A trajetória da Casa do Parto Nove Luas, Lua Nova: concepções e práticas na atenção à gestação, parto e nascimento / The trajectory of Casa do Parto Nove Luas, Lua Nova: conceptions and practices in pregnancy, labor and birth care

Esta pesquisa teve como objetivo principal analisar em perspectiva histórica a trajetória da Casa do Parto Nove Luas, Lua Nova e trazer, à luz dessa experiência, elementos para a reflexão acerca dos modelos de atenção à gestação, ao parto e ao nascimento. A Casa do Parto Nove Luas, Lua Nova foi uma instituição da rede privada que funcionou entre 1993 e 1999, no município de Niterói, no Estado do Rio de Janeiro. Embora desde o início desse século o funcionamento das casas de parto esteja previsto e regulamentado por lei, questões relativas à organização espacial, às práticas e às categorias profissionais que as executam são, atualmente, foco de discussão e controvérsias. Buscou-se, nessa dissertação, trazer visibilidade à experiência da Casa do Parto Nove Luas no intuito de contribuir com novas perspectivas sobre o campo de disputas profissionais e ideológicas que se instauram no campo da humanização da assistência à gestação, parto e nascimento. Para tal, foi realizada uma pesquisa qualitativa, de caráter histórico, a partir de procedimentos descritivos e interpretativos de fontes documentais e entrevistas com os gestores da instituição. O olhar analítico percorreu tanto o processo de desenvolvimento da experiência da casa de parto (seu contexto, seus enredos, seus personagens, suas práticas, as interações internas e externas, os limites e as oportunidades que se apresentaram), como os conteúdos temáticos, dos quais se extraiam as visões de mundo, os sistemas de ideias e valores que a guiaram. As práticas assistenciais ali promovidas e seu legado, visíveis em diversos cenários ­ como na criação da REHUNA (Rede pela Humanização do Nascimento) e na implantação da Maternidade Leila Diniz e da Casa de Parto de Juiz de Fora ­ mostram o pioneirismo da instituição e a importância de seu resgate histórico para a melhor compreensão dos processos envolvidos na conformação do atual panorama de assistência ao parto e nascimento no Brasil.

This research had as main goal to analyze in a historical perspective the trajectory of Casa do Parto Nove Luas, Lua Nova and bring, enlightened by this experience, elements of reflexion about the types of attendance to gestation, labor and birth. The Casa do Parto Nove Luas, Lua Nova was a private institute that operated from 1993 to 1999, in the city of Niterói, Rio de Janeiro state. Although, since from the beginning of this century the functioning of birth centers with homelike settings is described and regulated by the Constitution, matters of spatial organization, practices and professional categories that execute the work are, currently, under the spotlight of debate and controversy. It was pursued, in this dissertation, bringing visibility to the experience of Casa do Parto Nove Luas, Lua Nova with the idea of adding to new perspectives about the professional and ideological dispute field that are established on matters of humanization of the assistance provided to gestation, labor and birth. Therefore, a qualitative investigation was executed, with historical character, based on descriptive and interpretative procedures of documental sources. The analytical view went through from development processes of the experience of this birth center (its context, scenarios, practices, interaction inside and outside, the limits and opportunities that emerged) to thematic contents, from which were extracted the world view, the system of ideas and values that guided them. Its promoted assistance practices and its legacy, visible in many circumstances ­ like the creation of REHUNA (Network of Birth Humanization) and implantation of Maternidade Leila Diniz and Casa de Parto de Juiz de Fora ­ show the pioneering of the institution and the importance of its historical account for better understanding the processes related to the composition of the current panorama of birth assistance in Brazil.

[Reminiscence on the municipal out-of-hospital maternity unit and the motherhood home in Novi Sad].

INTRODUCTION: In the mid-twentieth century, the health care of women and children was inadequate in the post-war Yugoslavia, including the city of Novi Sad, due to the severe post-war reality: poverty in the devastated country, shortage of all commodities and services and especially of medical supplies, equipment and educated staff. OUT-OF-HOSPITAL MATERNITY UNIT: One of the serious problems was parturition at home and morbidity and mortality of the newborns and women. Soon after the World War II the action programme of improving the women's health was realized on the state level by establishing out-of-hospital maternity units but under the expert supervision. The Maternity unit at 30 Ljudevita Gaja Street in Novi Sad played a great role in providing skilled birth attendance at mainly normal deliveries. With a minimal number of medical staff and modest medical equipment, about 2000 healthy babies were born in this house. MOTHERHOOD HOME: After 5 years of functioning in that way, this unit was transformed into the Motherhood Home and became a social and medical institution for pregnant women and new mothers. Regardless of the redefined organization concept the curative and preventive health care as well as women and children social protection programmes were provided successfully for the next 12 years. Although the Motherhood Home was moved into the Women Health Centre of Novi Sad and later into the former Maternity Hospital in Sremski Karlovci, its great importance for women and children's health care remained unchanged. In 1979 the overall social situation and mostly economic issues led to its closing. EPILOGUE: The house in Gajeva Street is now used as the municipality office. However, this house with its story recommends itself to become a house for a special social function, such as a museum of medical history of Novi Sad. A small investment could make it possible to collect, preserve and display the valuable records of our past, which is something we do owe to the generations to come.

