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1.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 637-642, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747156

RESUMO

Тhe rapid increase in the frequency of сesarian section (CS) observed in recent years (up to 60% in some countries) is alarming and reduces the reproductive potential of the population. The operated uterus remains the main indication for CS (up to 40%). This is the factor which may allow reducing the frequency of the CS by subsequent delivering through the birth canal. A comparative analysis of maternal and neonatal outcomes enabled the authors to develop a two-stage delivery technology for patients with a caesarean scar, including the usage of the programmed delivery method. The presented algorithm confirmed the validity of vaginal delivery in such patients, and reduced the number of complications up to 4 times. Neonatal morbidity in children born through the birth canal in such patients was comparable to physiological birth.


Assuntos
Nascimento Vaginal Após Cesárea , Cesárea , Feminino , Humanos , Parto Normal , Gravidez
2.
Midwifery ; 79: 102547, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31610362

RESUMO

OBJECTIVE: To compare childbirth experiences between women having a waterbirth and women having an uncomplicated conventional birth. DESIGN: A prospective cohort study using the validated Childbirth Experience Questionnaire (CEQ) six weeks postpartum. The 22-item questionnaire assesses four domains of the childbirth experience; Own capacity, Professional support, Perceived safety and Participation. These four domains constituted the main outcome of the study. Further, supplementary questions about the second stage of labour were added to the web-questionnaire. SETTING: One city-located hospital in Stockholm and one small-town hospital in Southern Sweden offering waterbirth to low risk women. PARTICIPANTS: 215 women; 99 nulli- and 116 multiparas. 111 gave birth in water and 104 had an uncomplicated conventional birth. MEASUREMENTS AND FINDINGS: The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, "Own capacity" and lower in the domain, "Professional support". Women having a waterbirth rated less pain and higher scores of being in control in the second stage of labour. KEY CONCLUSIONS: A waterbirth seems to empower and enhance women's capacity for those who choose this alternative. Waterbirth can improve their birth experience and can possibly make women less dependent on the midwife. IMPLICATIONS FOR PRACTICE: To provide waterbirth could be a way of empowering women and giving them a positive birth experience.


Assuntos
Parto Obstétrico/métodos , Imersão , Trabalho de Parto , Tocologia , Satisfação do Paciente , Cuidado Pré-Natal , Adulto , Estudos de Coortes , Feminino , Humanos , Parto Normal , Gravidez , Estudos Prospectivos , Inquéritos e Questionários , Suécia
4.
Hist Cienc Saude Manguinhos ; 26(1): 53-70, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30942303

RESUMO

The article explores the dissemination of natural childbirth practices through an analysis of the books Parto natural: guia para os futuros pais, written by U.S. obstetrician Frederick Goodrich Jr. in 1950, under the title Natural Childbirth: a manual for expectant parents, and first published in Brazil in 1955, and of Parto natural sem dor, written by Brazilian obstetrician Beutner in 1962. Both books found a place in Brazilian culture and influenced thinking about childbirth and delivery in the field of Brazilian obstetrics and in representations of women. Based on Roger Chartier's contributions and on concepts of medicalization, we conclude that these new practices for childbirth preparation shared the period's prevalent medical views of childbirth and delivery.


Assuntos
Parto Obstétrico/história , Parto Normal/história , Cuidado Pré-Natal/história , Brasil , Feminino , História do Século XX , Humanos , Medicalização/história , Obstetrícia/história , Parto , Gravidez , Obras Médicas de Referência
5.
BMC Pregnancy Childbirth ; 19(1): 140, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029115

RESUMO

BACKGROUND: Previous research examining the birth of the placenta has focussed on quantitative outcomes comparing active and expectant (physiological) management. However, it is also important to understand women's experiences of birthing the placenta. METHODS: The participant group consisted of 11 women who had expectant management, eight who had active management and one who was unsure. Participants were interviewed in-depth and the data analysed using thematic analysis. RESULTS: Seven themes were identified in the data relating to before, during and after the birth of the placenta. Before birth themes focused on making decisions and included 'doing the research' and 'natural birth'. During the birth of the placenta themes were 'boundaries of time', 'focusing on baby' and 'sensations'. After the birth themes consisted of 'looking' and 'keeping'. CONCLUSION: Most of the women considered a physiological birth of the placenta to be an intrinsic element of natural birth. Active management was considered to be an intervention used if complications occurred. In contrast, women who chose active management did not consider the placenta to be an important element of natural birth, and chose active management in order to prevent complications. Decisions about birthing the placenta were informed by Internet sources and previous personal experiences rather than care providers. During the birth of the placenta care providers managed the boundaries of time whilst women focused on their baby. The sensations women described were consistent across both types of management. Women valued seeing their placenta and having the opportunity to keep it, and placenta encapsulation was popular. The findings of this study contribute the experiences of women to the body of knowledge informing practice during the birth of the placenta.


