[Association between disrespect and abuse during labor and the risk of postpartum depression: a cross-sectional study]. / Associação entre desrespeito e abuso durante o parto e o risco de depressão pós-parto: estudo transversal.

This study aimed to analyze the relationship between disrespect and abuse during labor and the risk of postpartum depression. This is a cross-sectional study carried out with women from the rural and urban areas of Caxias, Maranhão State, Brazil. Postpartum depression was considered the dependent variable, assessed using the Edinburgh Postnatal Depression Scale. The independent variables were sociodemographic characteristics, mental health history, behavioral aspects, obstetric characteristics and self-perception of disrespect and abuse during labor. Pearson's chi-square test and multiple logistic regression were used to assess the association between postpartum depression and disrespect and abuse during labor. A total of 190 women were interviewed. The prevalence of postpartum depression was 16.3%. The occurrence of at least one type of disrespect and abuse during labor was 97.4%, with health system conditions and restrictions predominating (94.7%). More than half of the women (66.3%) suffered two forms of disrespect and abuse during labor, while three or more forms were reported by 22.6%. Suffering two (adjustedOR = 3.01; 95%CI 1.08-8.33) and three or more forms of disrespect and abuse during labor (adjustedOR = 3.41; 95%CI: 1.68-24.40) increased the chance of postpartum depression. There was a significant association between disrespect and abuse during labor and postpartum depression, and dignified and respectful care for women during childbirth were found to reduce the risk of postpartum depression symptoms.

O objetivo deste estudo é analisar a relação entre desrespeito e abuso durante o parto e o risco de depressão pós-parto. Trata-se de estudo transversal, realizado com mulheres das zonas rural e urbana de Caxias, Maranhão, Brasil. Considerou-se a depressão pós-parto como variável dependente, avaliada pela Escala de Depressão Pós-Natal de Edimburgo. As variáveis independentes foram características sociodemográficas, antecedentes de saúde mental, aspectos comportamentais, características obstétricas e autopercepção do desrespeito e abuso durante o parto. Empregou-se o teste do qui-quadrado de Pearson e a regressão logística múltipla para avaliar a associação entre depressão pós-parto e desrespeito e abuso durante o parto. Foram entrevistadas 190 mulheres. A depressão pós-parto apresentou prevalência de 16,3%. A ocorrência de pelo menos um tipo de desrespeito e abuso durante o parto foi de 97,4%, com predomínio das condições do sistema de saúde e restrições (94,7%). Mais da metade das mulheres (66,3%) foram submetidas a dois tipos de desrespeito e abuso durante o parto, enquanto três ou mais formas foram relatadas por 22,6%. Sofrer duas (ORajustada = 3,01; IC95%: 1,08-8,33) e três ou mais formas de desrespeito e abuso durante o parto (ORajustada = 3,41; IC95%: 1,68-24,40) aumentou a chance da ocorrência de depressão pós-parto. Houve associação significativa entre desrespeito e abuso durante o parto e depressão pós-parto, e o atendimento digno e respeitoso às mulheres durante o parto pode reduzir os riscos da sintomatologia de depressão pós-parto.

El objetivo de este estudio fue analizar la relación entre la falta de respeto y el abuso durante el parto y el riesgo de depresión posparto. Se trata de un estudio transversal, realizado con mujeres de la zona rural y urbana de Caxias, Maranhão, Brasil. La depresión posparto fue considerada como una variable dependiente, evaluada por la Escala de Depresión Posnatal de Edimburgo. Las variables independientes fueron características sociodemográficas, antecedentes de salud mental, aspectos comportamentales, características obstétricas y autopercepción de falta de respeto y el abuso durante el parto. Se empleó la prueba de chi-cuadrado de Pearson y la regresión logística múltiple para evaluar la asociación entre depresión posparto y falta de respeto y el abuso durante el parto. Se entrevistó a 190 mujeres. La depresión posparto tuvo una prevalencia del 16,3%. La ocurrencia de al menos un tipo de falta de respeto y el abuso durante el parto fue del 97,4%, con predominio de las condiciones del sistema de salud y restricciones (94,7%). Más de la mitad de las mujeres (66,3%) padecieron dos tipos de falta de respeto y el abuso durante el parto, mientras que tres o más formas fueron referidas por el 22,6%. Sufrir dos (ORajustado = 3,01; IC95%: 1,08-8,33) y tres o más formas de falta de respeto y el abuso durante el parto (ORajustado = 3,41; IC95%: 1,68-24,40) aumentó la posibilidad de que se produjera depresión posparto. Hubo una asociación significativa entre falta de respeto y el abuso durante el parto y depresión posparto, y una atención digna y respetuosa a las mujeres durante el parto puede reducir los riesgos de los síntomas de depresión posparto.

