Birth plans: definitions, content, effects, and best practices.

The first written guide for birth plans was introduced in 1980 as a means for birthing people to document their choices in the child birthing experience. The birth plan offers an opportunity for the patient and the provider to discuss the birthing process and determine how to safely accommodate patient preferences. Patient satisfaction with birthing plans is variable and may depend on how many requests they have, how many of their plans are accomplished, route of delivery, and whether complications arise during or after delivery. Unmet expectations may lead to posttraumatic stress disorder, but following a birth plan may also be protective against it. Birthing people who use a birth plan may be less likely to use epidural anesthesia, have early amniotomy, or use oxytocin. The first stage of labor may be longer when a birth plan is used; however, there does not seem to be a decrease in the length of the second stage of labor among patients with a birth plan. Some providers believe that a disadvantage of birth plans is disappointment when birth plans are not able to be followed, and others consider that birth plans interfere with professional autonomy.

Hospital obstetric practices and their repercussions on maternal welfare. / Práticas obstétricas hospitalares e suas repercussões no bem-estar materno.

OBJECTIVE: To analyze the association of care practices performed by obstetric professionals with maternal welfare/malaise levels. METHOD: A quantitative study conducted in a Prepartum/Childbirth/Postpartum Unit of a Teaching Hospital with puerperal women who underwent vaginal births. An association was performed between obstetric practices and maternal welfare/malaise levels. RESULTS: There were 104 puerperal women who participated. Obstetric practices which caused mothers to feel unwell and which obtained statistical significance were: amniotomy (p = 0.018), episiotomy (p = 0.05), adoption of horizontal positions in the expulsive period (p = 0.04), the non-use of non-invasive care technologies (p = 0.029), and non-skin-to-skin contact between mother and child (p = 0.002). For most women, the presence of a companion favored welfare, even though it did not have a statistically significant association. After performing logistic regression, non-performance of amniotomy was the only variable which showed significance in maternal welfare. CONCLUSION: Humanized obstetric practices have greater potential to promote maternal welfare. The importance of obstetric nurses conducting practices which provide greater welfare to mothers is emphasized.

Factors associated with obstetric interventions in public maternity hospitals / Fatores associados a intervenções obstétricas em maternidades públicas

Abstract Objectives: to identify the prevalence and factors associated with obstetric interventions in parturients assisted in public maternity hospitals. Methods: a cross-sectional study with 344 puerperal women, from two public maternity hospitals, referring to childbirth by Sistema Único de Saúde (SUS) (Public Health Service System) in Londrina City, Paraná, Brazil, between January and June 2017. The medical records were the data source. The following obstetric interventions were considered: oxytocin use, artificial rupture of the membranes, instrumental childbirth and episiotomy. Multivariate Poisson regression was used to analyze associated factors, with p<5% being significant. Results: the prevalence of obstetric intervention was 55.5%, the maximum number of interventions in the same parturient woman was three. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated on maternal disease (p=0.005) and intrapartum meconium (p=0.022) independently increased, the risk of obstetric intervention, while dilation was equal to or greater than 5 cm at admission, there was a protective factor against this outcome (p=0.030). Conclusion: the prevalence of obstetric interventions was high. In the case of maternal disease and intrapartum meconium, special attention should be given to the parturient woman, in order to avoid unnecessary interventions. Thus, the maternity hospitals need to review their protocols, seeking good practices in childbirth care.

Resumo Objetivos: identificar a prevalência e os fatores associados a intervenções obstétricas em parturientes atendidas em maternidades públicas. Métodos: estudo transversal, com 344 puérperas, de duas maternidades públicas, referência ao parto pelo Sistema Único de Saúde no município de Londrina, Paraná, Brasil, entre janeiro e junho de 2017. Constituíram fonte de dados os prontuários hospitalares. As seguintes intervenções obstétricas foram consideradas: uso de ocitocina, rotura artificial das membranas, parto instrumental e realização de episiotomia. Para análise dos fatores associados utilizou-se a regressão multivariada de Poisson, sendo significativo p<5%. Resultados: a prevalência de intervenção obstétrica foi de 55,5%, o número máximo de intervenções em uma mesma parturiente foi três. As intervenções mais frequentes foram o uso de ocitocina (50,0%) e a rotura artificial das membranas (29,7%). As variáveis doença materna associada (p=0,005) e mecônio intraparto (p=0,022) aumentaram, de maneira independente, o risco de intervenção obstétrica, enquanto que a dilatação igual ou superior a 5 cm na internação constituiu fator de proteção a esse desfecho (p= 0,030). Conclusão: a prevalência de intervenções obstétricas foi elevada. Na vigência de doença materna e de mecônio intraparto, especial atenção deve ser dedicada à parturiente, para que sejam evitadas intervenções desnecessárias, assim as maternidades precisam rever seus protocolos, buscando as boas práticas de atenção ao parto.

