Motivações para escolha do parto domiciliar planejado / Motivos para elegir el parto a domicilio previsto / Motivations for choosing planned home birth

Objetivo: compreender as motivações das mulheres na escolha do parto domiciliar planejado e as percepções dessa vivência. Método: estudo descritivo, exploratório e qualitativo, desenvolvido com 14 mulheres que vivenciaram um parto domiciliar planejado entre janeiro de 2019 e dezembro de 2020. As entrevistas foram realizadas entre março e maio de 2021, transcritas na íntegra e submetidas à análise de conteúdo. Resultados: a análise possibilitou compreender que as motivações para escolha do parto domiciliar planejado estiveram relacionadas ao sentimento de medo das práticas obstétricas hospitalares. A segurança no ambiente domiciliar, a garantia da autonomia e a possibilidade da presença dos filhos foram tanto motivações como percepções positivas dessa vivência. A resistência por parte da sociedade foi frequentemente vivenciada. Conclusão: o modelo obstétrico vigente precisa ser repensado e readequado, com vistas à oferta assistência ao parto segura e respeitosa, seja em âmbito domiciliar ou hospitalar.

Objetivo: comprender las motivaciones de las mujeres en la elección del parto domiciliario planeado y las percepciones de esa vivencia. Método: estudio descriptivo, exploratorio y cualitativo, desarrollado con 14 mujeres que experimentaron un parto domiciliario planeado entre enero de 2019 y diciembre de 2020. Las entrevistas se realizaron entre marzo y mayo de 2021, transcritas en su totalidad y sometidas al análisis de contenido. Resultados: el análisis permitió comprender que las motivaciones para la elección del parto domiciliar planeado estuvieron relacionadas con el sentimiento de miedo de las prácticas obstétricas hospitalarias. La seguridad en el ambiente domiciliario, la garantía de la autonomía y la posibilidad de la presencia de los hijos fueron tanto motivaciones como percepciones positivas de esa vivencia. La resistencia por parte de la sociedad fue frecuentemente experimentada. Conclusión: el modelo obstétrico vigente necesita ser repensado y readequado, con vistas a la oferta asistencia al parto segura y respetuosa, sea en ámbito domiciliar u hospitalario.

Objective to understand the motivations of women in choosing the planned home birth and the perceptions of this experience. Method: descriptive, exploratory and qualitative study, developed with 14 women who experienced a planned home birth between January 2019 and December 2020. The interviews were conducted between March and May 2021, transcribed in full and submitted to content analysis. Results: the allowed understanding that the motivations for choosing planned home birth were related to the feeling of fear of hospital obstetric practices. Safety in the home environment, the guarantee of autonomy and the possibility of the presence of children were both motivations and positive perceptions of this experience. Resistance on the part of society was often experienced. Conclusion: the current obstetric model needs to be rethought and readjusted, in order to provide safe and respectful birth, whether at home or in the hospital.

Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial.

BACKGROUND: Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth. METHODS: One hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section). RESULTS: It was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome. CONCLUSIONS: An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC. TRIAL REGISTRATION: The Netherlands Trial Register (NTR; 4302 ).

Desejando parir naturalmente: perspectiva de mulheres sobre o parto domiciliar planejado com uma enfermeira obstétrica / Wanting to give birth naturally: women's perspective on planned homebirth with a nurse midwife / Deseando parir naturalmente: perspectiva de mujeres sobre el parto domiciliario planificado con una enfermera obstétrica

Objetivo: descrever a escolha do parto domiciliar planejado acompanhado por enfermeira obstétrica em um centro urbano de grande porte, na perspectiva de mulheres brasileiras. Métodos: estudo qualitativo guiado pela Grounded Theory. Foram entrevistadas dez mulheres com idade entre 20 e 41 anos que tiveram parto domiciliar planejado acompanhadas por enfermeiras obstétricas. As participantes foram recrutadas por meio de rede social, acessando um grupo de mulheres que escreveram sobre seu parto domiciliar. Resultados: Emergiram duas categorias: Não vendo possibilidade de parir naturalmente no ambiente hospitalar e Pensando na segurança do parto domiciliar planejado. O hospital representou vários aspectos desfavoráveis como intervenções desnecessárias e solidão. As mulheres consideravam o lar um lugar seguro para parir, conectado aos cuidados de enfermeiras obstétricas. Conclusão: há mulheres que não desejam parir no hospital, preferindo parir em casa e do ponto de vista dos direitos humanos e dos cuidados desmedicalizados, as enfermeiras obstétricas devem apoiar as mulheres nessa sua decisão.

