Parto domiciliar planejado assistido por enfermeira obstétrica: significados, experiências e motivação para essa escolha / Parto domiciliario planificado asistido por enfermera obstétrica: significados, experiencias y motivación para esta elección / Planned home birth assisted by a midwife nurse: meanings, experiences and motivation for this choice

RESUMO Objetivo: compreender os significados e experiências de mulheres que vivenciaram o parto domiciliar planejado assistido por enfermeira obstétrica e a motivação (das mulheres) para essa escolha. Metodologia: estudo qualitativo, exploratório e descritivo, com 16 mulheres, realizado por meio de entrevista semiestruturada e analisado pelos pressupostos da análise temática de conteúdo. Resultados: as mulheres vivenciaram o parto com tranquilidade, autonomia e respeito, escolheram as posições e as pessoas de sua preferência. O parto teve significado de vitória e de libertação, cuja experiência foi descrita como inesquecível, fantástica, intensa e protagonizada pela mulher. O descontentamento com o modelo de assistência vigente, a participação em grupo de gestantes, o acesso a informações e a vivência de violência obstétrica anterior motivaram as mulheres a optarem pelo parto domiciliar. Considerações finais: as experiências das mulheres convergem para o exercício da autonomia e respeito à individualidade. Evidencia-se o protagonismo das mulheres que vivenciaram um parto natural e livre de intervenções. A assistência obstétrica foi centrada nas necessidades da parturiente, proporcionou confiança, segurança, tranquilidade e respeito às suas escolhas. Aponta-se a necessidade de ampliar a assistência ao parto por enfermeiras obstétricas às mulheres que desejam o parto domiciliar planejado. Políticas públicas de assistência ao parto podem viabilizar isso.

RESUMEN Objetivo: comprender los significados y las experiencias de las mujeres que vivieron el parto domiciliario planificado asistido por enfermera obstétrica y la motivación (de las mujeres) para esta elección. Metodología: estudio cualitativo, exploratorio y descriptivo, con 16 mujeres, realizado a través de entrevista semiestructurada y analizado por los supuestos del análisis de contenido temático. Resultados: las mujeres experimentaron el parto con tranquilidad, autonomía y respeto, eligieron las posiciones y las personas de su preferencia. El parto tuvo un significado de victoria y liberación, cuya experiencia se describió como inolvidable, fantástica, intensa y protagonizada por la mujer. La insatisfacción con el modelo de atención actual, la participación en grupo de mujeres embarazadas, el acceso a informaciones y la experiencia de violencia obstétrica anterior motivaron a las mujeres a optar por el parto domiciliario. Consideraciones finales: las experiencias de las mujeres convergen para el ejercicio de la autonomía y respeto a la individualidad. Se evidencia el protagonismo de las mujeres que experimentaron un parto natural y libre de intervenciones. La atención obstétrica se centró en las necesidades de la parturienta, proporcionó confianza, seguridad, tranquilidad y respeto con sus elecciones. Se señala la necesidad de ampliar la atención al parto por enfermeras obstétricas a las mujeres que desean el parto domiciliario planificado. Las políticas públicas de atención al parto pueden hacer esto posible.

ABSTRACT Objective: to understand the meanings and experiences of women who dealt with planned home birth assisted by a nurse midwife and the motivation (of these women) for this choice. Methodology: qualitative, exploratory and descriptive study, with 16 women, performed by means of semi-structured interviews and analyzed by the assumptions of thematic content analysis. Results: the women experienced childbirth with tranquility, autonomy and respect, and they chose the positions and people of their preference. Childbirth had a meaning of victory and liberation, whose experience was described as unforgettable, fantastic, intense and carried out by the woman. The dissatisfaction with the current model of care, the participation in a group for pregnant women, the access to information and the experience of previous obstetric violence motivated women to choose home birth. Final considerations: the women's experiences converge towards the exercise of autonomy and respect for individuality. The leading role of women who experienced a natural birth and free of interventions, should be highlighted. Obstetric care was focused on the parturient woman's needs, provided confidence, security, tranquility and respect for her choices. There is a need to expand childbirth care provided by nurse midwives to women who wish to have a planned home birth. Public policies for childbirth care can make this possible.

