The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes.

BACKGROUND: Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. METHODS: Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. RESULTS: A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. CONCLUSIONS: The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.

"Care left undone" and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies.

OBJECTIVE: To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care. BACKGROUND: Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided. METHOD: Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the 'Care Left Undone' Scale, and ad hoc questionnaire for demographic variables. RESULTS: The mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies. CONCLUSION: Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

«Cuidados perdidos» y calidad de los cuidados durante la pandemia por COVID-19: factores y estrategias influyentes / “Missed care” and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies

Objetivo:Analizar la calidad de los cuidados brindados durante la pandemia por COVID-19, identificando los cuidados que se han priorizado y los factores que han influido. Ante la situación de adaptación de los cuidados exigidos por la pandemia, las enfermeras han podido estar sometidas a factores que las hayan afectado de manera negativa, pero también se han podido encontrar estrategias que han permitido mantener la calidad de los cuidados.Método:Estudio descriptivo con muestra de conveniencia de 225 enfermeras que atendieron a pacientes con COVID-19. Para la recogida de datos se emplea un cuestionario ad hoc de variables personales y laborales, una autovaloración de los cuidados y la escala Care Left Undone.Resultados:La tasa media de cuidados perdidos ha sido de 5,76 (DS 3,1). Se identifican diferencias significativas en función de la edad, experiencia profesional y del cambio de estructura y de especialidad. Las estrategias que se asocian de manera significativa con mayor valoración de la calidad de los cuidados estuvieron relacionadas con la cohesión del equipo, evitar la despersonalización, búsqueda activa de información, estrategias de control de estrés y de pensamiento positivo. Se han identificados sentimientos, características y estrategias personales y profesionales, que influyen tanto en la percepción de la calidad como en la pérdida de cuidados durante la atención a la pandemia.

Objective:To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care.Background:Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided.Method:Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the ‘Care Left Undone’ Scale, and ad hoc questionnaire for demographic variables.ResultsThe mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies.Conclusion:Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

["Missed care" and quality of care during the COVID-19 pandemic: Influential factors and modulating strategies]. / «Cuidados perdidos¼ y calidad de los cuidados durante la pandemia por COVID-19: factores y estrategias influyentes.

Objective: To analyze the quality of care provided during the COVID-19 pandemic, identifying what care has been prioritized and factors that have influenced such care. Background: Given the need to adapt care due to the pandemic, nurses may have been subjected to factors that have negatively affected them, however it has also been possible to find actions that have enabled nurses to maintain the quality of care provided. Method: Exploratory study with a sample of 225 nurses. Data collection was performed using a self-assessment of the care provided, the 'Care Left Undone' Scale, and ad hoc questionnaire for demographic variables. Results: The mean rate of missed care was 5.76. Significant differences were identified according to age, professional experience, field of specialty and personal and professional strategies. Conclusion: Both personal and professional feelings, characteristics, and strategies have an effect in the perception of quality of care provided and missed care during the pandemic.

La inducción de la lactancia en madres que no han dado a luz: un desafío para las matronas ante nuevas demandas / The induction of lactation in mothers who have not given birth: a challenge for midwives in the face of new demands