Objective: to describe the choice of planned homebirth attended by a nurse midwife in a large urban centre, from the perspective of Brazilian women. Methods: in this Grounded Theory study, ten women aged 20 to 41 years, who had a planned homebirth accompanied by a nurse midwife, were interviewed. Participants were recruited through a social network by accessing a group of women who wrote about their homebirth. Results: two categories emerged: seeing no possibility of giving birth naturally in the hospital environment; and thinking about the safety of a planned homebirth. Hospital represented several unfavourable aspects, such as unnecessary interventions and loneliness. Women thought of home as a safe place to give birth, connected with nurse midwife care. Conclusion: there are women who do not wish to give birth in hospital, but prefer to give birth at home and, from the point of view of human rights and de-medicalized care, nurse midwives should support women in their decision.

Objetivo: describir la elección del parto domiciliario planificado con enfermera obstétrica en un gran centro urbano, desde la perspectiva de mujeres brasileñas. Métodos: estudio cualitativo guiado por la Grounded Theory. Se entrevistó a diez mujeres entre 20 y 41 años que tuvieron parto domiciliario planificado, siendo acompañadas de enfermeras obstétricas. Las participantes fueron reclutadas a través de red social, accediendo a un grupo de mujeres que escribieron sobre su parto en domicilio. Resultados: surgieron dos categorías: las que no veían posibilidad de dar a luz naturalmente en el hospital y las que pensaron en la seguridad del parto domiciliario planificado. El hospital representó varios aspectos desfavorables como intervenciones innecesarias y soledad. Las mujeres consideraban que el hogar era un ambiente seguro para dar a luz, vinculado al cuidado de enfermeras obstétricas. Conclusión: hay mujeres que no desean dar a luz en el hospital, prefieren hacerlo en casa y, desde el punto de vista de los derechos humanos y de los cuidados sin la intervención de un médico, las enfermeras obstétricas deben apoyarlas en esa decisión.

Childbirth experience of women in a maternity hospital signatory of the Adequate Childbirth Project: mixed study / Experiencia de parto de mujeres en una maternidad signatorial del Proyecto Parto Adecuado: estudio mixto / Experiência de parto de mulheres em uma maternidade signatária do Projeto Parto Adequado: estudo misto

ABSTRACT Objective To understand the childbirth experience of women assisted in a maternity hospital signatory of the Adequate Childbirth Project. Methodology Mixed study, carried out in 2018. Applied the Free Word Association Test in 62 pregnant women and then conducted an open interview with 18 of them, then puerperal women, and, for analysis, the Central Nucleus Theory, Word Cloud, and thematic Categories, respectively. Results The predominant words revealed in the quantitative stage were: pain, wonderful, recovery, anxiety, and desires. The qualitative analysis is presented by thematic categories "Women's insecurities in the PPA model" and "New perspectives from experience in the PPA model". Conclusions The women's experiences demonstrated that the model favored the remodeling of childbirth care. However, they still experience pain, dissatisfaction, and lack of autonomy. The impossibility of choosing a trusted professional was a source of insecurity, and nurses had no voice in decisions and actions in care.

RESUMEN Objetivo Comprender la experiencia de parto de mujeres asistidas en una maternidad signataria del Proyecto Parto Adecuado. Metodología Estudio mixto, realizado en 2018. La prueba de asociación libre de palabras se aplicó a 62 mujeres embarazadas y después se realizó una entrevista abierta con 18 de ellas, en ese momento ya puérperas y, para el análisis, la Teoría del Núcleo Central, la Nube de palabras y las Categorías Temáticas, respectivamente. Resultados Las palabras predominantes reveladas en la etapa cuantitativa fueron: dolor, maravilloso, recuperación, ansiedad y deseos. El análisis cualitativo se presenta por las categorías temáticas "Inseguridades de las mujeres en el modelo PPA" y "Nuevas perspectivas desde la experiencia en el modelo PPA". Conclusiones Las experiencias de las mujeres mostraron que el modelo favoreció la remodelación de la atención del parto. Sin embargo, todavía experimentan dolor, insatisfacción y falta de autonomía. La imposibilidad de elegir un profesional de confianza era una fuente de inseguridad, y las enfermeras no tenían voz en las decisiones y acciones en la atención.

