"Uma vez cesárea, sempre cesárea"? Representações sociais de mulheres com uma cesárea em gestação anterior sobre o parto normal / Understanding the social representation of women with a previous cesarean over a vaginal delivery

Trata-se de um estudo que aborda as formas de pensar, sentir e agir de mulheres com uma cesárea em gestação anterior sobre o parto normal. Considerando as expressivas taxas de cesárea, seu recrudescimento em todo o Mundo, e a importância das indicações de cesárea por causa de cesárea anterior na manutenção dessas taxas, a proposta deste estudo foi construída tendo as seguintes tensões: de um lado a força da crença “uma vez cesárea, sempre cesárea” no conjunto social, seu vigor simbólico mantido pela falta de informação; a determinação das experiências de gestações prévias no modo como as mulheres irão lidar em futuras gravidezes, e por outro lado, a possibilidade de se ter um parto normal após uma cesárea, conforme as evidências científicas apontam, com benefícios para mãe e filho. Tudo isso configura uma investigação que se insere em um contexto de desafios. O objetivo é compreender as representações sociais de mulheres com uma cesárea em gestação anterior sobre o parto normal. Utilizou-se a abordagem qualitativa com orientação teórica da Teoria das Representações Sociais na perspectiva proposta por Serge Moscovici, realizado em duas maternidades, que prestam atendimento exclusivo ao Sistema Único de Saúde, no município de Belo Horizonte, Minas Gerais, Brasil. Participaram 31 puérperas que tiveram partos normais como via de parto atual e que, em uma experiência anterior, tiveram cesárea, que atenderam aos critérios de inclusão da pesquisa. Os dados foram obtidos, durante o período de 09/03/2012 e 27/04/2012, por meio de entrevista aberta. Os relatos foram analisados segundo a técnica de análise de conteúdo temática proposta por Bardin. A pesquisa foi aprovada pelo Comitê de Ética de Pesquisa da Universidade Federal de Minas Gerais e das instituições em que o estudo foi realizado. O termo de consentimento livre esclarecido foi assinado por todas as participantes. Foram identificadas duas categorias empíricas: a) a presença do “estranho”...

This study addresses the ways of thinking, feeling and acting of women with a previous cesarean over a vaginal delivery. Considering the expressive cesarean rates, its recrudescence worldwide and the importance of cesarean indications because of a previous cesarean in the keeping of these rates, the proposal of this study was built having the following tensions: on the one hand the strength of the belief that “oncecesarean, always cesarean” in the social set, its symbolic vigor , kept by lack of information; the determination of previous pregnancies in the way women are going to deal with future pregnancies and, on the other hand, the possibility of having a vaginal delivery after a cesarean, as scientific evidences point out, with benefits for both mother and infant, setting an investigation that is inserted in a context of challenges. The objective is to understand the social representation of women with a previous cesarean over a vaginal delivery. It was employed a qualitative approach with a theoretical orientation of the Theory of Social Representations in the perspective proposed by Serge Moscovici, carried out in two maternity hospitals, which render exclusive service to the National Health System, in Belo Horizonte, Minas Gerais, Brazil. In this study thirty one puerperal women who had vaginal delivery as a via of present delivery that, in a previous experience, had cesarean delivery and who accomplished the requirements for the criteria of inclusion in the research, took part. The data were collected between 09/03/2012 and 27/04/2012, through open interview. The reports were analyzed in accordance with the analyses technique of thematic content proposed by Bardin. The research was approved by the Ethics Research Committee of the Federal University ofMinas Gerais and by the institutions where the study was carried out. The informed consent form was signed by all participants. Two empirical categories were identified: a) The presence...

Ethnic differences in the use of intrapartum epidural analgesia.

BACKGROUND: Obstetric epidural analgesia (EA) is widely applied, but studies have reported that its use may be less extensive among immigrant women or those from minority ethnic groups. Our aim was to examine whether this was the case in our geographic area, which contains an important immigrant population, and if so, to describe the different components of this phenomenon. METHODS: Cross-sectional observational study. SETTING: general acute care hospital, located in Marbella, southern Spain. Analysis of computer records of deliveries performed from 2004 to 2010. Comparison of characteristics of deliveries according to the mothers' geographic origins and of vaginal deliveries noting whether EA was received, using univariate and bivariate statistical analysis and multiple logistic regression (MLR). RESULTS: A total of 21,034 deliveries were recorded, and 37.4% of these corresponded to immigrant women. EA was provided to 61.1% of the Spanish women and to 51.5% of the immigrants, with important variations according to geographic origin: over 52% of women from other European countries and South America received EA, compared with around 45% of the African women and 37% of the Asian women. These differences persisted in the MLR model after adjusting for the mother's age, type of labor initiation, the weight of the neonate and for single or multiple gestation. With the Spanish patients as the reference category, all the other countries of origin presented lower probabilities of EA use. This was particularly apparent for the patients from Asia (OR 0.38; 95%CI 0.31-0.46), Morocco (OR 0.49; 95%CI 0.43-0.54) and other Africa (OR 0.55; 95%CI 0.37-0.81). CONCLUSIONS: We observed a different use of EA in vaginal deliveries, according to the geographic origin of the women. The explanation for this involves a complex set of factors, depending both on the patient and on the healthcare staff.