The use of your own voice in labor: a phenomenological study.

OBJECTIVE: To understand the meaning attributed by women to the use of their own voice in labor. METHOD: Descriptive qualitative study based on the theoretical-philosophical-methodological framework of Heidegger. Phenomenological interviews were carried out with 20 women who experienced vaginal delivery without interventions in the second quarter of 2020 in the city of Rio de Janeiro - Brazil. RESULTS: The comprehensive analysis revealed that the voice can provoke a reaction from the environment that makes them suffer. The expression of the voice encompasses fear and despair. It is from what they hear that women fear being left in suffering for havingbothered the professionals. CONCLUSION: The meaning of using one's own voice in childbirth was understood as a request for help or an expression of freedom. Based on this understanding, the professionals can be opened to sensitive and individualized care, which goes beyond technology.

Factors associated with puerperal women's perception of the support received from their companions during labor and delivery.

OBJECTIVE: The aim of the current study was to associate sociodemographic characteristics and satisfaction with the support received from companions during labor and delivery. METHOD: An analytical cross-sectional study was performed in a maternity hospital in Fortaleza, Brazil, from March to August 2019, with 320 postpartum women. A form containing sociodemographic and obstetric questions, companion-related information, type of support provided, and the Birth Companion Support Questionnaire (BCSQ) were used to assess the frequency of social support behaviors. χ2 and Fisher exact tests were used for statistical analyses. RESULTS: Nonpharmacological methods were associated with an unsatisfactory perception of support, but the emotional support provided by companions was positively associated with women's satisfaction. CONCLUSION: The findings of the current study concerning women's perceptions of the support received from their companions may allow improvements in the delivery of care to women in labor toward the humanization of obstetric practices.

Validity and reliability of the lederman Prenatal Self-Evaluation Questionnaire (PSEQ) in Brazil.

BACKGROUND: The Lederman Prenatal Self-Evaluation Questionnaire (PSEQ) is used to assess psychosocial adaptation to pregnancy, labor, childbirth, and maternity. The PSEQ is a tool used in various countries and has been translated into Portuguese; however, it needs to be validated in Brazil. This study aimed to analyze the validity and reliability of the PSEQ in Brazilian pregnant women. METHOD: This methodological validity study investigated internal consistency and reliability using Cronbach's alpha and intraclass correlation coefficients. Construct validity was assessed using Pearson's correlation between domains and confirmatory factor analysis. To assess concurrent validity, Pearson's correlation between the different domains of the PSEQ and Prenatal Psychosocial Profile-Portuguese Version (PPP-VP) was determined. The level of significance was set at 5%. RESULTS: This study included 399 pregnant women in the northeastern region of Brazil. The internal consistency and reliability of the total PSEQ score were high (Cronbach's alpha = 0.89; intraclass correlation coefficient = 0.95). Validity analysis showed positive and significant correlations between all PSEQ domains, ranging from 0.14 to 0.56. Confirmatory factor analysis demonstrated the following values of goodness of fit: RMSEA = 0.05, SRMR = 0.08, CFI = 0.61, χ2/df = 1.77. The discriminant and concurrent validities of the PSEQ were confirmed. CONCLUSIONS: The Portuguese version of the PSEQ has adequate psychometric properties and is a valid and reliable tool to evaluate psychosocial adaptation to pregnancy in Brazilian pregnant women.

Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences.

BACKGROUND: Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women's preferences for mode of birth and factors underlying preferences for CS. METHODS: Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. RESULTS: We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women's partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). CONCLUSIONS: A wide variety of factors underlie women's preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.

Expectativas e vivências no processo de parto, a partir do interacionismo simbólico / Expectations and experiences in the childbirth process from the perspective of symbolic interactionism / Expectativas y vivencias en el proceso del parto a partir del interaccionismo simbólico

OBJETIVO: Compreender as expectativas e vivências de mulheres primíparas no parto. MÉTODO: Trata-se de um estudo descritivo, qualitativo tendo como referencial teórico o Interacionismo Simbólico. A coleta de dados ocorreu por meio de oficinas, entrevista semiestruturada no pré e pós-parto. Os dados foram analisados por meio de análise de conteúdo. RESULTADOS: Participaram do estudo 11 mulheres no pré-parto e oficina e 05 no pós-parto. Foram identificadas duas categorias: Parto: experiência marcante; e Entre expectativas e vivências. DISCUSSÃO: Nas expectativas e na realidade, no momento do parto, estiveram presentes significados construídos e modificados pelas interações com profissionais e rede social. CONCLUSÃO: A vivência do parto pode ressignificar paradigmas culturais e sociais. A valorização das técnicas relacionais qualifica a assistência na direção da construção de significados e experiências.

OBJECTIVE: To understand expectations and experiences related to childbirth in primiparous women. METHODS: Descriptive and qualitative study that applied symbolic interactionism as a theoretical framework. Data were collected during workshops with the pregnant participants, and by semi-structured interviews carried out before and after childbirth. Content analysis was used to analyze the gathered information. RESULTS: Eleven pregnant women and five postpartum women participated in the study. Two categories were identified: Childbirth: a remarkable experience; and Among expectations and experiences. DISCUSSION: Meanings developed and modified by interactions with professionals and social networks were present during childbirth, in both expectations and reality. CONCLUSION: Experiencing childbirth can resignify cultural and social paradigms. Recognizing relational techniques can improve quality of care by the inclusion of the development of meanings and experiences.

OBJETIVO: Comprender las expectativas y vivencias del parto en mujeres primerizas. MÉTODO: Se trata de un estudio descriptivo, cualitativo, cuyo referencial teórico fue el Interaccionismo Simbólico. Los datos fueron recolectados mediante talleres y entrevistas semiestructuradas aplicadas antes y después del parto. Datos analizados utilizando análisis de contenido. RESULTADOS: Participaron del estudio 11 mujeres en el preparto y el taller, y 5 en el posparto. Fueron identificadas dos categorías: Parto: experiencia trascendente; y Expectativas y vivencias. DISCUSIÓN: En las expectativas en la realidad, al momento del parto estuvieron presentes significados construidos y modificados por las interacciones con los profesionales y con la red social. CONCLUSIÓN: La vivencia del parto puede resignificar paradigmas culturales y sociales. La valoración de las técnicas relacionales califica la atención en el camino a la construcción de significados y experiencias.

Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study.

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the childbirth experience questionnaire.

BACKGROUND: The Childbirth Experience Questionnaire (CEQ) is a tool designed to assess women's perceptions about labor and delivery. The aim of this study was to perform the cross-cultural adaptation and validation of the Brazilian Portuguese version of the CEQ (CEQ-Br). METHODS: The original version of the CEQ was translated into Portuguese, analyzed by a committee of experts, back translated, and finally submitted to pilot-test. Two applications of the CEQ-Br were performed along with the quality of life questionnaire Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36). The SPSS software was used for statistical analysis, the intraclass correlation coefficient was used to investigate test-retest reliability, the internal consistency was investigated with the Cronbach's Alpha, and the construct validity was investigated via the Spearman correlation test. The level of significance was set at 5%. RESULTS: The study included 308 women with a mean age of 31.1 ± 8.7 years. The internal consistency results for the total CEQ-Br score was considered adequate (0.89), the test-retest showed a substantial result with an ICC of 0.90, and the construct validity was analyzed via the Spearman correlation between all SF-36 dimensions and the total CEQ-B score, the analyses were considered adequate. CONCLUSIONS: The results presented in this CEQ-Br validation study showed that the instrument was reliable in measuring the established psychometric properties and was considered valid. Therefore, the CEQ-Br can be applied to the Brazilian population.