RESUMO Objetivo Compreender a experiência de parto de mulheres assistidas em maternidade signatária do Projeto Parto Adequado. Metodologia Estudo misto, realizado em 2018. Aplicado o Teste de Associação Livre de Palavras em 62 gestantes e depois realizado entrevista aberta com 18 delas, então puérperas, e, para análise a Teoria do Núcleo Central, Nuvem de Palavras e Categorias temáticas, respectivamente. Resultados As palavras de predomínio reveladas na etapa quantitativa foram: dor, maravilhoso, recuperação, ansiedade e desejos. A análise qualitativa está apresentada pelas categorias temáticas "Inseguranças da mulher no modelo PPA" e "Novas perspectivas a partir da experiência no modelo PPA". Conclusões As experiências das mulheres demonstraram que o modelo favoreceu a remodelagem da atenção ao parto. Entretanto, elas ainda vivenciam dor, insatisfação e falta de autonomia. A impossibilidade de escolha do profissional de confiança foi um gerador de insegurança, e as enfermeiras não tiveram voz nas decisões e ações no cuidado.

Waterbirth in low-risk pregnancy: An exploration of women's experiences.

AIMS: To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths. DESIGN: A qualitative study. METHODS: Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015-October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N = 155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analysed with qualitative content analysis. RESULTS: Two themes were identified related to benefits: (a) physical benefits: the water eases labour progression while offering buoyancy and pain relief; and (b) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (a) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (b) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated. CONCLUSION: Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water. IMPACT: Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

"After having a waterbirth, I feel like it's the only way people should deliver babies": The decision making process of women who plan a waterbirth.

OBJECTIVE: To explore the decision making process of women who seek to give birth in water DESIGN: A qualitative design using semi-structured interviews with women who planned a waterbirth was used. Interviews were recorded, transcribed, and coded for emergent themes using a grounded theory approach for analyses SETTING: Twenty-three women (mean age = 33.5 years mean number of children = 2.5) who had planned a waterbirth were recruited from a prenatal care clinic in a mid-sized southeastern city in the United States. Questions explored how they decided to pursue a waterbirth, sources of information, support systems, resistance, and their birth experience FINDINGS: Although all participants used the tub during labor, five did not give birth in the water. Analyses revealed that a belief in their body's ability to give birth along with the desire for limited medical interventions were the primary reasons for choosing waterbirth. Previous positive and negative experiences with birth also shaped their decision. Women actively sought information about waterbirths from the internet and friends. One-third of participants decided to pursue a waterbirth later in pregnancy and changed OB practices in order to have access to a waterbirth. Midwives and doulas were viewed as critical supporters of their waterbirth decision. However, most participants experienced some form of resistance toward their decision from others including family, friends, coworkers, and strangers. The overwhelming majority were positive about their experience and indicated they felt empowered, even if they were unable to give birth in the water, and encouraged other women to consider waterbirth. Most indicated they wanted to have a waterbirth in the future.

Testing the waters - A cross-sectional survey of views about waterbirth among Swedish health professionals.