Assuntos
Tomada de Decisões , Parto Normal , Parto , Placenta , Austrália , Parto Obstétrico , Feminino , Humanos , Gravidez
6.
J Pediatr ; 209: 61-67.e2, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30952508

RESUMO

OBJECTIVE: To examine the association between cesarean delivery and healthcare utilization and costs in offspring from birth until age 7 years. STUDY DESIGN: A retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age 7 years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (cesarean delivery vs vaginal birth); the outcome was healthcare utilization and costs during the first 7 years of life. Associations were modeled using multiple regression adjusting for maternal prepregnancy weight and sociodemographic factors. RESULTS: In total, 32 464 births were included in the analysis. Compared with children born by vaginal birth, children born by cesarean delivery had more physician visits (incidence rate ratio 1.06, 95% CI 1.05-1.08) and longer hospital stays (incidence rate ratio 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (OR 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by cesarean delivery compared with vaginal birth. CONCLUSIONS: Cesarean delivery compared with vaginal birth is associated with small but statistically significant increases in healthcare utilization and costs during the first 7 years of life.


Assuntos
Cesárea/economia , Cesárea/estatística & dados numéricos , Custos de Cuidados de Saúde , Parto Normal/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Fatores Etários , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Estudos de Coortes , Parto Obstétrico/economia , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Nova Escócia , Gravidez , Estudos Retrospectivos , Fatores Sexuais
7.
Eur J Obstet Gynecol Reprod Biol ; 236: 22-25, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30877906

RESUMO

BACKGROUND: Many societies and their medical practitioners throughout the world have historically linked lunar phases to the frequency of births. During more recent decades, academics have discussed this alleged relationship using modern data, obtaining differing results. OBJECTIVES: The purpose of this study is to analyse the relationship between the phases of the moon and the frequency of deliveries in a rural historical context without electricity, and among women of low nutritional status. These characteristics are similar to some current rural areas in certain developing countries. The exceptionality of this case will allow us to test several of the existing theories on how the moon could influence births, particularly those related to lunar light. We will also analyse nulliparous and multiparous differences over the very long term. STUDY DESIGN: This study is a retrospective cohort analysis. In total, 23,689 births have been considered for 1484 lunar cycles between 1810 and 1929. Birth registers have been obtained from the Catholic parish archives of 10 rural Spanish agrarian villages. All the deliveries analysed were natural, without any medical follow-up, within the home and with little medical assistance. RESULTS: Using simple descriptive statistical techniques, we can conclude that there is no pattern with which to link lunar phases with the frequency of births. We can also conclude that neither electricity nor the rural environment affects this alleged relationship; neither have we found any relationship related to either the nulliparous or the multiparous and lunar phases. CONCLUSION: The analysis of a 120-year period has shown that there is no predictable influence of the lunar phases on the frequency of births. The myth of such a lunar influence can claim no scientific evidence from a historical perspective. Neither the arrival of the electric light nor the lower number of deliveries per woman have modified birth patterns. Deliveries by rural women of low nutritional status are not linked to the phases of the moon, and consequently the medical services in developing countries should disregard this belief; they do not need to take account of the phases of the moon with respect to their daily organisation.


Assuntos
Parto Domiciliar/história , Lua , Parto Normal/história , População Rural/história , Feminino , História do Século XIX , História do Século XX , Parto Domiciliar/estatística & dados numéricos , Humanos , Parto Normal/estatística & dados numéricos , Gravidez , População Rural/estatística & dados numéricos
8.
Int Urogynecol J ; 30(6): 909-915, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30783705