Practices suggested in social media for birth plans.

OBJECTIVE: To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. METHOD: Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. RESULTS: 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. CONCLUSION: Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth.

Verbal communication of the parturient nurse's dyad in the active phase of labor.

OBJECTIVES: to analyze verbal communication between the nurse and the parturient during the active phase of labor in two Lusophone countries. METHODS: quantitative analytical study. Sample of 709 interactions between nurses and parturients using verbal communication during the active phase of labor in Brazil and Cape Verde. The following variables were analyzed: companion, conative vocative, conative imperative, emotive/expressive and referential/context functions, contact/channel and code. RESULTS: the absence of interaction predominated in most of the variables analyzed during the active phase of labor in both countries. In Cape Verde all interactions occurred during the absence of the companion. CONCLUSIONS: considering the social and cultural aspects of each country, nurses need to develop skills to communicate verbally with the parturient, offering a better interaction during the parturition process.

Análise da percepção de puérperas sobre a assistência ao parto em uma maternidade do Tocantins / Analysis of the perception of puerperal women about maternity care assistance in a maternity of Tocantins

Objetivo: No decorrer dos séculos, o parto migrou do ambiente domiciliar para o hospitalar, sendo então repleto de procedimentos que, embora tenham o intuito de ajudar, nem sempre são adequados ou baseados em evidências. Por isso, o objetivo deste estudo é identificar os procedimentos realizados com parturientes durante o parto em uma maternidade do Tocantins, além de caracterizar o perfil dessas pacientes. Método: Foi aplicado um questionário a 70 puérperas de parto normal, maiores e menores de idade, durante quatro meses. O questionário de referência foi o utilizado do estudo Nascer no Brasil. Resultados: A maioria das pacientes se autodeclarou parda, tinha ao menos o ensino médio completo e era maior de 18 anos. Mais da metade delas tiveram alguma alteração no períneo, 25% sofreram manobra de Kristeller e 88% submeteram-se à litotomia. Além disso, a grande maioria avaliou o serviço da maternidade como bom/ótimo/excelente. Conclusão: A assistência ao parto no Tocantins ainda se divide em práticas adequadas e técnicas ultrapassadas. Trata-se de um estudo original e um dos primeiros nesse sentido realizado no estado mais novo do Brasil.(AU)

Objective: Throughout the centuries, childbirth has migrated from the home environment to the hospital, being then full of procedures that although they are intended to help, are not always adequate or based on evidence. Therefore, the objective of this study is to identify the procedures performed with parturients during childbirth in a maternity hospital in Tocantins, in addition to characterizing the profile of these patients. Method: A questionnaire was applied to 70 mothers of normal birth, older and younger, for four months. The reference questionnaire was used in the Nascer no Brasil study. Results: Most patients declared themselves to be brown, had at least completed high school, and were over 18 years old. More than half of them had some alteration in the perineum, 25% underwent a Kristeller maneuver and 88% underwent lithotomy. In addition, the vast majority rated the maternity service as good/excellent/excellent. Conclusion: Assistance to childbirth in Tocantins is still divided into outdated technical and appropriate practices. This is an original study and one of the first in this sense carried out in the newest state of Brazil.(AU)

Dimensions of childbirth care associated with maternal satisfaction among low-risk Chilean women.