Addressing disparities in access to care: lessons from the Kercheval Street clinic in the 1960s.

Health disparities for racial and ethnic minorities have been present in the United States and persist today. NMHCs (Nurse-Managed Health Center), which can serve as "Medical Homes," are one mechanism by which nurses can attempt to overcome these disparities within communities. In the mid-1960s, Nancy Milio developed and found funding for a NMHC to address disparities in Detroit, Michigan. History shows that the center was so valued by community members that it remained untouched during the Detroit riot of 1967, despite all buildings surrounding it having been burned down or destroyed. This article uses traditional historic methods to describe the establishment of the center in inner-city Detroit in the 1960s in historical context and analyze factors that led to Milio's success. To address disparities via NMHCs, nurses must be persistent in acquiring funding and should involve a racially and culturally diverse group representative of community members in the development, planning, and ongoing operation of the enterprise.

[The organization of maternity and child care in the Buryat-Mongolskaya ASSR during the Great Patriotic War].

In Ulan-Ude, in 1942, the mortality of children at the age from 0 to 15 years consisted 64% of total numbers of died persons. The main causes of children mortality during all the war were tuberculosis, pneumonia, toxic dyspepsia and diarrhea. In October 1942, the government adopted a special decree obligated Narcomzdrav of the USSR to re-establish the system of maternity and child care existed before the war. The focus was made on the district principle of functioning of women and children consultations and polyclinics and to take measures to enhance the children diet and food vitaminization. In Buryat-Mongolskaya ASSR, during the war period, no epidemics of infectious diseases were allowed. In this difficult period of life the first multifield children hospital and municipal infection hospital with children beds were established and functioned with success.

Profilaxia del abandono: cien años de protección de la infancia en Chile / Profylaxis of abandonment: one hundred years of children protecction in Chile

Introduction: During the 19th century and the beginning of the 20th century, infant mortality in Chile was one of the highest in the world. It was common that in poor spheres, children grew in orphan hood, abandonment, and vagrancy. Shelter and welfare institutions, which were supported by the religious and aristocratic philanthropy, had poor life expectancy indicators. Infancy rights were just appearing in the world. After the large epidemics at the end of 1900, the medical corps was sensitized and fomented promotion and primary prevention activities, which went beyond the pure biomedical scope, breaking the existent paradigms. From the second half of the century, life conditions, sanitation, and educational levels improved a lot. When the National Health Service was created, the medical care was organized and public policies with broad coverage were generated, which took us to health standards that were equivalent to those of developed countries. Aim: Travel through the history of infancy in our country and comment the effort of some infancy welfare works of large impact in mother and child health, such as Casa Nacional del Niño, Patronato Nacional de la Infancia, and Seguro Obrero Obligatorio. From here on, we consider the present and future challenges that are present in pediatrics. Conclusions: Chile has been through a fast epidemiologic and demographic transition, which has brought new challenges in the child health sphere, related with life styles, development and mental health. Accordingly, we, pediatricians, should broaden the welfare point of view, incorporating the development approach and the psychosocial and emotional dimensions in the children's care. Following our social pediatrics heritage, we should continue fighting for the equity of opportunities and for the actual fulfillment of the children's rights.