RESUMO

INTRODUCTION AND HYPOTHESIS: Obstetric anal sphincter injury (OASI) is a significant complication of vaginal delivery. Water birth has become a popular preference for women giving birth in the UK, however, there is limited data on the risk of OASI following water birth. Our aim was to assess OASI risk in low-risk women giving birth in water without medical intervention compared with on land and to create a prognostic model for OASI prediction. METHODS: This was a retrospective study of 15,734 low-risk women giving birth by spontaneous vaginal delivery between January 2008 and October 2014 in a midwifery-led unit (MLU). Patient factors and delivery data were analysed to identify differences between water and land births. Univariate analysis determined factors that statistically predicted OASI and was then used to create multivariate analysis. Significant multivariate factors were used to create a prognostic model to predict likelihood of OASI. RESULTS: OASI rates were 1.6% on land and 3.3% in water [odds ratio (OR) 2.10, 95% confidence interval (CI) 1.5-2.94). Multivariate analysis confirmed water birth, ethnicity and parity as independent risk factors for OASI (adjusted OR water birth: 1.77 (CI 1.25-2.51). Our prognostic model showed Black and Asian primigravidae following water birth had the highest risk of OASI and white multiparae on land the lowest. CONCLUSION: This study of comparable low-risk women shows an increased risk of OASI following water birth compared with land birth. Use of this prognostic model will help women determine their risk of OASI following birth in water or on land.


Assuntos
Canal Anal/lesões , Parto Normal/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Feminino , Previsões , Humanos , Masculino , Modelos Estatísticos , Paridade , Gravidez , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Reino Unido/epidemiologia , Ferimentos e Lesões/etnologia , Adulto Jovem
9.
Midwifery ; 68: 65-73, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30368119

RESUMO

OBJECTIVE: The principal objective was to test the effectiveness of an online learning tool to improve midwives' accuracy of blood loss estimations in a birthing pool environment. The secondary objective was to assess the acceptability of the online learning tool to the midwives using it. DESIGN: A one group pre-test, post-test experiment with immediate and six weeks follow-up to test ability together with an online questionnaire to assess perceived usefulness of an online learning tool. SETTING: A large NHS maternity hospital comprising an acute care obstetric unit, a small district unit labour ward, one alongside midwifery-led unit and three freestanding midwifery-led units. PARTICIPANTS: Volunteer NHS employed midwives who had experience in caring for women labouring and giving birth in water (n = 24). INTERVENTION: An online learning tool comprising six randomly ordered short video simulations of blood loss in a birthing pool in real time, and a tutorial giving verbal and pictorial guidance on making accurate blood loss estimations in water was developed then piloted. Midwives' accuracy scores for estimating blood loss in each of the videos were calculated at three timepoints; pre and immediately post the learning component, and six weeks later. The estimated blood loss volume was subtracted from the actual blood loss volume, to give the difference between estimated and real blood loss in millilitres (ml) which was then converted to percentage difference to standardise comparison across the six volumes. The differences between pre- and post-learning for each of the six blood volumes was analysed using a repeated measures ANOVA. Statistical significance was set at p < 0.05. An online questionnaire incorporated questions using Likert scales to gauge confidence and competence and free text. Free text responses were analysed using a modified form of inductive content analysis. FINDINGS: Twenty-two midwives completed the online learning and immediate post-test, 14 completed a post-test after six weeks, and 15 responded to the online questionnaire. Pre-test results showed under-estimation of all blood loss volumes and particularly for the two largest volumes (1000 and 1100 ml). Across all volumes, accuracy of estimation was significantly improved at post-test 1. Accuracy diminished slightly, but overall improvement remained, at post-test 2. Participants rated the online tool positively and made suggestions for refining it. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first study measuring the accuracy of midwives' blood loss estimations in a birthing pool using real-time simulations and testing the effectiveness of an online learning tool to improve this important skill. Our findings indicate a need to develop interventions to improve midwives' accuracy at visually estimating blood loss in water, and the potential of an online approach. Most women who labour and/or give birth in water do so in midwifery-led settings without immediate access to medical support. Accuracy in blood loss estimations is an essential core skill.