Obstetric practices performed by nurse-midwives of a hospital natural birth center / Prácticas obstétricas en centro de parto normal intrahospitalario realizadas por enfermeras obstetras / Práticas obstétricas em centro de parto normal intra-hospitalar realizadas por enfermeiras obstetras

Abstract Objectives: To characterize the practices used by nurse-midwives in a Natural Birth Center (NBC) and to verify the maternal and neonatal outcomes. Method: This was a cross-sectional, documentary, retrospective study with a quantitative approach in which the medical records of 300 parturients who gave birth in a state hospital in the city of São Paulo were analyzed. The categories of the World Health Organization (WHO) composed the criteria adopted for the analysis of the obstetric practices. Fisher's exact test or the likelihood ratio and Student t-test were used. Results: The nurse-midwives mostly used category A practices of the WHO. There were no statistically significant associations between practices and perineal outcomes. There was a statistically significant association between the weight of the newborn and the number of neonatal complications, as well as between the delivery position of the primiparous women and clavicle fractures of the newborns. Conclusion and Implications for the practice: Evidence-based practices were followed by the nurse-midwives in the NBC analyzed. The maternal and neonatal outcomes were adequate. There is a need to improve care in the second stage of the delivery in order to avoid behaviors that reflect in neonatal complications. The study makes it possible to reflect on the importance of the continuous evaluation of the care provided.

Resumen Objetivos: Caracterizar las prácticas utilizadas por las enfermeras obstetras en un Centro de Parto Normal (CPN) y verificar los resultados maternos y neonatales. Método: Estudio transversal, documental, retrospectivo, con abordaje cuantitativo, en el cual fueron analizados prontuarios de 300 parturientas que dieron a luz en hospital público de la ciudad de São Paulo. Los criterios adoptados para el análisis de las prácticas obstétricas fueron las categorías de la Organización Mundial de la Salud (OMS). Fueron utilizadas las pruebas, exacto de Fisher o razón de verosimilitud (Likelihood Ratio) y t-Student. Resultados: Las enfermeras obstetras utilizaron mayoritariamente las prácticas de la categoría A de la OMS. No hubo diferencia estadísticamente significativa en las asociaciones entre las prácticas y los resultados perineales. Se observó una diferencia estadísticamente significativa entre el peso del recién nacido y el número de intercurrencias neonatales, así como entre las posiciones de parto de las primíparas con la fractura de clavícula de los recién nacidos. Conclusión e Implicaciones para la práctica: Las prácticas basadas en evidencias son seguidas por las enfermeras obstetras en el CPN analizado. Los resultados maternos y neonatales se mostraron adecuados. Es necesario mejorar la asistencia en el segundo período del parto para evitar conductas que reflejen en las interacciones neonatales. El estudio posibilita la reflexión sobre la importancia de la evaluación continuada de la asistencia prestada.

Resumo Objetivos: Caracterizar as práticas utilizadas pelas enfermeiras obstetras em um Centro de Parto Normal (CPN) e verificar os desfechos maternos e neonatais. Método: Estudo transversal, documental, retrospectivo, com abordagem quantitativa. Analisaram-se prontuários de 300 parturientes que deram à luz em hospital estadual da cidade de São Paulo. Os critérios adotados para a análise das práticas obstétricas foram as categorias da Organização Mundial da Saúde (OMS). Utilizaram-se os testes exatos de Fisher ou razão de verossimilhança (Likelihood Ratio) e t-Student. Resultados: As enfermeiras obstetras utilizaram majoritariamente as práticas da categoria A da OMS. Não houve diferença estatisticamente significativa nas associações entre as práticas e os desfechos perineais. Houve diferença estatisticamente significativa entre o peso do recém-nascido e o número de intercorrências neonatais e entre as posições de parto das primíparas com a fratura de clavícula dos recém-nascidos. Conclusão e Implicações para a prática: As práticas baseadas em evidências são seguidas pelas enfermeiras obstetras no CPN analisado. Os desfechos maternos e neonatais mostraram-se adequados. Há necessidade de melhorar a assistência no segundo período do parto, evitando condutas que reflitam em intercorrências neonatais. O estudo possibilita a reflexão sobre a importância da avaliação continuada da assistência prestada.