The implementation of midwifery competency standards in applying behaviour of normal childbirth care (APN) on BIDAN PRAKTIK MANDIRI PERA

Maternity illness and death rate is high in many developing countries, including Indonesia due to bleeding in the post childbirth (28%), miscarriage complication (12%), and sepsis (9%). The main reason for maternity illness in implementation of APN which is in accordance with midwife competence standard is carried out. The objective of the research was to find out the implementation of midwife competence standard in APN implementation behavior. The research used qualitative narrative method. It was conducted at RSU Ridos, Medan. The informants were 4 midwives, 1 owner, and 2 childbirth women. The data were analyzed qualitatively by interpreting the data in the form of sentences. The result of the research showed that the implementation of midwife competence standard in carrying out normal childbirth care in RSU was good. Midwives' knowledge was good since all of them were D-III midwifery graduates. Senior midwives' skill was better than that of young ones although the latter were controlled by their seniors and bay the hospital owner. The skilled midwives had participated in APN training, while the unskilled ones had not. Midwives behavior, especially the seniors' was good in implementing APN in RSU Ridos, but young midwives still needed experience in implementing APN so that their behavior was in accordance with midwife competence standard and to oath of office. It is recommended that the hospital management increase midwives' knowledge and skill in Normal Childbirth Care, and make midwives who not yet followed training participate in it

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Trusting My Instincts to Protect Mothers.

A nurse-midwife describes how she had to trust her instincts when she suspected a woman was in danger.

Development and content validation of the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey.

AIM: To develop a validated tool to measure nursing and midwifery documentation burden. BACKGROUND: While an important record of care, documentation can be burdensome for nurses and midwives and may remove them from direct patient care, resulting in decreased job satisfaction, associated with decreased patient satisfaction. The amount of documentation is increasing at a time where staff rationalisation results in decreasing numbers of clinicians at the bedside. No instrument is available to measure staff perceptions of the burden of clinical documentation. DESIGN: Survey development, followed by rwo rounds of content validation (April and May 2019). METHODS: Based on the literature a 28 item survey, with items in 6 subscales, representing key areas of documentation burden was developed. Item (I-CVI), subscale (S-CVI/Ave by subscale) and overall content validity indexes (S-CVI/Ave) were calculated following two review rounds by an expert panel of clinical and academic nurses and midwives. RESULTS: Level of agreement for the first iteration of the survey was low, with many items failing to reach the critical I-CVI threshold of 0.78. No subscale reached a S-CVI/Ave above 0.8 and the overall scale only achieved a S-CVI/Ave score of 0.67. Thirteen items were removed, seven were edited and five new items added, based on the expert panel feedback, substantially improving the content validity. All individual items achieved an I-CVI ≥0.78, the S-CVI/Ave was above 0.85 for all subscales and the total S-CVI/Ave was 0.94. CONCLUSION: The Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey can be considered as content valid, according to the content validity analysis by an expert panel. IMPACT: The BurDoNsaM survey may be used by nurse leaders and researchers to measure the burden of documentation, providing the opportunity to review practice and implement strategies to decrease documentation burden, potentially improving patient satisfaction with the care received.

How are decisions made to access a planned epidural in labour? Midwife-woman interactions in antenatal consultations.