Assuntos
Educação Continuada em Enfermagem/normas , Hemorragia/classificação , Tocologia/normas , Parto Normal/classificação , Estatística como Assunto/normas , Adulto , Análise de Variância , Competência Clínica/normas , Educação a Distância/métodos , Educação a Distância/normas , Educação Continuada em Enfermagem/métodos , Feminino , Hemorragia/etiologia , Humanos , Internet , Tocologia/métodos , Parto Normal/métodos , Gravidez , Avaliação de Programas e Projetos de Saúde/métodos , Pesquisa Qualitativa , Medicina Estatal/organização & administração , Estatística como Assunto/métodos , Inquéritos e Questionários
10.
Am J Obstet Gynecol ; 220(1): 100.e1-100.e9, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30273585

RESUMO

BACKGROUND: The optimal route of delivery in early-onset preeclampsia before 34 weeks is debated because many clinicians are reluctant to proceed with induction for perceived high risk of failure. OBJECTIVE: Our objective was to investigate labor induction success rates and compare maternal and neonatal outcomes by intended mode of delivery in women with early preterm preeclampsia. STUDY DESIGN: We identified 914 singleton pregnancies with preeclampsia in the Consortium on Safe Labor study for analysis who delivered between 24 0/7 and 33 6/7 weeks. We excluded fetal anomalies, antepartum stillbirth, or spontaneous preterm labor. Maternal and neonatal outcomes were compared between women undergoing induction of labor (n = 460) and planned cesarean delivery (n = 454) and women with successful induction of labor (n = 214) and unsuccessful induction of labor (n = 246). We calculated relative risks and 95% confidence intervals to determine outcomes by Poisson regression model with propensity score adjustment. The calculation of propensity scores considered covariates such as maternal age, gestational age, parity, body mass index, tobacco use, diabetes mellitus, chronic hypertension, hospital type and site, birthweight, history of cesarean delivery, malpresentation/breech, simplified Bishop score, insurance, marital status, and steroid use. RESULTS: Among the 460 women with induction (50%), 47% of deliveries were vaginal. By gestational age, 24 to 27 6/7, 28 to 31 6/7, and 32 to 33 6/7, the induction of labor success rates were 38% (12 of 32), 39% (70 of 180), and 54% (132 of 248), respectively. Induction of labor compared with planned cesarean delivery was less likely to be associated with placental abruption (adjusted relative risk, 0.33; 95% confidence interval, 0.16-0.67), wound infection or separation (adjusted relative risk, 0.23; 95% confidence interval, 0.06-0.85), and neonatal asphyxia (0.12; 95% confidence interval, 0.02-0.78). Women with vaginal delivery compared with those with failed induction of labor had decreased maternal morbidity (adjusted relative risk, 0.27; 95% confidence interval, 0.09-0.82) and no difference in neonatal outcomes. CONCLUSION: About half of women with preterm preeclampsia who attempted an induction had a successful vaginal delivery. The rate of successful vaginal delivery increases with gestational age. Successful induction has the benefit of preventing maternal and fetal comorbidities associated with previous cesarean deliveries in subsequent pregnancies. While overall rates of a composite of serious maternal and neonatal morbidity/mortality did not differ between induction of labor and planned cesarean delivery groups, women with failed induction of labor had increased maternal morbidity highlighting the complex route of delivery counseling required in this high-risk population of women.


Assuntos
Cesárea/métodos , Mortalidade Infantil/tendências , Trabalho de Parto Induzido/métodos , Pré-Eclâmpsia/diagnóstico , Resultado da Gravidez , Adulto , Tomada de Decisão Clínica , Estudos de Coortes , Tomada de Decisões , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Trabalho de Parto , Mortalidade Materna/tendências , Parto Normal , Gravidez , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Estados Unidos , Adulto Jovem
11.
Birth ; 46(1): 97-104, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30033596

RESUMO

BACKGROUND: A vast majority of women who choose nitrous oxide for labor report high satisfaction despite variable analgesic effectiveness. We analyzed comments provided by women who used nitrous oxide for labor, to identify determinants of satisfaction in this population, and to better understand reasons for continuing with nitrous oxide despite variable analgesic effectiveness. METHODS: We conducted qualitative content analysis of comments in a quality improvement database of routine follow-up assessments of women who delivered vaginally, using nitrous oxide as the sole labor analgesic. An inductive grounded approach was used and emergent themes and subthemes were identified. RESULTS: Of 6507 vaginal deliveries over 34 months in 2011-2014, 753 (12%) used nitrous oxide as their sole analgesic. Analysis of 264 clarifying comments yielded six emergent themes. Parturients cited nonanalgesic benefits of nitrous oxide use (relaxation, distraction, focus on breathing), as well as partial analgesic effects that they deemed to be sufficient, or consistent with their expectations. Numerous women described their nitrous oxide experience as consistent with their birth plan, including 14 who equated it with natural childbirth. Several comments described nitrous oxide as a vital component of the parturients' birth experience. Some described using nitrous oxide when neuraxial analgesia was not possible. Side effects were identified, as were difficulties using the apparatus/mask. Analysis highlighted importance of timely administration upon request and attention to technical aspects. CONCLUSIONS: Among parturients who choose nitrous oxide as their sole labor analgesic, determinants of satisfaction are more variable than previously understood, and extend beyond analgesia.