Obstetric practices in planned home births assisted in Brazil.

OBJECTIVE: To describe obstetric practices in planned home births, assisted by qualified professionals in Brazil. METHOD: This is a descriptive study, with data collected in an online bank maintained by 49 professionals from December 2014 to November 2015, in which the target population was women and newborns assisted in home births. Data were analyzed through descriptive statistics. RESULTS: A total of 667 women and 665 newborns were included. Most of the women gave birth at home (84.4%), in a nonlithotomic position (99.1%); none underwent episiotomy; 32.3% had intact perineum; and 37.8% had first-degree lacerations, some underwent amniotomy (5.4%), oxytocin administration (0.4%), and Kristeller's maneuver (0.2%); 80.8% of the women with a previous cesarean section had home birth. The rate of transfer of parturients was 15.6%, of puerperal women was 1.9%, and of neonates 1.6%. The rate of cesarean section in the parturients that started labor at home was 9.0%. CONCLUSION: The obstetric practices taken are consistent with the scientific evidence; however, unnecessary interventions are still performed. The rates of cesarean sections and maternal and neonatal transfers are low. Home can be a place of birth option for women seeking a physiological delivery.

Vía de finalización en pacientes con segunda inducción al trabajo de parto en el Hospital Nacional prof. A. Posadas / Postterm pregnancy in patients with second labour induction - Author's experience

The labour induction is an intervention to initiate artificially the uterine contractions to produce the effacement and dilatation of the uterine cervix until the child-birth is achieved. It is indicated when the benefit of the termination of the pregnancy for the mother and the child is greater than its continuation. It is perfored in more or less the 20 % of the women. In our institution the rate oscillates in around the 9 % of the cases. It is understand as an successful induction the termination of the labour through the vaginal delivery. The methods for labour induction more commonly used at present are mechanical and pharmacological. Between the first group we can find the Hamilton maneuver and the amniotomy. And between the pharmacologicals we find the oxytocine. These elements are considered in the article

Humanização no atendimento ao parto baseada em evidências / Evidence-based humanization in childbirth care

Há diversas publicações científicas evidenciando os benefícios do atendimento humanizado ao parto vaginal. Assim mesmo, os profissionais mais resistentes à readequação de suas tradicionais condutas são os médicos. Por isso, realizou-se uma revisão de literatura com objetivo de avaliar quais as melhores condutas a serem adotadas pelos Obstetras, nos partos em que forem responsáveis pelo atendimento. Os principais tópicos pesquisados foram as intervenções médicas diretas ou prescricionais. Avaliou-se a prescrição de dieta, permissão de acompanhante e doula, posição da parturiente, realização de amniotomia e episiotomia, e o clampeamento do cordão umbilical. Deve-se permitir a ingesta líquida e de alimentos leves e incentivar a participação de acompanhantes e doulas. Recomenda-se ainda a adoção de posições verticalizadas, o uso da amniotomia e da episiotomia somente em casos selecionados e o clampeamento tardio do cordão umbilical. Os resultados, em geral, apontam para uma diminuição de intervenções, respeitando os desejos das mulheres, sem abandonar a vigilância do bem-estar fetal.(AU)

There are several scientific publications demonstrating the benefits of humanized childbirth care. However, the most resistant professionals to readjust their traditional behaviors are physicians. Therefore, we carried out a literature review to evaluate what are the best measures to be adopted by Obstetricians in births that they are responsible for. The main topics studied were the direct or prescriptive medical interventions. It has been assessed diet prescription, companion and doula permission, labour's positioning, amniotomy and episiotomy performing and umbilical cord clamping. Liquids and food intake should be allowed and the participation of companions and doulas should be encouraged. It is also recommended the adoption of upright positions, selective use of amniotomy and episiotomy and late umbilical cord clamping. The results generally indicates interventions declining, in respect of women desires, without abandoning the fetal well-being surveillance.(AU)

Caracterização da assistência ao parto em adolescentes primigestas no município de cuiabá-mt / Caracterización de la atención al parto en adolescentes primigestas en el municipio de cuiabá-mt / Characterization of pregnancy labor assistance of primigravida adolescents in the city of cuiabá-mt

