Promovendo saúde por meio da música na maternidade: percepções de gestantes e puérperas / Promoting health through music in motherhood: perceptions of pregnant and puerperal women / Promoviendo la salud a través de la música en la maternidad: percepciones de las mujeres embarazadas y puérperas

Objetivo: compreender as percepções de gestantes e puérperas sobre o uso da música como tecnologia de cuidado para promoção da saúde. Método: estudo qualitativo, fundamentado nos pressupostos da promoção da saúde, realizado com sete gestantes e oito puérperas internadas na maternidade de um hospital público de Santa Catarina. Realizou-se entrevistas semiestruturadas, entre setembro de 2021 e fevereiro de 2022, após aprovação do Comitê de Ética em Pesquisa. Os dados foram analisados por meio da análise de conteúdo. Resultados: a música na maternidade diminui o estresse e a tristeza. Alem disso, proporciona distração, alegria, animação, resgate de lembranças, momento especial, gratidão e tranquilidade para as mulheres hospitalizadas e para os seus bebês. Considerações finais: para as gestantes e puérperas, a música tem a capacidade de promover a saúde, sendo uma tecnologia de cuidado que deveria estar presente em todas as maternidades do Brasil(AU)

Objective: to understand the perceptions of pregnant and postpartum women about the use of music as a care technology for health promotion. Method: qualitative research, based on the assumptions of health promotion, carried out with seven pregnant women and eight postpartum women admitted to the maternity ward of a public hospital in Santa Catarina. Semi-structured interviews were carried out between September 2021 and February 2022, after approval by the Research Ethics Committee. Data were analyzed using content analysis. Results: music in the maternity ward reduces stress and sadness. In addition, it provides distraction, joy, animation, recall of memories, a special moment, gratitude and tranquility for hospitalized women and their babies. Final considerations: for pregnant and postpartum women, music has the ability to promote health, being a care technology that should be present in all maternity hospitals in Brazil(AU)

Objetivo: comprender las percepciones de embarazadas y puérperas sobre el uso de la música como tecnología de cuidado para la promoción de la salud. Método: estudio cualitativo, basado en los supuestos de la promoción de la salud, realizado junto a siete mujeres embarazadas y ocho puérperas internadas en la maternidad de un hospital público de Santa Catarina. Las entrevistas semiestructuradas se realizaron entre septiembre de 2021 y febrero de 2022, previa aprobación del Comité de Ética en Investigación. Los datos se analizaron mediante análisis de contenido. Resultados: la música en la sala de maternidad reduce el estrés y la tristeza. Además, brinda distracción, alegría, animación, recuperación de recuerdos, momento especial, gratitud y tranquilidad para las mujeres hospitalizadas y sus bebés. Consideraciones finales: para las mujeres embarazadas y puérperas, la música tiene la capacidad de promover la salud, siendo una tecnología de atención que debe estar presente en todas las maternidades de Brasil(AU)

Experiências de puerpério hospitalar imediato na pandemia de Covid-19: histórias contadas pelas mulheres / Experiences of immediate hospital postpartum during the Covid-19 pandemic: stories told by women

Resumo: A pandemia de covid-19 impôs alterações à sociedade, impactando na assistência prestada ao parto, nascimento e puerpério, refletindo na experiência das mulheres. Este estudo teve como objetivo descrever a experiência de puerpério imediato de mulheres na pandemia da covid-19 em maternidade pública de Curitiba- PR, sul do Brasil". De abordagem qualitativa seguindo o método História Oral Temática, segundo Meihy e Holanda (2017), à luz do referencial teórico dos paradigmas de assistência ao parto e nascimento conforme Robbie Davis Floyd (2001). O estudo ocorreu em uma maternidade de ensino pública de Curitiba- Paraná. O recrutamento das participantes se deu por convite verbal individual com a coleta de dados orientada por entrevista semiestruturada audiogravada dos relatos. Cada entrevista ocorreu em sala reservada na maternidade entre os meses de outubro a dezembro de 2021 e iniciou após aprovação pelo Comitê de Ética em Pesquisa da instituição. Houve devolutiva do texto para conferência e autorização de cada participante. A análise das entrevistas seguiu as orientações do método que compreende as etapas de transcrição absoluta, textualização e transcriação com a elaboração da versão final dos textos, que foram lidos de forma flutuante para uma aproximação com seu conteúdo. Depois, foram lidos inúmeras vezes a fim de elencar temas convergentes entre elas. Assim, emergiram das narrativas quatro Temas Relevantes. Houve triangulação da leitura das entrevistas por duas outras pesquisadoras que corroboraram os temas. Como resultados, participaram nove mulheres no puerpério imediato, com profissões variadas e idade entre 25 e 34 anos. Os Temas Relevantes foram "Maternar num contexto de risco" que fala sobre o medo e preocupação com características próprias da pandemia, tais como a contaminação pelo vírus, vacinação e alterações nas rotinas da maternidade; "Percepções físicas e simbólicas do aleitamento materno" que inclui a experiência de aleitamento materno e o valor que as participantes atribuem à esta prática; "Conseguir: verbo transitivo direto e indireto" em que as participantes trouxeram sobre o poder de parturição e "Nuances do cuidar" que aborda mais diretamente aspectos dos modelos assistenciais tecnocrático e humanístico. Com a pesquisa considera-se que a experiência de puerpério imediato teve a pandemia como elemento causador de medo e preocupação. Evidenciou-se características do modelo assistencial tecnocrático e do humanístico com aspectos tais como a escolha informada e o acolhimento e escuta da mulher a serem fomentados na assistência obstétrica. Considera-se que a experiência de puerpério imediato está fortemente conectada a todo caminho anterior percorrido pela mulher na gestação e no parto, tendo esse ciclo um caráter imanente, experiência excelsa que propulsiona a mulher para outro momento de vida.