Assuntos
Analgesia Obstétrica/estatística & dados numéricos , Anestésicos Inalatórios/administração & dosagem , Dor do Parto/terapia , Óxido Nitroso/administração & dosagem , Analgesia Obstétrica/métodos , Anestésicos Inalatórios/efeitos adversos , Feminino , Humanos , Parto Normal , Óxido Nitroso/efeitos adversos , Manejo da Dor/métodos , Parto , Satisfação do Paciente , Gravidez , Tennessee
12.
Women Birth ; 32(1): e95-e101, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29731383

RESUMO

PROBLEM: Studies of women's childbirth preferences repeatedly show that natural birth remains highly valued, yet the majority of births involve some form of medical intervention. Reasons for this lack of correspondence have typically been investigated through interviews and focus-groups with women. Relatively little research explores the ways in which women describe their experiences of childbirth outside of such research settings. BACKGROUND: Most maternity services promote woman-centred care, whereby women are encouraged to take active roles in deciding how to give birth. However, recent research indicates that women often report feeling disempowered during labour and birth in hospital settings. AIM: We sought to examine how women account for use of medical intervention in hospitals by examining narratives posted on online discussion forums. METHOD: A thematic analysis of 106 publically available birth stories, sourced using the Internet search terms 'birth story', and 'birth narrative', was undertaken. FINDINGS: Medical interventions in childbirth were routinely described as unwanted, yet as unavoidable, and two types of account were typically drawn on to explain their use: Protection of the baby/mother; and inflexible hospital policy/practice. We examine these two types of account, focusing on how their design oriented to the discordance between mothers' reported desires for a natural birth, and their experiences in hospital. CONCLUSION: The experience of medical intervention in childbirth is routinely oriented to as a matter that requires explanation or account in online birth narratives. Women repeatedly referred to their preference to avoid intervention, but described being unable to do so in hospital.


Assuntos
Parto Obstétrico/psicologia , Mães/psicologia , Parto/psicologia , Parto Obstétrico/métodos , Feminino , Humanos , Parto Normal/psicologia
13.
Midwifery ; 70: 46-53, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30579098

RESUMO

OBJECTIVE: Prior to implementation of a Normal Labour and Birth Bundle (NLBB) at a regional maternity service in Victoria, Australia, this study aimed to understand clinician factors that may influence the uptake, acceptance and use of the NLBB. DESIGN: This was a mixed methods study in which The Theory of Planned Behaviour (TPB) provided the framework for the conduct and analysis of the staff survey and focus groups. Descriptive and multiple regression were used to analyse the survey data and thematic analysis was used for the focus group data. PARTICIPANTS: Participants for the survey and focus groups included clinicians providing publicly funded care and management of labour for women birthing at the health service. Maternity care clinicians were invited to participate in both the survey and the focus groups. FINDINGS: Seventy-six clinicians (88.8%) responded to the survey. Mean scores for TPB constructs were well above the mid-scale score of 4, indicating strong positive attitudes, high levels of self-efficacy and positive social pressure to use the NLBB and strong intentions to use it in the future. Self-efficacy was the strongest independent predictor (ß = 0.45, p < 0.001) of intention to use the NLBB (overall model R2=0.38). A valued consequence of implementing standardised and objective guidelines, highlighted in the focus groups, was the positive impact on clinicians' confidence in their decision-making. KEY CONCLUSIONS: This study found that midwives and obstetricians were in favour of using a normal labour and birth care bundle and perceived the bundle to align with the expectations of work colleagues and the women they care for. The findings of this study show that clinicians at the health service had strong intentions to use the normal labour and birth care bundle in the future. IMPLICATIONS FOR PRACTICE: Implementation science is important in embedding and sustaining practice change. Understanding staff perceptions is an essential first step of this process.