BACKGROUND: For women with low risk births, waterbirth is an alternative that is requested and provided in approximately a hundred countries. However, in some countries, including Sweden, waterbirth is not generally available. AIM: To explore the experiences, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynaecologists and neonatologists. METHODS: A cross-sectional study was conducted in Sweden, using a web-based survey distributed via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016. The respondents (n = 1609) answered a combination of Likert-scale and open-ended questions. The responses were analysed with descriptive statistics and quantitative content analyses. FINDINGS: Both midwives and physicians stated a lack of experience, knowledge and clinical guidelines related to attending and assisting waterbirths. Overall, midwives had more positive attitudes to waterbirth (38.8% vs 4.5%) as well as towards providing and implementing waterbirth, compared to physicians (71.0% vs 14.9%). Midwives stated significantly more benefits and fewer risks for women and babies, compared to physicians who requested more evidence. CONCLUSIONS: Opinions regarding waterbirth are to some extent based on attitudes rather than actual experience and knowledge. There are diverse interpretations of the strength of evidence and a lack of updating in the research field of waterbirth. As waterbirth is requested by women, health professionals need to update their knowledge in this topic in order to give coherent and evidence-based information and care to prospective parents.

Analysing constructions of childbirth in the media; Moving possibilities for childbirth beyond gender essentialism.

PROBLEM: Birth can be a contentious issue with maternity care providers and consumers alike advocating fiercely defended and polarising views. These positions are largely shaped by opposing biomedical and natural childbirth constructions of birth. Contemporary debate on homebirth is one such example which illustrates this divide. AIM: To reconceptualise birth by deconstructing current constructions of childbirth contained in homebirth articles published by one online media source in Australia. METHODS: Australia's self-acclaimed largest women's media company was searched for articles pertaining to homebirth. Articles which met inclusion criteria were analysed using poststructural feminist theory and deconstruction techniques informed by Davies and Gannon, Butler and others. FINDINGS: Gender essentialism present in both the biomedical and natural childbirth approaches constructs birth as an act of nature, dictated by biology rather than one with a sociohistorical location. DISCUSSION: Gender essentialism at birth serves to obscure the sociohistorical determinants of birth, making it appear as a static, immutable sort of act, rather than one which is defined by its sociohistorical location and which can be redefined, even reinvented, by its sociohistorical location. CONCLUSION: Gender essentialism is an enduring phenomenon, underpinning seemingly opposing constructions of childbirth. Disengaging childbirth from essentialisms of woman's nature may create possibilities and meanings of childbirth that could be useful for childbearing women.

Outcomes of Waterbirth in a US Hospital-Based Midwifery Practice: A Retrospective Cohort Study of Water Immersion During Labor and Birth.

INTRODUCTION: Although the safety of water immersion during labor is largely supported by evidence from research, the risks to women and neonates during waterbirth are not well established. The purpose of this study was to generate evidence regarding maternal and neonatal outcomes related to water immersion in labor and during birth. METHODS: A retrospective cohort study included a convenience sample of women receiving prenatal care at a nurse-midwifery practice. Participants were categorized into 3 groups: 1) waterbirth, 2) water labor, or 3) neither. Participant characteristics, maternal outcomes, and newborn outcomes were collected at time of birth and health record abstraction. At the 6-week postpartum visit, another maternal outcome, satisfaction with birth, was measured using the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale. Analysis included effect size, descriptive statistics (sample characteristics), and maternal and neonatal group differences (analysis of variance and chi-square) with a significance level of P < .05. RESULTS: Women in the waterbirth (n = 58), water labor (n = 61), and neither (n = 111) groups were primarily white, married, and college educated and did not differ by age or education. Women in the waterbirth group were more likely to be multiparous. Nulliparous women who had a waterbirth had a significantly shorter second stage of labor than nulliparous women who did not have a waterbirth (P = .03). The most commonly cited reasons for discontinuation of hydrotherapy were maternal choice (42.6%) and need for pain medication (29.5%). Significantly more women in the waterbirth group experienced a postpartum hemorrhage, compared with water labor or neither (n = 5, n = 3, n = 1, respectively; P = .045); there was no difference in related clinical measures. Neonatal outcomes were not significantly different. Maternal satisfaction was high across all groups. DISCUSSION: The results of this study suggest that waterbirth, attended by qualified intrapartum care providers in hospital settings in the United States, is a reasonable option for low-risk women and their neonates.