The authors of this study aimed to describe the level of maternal satisfaction during labor reported by a national sample of low-risk childbearing women in Chile by identifying the dimensions of intrapartum care most determinant for overall satisfaction. Maternal satisfaction was measured in the postpartum period with an instrument previously validated in Chile. Almost half of the participants (49.4%) reported having optimal satisfaction, 29% adequate, and 22% worse. Treatment of women by professionals and the physical environment were the most important dimension predicting of maternal satisfaction, consistent with findings from developing countries emphasizing patient-provider interaction during labor as a key component of birth care quality.

Components of obstetric violence in health facilities in Quito, Ecuador: A descriptive study on information, accompaniment, and position during childbirth.

OBJECTIVE: To describe three factors of obstetric violence in health centers that attend births in Quito, Ecuador: information; accompaniment; and free position. METHOD: A cross-sectional descriptive study of 388 women was conducted, focusing on the analysis of three factors of obstetric violence. This study forms part of a larger study that explores the experiences of women in childbirth in Quito between July 1, 2016 and July 1, 2017. RESULTS: Of all procedures, the performance of episiotomies and the application of fundal pressure during the second stage of labor (Kristeller) stand out, as more than 35% of the women were not informed about them. In total, 121 (46.9%) women who gave birth vaginally were not given the opportunity to be accompanied by someone of their choice, neither in labor nor during delivery. While in the cases of cesarean deliveries, this increased to 116 (92.1%) women. A total of 119 (37.2%) women did not have the opportunity to choose their birthing position (or they did not know they could choose). During delivery, 138 (53.5%) women indicated the same. CONCLUSION: Obstetric violence is seen in all three components: information; accompaniment; and free position.

Practices suggested in social media for birth plans / Prácticas sugeridas en las redes sociales sobre la planificación de los partos / Práticas sugeridas em mídias sociais para planos de parto

ABSTRACT Objective: To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. Method: Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. Results: 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. Conclusion: Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth.

RESUMEN Objetivo: Describir y analizar las prácticas sugeridas en las redes sociales como Blogs/Sitios, no recomendadas por la OMS, sobre la planificación de los partos. Método: Se trata de un estudio cualitativo, exploratorio y descriptivo, de análisis temático. Entre marzo y julio de 2016, se seleccionaron 41 direcciones electrónicas de 200 identificadas con antelación. Tres estaban situadas en Portugal y las demás, en Brasil. Resultados: Se identificaron 48 prácticas no citadas entre las recomendaciones de la Organización Mundial de la Salud (OMS). Conclusión: Los Blogs/Sitios, al ser vehículos de transmisión, circulación y producción de conocimientos, permiten la expresión de valores de manera horizontal, instigando a las mujeres a planificar eventos considerados importantes para sus partos y a transferir las decisiones de las prácticas del parto para sí, lo que ha generado controversia en el discurso de la humanización del trabajo de parto.

RESUMO Objetivo: Descrever e analisar práticas sugeridas nas mídias sociais para elaboração de Planos de Partos disponíveis em Blogs/Sites e que não constam nas recomendações da OMS. Método: Estudo qualitativo, exploratório, descritivo, de análise temática. Foram selecionados para análise 41 endereços eletrônicos dos 200 previamente identificados, entre março e julho de 2016. Três endereços eletrônicos estavam sitiados em Portugal e os demais no Brasil. Resultados: Foram identificadas 48 práticas não citadas entre as recomendações da Organização Mundial da Saúde (OMS). Conclusões: Os Blogs/Sites, por serem ferramentas de transmissão, circulação e produção de conhecimentos, possibilitam a expressão de valores de forma horizontal, instigando mulheres ao planejamento dos eventos considerados importantes para seus partos e deslocando as decisões das práticas de parto para si, o que tem provocado polêmica no discurso da humanização do parto.