RESUMO O objetivo foi analisar a assistência ao parto de adolescentes primigestas no contexto do Sistema Único de Saúde (SUS) no município de Cuiabá, Mato Grosso. Estudo transversal, descritivo e documental com amostragem aleatória simples composta por 164 prontuários de puérperas adolescentes coletados por meio de ficha estruturada durante os meses de dezembro de 2012 a maio de 2013. Foi realizada análise descritiva simples dos dados. Os resultados indicaram que o parto cesáreo apresentou taxa de 37,2%, a amniotomia foi adotada em 62,1%, a ocitocina em 53,4% e a episiotomia em 82,4%. A desproporção céfalo-pélvica representou 27,9% das indicações de cesariana e dentre as complicações maternas, a hemorragia destacou-se em ambos os tipos de parto. Conclui-se a existência de uma forte influência do modelo tecnicista sobre os resultados maternos na assistência obstétrica de adolescentes primigestas e que o fato do desconhecimento atrelado à vulnerabilidade deste grupo populacional evidencia a soberania do profissional em relação às decisões obstétricas.

RESUMEN El objetivo ha sido analizar la atención al parto de adolescentes primigestas en el contexto del Sistema Único de Salud (SUS) en el municipio de Cuiabá, Mato Grosso. Estudio transversal, descriptivo y documental con muestreo aleatorio simple compuesto de 164 registros médicos de puérperas adolescentes recogidos a través del formulario estructurado durante los meses de diciembre de 2012 hasta mayo de 2013. Fue realizado el análisis descriptivo simple de los datos. Los resultados indicaron que el parto por cesárea ha presentado tasa de 37,2%, la amniotomía fue adoptada en 62,1%, la oxitocina en 53,4% y la episiotomía en 82,4%. La desproporción cefalopélvica ha representado 27,9% de las indicaciones de la cesárea y entre las complicaciones maternas, la hemorragia se ha destacado en ambos tipos de parto. Se concluye que existe una fuerte influencia del modelo técnico sobre los resultados maternos en la atención obstétrica a las adolescentes primigestas y que el hecho del desconocimiento relacionado a la vulnerabilidad de este grupo poblacional evidencia la soberanía del profesional en relación a las decisiones obstétricas.

ABSTRACT It aimed to analyze labor assistance for primigravida adolescents in the context of the Unified Health System (SUS) in the city of Cuiabá, Mato Grosso. Cross-sectional, descriptive and documental study with a random sample composed of 164 medical records of postpartum adolescent collected through structured file during the months of December 2012 to May 2013. Data were analyzed through simple descriptive analysis. The results indicated that cesarean section showed rate of 37.2%, amniotomy was adopted in 62.1%, oxytocin 53.4% and 82.4% in the episiotomy. Cephalopelvic disproportion represented 27.9% of cesarean section indications and among maternal complications, hemorrhage stood out in both types of delivery. It is concluded that there is a strong influence of the technicist model on maternal outcomes in obstetric care to pregnant adolescents and that the lack of knowledge linked to the vulnerability of this group shows the professional sovereignty in relation to obstetric decisions.

Tratamiento activo con oxitocina y rotura artificial tardía de membranas en la distocia de fase latente del trabajo de parto / Active treatment with oxytocin and late artificial rupture of membranes in the dystocia of the latent phase of labor

Se realizó un estudio prospectivo, longitudinal y de intervención, de las 90 gestantes con fase latente prolongada del trabajo de parto, a partir de ocho horas, atendidas en el Servicio de Perinatología del Hospital "Mariana Grajales Coello" y "Juan Bruno Zayas Alfonso" de Santiago de Cuba, en el período 2011-2013, con el objetivo de demostrar la utilidad del tratamiento activo con rotura artificial de membrana tardía, empleado en la fase latente prolongada del trabajo de parto. Se obtuvo que el tiempo promedio para alcanzar la fase activa después de iniciada la conducción fue de 5,08 horas y 80,3 % de las mujeres tuvieron respuesta rápida; mientras que la duración de la fase activa fue de 4,05 horas como promedio. Se demostró la utilidad del nuevo protocolo terapéutico para la distocia de fase latente.

A prospective, longitudinal intervention study, of the 90 pregnant women with prolonged latent phase of labor, from eight hours on, assisted in the Perinatology Service of "Mariana Grajales Coello" and "Juan Bruno Zayas Alfonso" Hospitals in Santiago de Cuba was carried out in the period 2011-2013, with the objective of demonstrating the usefulness of the active treatment with late artificial rupture of membrane, used in the prolonged latent phase of labor. It was obtained that the average time to reach the active phase after initiating the induction was of 5,08 hours and 80,3% of the women had a fast response; while the duration of the active phase was of 4,05 hours as average. The usefulness of the new therapeutic protocol for the dystocia of latent phase was demonstrated.