anxiety, improved maternal satisfaction and decreased duration of labor, nausea and vomiting. Conclusion: Essential oils may be an additional alternative for pregnant women because of their effectiveness in relieving pain, anxiety, improved satisfaction, simplicity of use, low cost and non-invasive.(AU)

Objetivo: describir el estado actual del conocimiento sobre el uso de aceites esenciales en el trabajo de parto y en el parto. Método: se realizó una revisión de la literatura utilizando el método scoping review en las bases de datos CINAHL, PubMed y Scopus entre agosto de 2008 y agosto de 2018. Se incluyeron ensayos experimentales, cuasi-experimentales, controlados aleatorios, no aleatorios controlados antes y después de estudios y series temporales interrumpidas. Además, se consideraron estudios observacionales analíticos que incluyeron estudios de cohorte prospectivo y retrospectivo, estudios de casos y controles y estudios analíticos transversales. Esta revisión también consideró proyectos de estudios observacionales descriptivos incluyendo series de casos, informes de casos individuales y estudios descriptivos de corte transversal para su inclusión. También se consideraron estudios cualitativos de diferentes diseños de investigación. Resultados: la revisión incluyó ocho estudios publicados entre 2010 y 2018, centrándose en la publicación de Oriente. Se mencionaron varios aceites esenciales, así como su aplicación, especialmente para la lavanda. El uso de aceites esenciales se resumió para los siguientes propósitos: disminución del dolor y la ansiedad, mejora de la satisfacción materna y disminución de la duración del parto, náuseas y vómitos. Conclusión: los aceites esenciales pueden ser una alternativa adicional para las mujeres embarazadas debido a su efectividad para aliviar el dolor, disminuir la ansiedad, mejorar la satisfacción, su simplicidad de uso, el bajo coste y por no ser invasivos.(AU)

Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study.

OBJECTIVES: To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. DESIGN: Prospective cohort study. SETTING: Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. PARTICIPANTS: 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. MAIN OUTCOME MEASUREMENTS: The Optimality IndexNL-2015, a tool to measure 'maximum outcome with minimal intervention', was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. RESULTS: There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. CONCLUSION: The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.

Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

BACKGROUND: During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. METHODS: International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. RESULTS: From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all freestanding and alongside birth centres. Birth centres varied in their reason for establishment and their characteristics. CONCLUSIONS: Twenty-three Dutch birth centres were identified and divided into three different types based on location according to the situation in September 2013. Birth centres differed in their reason for establishment, facilities, philosophies, staffing and service delivery.

Recursos não farmacológicos: atuação da fisioterapia no trabalho de parto, uma revisão sistemática / Non pharmacological resources: physical therapy practice in labor, a systematic review

O trabalho de parto consiste em um evento único e complexo que envolve vários fatores biopsicossociais. A dor experimentada na parturição é uma resposta fisiológica e complexa aos estímulos sensoriais. Objetivo: Realizar revisão sistemática sobre os efeitos dos recursos fisioterapêuticos aplicados para o alívio da dor durante o trabalho de parto. Material e métodos: Foi realizada uma revisão sistemática, buscando artigos nas bases de dados Scielo, Medline, Bireme e Lilacs, com estudos publicados até 2014. Utilizaram-se os Descritores em Ciências da Saúde (DeCS) ou sinônimos em português e inglês. Resultados: Foram encontrados 49 artigos e selecionados 13 para análise. A mediana do nível de evidência PEDro foi 8. Foi encontrada uma variedade de intervenções: massoterapia, TENS, exercícios na bola, banho de imersão, exercícios respiratórios, acupuntura, deambulação, mobilidade e banho de chuveiro. Conclusão: Os estudos sugerem que as técnicas fisioterapêuticas investigadas, em sua maioria, contribuíram de forma benéfica para alívio da dor das parturientes. No entanto, alguns achados demonstraram resultados inconclusivos acerca da eficácia das técnicas. (AU)

Introduction: Labor consists of a unique and complex event that involves multiple biopsychosocial factors. The pain experienced during labor is a complex and physiological response to sensory stimuli. Objective: To realize a systematic review about the effects of physical therapy resources applied for pain relief during labor. Methods: It was performed a systematic review searching articles in the Scielo, Medline, Bireme and Lilacs databases, published until 2014. Results: Forty-nine studies were found and thirteen were selected for analysis. The median PEDro score of evidence was 8. A variety of interventions were found: massage therapy, TENS, ball exercises, immersion bath, breathing exercises, acupuncture, ambulation, mobility and shower. Conclusion: Studies suggest that physical therapy techniques researched contributed beneficially to relieve pain of women in labor. However, some findings showed inconclusive results about the effectiveness of the techniques. (AU)