Abstract: The covid-19 pandemic imposed changes on society, affecting the assistance provided to labor, birth, and the postpartum period, reflecting on women's experience. This study aimed to describe the experience of the immediate postpartum period of women during the covid-19 pandemic in a public maternity hospital in Curitiba-PR, southern Brazil. Of qualitative approach follows the Thematic Oral History method, according to Meihy and Holanda (2017), in the light of the theoretical referential of the paradigms of assistance to labor and birth according to Robbie Davis-Floyd (2001). The study was conducted in a public teaching maternity hospital in Curitiba-Paraná. The recruitment of the participants took place by individual verbal invitation with data collection guided by semi-structured audiorecorded interviews of the reports. Each interview occurred in a reserved room in the maternity hospital between October and December 2021 and began after approval by the Research Ethics Committee of the institution. The text was returned to each participant for checking and authorization. The analysis of the interviews followed the guidelines of the method that comprises the steps of absolute transcription, textualization, and transcription with the elaboration of the final version of the texts, which were read in a floating manner for an approximation of their content. Then, they were read several times to list the convergent themes among them. Thus, four Relevant Themes emerged from the narratives. There was a triangulation of the reading of the interviews by two other researchers who corroborated the themes. As a result, nine women participated in the immediate puerperium, with varied professions and ages between 25 and 34 years. The Relevant Themes were "Mothering in a context of risk" which talks about the fear and concern with characteristics of the pandemic, such as contamination by the virus, vaccination, and changes in the routines of motherhood; "Physical and symbolic perceptions of breastfeeding" which includes the experience of breastfeeding and the value that the participants attribute to this practice; "To achieve: the direct and indirect transitive verb" in which the participants brought about the power of parturition and "Nuances of care" which more directly addresses aspects of the technocratic and humanistic care models. The research considered that the experience of the immediate puerperium had the pandemic as a causative element of fear and concern. Characteristics of the technocratic and humanistic models of care were evidenced, with aspects such as informed choice and welcoming and listening to the woman to be promoted in obstetric care. The experience of the immediate postpartum period is connected in a strong way to all the previous paths taken by the woman during pregnancy and childbirth, with this cycle having an immanent character. This sublime experience propels the woman to another moment of life.

Resumen: La pandemia del covid-19 impuso cambios en la sociedad, impactando la asistencia ofrecida durante el parto, nacimiento y puerperio, reflejándose en la experiencia de las mujeres. Este estudio objetivó describir la experiencia del puerperio inmediato en mujeres durante la pandemia de covid-19 en una maternidad pública en Curitiba-PR, al sur de Brasil". Este estudio posee un enfoque cualitativo, siguiendo el método de la Historia Oral Temática, bajo preceptos de Meihy y Holanda (2017), y a la luz del marco teórico de los paradigmas de atención al parto y nacimiento según Robbie Davis-Floyd (2001). El local de investigación fue una maternidad pública de CuritibaParaná. Los participantes fueron reclutados por invitación verbal individual, con la recolección de datos guiada por una entrevista semiestructurada grabada en audio. Cada entrevista se llevó a cabo en una habitación privada dentro de la maternidad una vez recibida la aprobación del Comité de Ética en Investigación de la institución, siendo el periodo de e recolecta especifico entre octubre y diciembre de 2021. Una vez transcrito cada audio el texto fue devuelto para conferencia y autorización de cada participante. El análisis de las entrevistas siguió los lineamientos del método que comprende las etapas de transcripción absoluta, textualización y transcreación con la elaboración de la versión final de los textos, los cuales fueron leídos de forma fluctuante para una aproximación con su contenido. Posteriormente, fueron leídos repetidas con la finalidad de identificar los temas convergentes entre ellos. De esta manera, surgieron cuatro Temas Relevantes de las narraciones. Se realizó una triangulación de la lectura de las entrevistas por otros tres investigadores que corroboraron los temas. Como resultado participaron nueve mujeres en puerperio inmediato, con variadas profesiones y con edades entre 25 y 34 años. Los Temas Relevantes fueron "Maternidad en un contexto de riesgo", que describe el miedo y la preocupación por las características de la pandemia, como la contaminación con el virus, la vacunación y los cambios en las rutinas de la maternidad; "Percepciones físicas y simbólicas de la lactancia materna", trayendo la experiencia de amamantar y el valor que los participantes le atribuyen a esta práctica; "Conseguir: verbo transitivo directo e indirecto" en el que los participantes incidieron en el poder del parto y "Matices del cuidar" abordando de manera más directa aspectos de los modelos tecnocráticos y humanísticos del cuidado. Mediante esta investigación, se llegó a la consideración de que la experiencia del posparto inmediato tuvo a la pandemia como un elemento que generador de miedo y preocupación. Se evidenciaron características de los modelos de atención tecnocráticos y humanísticos, con aspectos como la elección informada, la acogida y la escucha activa de estas mujeres lo cual debe ser fomentado en la atención obstétrica. Se considera que la experiencia del puerperio inmediato está fuertemente ligada a todo el camino previo recorrido por la mujer durante el embarazo y el parto, teniendo este ciclo un carácter inmanente, una experiencia sublime que impulsa a la mujer a otro momento de la vida.

Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis.

INTRODUCTION: The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran. METHODS: This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software. RESULTS: Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation. CONCLUSIONS: The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Translating and Validating the Vietnamese Version of the Health Sciences Evidence-Based Practice Questionnaire.