Assuntos
Pessoal de Saúde/psicologia , Promoção da Saúde/métodos , Parto Normal/estatística & dados numéricos , Percepção , Grupos Focais , Promoção da Saúde/normas , Humanos , Parto Normal/métodos , Pesquisa Qualitativa , Autoeficácia , Inquéritos e Questionários , Vitória
14.
Rev Assoc Med Bras (1992) ; 64(11): 1045-1049, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30570059

RESUMO

OBJECTIVE: To describe the number of funds made by the Brazilian National Health System to normal delivery and cesarean procedures, according to the Brazilian regions in 2015, and estimate the cost cutting if the recommendation concerning the prevalence of cesarean deliveries by the World Health Organization (10 to 15%) were respected. METHODS: Secondary analysis of data from the Hospital Information System of the Brazilian National Health System. The variables considered were the type of delivery (cesarean section and normal), geographic region of admission, length of stay and amount paid for admission in 2015. RESULTS: In the year 2015, there were 984,307 admissions to perform labor in the five Brazilian regions, of which 36.2% were cesarean section. The Northeast and Southeast regions were the two regions that had the highest number of normal deliveries and cesarean sections. The overall average hospital stay for delivery was 3.2 days. About R$ 650 million (US$ 208,5 million) were paid, 45% of the total in cesarean deliveries. If the maximum prevalence proposed by the World Health Organization (WHO) were considered, there would be a potential reduction in spending in the order of R$ 57.7 million (US$ 18,5 million). CONCLUSIONS: Cesarean sections are above the parameter recommended by the WHO in all Brazilian regions. The Northeast and Southeast had the highest total number of normal and cesarean deliveries and thus the greatest potential reduction in estimated costs (69.6% of all considered reduction).


Assuntos
Cesárea/economia , Cesárea/estatística & dados numéricos , Parto Obstétrico/economia , Parto Normal/economia , Parto Normal/estatística & dados numéricos , Adolescente , Adulto , Brasil , Criança , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Gravidez , Características de Residência , Adulto Jovem
15.
AMA J Ethics ; 20(12): E1168-1174, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30585580

RESUMO

Much has been made of distinguishing natural from medical in childbirth in both popular and professional contexts. But what do we really mean by natural childbirth? This essay examines the history behind the natural childbirth movement and suggests that distinguishing natural from medical childbirth is no longer productive in ongoing efforts to improve maternal health care.


Assuntos
Serviços de Saúde Materna/organização & administração , Medicalização , Parto Normal/métodos , Parto Normal/psicologia , Autonomia Pessoal , Gestantes/psicologia , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez
16.
PLoS One ; 13(10): e0205696, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30379859

RESUMO

BACKGROUND: Despite the World Health Organization's (WHO) recommendation for immediate skin-to-skin contact (SSC) after birth, separation of mothers and infants seems to be common practice in many hospitals. It is unknown how common the practice of SSC is worldwide. Therefore, we aimed to determine the reported prevalence of SSC for healthy mothers and infants immediately after normal birth. METHODS: We systematically searched CINAHL, Medline, ProQuest Central, PubMed and the Cochrane Library for articles published between January 2007 and October 2017 using the keywords "kangaroo care" or "skin to skin contact" or "breastfeeding initiation" or "breast crawl" or "maternal infant contact" or "maternal newborn contact" or "baby friendly hospital initiative" or "ten steps for successful breastfeeding". RESULTS: After an initial screening of 5266 records, 84 full text articles were assessed for eligibility, and 35 of these met the inclusion criteria. The studies were from 28 countries representing all six WHO world regions. There was a wide range in the practice of SSC for mother-infant dyads around the world: from 1% to 98%. Only 15 studies clearly defined SSC. Most of the studies were from high-income countries, and these reported higher rates of SSC than studies from low and middle-income countries. CONCLUSION: There was a great heterogeneity in the definition of SSC as well as study designs, which makes cross-county comparison difficult. National studies reporting SSC rates are lacking. Future studies and guidelines to enhance SSC practice should include a standardised set of indicators and measurement tools that document SSC starting time and duration of SSC.