Introducción: Durante los Siglos XIX y principios del XX, la mortalidad infantil en Chile se encontraban entre las más elevadas del mundo y en los sectores populares era frecuente que los niños crecieran en medio de la orfandad, el abandono y la vagancia. Las instituciones de acogida y protección, que eran sustentadas por filantropía religiosa y aristocrática, tenían pobres indicadores de sobrevida; los derechos de la infancia recién emergían. Tras las grandes epidemias de fines del 1900 se sensibilizó el cuerpo médico, impulsando actividades de promoción y prevención primaria, que iban más allá del ámbito biomédico puro, lo que derribó los paradigmas existentes. En la segunda mitad del siglo se avanzó a pasos agigantados en las condiciones de vida, en el saneamiento ambiental y los niveles de educación. Con la creación del Servicio Nacional de Salud se organizó la atención médica y se generaron políticas públicas de amplia cobertura, las que nos llevaron a estándares comparables con países desarrollados. Objetivo: Recorrer la historia de la infancia en nuestro país y comentar la labor de algunas instituciones que tuvieron gran impacto en la salud materno infantil, como la Casa Nacional del Niño, el Patronato Nacional de la Infancia y el Seguro Obrero Obligatorio. A partir de ello, se reflexiona sobre los retos actuales y futuros de la pediatría. Conclusiones: Chile ha pasado por una rápida transición epidemiológica y demográfica que ha traído consigo nuevos desafíos en el ámbito de la salud infantil, relacionados fundamentalmente con los estilos de vida, desarrollo y salud mental. En consonancia, los pediatras deberíamos ampliar la mirada asistencialista incorporando el enfoque de desarrollo y las dimensiones psicosocial y emocional en el cuidado de los niños. Siguiendo nuestra herencia de pediatría social, deberíamos continuar abogando por la igualdad de oportunidades y por el efectivo cumplimiento de los derechos de la infancia.

[The life and works of Han Shin Gwang: a midwife and nurse of Korean modern times].

Han Shin Gwang, born in an early Christian family in Korea in 1902, could get western education different from the ordinary Korean girls in that period. She participated in the 1919 Samil Independence Movement in her teens, and got nursing and midwifery education in a missionary hospital. She got a midwife license and worked as a member in an early mother-and-child health center. She organized 'Korean Nurses' Association (see text)' in 1924 and focused on public health movement as the chairwoman. She actively participated in women's movement organizations, and Gwangjoo Student's Movement. She was known to be a representative of leading working women, and wrote articles on woman's right, the needs and works of nurses and midwives. From late Japanese colonial period, she opened her own clinic and devoted herself to midwifery. After the Korean Liberation in 1945, she began political movement and went in for a senate election. During the Korean War, she founded a shelter for mothers and children in help. After the War, she reopened a midwifery clinic and devoted to the works of Korean Midwives' Association. Han Shin Gwang's life and works belong to the first generation of Korean working women in modern times. She actively participated in women's movement, nurses' and midwives professional movement, Korea liberation movement, and mother-and-child health movement for 60 years. Her life is truly exemplary as one of the first generation of working women in modern Korea, distinguished of devotion and calling.

The Life and Works of Han Shin Gwang: a Midwife and Nurse of Korean Modern Times / 의사학

Han Shin Gwang, born in an early Christian family in Korea in 1902, could get western education different from the ordinary Korean girls in that period. She participated in the 1919 Samil Independence Movement in her teens, and got nursing and midwifery education in a missionary hospital. She got a midwife license and worked as a member in an early mother-and-child health center. She organized 'Korean Nurses' Association' in 1924 and focused on public health movement as the chairwoman. She actively participated in women's movement organizations, and Gwangjoo Student's Movement. She was known to be a representative of leading working women, and wrote articles on woman's right, the needs and works of nurses and midwives. From late Japanese colonial period, she opened her own clinic and devoted herself to midwifery. After the Korean Liberation in 1945, she began political movement and went in for a senate election. During the Korean War, she founded a shelter for mothers and children in help. After the War, she reopened a midwifery clinic and devoted to the works of Korean Midwives' Association. Han Shin Gwang's life and works belong to the first generation of Korean working women in modern times. She actively participated in women's movement, nurses' and midwives professional movement, Korea liberation movement, and mother-and-child health movement for 60 years. Her life is truly exemplary as one of the first generation of working women in modern Korea, distinguished of devotion and calling.

The Jerusalem experience: three decades of service, research, and training in community-oriented primary care.

Community-oriented primary care (COPC) developed and was tested over nearly 3 decades in the Hadassah Community Health Center in Jerusalem, Israel. Integration of public health responsibility with individual-based clinical management of patients formed the cornerstone of the COPC approach. A family medicine practice and a mother and child preventive service provided the frameworks for this development. The health needs of the community were assessed, priorities determined, and intervention programs developed and implemented on the basis of detailed analysis of the factors responsible for defined health states. Ongoing health surveillance facilitated evaluation, and the effectiveness of interventions in different population groups was illustrated. The center's international COPC involvement has had effects on primary health care policy worldwide.