No validated instrument is available for assessing the evidence-based practice capacity of Vietnamese health professionals. This study aimed to translate and validate the Health Sciences Evidence-Based Practice questionnaire (HS-EBP) from English to Vietnamese and ascertain its psychometric properties. Data were collected from two obstetric hospitals in Vietnam. Participants: A total of 343 midwives were randomly selected. The HS-EBP questionnaire was translated by a group of bilingual experts into Vietnamese (HS-EBP-V). Content validity was assessed by two experts. Internal consistency and test-retest reliabilities were assessed using Cronbach's α and intraclass correlation (ICC), respectively. Construct validity was assessed using the contrasted groups approach. As a result, the content validity index of the HS-EBP-V reached 1.0. For the individual subscales, Cronbach's α was 0.92-0.97 and ICC was between 0.45 and 0.66. The validity of the contrasted-groups approach showed discrimination by a significant difference in the subscale scores among diploma holders compared with bachelor's degree holders (p < 0.001). The validation of the HS-EBP questionnaire indicated satisfactory psychometric properties. The results indicate that the HS-EBP is a reliable and valid instrument which assesses the competencies of as well as facilitators of and barriers to the five steps of EBP among midwives. The HS-EBP-V was deemed a reliable and validated tool for assessing the competency and application of EBP among Vietnamese healthcare professionals.

O cuidado das enfermeiras no parto e no nascimento após a inserção do projeto Apice On / Cuidado de enfermería durante el parto y el nacimiento tras la implementación del proyecto Apice On / Nursing care during childbirth after the insertion of the Apice On Project

Objetivo: descrever os saberes e cuidados realizados pelas enfermeiras no campo do parto e do nascimento, a partir da inserção do projeto "Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia" (Apice On). Materiais e método: estudo descritivo, com abordagem qualitativa, com aplicação de entrevistas semiestruturadas com 13 enfermeiras atuantes em uma maternidade de risco habitual na região metropolitana II do estado do Rio de Janeiro, Brasil. As entrevistas foram transcritas e submetidas à análise de conteúdo na modalidade temática. Resultados: foram identificadas duas categorias temáticas: "Saberes do cotidiano da enfermeira no cuidado à mulher no processo do parto e do nascimento" e "Modo de cuidar da enfermeira à mulher no processo do parto e do nascimento após a inserção do Apice On". A sustentação de um cuidado contínuo, integral e embasado em evidências científicas valoriza a fisiologia da parturição, além de ser decisivo para as mudanças institucionais. Conclusões: as enfermeiras têm potencializado mudanças práticas no cotidiano da assistência na maternidade, influenciadas pelo compromisso de manter um cuidado centrado na mulher com aceno para as práticas interprofissionais.

Objetivo: describir los conocimientos y cuidados que practican los profesionales de enfermería durante el parto y el nacimiento tras la implementación del proyecto Perfeccionamiento e Innovación en el Cuidado y Enseñanza en Obstetricia y Neonatología (Apice On, en su sigla en portugués). Materiales y método: estudio descriptivo de abordaje cualitativo, con base en la aplicación de entrevistas semiestructuradas a 13 enfermeras que laboran en un área de maternidad de riesgo estándar en la II Región Metropolitana del Estado de Rio de Janeiro, Brasil. Estas entrevistas fueron transcritas y sometidas a análisis de contenido en la modalidad temática. Resultados: se identificaron dos categorías temáticas: "Conocimiento cotidiano del enfermero en el cuidado de la mujer en el trabajo de parto y el alumbramiento" y "Enfoque del cuidado del enfermero a la mujer en proceso de parto y alumbramiento tras la implementación de Apice On". Se observa que una atención continua, integral y basada en evidencia científicas valoriza la fisiología del parto, además de ser determinante para la adopción de cambios a nivel institucional. Conclusiones: los profesionales de enfermería han potencializado cambios prácticos en el cuidado diario de la maternidad, influenciados por el compromiso de mantener un cuidado centrado en la mujer y la adopción de prácticas interprofesionales.

Objective: To describe the knowledge and care practices applied by nursing professionals during labor and birth after the insertion of the project Enhancement and Innovation in Care and Teaching of Obstetric and Neonatology (Apice On, in Portuguese). Materials and method: Descriptive study with a qualitative approach, based on semi-structured interviews with 13 nurses working at maternity hospital of usual risk at the II metropolitan region of Rio de Janeiro State, Brazil, which were transcript and submitted to content analysis under thematic modality. Results: Two thematic categories were identified: "Common knowledge by nurses in labor and delivery care towards women" and "Nursing care towards women in the process of labor and delivery after the insertion of Apice On". Findings show that a continuous and comprehensive care based on scientific evidence values the physiology of childbirth, being also decisive for institutional changes. Conclusions: Nursing professionals have promoted practical changes in daily maternity care, influenced and compromised to sustaining a woman-centered approach in health care and the adoption of interprofessional practices.

[Couder's maneuver. Knowledge and practices in a French university maternity hospital]. / Manœuvre de Couder. Connaissances et pratiques dans une maternité universitaire française.

BACKGROUND: During childbirth, the performance of a systematic Couder's maneuver could be linked to a reduction in the risk of perineal tear. OBJECTIVE: To know the practices and knowledge of childbirth professionals regarding the Couder's maneuver. To measure the effect of a training program for juniors. MATERIALS AND METHODS: Single-center questionnaire survey of senior and junior obstetricians and midwives. Before-and-after study in juniors to evaluate maneuver training. RESULTS: One hundred and twenty-five caregivers responded to the questionnaire: (19 physicians and 46 senior midwives; 21 residents and 39 midwifery students). Only one third of the respondents said they practiced the Couder's maneuver "always or almost always" (41/125, 32.8%) and less than one third felt "very comfortable" with the maneuver (34/125, 27.2%), with large differences according to profession and senior vs junior status. Being a doctor (vs midwife) was significantly related to systematic or frequent practice of the maneuver (70.0 vs 15.3%, ORMH=42.7 [9.4; 192.3]) as was being a senior (vs junior) (46.2 vs 18.3%, ORMH=15.9 [3.5; 72.9]). Less than half of the seniors surveyed had received education in maneuvering. Of those who did not practice the maneuver, the majority did not consider its systematic practice to be useful (19/26, 73.1%), and one third considered it potentially harmful (8/26, 30.8%). Theoretical and practical training of the juniors significantly improved their knowledge. CONCLUSION: There are great differences in the practice of the Couder's maneuver. It deserves to be better known, practiced and evaluated.