Verbal communication of the parturient nurse's dyad in the active phase of labor / Comunicación verbal de la diade enfermera parturienta en la fase activa del trabajo de parto / Comunicação verbal da díade enfermeiro-parturiente na fase ativa do trabalho de parto

ABSTRACT Objectives: to analyze verbal communication between the nurse and the parturient during the active phase of labor in two Lusophone countries. Methods: quantitative analytical study. Sample of 709 interactions between nurses and parturients using verbal communication during the active phase of labor in Brazil and Cape Verde. The following variables were analyzed: companion, conative vocative, conative imperative, emotive/expressive and referential/context functions, contact/channel and code. Results: the absence of interaction predominated in most of the variables analyzed during the active phase of labor in both countries. In Cape Verde all interactions occurred during the absence of the companion. Conclusions: considering the social and cultural aspects of each country, nurses need to develop skills to communicate verbally with the parturient, offering a better interaction during the parturition process.

RESUMEN Objetivos: analizar la comunicación verbal entre enfermero y parturienta durante la fase activa del trabajo de parto en dos países lusófonos. Métodos: estudio analítico cuantitativo. Muestra con 709 interacciones utilizando comunicación verbal de enfermeros y parturientas en la fase activa del trabajo de parto en Brasil y Cabo Verde. Se analizaron las variables: acompañante, funciones conativa/ vocativo e imperativo, emotiva/expresiva, referencial/contexto, contacto/canal y código. Resultados: predominó ausencia de interacciones en la mayoría de las variables analizadas en la fase activa del trabajo de parto en los dos países. En Cabo Verde, todas las interacciones han sido establecidas con la ausencia del acompañante. Conclusiones: considerando los aspectos sociales y culturales de cada país, los enfermeros necesitan desarrollar habilidades para se comunicaren verbalmente con las parturientas, ofreciéndoles mejor interacción en el proceso de parturición.

RESUMO Objetivos analisar a comunicação verbal entre enfermeiro e parturiente durante a fase ativa do trabalho de parto em dois países lusófonos. Métodos: estudo analítico quantitativo. Amostra com 709 interações utilizando comunicação verbal de enfermeiros e parturientes na fase ativa do trabalho de parto no Brasil e Cabo Verde. Analisaram-se as variáveis: acompanhante, funções conativa vocativa, conativa imperativa, emotiva/expressiva, referencial/contexto, contato/canal e código. Resultados: predominou ausência de interações na maioria das variáveis analisadas na fase ativa do trabalho de parto nos dois países. Em Cabo Verde, todas as interações foram estabelecidas com a ausência do acompanhante. Conclusões: considerando os aspectos sociais e culturais de cada país, os enfermeiros precisam desenvolver habilidades para comunicarem-se verbalmente com as parturientes, oferecendo a elas melhor interação no processo de parturição.

Applying best practices to pregnant women in the obstetric center.

OBJECTIVE: To identify the meaning attributed by nursing technicians to good care practices based on scientific evidence used with the pregnant women during the dilation stage of labor. METHOD: A qualitative study, based on Grounded Theory principles. Twelve interviews with nursing technicians attending labor in the obstetric center of two public hospitals, in Florianópolis/SC, were performed, from August of 2016 to March of 2017. Data were analyzed using open, axial coding. RESULTS: The implementation of good practices, for nursing technicians, means adequately performing their activities, providing humanized care to the pregnant woman, respecting her autonomy, promoting pain relief, and a peaceful labor. FINAL CONSIDERATIONS: An adequate number of technicians must be determined to maintain quality of care, and to complete nursing records in a more detailed and systematized manner.

Concept formation of ambience for labor and normal institutionalized delivery.

OBJECTIVE: to develop the concept ambience for labor and normal institutionalized delivery, identifying in the literature its antecedent, defining attributes and the consequent. METHOD: the method used was the analysis of literature, corresponding to the first stage of the qualitative method of concept analysis. The theoretical operation was performed in the databases CINAHL COCHRANE, LILACS, PsycINFO, and PubMed. RESULTS: aspects of the parturient woman and the qualification of the physical and social space are presented as the antecedent. The defining attributes outline the assistance interaction process with Non-Invasive Technologies. As the consequent, we highlight the outcome for normal delivery, pain relief and comfort, woman satisfaction and well-being. FINAL CONSIDERATIONS: the analysis of the antecedent, defining attributes and the consequent allowed the elaboration of an unprecedent theoretical proposition of this concept.