OBJECTIVE: The purpose of this study was to examine the ways in the decision to access a planned epidural in labour was topicalised and negotiated between pregnant women and midwives. DESIGN: This article uses conversation analysis to examine how decision-making unfolds in antenatal consultations in a large metropolitan hospital in South Australia. Data were sampled from naturally-occurring interactions between women and midwives in routine antenatal consultations. Analysis focused on talk about planning to access (or, avoid) an epidural during an upcoming labour. FINDINGS: This paper illustrates that in the context of woman-centred care, women are held unilaterally responsible for the decision to accept or reject a planned epidural in labour with little or no input from the midwife. Midwives take a step back from involvement in the discussion beyond the solicitation of a decision from the woman. Women wanting a planned epidural took a strong, assertive stance in the interaction and drew on their previous birthing experience, limiting opportunity for the midwife to engage in meaningful discussion about the risks and benefits. On the other hand, women rejecting a planned epidural were less assertive and engaged in more complex interactional work to account for their decision. KEY CONCLUSIONS: The lack of involvement by midwives may be linked to the non-directive ethos that prevails in maternity care. It is argued that, in this dataset, the institutional imperative for women to know and decide on pain relief while pregnant in order to allocate to a model of care is prioritised over women's aspirations and expectations of childbirth. IMPLICATIONS FOR PRACTICE: By analysing the ways in which midwives and women interact at the point in time at which decisions were made to plan access to an epidural we can continue to reveal underlying forces that drive the rising rates of medical interventions in childbirth. This paper also contributes to research evidence on how midwives manage the potentially contradictory dialect between supporting women's childbirth preferences while also managing institutional requirements and evidence-based practice.

Incidentes de seguridad en el Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona / Security incidents in the Maternofetal Medicine Service of Hospital Clínic of Barcelona

OBJETIVO: Analizar la información que proporcionan los incidentes de seguridad reportados mediante el sistema de notificación de incidentes en el Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona en el primer año tras su implantación. METODOLOGÍA: Se ha realizado un estudio transversal observacional descriptivo incluyendo todos los incidentes de seguridad reportados al Servicio de Medicina Maternofetal del Hospital Clínic de Barcelona en 2016. Las variables estudiadas fueron las siguientes: tipo de incidente, riesgo, turno y notificador. Para su análisis se utilizó el programa Microsoft Excel de Windows. RESULTADOS: Los incidentes de seguridad más frecuentes corresponden a los relacionados con la gestión clínica y los procedimientos, seguidos de los de medicación. La mayoría de los incidentes que se reportan son de riesgo bajo y se observaron en el turno de día; sin embargo, los de riesgo alto se produjeron durante el turno de noche. Destaca también que el colectivo que más notifica es el de enfermeras y matronas. CONCLUSIONES: El personal de enfermería, y concretamente las matronas, son una pieza fundamental en la seguridad obstétrica. Es básico seguir las estrategias y prácticas seguras recomendadas y continuar trabajando para crear una cultura de seguridad

OBJECTIVE: Analyze the information provided by the security incidents reported through the incident reporting system in the Materno-Fetal Medicine Service of the Hospital Clínic of Barcelona in the first year after its implementation. METHODOLOGY: A descriptive observational cross-sectional study was conducted, including all safety incidents reported to the Maternal-Fetal Medicine Service of the Hospital Clínic de Barcelona in 2016. The variables studied were: type of incident, risk, shift and notifier. For its analysis, the Microsoft Excel Windows program was used. RESULTS: The most frequent safety incidents correspond to those related to clinical management and procedures, followed by those of medication. The majority of incidents that are reported are of low risk and were observed in the day shift, however, those of high risk occurred during the night shift. It also highlights that the group that most notifies is that of nurses and midwives. CONCLUSIONS: Nursing and specifically midwives are a fundamental part of obstetric safety. It is essential to follow the recommended safe strategies and practices and continue working to create a safety culture

Knowledge levels of midwives regarding the interpretation of cardiotocographs at labour units in KwaZulu-Natal public hospitals.

BACKGROUND: The primary purpose of cardiotocography is to detect early signs of intrapartum hypoxia and improve foetal outcomes. Intrapartum hypoxia remains the major cause of perinatal deaths during monitored labours. This is attributed to the midwives' lack of knowledge and skills in the foetal implementation and interpretation of cardiotocographs. OBJECTIVES: This study aimed to establish midwives' knowledge and interpretive skills of cardiotocography. METHOD: The study employed a quantitative research approach with an explorative, descriptive, cross-sectional design. A total of 226 purposively selected participants were asked to complete a self-administered, structured questionnaire, of which 125 responded by completing the questionnaire. The study was conducted in labour wards in KwaZulu-Natal public hospitals in 2014. Data analysis was performed by means of descriptive and inferential statistics using analysis of variance. RESULTS: The findings revealed that the midwives in KwaZulu-Natal public hospitals were found to be clinically lacking in knowledge of cardiotocography. CONCLUSION: The limited cardiotocographic knowledge of the midwives in KwaZulu-Natal public hospitals was possibly because of a lack of in-service training, as more than half of the participants (70%) indicated a need for this.