Assuntos
Trabalho de Parto , Relações Mãe-Filho , Parto Normal , Gravidez , Pele , Feminino , Humanos , Masculino
17.
Cien Saude Colet ; 23(11): 3525-3534, 2018 Nov.
Artigo em Português | MEDLINE | ID: mdl-30427426

RESUMO

The scope of this study is to discuss teaching strategies directed towards women to institutionalize the representation of normal birth based on the work "Natural Childbirth: A Guide for Future Parents", published in 1955. The research begins with a historical and cultural analysis of the 1955, 1957, 1960 and 1964 editions of this book. It is aided by materials published, in the same period, which share the same meanings and representations concerning issues surrounding childbirth in the Brazilian context. It is a period marked by retrospectives and the emergence of methods for preparing women for the childbirth process. The results of our analysis, in the light of Roger Chartier's theoretical framework, especially applying the notion of representation of Michel Foucault, indicate that the apparatuses used in the work's registers sought to propose a disciplinary model for childbirth: institutionalization, medical insertion and industrialization of normal childbirth in the Brazilian context of the mid-twentieth century.


Assuntos
Parto Obstétrico/história , Parto Normal/história , Parto , Brasil , Características Culturais , Feminino , História do Século XX , Humanos , Medicalização/história , Gravidez
18.
Nurs Health Sci ; 20(3): 338-345, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30311412

RESUMO

Antenatal fear of childbirth (FOC) is associated with negative effects, such as postnatal traumatic symptoms. As the birth-related culture of East Asian countries differs from that in Western countries, the aim of the present qualitative, descriptive study was to explore FOC, perceptions for Caesarean section (CS), and obstetric analgesia (OA) among Japanese primiparas. The qualitative, descriptive study included focus group interviews with 11 primiparous women, which were conducted in a birth house and a maternity hospital in a metropolitan area of Japan in 2013. As a result, seven categories emerged from the analysis: Maternal and child risk, pain, losing control, uncertainty, prolonged labor, poor family support and loneliness before hospitalization. All participants denied having a preference for CS birth due to fear. Opposing values of OA were identified in women who chose OA and those who did not. In conclusion, it is necessary to increase clinical awareness that the objects of fear are diverse. Furthermore, diverse values regarding OA should be understood and equally respected by health-care professionals.


Assuntos
Medo/psicologia , Parto/psicologia , Adulto , Cesárea/métodos , Cesárea/psicologia , Cesárea/normas , Comportamento de Escolha , Feminino , Grupos Focais/métodos , Humanos , Japão , Parto Normal/métodos , Parto Normal/psicologia , Parto Normal/normas , Gravidez , Pesquisa Qualitativa
19.
Midwifery ; 67: 26-31, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30223104

RESUMO

OBJECTIVE: To describe women´s experiences and perceptions of giving birth in water. DESIGN: A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made. SETTING: One city-located hospital in Stockholm, offering waterbirth to low risk women. PARTICIPANTS: 20 women, 12 primiparas and 8 multiparas, aged 27-39. MEASUREMENTS AND FINDINGS: The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant". KEY CONCLUSIONS: The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women. IMPLICATIONS FOR PRACTICE: This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.


Assuntos
Mães/psicologia , Parto Normal , Adulto , Cidades , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Suécia
20.
Rev Bras Epidemiol ; 21: e180010, 2018 Aug 20.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30133598

RESUMO

INTRODUCTION: The rates of cesarean section births significantly increased in Brazil and worldwide in recent years; and along with them, the interest in studying the complications related to this procedure. OBJECTIVE: To assess the early and late maternal complications associated with the mode of delivery in up to six years after labor. METHODS: This is a prospective cohort study that followed all births in the city of Pelotas, in Southern Brazil (4,244 mothers) in 2004, for a period of 6 years. Descriptive analyses and the association between the outcome and mode of delivery were performed. The control for potential confounding factors was performed using Poisson regression with robust error variance. RESULTS: About half (44.9%) of the women underwent cesarean section. Cesarean sections were associated with a 56% higher risk of early complications, 2.98 times higher risk of postpartum infection, 79% higher risk of urinary tract infection, 2.40 times higher risk of pain, 6.16 times higher risk of headaches, and 12 times higher risk of anesthetic complications compared to the vaginal delivery. Cesarean section was a protection factor against the presence of hemorrhoids. The mode of delivery was not associated with any of the late complications studied. CONCLUSIONS: Due to the risk of associated complications, cesarean sections should be performed with caution, when their benefits outweigh the risks.


Assuntos
Cesárea/efeitos adversos , Parto Normal/efeitos adversos , Transtornos Puerperais/etiologia , Adulto , Brasil , Estudos de Coortes , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Transtornos Puerperais/epidemiologia , Medição de Risco , Fatores de Tempo , Adulto Jovem
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