Bienestar de la mujer durante el proceso de parto: comparación de dos herramientas de evaluación / Women's welfare during the process of childbirth: a comparison of two evaluation tolos

OBJETIVO: Describir la experiencia y el bienestar de las mujeres durante el proceso de parto atendido en el Área de Salud 2-Cartagena, del Servicio Murciano de Salud, y relacionarlos con las características ociodemográficas y obstétricas de la muestra y discutir la adecuación de las escalas utilizadas CEQ-E y BMSP2 en el entorno donde se emplean. MÉTODO: Estudio descriptivo de corte transversal realizado sobre 120 mujeres con parto eutócico. Los datos fueron recogidos mediante las encuestas CEQ-E y BMSP2. RESULTADOS: El bienestar y la experiencia durante el parto fueron valorados entre adecuados y óptimos por un 83,8% de las participantes (120 mujeres) con la escala BMSP2, y con una puntuación media de 3,19 sobre 4 puntos con la herramienta CEQ-E. Los resultados de las subescalas indican que el apoyo profesional y el contacto madre-hijo fueron las dimensiones mejor valoradas. El bienestar y la satisfacción no se relacionaron con la edad, la fórmula obstétrica, el tipo de inicio de parto, la duración del parto y el desgarro durante el expulsivo. Únicamente la nacionalidad y el tipo de anestesia se relacionaron de forma estadísticamente significativa con algunas de las subescalas de las herramientas utilizadas. Entre las dos escalas de nuestro estudio existe una correlación positiva moderada (R = 0,557) que contribuye a la validez de criterio de la escala BMSP2. CONCLUSIONES: La correlación positiva entre las dos herramientas nos indica que ambas pueden ser útiles en contextos culturales como el mediterráneo, en el que son valoradas tanto la autoeficacia (dimensión que enfatiza la herramienta CEQ-E elaborada en Suecia) como la participación de la familia (dimensión incluida en la herramienta chilena BMSP2)

OBJECTIVE: Describe the experience and well-being of women in Area II of the Murcian Health Service during the birth process, and relate them to the sociodemographic and obstetric characteristics of the sam-ple, and discuss the adequacy of the scales used CEQ-E and BMSP2 in the environment where they are used. METHOD: Descriptive crosssectional study performed on 120 women with eutocic delivery. The data was collected through the CEQ-E and BMSP2 surveys. RESULTS: The level of well-being was assessed as adequate and optimal in 83.8% of the participants (120 women), with the BMSP2 scale, and with an average score of 3.19 over 4 points with the CEQ-E tool. The results of the subscales indicate that the professional support and the contact mother-newborn were the most valued dimensions. Well-being was not related to age, the obstetric formula, type of onset of labor, the duration of delivery and the tear during the expulsive period. Only the nationality and the type of anesthesia were related in a statistically significant way with some of the subscales of the tools used. Between the two scales of our study, there is moderate positive correlation (R = 0.557) that contributes to the criterion validity of the BMSP2 scale. CONCLUSIONS: The positive correlation between the two surveys indicates that both can be useful in cultural contexts such as the Mediterranean, in which both self-efficacy (dimension that emphasizes the CEQ-E scale developed in Sweden) and family participation are valued (dimension included in the Chilean questionary BMSP2)

Parir y cuidar desde la oralidad de un sabedor y padre de la comunidad U'wa / Parish and care from the orality of a wise and father of the U'wa community / Parar e cuidar da oralidade de um sábio e um pai da comunidade de U'wa

INTRODUCCIÓN: la Organización Mundial de la Salud (OMS) establece la participación activa y la inclusión de los grupos étnicos en las decisiones de la atención en salud, para que pueda existir un pluralismo médico e intercultural. Se retoma el parto como una necesidad de la comunidad U'WA del municipio de Cubará, desde un intento por fortalecer las identidades ancestrales tradicionalmente excluidas o desconocidas, estableciendo formas de diálogo que permitieron desligar el concepto de salud occidental como único modelo válido para el cuidado de la salud y como un aporte a la de colonialidad en las prácticas imperantes. OBJETIVO: Reconocer las representaciones sociales alrededor del parto, a partir del relato y oralidad de un sabedor y padre de la comunidad U'wa. MÉTODO: Investigación cualitativa de tipo descriptivo con enfoque fenomenológico y método de relato biográfico, a partir de la entrevista a profundidad a un sabedor y padre U'wa. RESULTADOS: Del análisis cualitativo realizado emergieron cuatro categorías: Autoridades tradicionales dentro de la comunidad U'WA, Concepción de mujer, hombre y el nuevo ser, visión de la llegada de una nueva vida desde el sabedor una nueva concepción para el mundo occidental y complicaciones y cuidado tradicional. CONCLUSIONES: Para la comunidad ancestral U'wa el parto y el nacimiento son eventos trascendentes, cuya importancia está profundamente ligada a la concepción del mundo, al acontecer cotidiano y a ser y estar en conexión con la naturaleza