Witnessing Obstetric Violence during Fieldwork: Notes from Latin America.

Violence against women in labor occurs frequently in Latin America, based on observations from my extensive ethnographic fieldwork in various Latin American countries. In this article, focused on Mexico and the Dominican Republic, I contextualize obstetric violence within the larger context of social exclusion and discrimination against women. I establish associations between maternal deaths and health care systems characterized by a lack of continuum of care, a lack of accountability toward women, and the withholding of care. I argue that clinical staff learn to operate within the structural limitations of health care systems by not assuming the responsibility of the continuum of care that each woman needs, and that this discharge of accountability is at the heart of how health professionals can navigate, tolerate, and perpetuate the structure of the system and, in so doing, create the breeding ground for obstetric violence to occur. Finally, I explain that although reporting on the suffering of women will not, on its own, prevent obstetric violence, increasing its visibility through research can contribute to human rights-based advocacy on behalf of women in labor, to the monitoring of human rights standards, and to the creation of accountability measures within health systems to prevent obstetric violence.

Early maternal-newborn contact and positive birth experience.

BACKGROUND: In recent years, there has been increasing recognition of the importance of early maternal-newborn contact for the health and well-being of the newborn and promotion of breastfeeding. However, little research has investigated the association between early maternal-newborn contact and the mother's birth experience. METHODS: As part of a large-scale prospective, cohort study (the First Baby Study [FBS]), nearly 3000 women who delivered in Pennsylvania (2009-2011) reported how soon after delivery they first saw, held, and fed their newborns. Birth experience was measured via telephone interview 1 month postpartum, using the FBS Birth Experience Scale, a 16-item scale which addresses women's feelings about the delivery. General linear models were used to measure associations between time to first maternal-newborn contact and birth experience, controlling for relevant confounders, including maternal age, race/ethnicity, insurance coverage, delivery mode, gestational age, and pregnancy and delivery complications. RESULTS: The sooner that new mothers first saw, held, and fed their newborns after delivery the more positive their childbirth experiences (all P-values < 0.001). Women who delivered by cesarean were less likely to see, hold and feed their newborns shortly after delivery than those who delivered vaginally (all P-values < 0.001), and reported less positive birth experiences (P < 0.001). However, if they first saw, held, and fed their newborns shortly after delivery, they reported more positive birth experiences than those who delivered vaginally (P = 0.010). DISCUSSION: Early maternal-newborn contact after delivery was associated with positive birth experiences for new mothers, particularly those who delivered by cesarean.

Perspective of pregnant women regarding antenatal preparation: A qualitative study.

BACKGROUND: Antenatal Education programs have been recommended for pregnant women to help them during gestation, childbirth and development of parenthood. Evidence on the perspectives and expectations of pregnant women regarding antenatal education in hospital settings, specifically in developing countries is still scarce. In-depth understanding is a key issue to organize interventions. AIM: Identify experiences, needs and expectations of a group of pregnant women regarding antenatal education. METHODS: A qualitative study was conducted. Data were collected through semi-structured interviews at the antenatal clinic of a public maternity teaching hospital in the southeastern region of Brazil. The interviews were recorded, transcribed verbatim and thematic analysis was performed. Twenty-two pregnant women were recruited following the logic of purposive sampling. FINDINGS: All the participants reported they would like to receive guidance on non-pharmacological techniques for pain management during labor. The participants reported barriers to performed physical exercise; however, they also said that if they were encouraged by healthcare professionals they would exercise. According to the majority, the exercises should be of low intensity, and the improvement of general wellbeing was the most commented benefit. Also participants said that antenatal education meetings should be linked to antenatal consultations to facilitate participation. According to some participants, knowledge about antenatal education was acquired in conversations with other women, from lay media, and some reported a lack of guidance during antenatal consultation. CONCLUSION: The participants of our study reported they would like to participate in antenatal education groups to receive guidance on non-pharmacological techniques to use during labor and childbirth.