Objetivo: Conocer las demandas que dirigen a las matronas las mujeres que han pasado por un proceso de inducción de la lactancia o relactación en España, así como profundizar en los sentimientos que pueden presentar estas mujeres. Métodos: Estudio cualitativo fenomenológico. Se realizó un muestreo de máxima variabilidad con el fin de entrevistar a 9 mujeres españolas: 3 de cada perfil (adopción, subrogación, pareja de dos mujeres) que habían pasado por un proceso de inducción de la lactancia materna o relactación entre los años 2000 y 2015. Como técnica se usó la entrevista en profundidad. Después de transcribir las entrevistas, los datos fueron interpretados mediante análisis de contenido con la ayuda del programa Atlas.ti versión 7.5.7.Resultados: Participaron 9 mujeres. De los principales hallazgos se desprenden demandas de información, seguimiento y apoyo durante el proceso. La mayoría de las mujeres no recibió seguimiento por parte de los profesionales sanitarios, quienes mostraron desconocimiento o poca confianza en el proceso y en su éxito. El apoyo recibido vino fundamentalmente por parte de sus parejas. Esta falta de apoyo profesional se tradujo en sentimientos de soledad y vulnerabilidad entre las participantes. Los foros sobre lactancia en internet, las experiencias en la red de otras madres que habían pasado por el mismo proceso y los grupos de lactancia fueron la fuente principal de información para poder realizar los procesos.Conclusiones: Para dar respuesta a la demanda de información, seguimiento y apoyo durante el proceso de inducción de la lactancia y relactación es necesario incluir dichos contenidos en la formación de matronas y otros profesionales sanitarios. Dando respuesta a estas demandas, se podrán evitar situaciones de soledad y vulnerabilidad entre las mujeres que deciden pasar por estos procesos, así como mejorar los índices de lactancia materna. (AU)

Objective: To know what are the demands that women who have undergone a process of induction of lactation or relactation direct to midwives, as well as to delve into the feels that these women may present. Methods: Qualitative phenomenological study. A maximum variability sampling was carried out in order to interview 9 Spanish women: 3 of each profile (adoption, surrogacy, female couple) who had undergone a process of induction of breastfeeding or relactation between the years 2000 and 2015. The in-depth interview was used as a technique. After transcribing the interviews, the data were analyzed by content analysis with the help of Atlas.ti version 7.5.7 program.Results: 9 women participated. The women interviewed expressed demands for information, follow-up and support during the process. Most of the women were not followed up by health professionals, since they showed ignorance or little confidence in the process and its success. The women state that the support, received which was mainly from their partners. This lack of professional support translated into feelings of loneliness and vulnerability among the participants. The forums on breastfeeding on the Internet, experiences in the network of other mothers who had gone through the process and the breastfeeding groups were the main source of information to be able to carry out the processes of induction of lactation and relactation.Conclusions: It is necessary to include both processes, induction of lactation and relactation, in the training of midwives and other health professionals to avoid situations of loneliness and vulnerability of women who decide to go through these processes. (AU)

Obstetric Violence as an Infringement on Basic Bioethical Principles. Reflections Inspired by Focus Groups with Midwives.

BACKGROUND: obstetric violence is still far too invisible; the word "violence" generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. METHODOLOGY: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. RESULTS AND DISCUSSION: four categories were arrived at; they are "the maleficence of forgetting my vulnerability", "beneficence requires respect for my integrity and dignity", "my autonomy is being removed from me" and "a problem of social justice towards us, women". CONCLUSION: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

Level of Job Burnout among Midwives Working in Labour Rooms in Barcelona Region: A Cross-Sectional Study.

BACKGROUND: Nowadays, burnout syndrome (BS) symptoms appear to have increased in healthcare workers, specifically midwives, but there are no studies on burnout among midwives in Catalonia. The present study aimed to assess and describe the prevalence of BS in midwives working in labour rooms. METHODS: A cross-sectional descriptive study was conducted on 122 midwives working in 24 maternity hospitals in the Barcelona (region) which were selected using purposive sampling from January to March 2017. Data were collected using two questionnaires (demographic information, job burnout using Spanish Burnout Inventory with 20 items and four subscales). Data analysis was performed using SPSS software version 21 and Chi-Square, U Mann-Whitney, and Kruskall-Wallis. P<0.05 was considered statistically significant. RESULTS: None of the participants obtained a critical level of BS. 37 (30.33%) participants scored medium burnout and 47 (38.52%) recorded low burnout. Statistically, work stress (P=0.01), marital status (P=0.006), attendance of more than three women per shift (P=0.001), the number of children (P=0.01), parity (P=0.005), health status (P=0.04), and being on sick leave over last year (P=0.04) were significantly correlated with medium-high levels of burnout. Burnout scores were higher in midwives having a life partner and those without children. CONCLUSION: Following the results, no participant obtained a critical level of BS; about one-third of them scored medium-high burnout. However, specific interventions are suggested to be conducted to maintain the midwives' motivation and prevent burnout development.