INTRODUCTION: The World Health Organization (WHO) establishes the active participation and inclusion of ethnic groups in health care decisions, so that there may be a medical and intercultural pluralism. The delivery is resumed as a need of the U'WA community of the municipality of Cubará, from an attempt to strengthen ancestral identities traditionally excluded or unknown, establishing forms of dialogue that allowed the concept of western health to be separated as the only valid model for care of health and as a contribution to decoloniality in prevailing practices. OBJECTIVE:To recognize the social representations around childbirth, from the story and orality of a savant and father of the U'wa community. METHOD: Qualitative research of a descriptive type with a phenomenological approach and biographical narrative method, based on an in-depth interview with a knowledgeable father and U'wa father. RESULTS: From the qualitative analysis conducted, four categories emerged: Traditional authorities within the U'WA community, Conception of women, men and the new being, vision of the arrival of a new life from the knowledge of a new conception for the Western world and complications and traditional care. CONCLUSIONS: For the U'wa ancestral community birth and birth are transcendental events, whose importance is deeply linked to the conception of the world, to the daily occurrence and to be and to be in connection with nature

INTRODUCCIÓN: A Organização Mundial da Saúde (OMS) estabelece uma participação ativa e uma relação de grupos étnicos nas decisões de atenção para a saúde, para que seja um médico pluralista e intercultural. A compra é retomada como uma comunidade da comunidade do Cubará, com base em uma tentativa de fortalecer identidades ancestrais como sendo excluídas ou desconhecidas, enquanto formas de diálogo permitem que o conceito de saúde ocorra como um todo. for health and health member for descolonialidade nas practice vigentes. OBJETIVO: Reconhecer como representações sociais no mundo do parto, a partir da história e da oralidade do pai e da comunidade da U'wa. MÉTODO: Pesquisa qualitativa, do tipo descritiva, com abordagem fenomenológica e descritiva do narrativo biográfico, com o propósito de explicar em profundidade com o pai e o pai u'wa. RESULTADOS: A partir da análise qualitativa realizada, quatro categorias emergiram: Autoridades da comunidade U'WA, Concepção de mulheres, o homem e o novo ser, a visão da nova vida e oconhecimento de uma nova concepção paraomundo e complicações e ensinoroll. CONCLUSÕES: Para o nascimento e nascimentoda comunidade, os eventos transcendentais,estão sendo fundamentados na Educação, nomundo da vida cotidiana e na sua conexãocom a natureza

Partejar de primíparas: reflexos na amamentação / Childbirth care for primiparas: reflexes in breastfeeding / Cuidado al parto de primiparas: reflejos en la lactancia materna

Objetivo: analisar, a partir da experiência de primíparas, a relação entre a assistência recebida durante o parto normal e o pósparto imediato e seus reflexos na amamentação. Método: qualitativo, descritivo, aprovado pelo Comitê de Ética, realizado em um Centro de Parto Normal, do polo Petrolina-Juazeiro, em 2018. Participaram 17 primíparas, através de entrevista semiestruturada, sendo os dados submetidos a análise temática de conteúdo. Resultados: a amamentação ocorreu positivamente, pois esse lócus é apropriado para essa prática, favorecendo-a de maneira natural. O apoio e a compreensão são primordiais e devem superar uma assistência focada apenas em informações rápidas, técnicas e generalizadas. Conclusão: os anseios e particularidades de cada puérpera precisam ser respeitados e atendidos, valorizando o investimento em políticas de saúde que enfatizem o cuidado humanizado para cada mulher. Logo, a educação em saúde precisa estabelecer reflexão, discussão e aprendizado nesse processo que transcende o biológico.