Determinants of successful labor induction in a teaching hospital in Nigeria: a 10-year review / Determinantes da indução do trabalho de parto bem sucedida em hospital-escola na Nigéria: uma revisão de 10 anos

Abstract Objectives: to evaluate the success rate of labor induction and determinants of successful outcome. Methods: retrospective cohort study of parturients that undergone labor induction between 2006 and 2015. Data was retrieved from the medical records and multivariate logistic regression was used to evaluate the determinants of successful labor induction. Results: the rate of labor induction was 10.9%. Out of the 940 women analysed, six hundred and fifty-six women (69.8%) had successful vaginal delivery. Labor induction at 39-40 weeks (OR=2.70; CI95%=1.17-6.36), 41 weeks (OR=2.44; CI95%=1.14-5.28), estimated fetal weight between 2.5 and 3.4kg (OR=4.27, CI95%=1.96-5.59) and estimated fetal weight of 3.5-3.9kg (OR=5.45; CI95%=2.81-10.60) increased the odds of achieving vaginal delivery. Conclusions: our findings suggest that 39, 40 and 41 weeks are optimal gestational ages for labor induction with respect to successful vaginal delivery. Also, estimated fetal weight between 2.5kg and 3.9kg favours successful vaginal delivery.

Resumo Objetivos: avaliar a taxa de sucesso da indução do trabalho de parto e determinantes de um resultado bem sucedido. Métodos: estudo de coorte retrospectivo de parturientes que submeteram a indução de trabalho de parto entre 2006 e 2015. Os dados foram recuperados dos registros médicos e a regressão logística multivariada foi utilizada para avaliar os determinantes da indução de trabalho de parto bem sucedida. Resultados: a taxa de indução de trabalho de parto foi de 10,9%. Das 940 mulheres analisadas, seiscentas e cinquenta e seis mulheres (69,8%) tiveram um parto vaginal bem sucedido. A indução de trabalho de parto nas 39-40 semanas (OR=2,70; IC95%=1,17-6,36), 41 semanas (OR=2,44; IC95%=1,14-5,28), peso fetal estimado entre 2,5 e 3,4kg OR=4,27; IC95%=1,96-5,59) e peso fetal estimado entre 3,5-3,9kg (OR=5,45; IC95%=2,81-10,60) aumentou as probabilidades de conseguir um parto vaginal. Conclusões: as nossas conclusões sugerem que as 39, 40 e 41 semanas são idades gestacionais ideais para a indução do trabalho de parto no que diz respeito ao sucesso do parto vaginal. Além disso, o peso fetal estimado entre 2,5kg e 3,9kg favorece o parto vaginal bem sucedido.

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Percepção sobre o cuidado à perda gestacional: estudo qualitativo com casais brasileiros / Perceptions on pregnancy loss care: a qualitative study with brazilian couples / Percepción sobre la atención a la pérdida del embarazo: estudio cualitativo con parejas brasileñas

Este artigo analisou a percepção e os sentimentos de casais sobre o atendimento recebido nos serviços de saúde acessados em função de perda gestacional (óbito fetal ante e intraparto). O convite para a pesquisa foi divulgado em mídias sociais (Instagram e Facebook). Dos 66 casais que contataram a equipe, 12 participaram do estudo, cuja coleta de dados ocorreu em 2018. Os casais responderam conjuntamente a uma ficha de dados sociodemográficos e uma entrevista semiestruturada, realizada presencialmente (n=4) ou por videochamada (n=8). Os dados foram gravados em áudio e posteriormente transcritos. A Análise Temática indutiva das entrevistas identificou cinco temas: sentimento de impotência, iatrogenia vivida nos serviços, falta de cuidado em saúde mental, não reconhecimento da perda como evento com consequências emocionais negativas, e características do bom atendimento. Os achados demonstraram situações de violência, comunicação deficitária, desvalorização das perdas precoces, falta de suporte para contato com o bebê falecido e rotinas pouco humanizadas, especialmente durante a internação após a perda. Para aprimorar a assistência às famílias enlutadas, sugere-se qualificação profissional, ampliação da visibilidade do tema entre diferentes atores e reorganização dos serviços, considerando uma diretriz clínica para atenção ao luto perinatal, com destaque para o fortalecimento da inserção de equipes de saúde mental no contexto hospitalar.(AU)

This study analyzed couples' perceptions and feelings about pregnancy loss care (ante and intrapartum fetal death). A research invitation was published on social media (Instagram and Facebook) and data collection took place in 2018. Of the 66 couples who contacted the research team, 12 participated in the study by filling a sociodemographic questionnaire and answering a semi-structured interview in person (n=04) or by video call (n=08). All interviews were audio recorded, transcribed, and examined by Inductive Thematic Analysis, which identified five themes: feelings of impotence, iatrogenic experiences in health services, lack of mental health care, not recognizing pregnancy loss as an emotionally overwhelming event, and aspects of good healthcare. Analysis showed experiences of violence, poor communication, devaluation of early losses, lack of support for contact with the deceased baby, and dehumanizing routines, especially during hospitalization after loss. Professional qualification, extended pregnancy loss visibility among different stakeholders, and reorganization of health services are needed to improve the care offered to grieving families, considering a clinical guideline for perinatal grief care with emphasis on strengthening the insertion of mental health teams in the hospital context.(AU)