Understanding the Challenges of Induction of Lactation and Relactation for Non-Gestating Spanish Mothers.

BACKGROUND: Induced lactation and relactation are the processes that enable breastfeeding in non-gestating mothers. RESEARCH AIM: The aim of this study was to describe and interpret the challenges faced by mothers who undergo induced breastfeeding and relactation for adopted infants, infants born via surrogacy, and infants born to same-sex female partners. METHODS: A qualitative study was performed using in-depth interviews conducted with Spanish women (N = 9) who had decided to undergo induced lactation or relactation. The data were collected between October 2014 and May 2017. The length of the study was due to the difficulty in locating and recruiting the sample. Interviews were transcribed and coded with the ATLAS.ti v.7.5.7 software. We performed a deductive thematic analysis, creating categories based on the interview questions, which we developed on the basis of previous literature about induced lactation and relactation. RESULTS: Participants described the following challenges: the physical hardships of the process; breastfeeding problems; difficulty with accessing information about induced lactation or relactation; and lack of support from health professionals. Breastfeeding periods lasted from 1.5 months to 4 years. Participants reported that breastfeeding increased the closeness between the mother and child and that this feeling of closeness tended to decrease after breastfeeding cessation. CONCLUSION: We offer data and analysis that can improve our understanding of the lived experiences of women undergoing the process of relactation or induced lactation and may help guide intervention strategies to support women in this situation.

Ansiedad y depresión en las madres de recién nacidos prematuros. Estrategias de intervención y revisión de la bibliografía / Anxiety and depression in mothers of preterm infants. Intervention strategies and literature review

INTRODUCCIÓN: El parto prematuro es una situación muy estresante para las mujeres que lo sufren, ya que supone enfrentarse a una realidad no esperada, en la que se pierden sus expectativas sobre la vivencia del embarazo y el parto normal. Además, deberán afrontar no sólo la separación inicial de su hijo, sino también la pérdida de su rol maternal, ya que los cuidados se asumirán en la unidad neonatal (UNN). Por todo ello, durante el puerperio estas mujeres serán especialmente vulnerables a los problemas de salud mental, y tendrán más riesgo de sufrir niveles altos de ansiedad, depresión e incluso síntomas de estrés postraumático. OBJETIVOS: Conocer y valorar las estrategias de intervención que han demostrado ser eficaces para prevenir, mejorar y/o tratar los riesgos para la salud mental de las madres que pasan por el proceso de tener un hijo prematuro. METODOLOGÍA: Se ha realizado una búsqueda de la bibliografía publicada en los últimos 5 años en las bases de datos CINHAL, PubMed, Web of Science y PsycINFO. RESULTADOS: Las estrategias que han demostrado ser eficaces para mejorar la salud mental son las que incluyen a las madres como cuidadoras, ya sea a través de la promoción de la lactancia materna, el método canguro o los masajes en la UNN, y también las intervenciones que aumentan los conocimientos, tanto en referencia al ambiente de la UNN como a los cuidados y progresos de sus hijos. CONCLUSIONES: La matrona, como profesional de referencia del cuidado del puerperio, ha de conocer el riesgo para la salud mental de estas puérperas, con el fin de detectarlo precozmente y promover actividades preventivas que faciliten su rol maternal, y así contribuir a mejorar la experiencia de tener un hijo prematuro