Objective: to analyze the relationship between the care received during normal delivery and the immediate postpartum and its effects on breastfeeding, from the experience of primiparous women. Method: qualitative and descriptive study, approved by the Ethics Committee, held in a Normal Birth Center in Petrolina-Juazeiro Center, Brazil, in 2018. Seventeen primiparous women participated through semi-structured interviews, treated by thematic content analysis. Results: breastfeeding occurred positively, as this locus is appropriate for this practice, favoring it naturally. Supporting and understanding are primordial and should go beyond assistance focused only on quick, technical and generalized information. Conclusion: the wishes and particularities of each postpartum woman need to be respected and met, valuing the increment in health policies that emphasize humanized care for each woman. Therefore, health education needs to establish reflection, discussion and learning in this process that transcends the biological.

Objetivo: analizar la relación entre la atención recibida durante el parto normal y el posparto inmediato y sus efectos sobre la lactancia materna, a partir de la experiencia de las mujeres primíparas. Método: estudio cualitativo y descriptivo, aprobado por el Comité de Ética, realizado en un Centro de Parto Normal en el Centro Petrolina-Juazeiro, Brasil, en 2018. Diecisiete mujeres primíparas participaron a través de entrevistas semiestructuradas, tratadas por análisis de contenido temático. Resultados: la lactancia materna ocurrió positivamente, ya que este lugar es apropiado para esta práctica, favoreciéndolo naturalmente. El apoyo y la comprensión son primordiales y deben ir más allá de la asistencia centrada solo en información rápida, técnica y generalizada. Conclusión: los deseos y particularidades de cada mujer posparto deben ser respetados y cumplidos, valorando el incremento en las políticas de salud que enfatizan la atención humanizada para cada mujer. Por lo tanto, la educación sanitaria necesita establecer reflexión, discusión y aprendizaje en este proceso que trasciende lo biológico.

"Trying to give birth naturally was out of the question": Accounting for intervention in childbirth.

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.

Miedo al parto: revisión bibliográfica de los instrumentos de medida / Fear of childbirth: literature review of measuring instruments

Objetivo: Analizar los instrumentos de evaluación del miedo al parto y sus características de validez. Metodología: Revisión bibliográfica en CINAHL, PubMed, Scopus y Cuiden de los estudios publicados entre 1982 y 2018, mediante combinaciones booleanas de palabras clave, que exploraran el miedo al parto mediante instrumentos validados o instrumentos con propiedades psicométricas de validez. Resultados: Se seleccionó un total de 12 artículos originales que presentan instrumentos de medición del miedo. Dos escalas evaluaban el miedo al parto antes del embarazo, mientras que las 10 restantes evaluaban el miedo durante el embarazo y/o el parto y tras el mismo. Todas las escalas muestran una buena fiabilidad con valores alfa de Cronbach >0,70. Conclusiones: La presente revisión ha permitido identificar 12 instrumentos que se han desarrollado con el fin de medir el miedo al parto. Presentan buenas propiedades psicométricas y han demostrado ser válidos en diferentes muestras culturales

Objective: Analyze the evaluation instruments of fear of childbirth and its validity characteristics. Methods: Bibliographic review in CINAHL, PubMed, Scopus and Cuiden of the studies published between 1982 and 2018, using Boolean combinations of keywords, which explore fear of childbirth through validated instruments or instruments with valid psychometric properties. Results: A total of 12 original articles were selected that present fear measuring instruments. Two scales assess the fear of childbirth before pregnancy while the other ten evaluate fear during pregnancy and/or delivery and after it. All scales show good reliability with Cronbach alpha values >0.70. Conclusions: The results of this review contribute to identify the instruments that have been developed in order to measure the fear of childbirth

Beyond the Nature/Medicine Divide in Maternity Care.

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.

Qualitative exploration of fear of childbirth and preferences for mode of birth among Japanese primiparas.

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.

Maternal Confidence for Physiologic Childbirth: A Concept Analysis.