Este estudio analizó las percepciones y sentimientos de parejas sobre la atención recibida en los servicios de salud a los que accedieron debido a la pérdida del embarazo (muerte fetal ante e intraparto). La invitación al estudio se publicó en las redes sociales (Instagram y Facebook). De las 66 parejas que se contactaron con el equipo, 12 participaron en el estudio, cuya recolección de datos se realizó en 2018. Las parejas respondieron un formulario de datos sociodemográficos y realizaron una entrevista semiestructurada presencialmente (n=4) o por videollamada (n=08). Los datos se grabaron en audio para su posterior transcripción. El análisis temático inductivo identificó cinco temas: Sentimiento de impotencia, experiencias iatrogénicas en los servicios, falta de atención a la salud mental, falta de reconocimiento de la pérdida como un evento con consecuencias emocionales negativas y características de buena atención. Los hallazgos evidenciaron situaciones de violencia, comunicación deficiente, desvalorización de las pérdidas tempranas, falta de apoyo para el contacto con el bebé fallecido y rutinas poco humanizadas, especialmente durante la hospitalización tras la pérdida. Para mejorar la atención a las familias en duelo, se sugiere capacitación profesional, ampliación de la visibilidad del tema entre los diferentes actores y reorganización de los servicios, teniendo en cuenta una guía clínica para la atención del duelo perinatal, enfocada en fortalecer la inserción de los equipos de salud mental en el contexto hospitalario.(AU)

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)

Measurement of the prevalence of intervention/complication in puerperal women attending a university hospital during the pandemic of COVID-19 by the maternity safety thermometer / Medida da prevalência de intervenção/complicação em puérperas atendidas em hospital universitário durante a pandemia de COVID-19 pelo termômetro de segurança da maternidade

Abstract Objectives: measuring the prevalence of interventions and/or complications based on the Maternity Safety Thermometer (MST) criteria and verifying associations with sociodemographic, clinical, and obstetric factors. Methods: prospective observational study conducted with postpartum women admitted to the maternity ward of a tertiary hospital, from October 10th to December 30th, 2020. Data were collected from medical records and self-administered questionnaires from 260 patients. Results: harm-free care was detected in 17.7% of participants, 66.9% had low-temperature damage (one or less intervention/complication) and 33.1% of patients had elevated temperature damage (two or more intervention/complication). The most frequent intervention was the "scar", given that 38.5% had abdominal scarring (cesarean section) and 26.5% had perineal scarring (2nd-degree tear or greater - spontaneous or by episiotomy). The second most frequent MST item was related to the perception of safety (30%), followed by complications to the newborn (12.3%), infection (11.2%), and hemorrhage (9.2%). Factors related to high temperature were: being of social class A or B, having a previous cesarean section, and being hospitalized during pregnancy. Conclusions: one-third of the participating women had two or more complications/interventions (high temperature by the MST), factors that are related to this temperature were: being of social class A or B, having a previous cesarean section, and being hospitalized during pregnancy.

Resumo Objetivos: mensurar a prevalência de intervenções e/ou complicações a partir dos critérios estabelecidos pelo Termômetro de Segurança da Maternidade (TSM) e avaliar associações com fatores sociodemográficos, clínicos e obstétricos. Métodos: estudo observacional prospectivo realizado com puérperas internadas na maternidade de hospital terciário, de 10 de outubro a 30 de dezembro de 2020. Foram coletados dados do prontuário e de questionários autoaplicáveis de 260 pacientes. Resultados: um cuidado livre de intervenções/complicações foi detectado em 17,7% das participantes, 66,9% apresentaram baixa temperatura (até uma intervenção/complicação) e 33,1% tiveram alta temperatura de intervenções/complicações (2 ou mais). A intervenção mais frequente foi a denominada "cicatriz", sendo que 38,5% tiveram cicatriz abdominal (cesariana) e 26,5% tiveram "cicatriz" perineal (laceração de 2º grau ou mais - espontânea ou por episiotomia). O segundo dano mais frequente foi o relacionado à percepção de segurança (30%), seguido de complicações do recémnascido (12,3%), infecção (11,2%), e hemorragia (9,2%). Houve associação de ter alta temperatura com ser de classe social A ou B, ter cesárea anterior e ser internada na gestação. Conclusões: das mulheres participantes, um terço teve duas ou mais complicações/intervenções (alta temperatura no TSM), estiveram relacionados a essa temperatura: ser de classe social A ou B, ter cesárea anterior e ser internada ao longo da gestação.

Obstetric interventions in a maternity hospital with a collaborative model of care: a comparative observational study.

Collaborative models (CM) focused on intrapartum care shared between both midwives and obstetricians have been proposed as a strategy to reduce these rates. Our aim was to compare use of evidence-based practices, obstetric interventions and c-section rates in two settings: a maternity hospital that applies a CM of care (MRJ) and data from a pool of maternity hospitals included in the Birth in Brazil Survey (NB) that do not adopt a CM. Data was abstracted from medical and administrative records in MRJ and from medical records and face-to-face interviews in NB. Differences were compared using chi-square test, with significance level set at p<0.05. MRJ showed a higher frequency of labour companionship, labour care provided by nurse midwives, non-pharmacological pain relief methods, food intake during labour, and less use of oxytocin, analgesia and amniotomy. More women also had second stage assisted by a nurse midwife and in a vertical position, as well as lower use of episiotomies and vacuum-extractor/forceps. The c-section rate was lower at MRJ. Shared care between midwives and obstetricians can be an effective strategy to improve quality of intrapartum care.