Implementing the skilled birth attendance strategy in Uganda: a policy analysis.

BACKGROUND: Uganda, a low resource country, implemented the skilled attendance at birth strategy, to meet a key target of the 5th Millenium Development Goal (MDG), 75% reduction in maternal mortality ratio. Maternal mortality rates remained high, despite the improvement in facility delivery rates. In this paper, we analyse the strategies implemented and bottlenecks experienced as Uganda's skilled birth attendance policy was rolled out. These experiences provide important lessons for decision makers as they implement policies to further improve maternity care. METHODS: This is a case study of the implementation process, involving a document review and in-depth interviews among key informants selected from the Ministry of Health, Professional Organisations, Ugandan Parliament, the Health Service Commission, the private not-for-profit sector, non-government organisations, and District Health Officers. The Walt and Gilson health policy triangle guided data collection and analysis. RESULTS: The skilled birth attendance policy was an important priority on Uganda's maternal health agenda and received strong political commitment, and support from development partners and national stakeholders. Considerable effort was devoted to implementation of this policy through strategies to increase the availability of skilled health workers for instance through expanded midwifery training, and creation of the comprehensive nurse midwife cadre. In addition, access to emergency obstetric care improved to some extent as the physical infrastructure expanded, and distribution of medicines and supplies improved. However, health worker recruitment was slow in part due to the restrictive staff norms that were remnants of previous policies. Despite considerable resources allocated to creating the comprehensive nurse midwife cadre, this resulted in nurses that lacked midwifery skills, while the training of specialised midwives reduced. The rate of expansion of the physical infrastructure outpaced the available human resources, equipment, blood infrastructure, and several health facilities were not fully functional. CONCLUSION: Uganda's skilled birth attendance policy aimed to increase access to obstetric care, but recruitment of human resources, and infrastructural capacity to provide good quality care remain a challenge. This study highlights the complex issues and unexpected consequences of policy implementation. Further evaluation of this policy is needed as decision-makers develop strategies to improve access to skilled care at birth.

Implementation of HPV-based Cervical Cancer Screening Combined with Self-sampling Using a Midwifery Network Across Rural Greece: The GRECOSELF Study.

Self-sampling for human papillomavirus (HPV) testing is an alternative to physician sampling particularly for cervical cancer screening nonattenders. The GRECOSELF study is a nationwide observational cross-sectional study aiming to suggest a way to implement HPV-DNA testing in conjunction with self-sampling for cervical cancer screening in Greece, utilizing a midwifery network. Women residing in remote areas of Greece were approached by midwives, of a nationwide network, and were provided with a self-collection kit (dry swab) for cervicovaginal sampling and asked to answer a questionnaire about their cervical cancer screening history. Each sample was tested for high-risk (hr) HPV with the Cobas HPV test. HrHPV-Positive women were referred to undergo colposcopy and, if needed, treatment according to colposcopy/biopsy results. Between May 2016 and November 2018, 13,111 women were recruited. Of these, 12,787 women gave valid answers in the study questionnaire and had valid HPV-DNA results; hrHPV prevalence was 8.3%; high-grade cervical/vaginal disease or cancer prevalence was 0.6%. HrHPV positivity rate decreased with age from 20.7% for women aged 25-29 years to 5.1% for women aged 50-60 years. Positive predictive value for hrHPV testing and for HPV16/18 genotyping ranged from 5.0% to 11.6% and from 11.8% to 27.0%, respectively, in different age groups. Compliance to colposcopy referral rate ranged from 68.6% (for women 25-29) to 76.3% (for women 40-49). For women residing in remote areas of Greece, the detection of hrHPV DNA with the Cobas HPV test, on self-collected cervicovaginal samples using dry cotton swabs, which are provided by visiting midwives, is a promising method for cervical cancer secondary prevention.