[Factors that interfere in the parturient women's behavior: focus on ethnonursing]. / Fatores interferentes no comportamento das parturientes: enfoque na etnoenfermagem.

This study aimed to understand the behavior of pregnant women in labor and delivery. Seven parturient women who had their children through normal delivery in a public maternity in Fortaleza, Ceará. Data collection was carried out in June to August, 2003. The research method used for the collection and analysis of data was the etnonursing. The data studied showed us through the categories: experiencing pregnancy and assistance in the maternity. We concluded that there are several factors that justify the woman's behavior during the experience of labor and delivery and that the health professionals' assistance should be always aimed at the humanistic care linking cultural and scientific knowledge.

Length of normal labor in women of Hispanic origin.

Emanuel Friedman in the 1950s established means and statistical guidelines for normal lengths of labor. The childbearing population in the United States has changed considerably since Friedman's research was conducted. This study documented the duration of labor in a cohort of 240 Hispanic women who had normal vaginal births of singleton term infants from January 1995 through December 1998 and compared these results with the mean duration of the first and second stages of labor as established by Friedman. The mean duration of the active phase first stage labor duration for nulliparous Hispanic women was 6.2 hours, and for multiparous Hispanic women was 4.4 hours, both significantly longer than Friedman's group (P <.01). The mean duration of the second stage of labor in nulliparous Hispanic women was 54.2 minutes and for multiparous Hispanic women was 22.2 minutes, not significantly different from Friedman's group (P =.5 and P =.09, respectively).

Atuaçäo da enfermeira junto ao casal/rn no processo de parir embasada na Teoria de Madeleine Leininger / Nurse performance next to the couple/newborn in the parturition process founded on Madeleine Leininger's Theory

Este artigo relata a experiência vivenciada pela mestranda durante a prática assistencial de mestrado. Teve como objetivo geral: implementar uma proposta assistencial com enfoque na teoria da Diversidade e Universalidade do Cuidado Cultural de Madeleine Leininger, junto ao casal/RN no processo de parir. Foi desenvolvida em uma maternidade-escola, de junho a agosto de 1999. A clientela foi composta por três casais que já tinham filhos e cujo parto anterior foi na posiçäo horizontal. Esta prática nos remeteu a muitas reflexöes a respeito da influência da cultura na vida destes casais e as repercussöes destas no processo de parir.

Os vazios da assistência obstétrica: reflexöes sobre o parto a partir de um estudo etnográfico / The gaps in maternity care: reflexion about care delivery in childbirth based on an ethnographic research

A proposta deste trabalho foi explorar algumas falhas na assistência à mulher durante o parto no contexto atual. Após breve relato da evoluçäo histórica da assistência ao parto e dos resultados de uma pesquisa etnográfica sobre a vivência do parto, säo feitas algumas consideraçöes sobre a situaçäo atual do atendimento ao parto. Esta caracteriza-se pela falta de autonomia na tomada de decisöes e pela falta de controle do processo de nascimento por parte das mulheres, que é apontada como sendo resultado do distanciamento entre o conhecimento profissional e o conhecimento popular.

Partograma con curvas de alerta en pacientes del cono sur de Lima / Partograph with alert linen in pregnancy patients of Lima

Durante los años 1991 y 1992, en el "Hospital María Auxiliadora" se escogió 1500 parturientas, de las cuales 587 fueron nuliparas y 913 multiparas. A todas se les aplicó los siguientes criterios: cronologia del embarazo entre 37 y 41 semanas, ausencia de patología, parto de inicio y evolución espontanea, no medicación durante el parto, pelvis normal, presentación cefálica y recien nacido de 2500 a 4000 gramos con score de Apgar mayor de 6 al nacer. Despues de aplicar estos criterios, reunimos finalmente 317 nuliparas (209 con membranas integras y 108 con membranas rotas) y 306 multiparas (231 con membranas integras y 75 con membranas rotas). Todas las pacientes estuvieron en decubito durante el trabajo de parto y fueron controladas en el centro obstetrico utilizando el partograma diseñado por el CLAP y cuidando de hacer los registros gráficos a partir de los 4 a 5 cms de dilatación cervical en adelante. Los datos de dilatación del cuello uterino en relación al tiempo fueron procesados en computadoras y se calculo el percentil 10, o sea el tiempo máximo aceptable que demora la dilatación cervical de centimetro a centimetro hasta el periodo expulsivo, y con ellos se construyo las curvas de alerta para cada uno de los cuatros subgrupos. La pendiente seguida en el proceso de dilatación del cuello uterino es la misma en nuestras parturientas que las reportadas por el CLAP, pero los tiempos estan recostados un poco hacia la derecha, particularmente en el subgrupo de nuliparas con membranas integras