Analysis of the structural adequacy of maternity hospitals in Piauí, Brazil, 2018-2019 / Análise da adequação estrutural das maternidades do Piauí, Brasil, 2018-2019

Abstract Objectives: to evaluate the structure and adequacy of maternal healthcare facilities in Piauí. Methods: cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher's chi-square/exact tests were used to assess differences in adequacy of structure. Results: only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031). Conclusions: Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.

Resumo Objetivos: avaliar a estrutura e adequação das maternidades do Piauí. Métodos: estudo transversal em 26 hospitais com mais de 200 partos/ano entre 2018 e 2019. A estrutura foi avaliada por observação direta e entrevista com gestor, em quatro domínios: aspectos físicos, recursos humanos, equipamentos e medicamentos. Foram empregados os testes do quiquadrado/exato de Fisher para avaliar diferenças na adequação da estrutura. Resultados: apenas 46,2% das maternidades tinham quarto pré-parto, parto e puerpério. Pediatras (73,1%) e anestesistas (61,5%) foram os profissionais menos presentes em regime de plantão. Dos medicamentes, sulfato de magnésio e ocitocina foram observados em 76,9% dos hospitais. A adequação global foi de 23,1%, sendo maior em maternidades da capital (p=0,034) e privadas (p=0,031) Conclusões: os dados exibem desigualdades na estrutura das maternidades do estado. A ausência de profissionais de saúde, medicamentos essenciais e estrutura física apropriada pode expor mulheres e recém-nascidos a riscos desnecessários e evitáveis.

Who is at risk of burnout? A cross-sectional survey of midwives in a tertiary maternity hospital in Melbourne, Australia.

BACKGROUND: Burnout is an occupational phenomenon with the potential to affect a person's physical and mental health, job satisfaction and quality of work. There is evidence of burnout occurring in the midwifery profession, but inadequate data on the prevalence of, and the factors associated with, burnout. AIM: Identify the prevalence of burnout in a population of midwives and explore what individual and workforce characteristics, and what occupational stressors, were associated with burnout. METHODS: A cross-sectional survey of permanently employed midwives was conducted in a tertiary maternity service in Melbourne, Australia in 2017. Data collected included individual and workforce-related characteristics and occupational stressors. Burnout was explored using the Copenhagen Burnout Inventory. Univariate and multivariate analyses were conducted to ascertain associations between respondents' characteristics, stressors, and burnout levels. FINDINGS: A total of 257/266 midwives (97%) responded. There were significant levels of exhaustion and fatigue among respondents; 68% of midwives were experiencing personal burnout, 51% work-related burnout, and 10% were experiencing client-related burnout. Being aged ≤ 35 years, and/or having inadequate support was associated with personal and work-related burnout. Having inadequate acknowledgement was associated with client-related burnout. CONCLUSION: Health services need to understand the risk factors for burnout among midwives, identify and support groups that are most vulnerable, and address areas that are amenable to intervention. In our context this means ensuring midwives receive adequate acknowledgement and support, particularly younger midwives. These findings need to be tested in other settings to help inform a broader understanding and ensure the sustainability of the midwifery profession.

SARS-CoV-2 infection in pregnant women assisted in a high-risk maternity hospital in Brazil: Clinical aspects and obstetric outcomes.

BACKGROUND: The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the possible development of serious illness, and the possibility of severe obstetric outcomes highlight the importance of addressing SARS-CoV-2 infection in obstetric management. METHODS AND FINDINGS: A cross-sectional study of pregnant women assisted in a high-risk maternity hospital in Brazil in 2020. All patients admitted for delivery or miscarriage care were tested for SARS-CoV-2 using polymerase chain reaction (PCR) and for immunoglobulin (I)gM, and/or IgG by immunochromatography. Clinical aspects and obstetric outcomes were analyzed. A total of 265 pregnant women were included in the study. There were 38 (14.4%) PCR positive cases during pregnancy, 12 (31.6%) on admission screening, and 71(27.2%) patients were IgM- and/or IgG-positive. Among the participants, 86 (32.4%) had at least one positive test during pregnancy. SARS-CoV-2 positive patients had greater contact with known positive patients (p = 0.005). The most frequently reported symptoms were runny nose, cough, loss of smell and taste, headache, and fever. There was also a 35% rate of asymptomatic infections and a 4.6% rate of severe or critical infections. Patients exposed or infected with SARS-CoV-2 had a higher incidence of preterm delivery, cesarean section, need for resuscitation in the delivery room, Apgar score <7 at 5 min, admission to the neonatal intensive care unit, and jaundice. Newborns with at least one positive test had a significantly greater need for phototherapy after delivery (p = 0.05). The results showed a high rate of positive tests among newborns (37.5%), which seems to be compatible with both neonatal and perinatal infection. CONCLUSIONS: It is important to further investigate SARS-CoV-2 infection during pregnancy, including the clinical course and the possibility of adverse outcomes with impact on maternal and fetal health, regardless of the development of symptoms.

Where do low risk women live relative to maternity services across Victoria? Expanding access to public homebirth models across Victoria.

PROBLEM: Currently <1% of Australian women give birth at home. BACKGROUND: In Australia there are very few options for women to access public funded homebirth. AIM: We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25kms of suitable maternity services, to plan future maternity care options. METHODS: Retrospective study of births between 2015 and 2017 in Victoria, Australia. All women who were identified as having a low risk pregnancy at the beginning of pregnancy were included. The number of women within 15 and 25km of a suitable Victorian public maternity hospital and catchment boundaries around each hospital were determined. FINDINGS: Between 2015 and 2017, 126,830 low risk women gave birth in Victoria, of whom half live within 25km of seven Victorian hospitals. Currently, 2% of suitable women who live close to the current public homebirth models accessed them. DISCUSSION: We present a method to inform the expansion of maternity service options using Victoria as an example. On the basis of the maximum number of low risk women living close by, we have also identified the Victorian maternity services that would be most suitable for creation of public homebirth or low risk continuity of midwifery models. CONCLUSION: This approach could can be used to plan other maternity care services.