Where there is no nurse: an observational study of large-scale mentoring of auxiliary nurses to improve quality of care during childbirth at primary health centres in India.

OBJECTIVE: Clinician scarcity in Low and Middle-Income Countries (LMIC) often results in de facto task shifting; this raises concerns about the quality of care. This study examines if a long-term mentoring programme improved the ability of auxiliary nurse-midwives (ANMs), who function as paramedical community health workers, to provide quality care during childbirth, and how they compared with staff nurses. DESIGN: Quasi-experimental post-test with matched comparison group. SETTING: Primary health centres (PHC) in the state of Bihar, India; a total of 239 PHCs surveyed and matched analysis based on 190 (134 intervention and 56 comparison) facilities. PARTICIPANTS: Analysis based on 335 ANMs (237 mentored and 98 comparison) and 42 staff nurses (28 mentored and 14 comparison). INTERVENTION: Mentoring for a duration of 6-9 months focused on nurses at PHCs to improve the quality of basic emergency obstetric and newborn care. PRIMARY OUTCOME MEASURES: Nurse ability to provide correct actions in managing cases of normal delivery, postpartum haemorrhage and neonatal resuscitation assessed using a combination of clinical vignettes and Objective Structured Clinical Examinations. RESULTS: Mentoring increased correct actions taken by ANMs to manage normal deliveries by 17.5 (95% CI 14.8 to 20.2), postpartum haemorrhage by 25.9 (95% CI 22.4 to 29.4) and neonatal resuscitation 28.4 (95% CI 23.2 to 33.7) percentage points. There was no significant difference between the average ability of mentored ANMs and staff nurses. However, they provided only half the required correct actions. There was substantial variation in ability; 41% of nurses for normal delivery, 60% for postpartum haemorrhage and 45% for neonatal resuscitation provided less than half the correct actions. Ability declined with time after mentoring was completed. DISCUSSION: Mentoring improved the ability of ANMs to levels comparable with trained nurses. However, only some mentored nurses have the ability to conduct quality deliveries. Continuing education programmes are critical to sustain quality gains.

Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 being implemented in countries? Findings from a cross-sectional analysis.

BACKGROUND: Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs). METHODS: This is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively. RESULTS: Thirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of "completed"; 55% were reportedly "in progress" and 26% indicated a status of "not started". Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented. CONCLUSION: Monitoring and accountability of countries' commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers' deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs.

Best practices in the delivery process: conceptions from nurse midwives.

OBJECTIVE: to know the conceptions of nurse midwives about the care guided in the best practices to the women in the delivery process. METHOD: descriptive research with a qualitative approach developed in a Federal Maternity-School. Semi-structured interviews were conducted with 20 nurse midwives, and the speeches were categorized according to the thematic content analysis proposed by Franco. RESULTS: the study reveals that care based on best practices should be based on scientific knowledge, avoiding unnecessary interventions and encourages the use of non-pharmacological techniques for pain relief, appropriate environment, individualized care, the bond between professional and parturient, as well as its role. FINAL CONSIDERATION: while criticizing the excess of interventions, nurse midwives value noninvasive techniques and interpersonal relationships, as well as the subjectivities of the parturient that contributes to the humanized care in the delivery process.

Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives.

OBJECTIVE: To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents. DESIGN: Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks". SETTING: Two towns in mid-Sweden and a suburb of the capital city of Sweden. PARTICIPANTS: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling. FINDINGS: Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth. KEY CONCLUSIONS: ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.

Best practices in the delivery process: conceptions from nurse midwives / Buenas prácticas en el proceso de parto: concepciones de enfermeras obstetrices / Boas práticas no processo de parto: concepções de enfermeiras obstétricas

ABSTRACT Objective: to know the conceptions of nurse midwives about the care guided in the best practices to the women in the delivery process. Method: descriptive research with a qualitative approach developed in a Federal Maternity-School. Semi-structured interviews were conducted with 20 nurse midwives, and the speeches were categorized according to the thematic content analysis proposed by Franco. Results: the study reveals that care based on best practices should be based on scientific knowledge, avoiding unnecessary interventions and encourages the use of non-pharmacological techniques for pain relief, appropriate environment, individualized care, the bond between professional and parturient, as well as its role. Final Consideration: while criticizing the excess of interventions, nurse midwives value noninvasive techniques and interpersonal relationships, as well as the subjectivities of the parturient that contributes to the humanized care in the delivery process.