INTRODUCTION: Preterm birth represents a stressful situation for women who suffer it. They have to face an unexpected reality. A new reality far from their initial expectations about pregnancy and birth, as well as the separation from their baby after giving birth. Premature babies need special cares assumed by the neonatal intensive care unit so mothers have to delegate her maternal role to health professionals. Therefore, all women who have to face a preterm birth are especially vulnerable during the postpartum period to develop mental health problems and to present more anxiety, depression and even post-traumatic stress. OBJECTIVE: Identify and evaluate intervention strategies that proved to be effective in order to prevent, improve and/or treat the risks in mental health of all mothers who have to face a preterm baby. METHODOLOGY: Bibliographic research in the scientific literature published during the last five years in the databases CINHAL, PubMed, Web of Science and PsycINFO. RESULTS: The strategies which demonstrated to be more effective to improve the mental health are interventions that included mothers as the responsible of giving care to the baby. There are different strategies such the promotion in breastfeeding, the kangaroo method or the introduction in massage techniques in the neonatal unit. The activities that help them to increases the knowledge about the function of the neonatal intensive care unit and giving them all the information about the care and progress of their baby are effective options as well. CONCLUSIONS: The midwife is the responsible to take care of mothers during the postpartum. This professional has to know the risk of this women to develop mental health problems during this process. In that case, they have to detect it early and work to promote preventive activities that help mothers to develop her maternal role in this way they will contribute to improve the experience of having a premature baby

Desigualdades en el acceso a los programas preventivos en salud sexual y reproductiva / Inequalities in access to preventive programs in sexual and reproductive health

La presente revisión tiene como objetivos analizar si dentro de los programas preventivos europeos de salud sexual y reproductiva existen barreras de acceso, identificar qué grupos son más vulnerables respecto a la prevención y conocer estrategias que permitan un mejor acceso a dichos programas. El método es una revisión de la bibliografía publicada en los últimos 10 años sobre iniciativas de prevención en salud sexual y reproductiva en Europa. Los resultados muestran la existencia de desigualdades en el acceso, y se identifican propuestas para contribuir a su disminución. La conclusión principal es que las mujeres con condiciones socioeconómicas desfavorables tendrán un mayor riesgo de exclusión sino se aplican medidas correctoras en el diseño de los programas (AU)

This present review aims to analyze, within the European preventive programs of sexual and reproductive health: the existence of barriers to access, identify vulnerable groups, and recognize the proposed strategies to ensure a better access to such programs. The method is a literature review of references published in the last 10 years, about prevention efforts in reproductive health. The results identified inequalities in access, in the activities of prevention, and some proposes strategies to reduce inequalities of access, ranging from changes to the design and evaluation of programs and greater community participation. The principal conclusion is that the women with unfavorable socioeconomic conditions will have a higher risk of exclusion, if corrective measures are not applied in their design (AU)

El triaje obstétrico: nuevo reto para las matronas. Experiencia del Hospital Parc Taulí en la implementación de un sistema de triaje obstétrico / The obstetric triage: a new challenge for midwives. Experience at the Hospital Parc Taulí in the implementation of an obstetric triage system

El triaje es una práctica ampliamente implantada en los servicios de urgencias generales de nuestro país, que ha demostrado su eficacia en la identificación de situaciones de riesgo al asegurar la priorización de la visita médica en función de la urgencia. En las urgencias obstétricas el triaje es una actividad relativamente nueva. Basándonos en la revisión bibliográfica y competencial realizada, se defiende que el profesional más adecuado para realizar esta actividades la matrona, ya que la valoración de la gestante y la atención de enfermería que de ella se deriva requieren la actuación de una enfermeraespecializada. Mediante el ejemplo de la instauración del triaje obstétrico en el Hospital de Sabadell se describe cómo se intenta mejorar la respuesta a las necesidades de las usuarias que acuden a urgencias (AU)

Triage practice is widely implemented in general emergency departments of our country, which has proved effective in identifying risk situations,ensuring prioritization of medical visits according to urgency. In midwifery is the midwife who performs the triage, as it is the nursespecialist in obstetrics and gynecology. The resulting nursing care of the grounds of urgency as well as conducting advanced triage requires actionby a nurse practitioner.The introduction of obstetric triage in CSPT, while improving responsivenessto the needs of users, establishes uniform criteria and consistent scientific adequate attention to the needs of the user has about their demand for care (AU)