How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical, reflexive thematic analysis.

BACKGROUND: A care bundle to reduce severe perineal trauma (the bundle) was introduced in 28 Australian maternity hospitals in 2018. The bundle includes five components of which only one - warm perineal compresses - has highest level evidence. There is scant published research about the impact of implementation of perineal bundles. QUESTION: How does a perineal care bundle impact midwifery practice in Australian maternity hospitals? METHODS: Purposively sampled midwives who worked in hospitals where the bundle had been implemented. Interested midwives were recruited to participate in one-to-one, semi-structured interviews. The researchers conducted critical, reflexive thematic analysis informed by Foucauldian concepts of power. FINDINGS: We interviewed 12 midwives from five hospitals in one state of Australia. Participants varied by age, clinical role, experience, and education. Three themes were generated: 1) bundle design and implementation 2) changing midwifery practice: obedience, subversion, and compliance; and 3) obstetric dominance and midwifery submission. DISCUSSION: The bundle exemplifies tensions between obstetric and midwifery constructs of safety in normal birth. Participants' responses appear consistent with oppressed group behaviour previously reported in nurses and midwives. Women expect midwives to facilitate maternal autonomy yet decision-making in maternity care is commonly geared towards obtaining consent. In our study midwives encouraged women to consent or decline depending on their personal preferences. CONCLUSION: The introduction of the perineal bundle acts as an exemplar of obstetric dominance in Australian maternity care. We recommend midwives advocate autonomy - women's and their own - by using clinical judgement, evidence, and woman-centred care.

Factors associated with midwives' job satisfaction and experience of work: a cross-sectional survey of midwives in a tertiary maternity hospital in Melbourne, Australia.

BACKGROUND: Significant factors affecting the Australian maternity care context include an ageing, predominantly part-time midwifery workforce, increasingly medicalised maternity care, and women with more complex health/social needs. This results in challenges for the maternity care system. There is a lack of understanding of midwives' experiences and job satisfaction in this context. AIM: To explore factors affecting Australian midwives' job satisfaction and experience of work. METHODS: In 2017 an online cross-sectional questionnaire was used to survey midwives employed in a tertiary hospital. Data collected included characteristics, work roles, hours, midwives' views and experiences of their job. The Midwifery Process Questionnaire was used to measure midwives' satisfaction in four domains: Professional Satisfaction, Professional Support, Client Interaction and Professional Development. Data were analysed as a whole, then univariate and multivariate logistic regression analyses conducted to explore any associations between each domain, participant characteristics and other relevant factors. FINDINGS: The overall survey response rate was 73% (302/411), with 96% (255/266) of permanently employed midwives responding. About half (53%) had a negative attitude about their Professional Support and Client Interaction (49%), and 21% felt negatively about Professional Development. The majority felt positively regarding Professional Satisfaction (85%). The main factors that impacted midwives' satisfaction was inadequate acknowledgment from the organisation and needing more support to fulfil their current role. CONCLUSION: Focus on leadership and mentorship around appropriate acknowledgement and support may impact positively on midwives' satisfaction and experiences of work. A larger study could explore how widespread these findings are in the Australian maternity care setting.

Maternity waiting Home-use and associated factors among mothers in northwest Ethiopia, The application of the integrated behavioral model

Background: Data-informed decision making is influenced by organizational, technical, and behavioral factors.Behavioral factors are the major contributing factors for data-informed decision-making practices. This study aimed to explore health workers' perceptions of data-informed decision making at primary health care units in Awi zone. Method: A cross-sectional qualitative study was undertaken to explore health workers' perceptions on the barriers of health data-informed decision-making practices. Eleven healthcare workers were purposively selected from primary hospitals, health centers and health posts. Medical doctors, nurses, midwifes and health extension workers were selected as key informants for the in-depth interview. The selected healthcare workers were asked about their perceptions that affect health data use practices. The data obtained was analyzed through thematic analysis using Open Code software. Analysis was performed using three themes namely, organizational, behavioral, and technical barriers of data-informed decision making. Results: All the health care workers including health extension workers utilized a data-informed decision-making practice at least once during their point of care. Five of the eleven key informants reported their data-informed decision-making practice as reviewing quality of facility data, while none of them reported data-informed decision-making practices for their monthly performance monitoring. Behavioral factors included negligence, workarounds, and skill gaps. Organizational factors included staff turnover and shortage of recording tools. Technical factors included high workloads which lead to data error and paper-based systems were considered major barriers to data-informed decision-making practices. Conclusion: Data-informed decision-making practices were low at primary health care units. Behavioral, organizational, and technical factors contributed to the decreased use of data. [Ethiop. J. Health Dev. 2022;36(2):000-000]

Suplementação com fórmula infantil em recém-nascidos nas maternidades brasileiras: análise a partir do estudo Nascer no Brasil / Infant formula supplementation for newborns in brazilian maternity hospitals: an analysis based on the Born in Brazil study