INTRODUCTION: Confidence is a term often used in research literature and consumer media in relation to birth, but maternal confidence has not been clearly defined, especially as it relates to physiologic labor and birth. The aim of this concept analysis was to define maternal confidence in the context of physiologic labor and childbirth. METHODS: Rodgers' evolutionary method was used to identify attributes, antecedents, and consequences of maternal confidence for physiologic birth. Databases searched included Ovid MEDLINE, CINAHL, PsycINFO, and Sociological Abstracts from the years 1995 to 2015. A total of 505 articles were retrieved, using the search terms pregnancy, obstetric care, prenatal care, and self-efficacy and the keyword confidence. Articles were identified for in-depth review and inclusion based on whether the term confidence was used or assessed in relationship to labor and/or birth. In addition, a hand search of the reference lists of the selected articles was performed. Twenty-four articles were reviewed in this concept analysis. RESULTS: We define maternal confidence for physiologic birth as a woman's belief that physiologic birth can be achieved, based on her view of birth as a normal process and her belief in her body's innate ability to birth, which is supported by social support, knowledge, and information founded on a trusted relationship with a maternity care provider in an environment where the woman feels safe. DISCUSSION: This concept analysis advances the concept of maternal confidence for physiologic birth and provides new insight into how women's confidence for physiologic birth might be enhanced during the prenatal period. Further investigation of confidence for physiologic birth across different cultures is needed to identify cultural differences in constructions of the concept.

A Qualitative Study on Midwives' Perceptions of Physiologic Birth in Singapore.

Midwives are advocates for parturients, and their actions and attitudes can influence a woman's experience during childbirth. Hence, it is valuable to examine midwives' perceptions of physiologic birth in an obstetric-led environment. A descriptive, qualitative study design was utilized. Semistructured face-to-face interviews were conducted with 10 registered midwives from the birthing suite of a public hospital in Singapore. Data were analyzed using thematic analysis. Three major themes were (1) perceptions of physiologic birth, (2) perceived facilitators of physiologic birth, and (3) perceived barriers to physiologic birth. Interestingly, senior midwives in this study experienced more negative outcomes with physiologic birth, resulting in apprehension and reduced confidence levels. This study contributed to the understanding of midwives' perceptions regarding facilitators and barriers to physiologic birth. Factors such as supporting birthing team and antepartum education could be useful in supporting physiologic birth. However, advanced age of some of the midwives was found in this study to be a barrier to physiologic birth.

The perceptions and experiences of women who achieved and did not achieve a waterbirth.

BACKGROUND: There is a gap in knowledge and understanding relating to the experiences of women exposed to the opportunity of waterbirth. Our aim was to explore the perceptions and experiences of women who achieved or did not achieve their planned waterbirth. METHODS: An exploratory design using critical incident techniques was conducted between December 2015 and July 2016, in the birth centre of the tertiary public maternity hospital in Western Australia. Women were telephoned 6 weeks post birth. Demographic data included: age; education; parity; and previous birth mode. Women were also asked the following: what made you choose to plan a waterbirth?; what do you think contributed to you having (or not having) a waterbirth?; and which three words would you use to describe your birth experience? Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis was undertaken to extract common themes from the interviews. RESULTS: A total of 31% (93 of 296) of women achieved a waterbirth and 69% (203 of 296) did not. Multiparous women were more likely to achieve a waterbirth (57% vs 32%; p < 0.001). Women who achieved a waterbirth were less likely to have planned a waterbirth for pain relief (38% vs 52%; p = 0.24). The primary reasons women gave for planning a waterbirth were: pain relief; they liked the idea; it was associated with a natural birth; it provided a relaxing environment; and it was recommended. Two fifths (40%) of women who achieved a waterbirth suggested support was the primary reason they achieved their waterbirth, with the midwife named as the primary support person by 34 of 37 women. Most (66%) women who did not achieve a waterbirth perceived this was because they experienced an obstetric complication. The words women used to describe their birth were coded as: affirming; distressing; enduring; natural; quick; empowering; and long. CONCLUSIONS: Immersion in water for birth facilitates a shift of focus from high risk obstetric-led care to low risk midwifery-led care. It also facilitates evidence based, respectful midwifery care which in turn optimises the potential for women to view their birthing experience through a positive lens.