RESUMEN Objetivo: conocer las concepciones de enfermeras obstetrices sobre el cuidado pautado en las buenas prácticas a las mujeres en el proceso de parto. Método: investigación descriptiva con abordaje cualitativo desarrollada en una Maternidad-Escuela Federal. Se realizaron entrevistas semiestructuradas con 20 enfermeras obstetrices, siendo las palabras categorizadas conforme análisis de contenido temático, propuesta por Franco. Resultados: el estudio revela que el cuidado pautado en las buenas prácticas debe basarse en conocimiento científico, evitar intervenciones innecesarias e incentivar el uso de técnicas no farmacológicas para alivio del dolor, el ambiente apropiado, la atención individualizada, el vínculo y sintonía entre profesional y parturienta , así como su protagonismo. Consideraciones Finales: al tiempo que critican el exceso de intervenciones, las enfermeras obstetrices valoran las técnicas no invasivas y las relaciones interpersonal, así como las subjetividades de la parturienta, lo que contribuye al cuidado humanizado en el proceso de parto.

RESUMO Objetivo: conhecer as concepções de enfermeiras obstétricas sobre o cuidado pautado nas boas práticas às mulheres no processo de parto. Método: pesquisa descritiva com abordagem qualitativa desenvolvida em uma Maternidade-Escola Federal. Realizaram-se entrevistas semiestruturadas com 20 enfermeiras obstétricas, sendo as falas categorizadas conforme análise de conteúdo temática, proposta por Franco. Resultados: o estudo revela que o cuidado pautado nas boas práticas deve embasar-se em conhecimento científico, evitar intervenções desnecessárias e incentivar o uso de técnicas não farmacológicas para alívio da dor, a ambiência apropriada, a atenção individualizada, o vínculo e sintonia entre profissional e parturiente, bem como o seu protagonismo. Considerações Finais: ao tempo que criticam o excesso de intervenções, as enfermeiras obstétricas valorizam as técnicas não invasivas e as relações interpessoais, bem como as subjetividades da parturiente, o que contribui para o cuidado humanizado no processo de parto.

Exploring moral problems and moral competences in midwifery: A qualitative study.

BACKGROUND: Most undergraduate midwifery curricula comprise ethics courses to strengthen the moral competences of future midwives. By contrast, surprisingly little is known about the specific moral competences considered to be relevant for midwifery practice. Describing these competences not only depends on generic assumptions about the moral nature of midwifery practice but also reflects which issues practitioners themselves classify as moral. OBJECTIVE: The goal of this study was to gain insight into the ethical issues midwives encounter in their daily work, the key competences and resources they consider indispensable to understand and deal with them, and to assess phenomena linked to moral distress. METHODS: We conducted individual semi-structured interviews with eight midwives and two other health professionals, varying in terms of years of experience and work setting. Interview transcripts were analyzed in an interdisciplinary research group, following thematic analysis. ETHICAL CONSIDERATIONS: This study was not subject to approval according to the Swiss Law on Research with Humans. Participants were informed about the study goals and gave written informed consent prior to participation. RESULTS: External constraints limiting the midwife's and the patient's autonomy and resulting interpersonal conflicts were found to be the most relevant ethical issues encountered in clinical practice and were most often associated with moral distress. These conflicts often arise in the context of medical interventions midwives consider as not appropriate and situations in which less experienced midwives in particular observe a lack of both interprofessional communication and trust in their professional competence. Ethical issues related to late abortions or prenatal diagnostics and selective abortions were also frequently addressed, but many midwives involved had learned to cope with them. DISCUSSION: In the light of the ethical issues and factors contributing to phenomena of moral distress, an empirically grounded profile of moral competences is drafted. Curricular implications in the light of possible adaptations within undergraduate midwifery education are critically discussed.