O Passo Seis da Iniciativa Hospital Amigo da Criança compreende não dar a recém-nascidos nenhum outro alimento ou bebida além do leite materno, a não ser que haja uma indicação médica. Apesar das diretrizes que justificam o uso apropriado de fórmula infantil na internação pós-parto, é comum sua utilização sem que haja indicação. Tendo em vista a necessidade de reduzir o uso desnecessário de fórmula infantil no pós-parto, este estudo objetivou analisar fatores associados à suplementação com fórmula infantil em recém-nascidos clinicamente estáveis na maternidade. A pesquisa foi realizada a partir de dados amostrais do estudo "Nascer no Brasil", coorte nacional de base hospitalar, realizada entre fevereiro de 2011 e outubro de 2012. Foram selecionados os recém-nascidos encaminhados ao alojamento conjunto após o nascimento. Foram excluídos nascidos de mães com sorologia positiva para o Vírus da Imunodeficiência Humana, near miss materno, nascidos com malformações congênitas e internados em Unidade de Terapia Intensiva. Foram excluídos bebês que utilizaram outros líquidos, pois as indicações de seu uso diferem das indicações de suplementação por fórmula infantil. A amostra final incluiu 14.531 puérperas e recém-nascidos. As variáveis foram selecionadas a partir de um modelo conceitual das variáveis distais, intermediárias e proximais associadas ao desfecho. Foi construído um modelo de regressão logística hierarquizado a partir das variáveis cuja associação com o desfecho apresentaram p-valor ≤ 0,20, com nível de significância de 5% para o modelo final. Foram categorizados os motivos relatados pelas puérperas para seu bebê ter recebido fórmula infantil para análise descritiva e exploratória, verificando-se as proporções através de tabelas de contingência. 21,2% dos recém-nascidos receberam fórmula infantil durante a internação. Fatores associados ao uso de fórmula infantil: idade materna ≥ 35 anos (OR=1,51; IC95%:1,30-1,75), pré-natal em serviço privado (OR=2,22; IC:1,72- 2,85) /serviço público e privado (OR=1,67; IC:1,24-2,23), parto cesáreo (OR=1,83; IC:1,41-2,38), gravidez múltipla (OR=3,786; IC:2,02-7,06), não amamentação na sala de parto (OR=1,780; IC:1,43-2,21), parto em hospital privado (OR=1,695; IC:1,02-2,79), prematuridade (OR= 1,656; IC:1,32-2,06), extremos de peso ao nascer (< 2,500 g: OR=2,084; IC: 1,585-2,741/ ≥4,000g: OR=1,672; IC:1,31-2,11), idade adolescente (OR= 0,651; IC:0,55-0,76), baixo nível de escolaridade materna (OR=0,579; IC:0,43-0,77), multiparidade (OR=0,588; IC:0,510-0,678). Metade do total de razões maternas para uso de fórmula correspondeu a "leite não havia descido/ pouco leite", motivo não aceitável como justificativa para fornecimento de suplemento. Apenas 5,6% corresponderam aos critérios para indicações ou possíveis indicações para a suplementação com fórmula. As razões maternas mais prevalentes são passíveis de intervenção pelos profissionais de saúde, como o aconselhamento e manejo clínico individualizado em amamentação. Dos fatores associados, destacam-se parto cesáreo e a não amamentação na sala de parto, mostrando que é necessário fortalecer políticas que estimulem as boas práticas na assistência ao parto e nascimento, a fim de promover o aleitamento materno exclusivo e proteger mães e recém-nascidos de todas as classes sociais contra o uso indevido de fórmula infantil.

The Step Six of the Baby-Friendly Hospital Initiative involves not giving newborns any food or drink other than breast milk, unless there is a medical indication. Despite the guidelines that justify the appropriate use of infant formula in postpartum hospitalization, its use without indication is common. Considering the need to reduce the unnecessary use of infant formula in the postpartum period, this study aimed to analyze factors associated with infant formula supplementation in clinically stable newborns in the maternity ward. The research was carried out using sample data from the study "Born in Brazil", a national hospital-based cohort, carried out between February 2011 and October 2012. Newborns referred to rooming-in after birth were selected. Infants born to mothers with positive serology for the Human Immunodeficiency Virus, maternal near miss, born with congenital malformations and hospitalized in the Intensive Care Unit were excluded. Babies who used other liquids were excluded, as the indications for their use differ from the indications for supplementation with infant formula. The final sample included 14,531 postpartum women and newborns. The variables were selected from a conceptual model of distal, intermediate and proximal variables associated with the outcome. A hierarchical logistic regression model was constructed from the variables whose association with the outcome presented p-value ≤ 0.20, with a significance level of 5% for the final model. The reasons reported by the puerperal women for having received infant formula were categorized for descriptive and exploratory analysis, verifying the proportions through contingency tables. 21.2% of newborns received infant formula during hospitalization. Factors associated with the use of infant formula: maternal age ≥ 35 years (OR=1.51; 95%CI:1.30-1.75), prenatal care in a private service (OR=2.22; CI:1.72 - 2.85) / public and private service (OR=1.67; CI:1.24-2.23), cesarean delivery (OR=1.83; CI:1.41-2.38), multiple pregnancy (OR=3.786; CI:2.02-7.06), non-breastfeeding in the delivery room (OR=1.780; CI:1.43-2.21), delivery in a private hospital (OR=1.695; CI:1 .02-2.79), prematurity (OR= 1.656; CI: 1.32-2.06), extremes of birth weight (< 2.500 g: OR=2.084; CI: 1.585-2.741/ ≥4.000g: OR =1.672; CI:1.31-2.11), adolescent age (OR=0.651; CI:0.55-0.76), low maternal education (OR=0.579; CI:0.43-0.77) , multiparity (OR=0.588; IC:0.510-0.678). Half of the total maternal reasons for using formula corresponded to "there was not enough milk/low milk", a reason not acceptable as a justification for providing the supplement. Only 5.6% met the criteria for indications or possible indications for formula supplementation. The most prevalent maternal reasons are subject to intervention by health professionals, such as counseling and individualized clinical management of breastfeeding. Of the associated factors, cesarean delivery and non-breastfeeding in the delivery room stand out, showing that it is necessary to strengthen policies that encourage good practices in childbirth and birth care to promote exclusive breastfeeding and protect mothers and newborns of all social classes against the misuse of infant formula.