Humanización de los cuidados en salud, Maternidad Pública de Rocha, 2014-2016 / Humanization of health care, Rocha Public Maternity Hospital, 2014-2016 / Humanização dos cuidados de saúde, Hospital Público da Maternidade Rocha, 2014-2016

Introducción: La noción de humanización de los cuidados en salud aparece como consecuencia del avance de las tecnologías médicas. Si bien el parto institucional generó disminución de la mor-talidad materna esto se produjo a expensas de una deshumanización de los cuidados liderada por el parto sin acompañante. Objetivo general: Implementar un modelo de asistencia humanizado en salud perinatal, en la Maternidad pública del Depto. de Rocha, Uruguay, entre los años 2014 y 2016. Objetivos específicos: generar instancias de formación a todo el equipo de la Maternidad, sensibilizar a las mujeres embarazadas y sus parejas en cuanto a los derechos reproductivos, particularmente durante el embarazo, parto y posparto, evaluar los resultados del cambio de asistencia mediante un abordaje antes-después y un estudio cualitativo de percepción de los/as actores participantes. Metodología: Se desarrolló un estudio cuasi experimental con mediciones antes y después, para evaluar los efectos de la implantación de un Programa de humanización de los cuidados en salud materna. Se utilizaron variables del SIP (Sistema informático Perinatal). Se realizó una encuesta en el puerperio para evaluar el cumplimiento del protocolo de asistencia humanizado. Se evaluó la percepción de los actores mediante entrevistas en profundidad y entrevistas grupales. Resultados: Se observa una tendencia al descenso en la proporción de cesáreas, un aumento del acompañamiento en el parto, un aumento leve del contacto piel con piel con relación a la línea de base, y de las posiciones no supinas en el parto, mejoras en el manejo del periné y un compromiso significativo de las usuarias y sus familias con la propuesta.

Introduction: The notion of humanization of health care appears as a consequence of the advancement of medical technologies. Although institutional delivery has led to a reduction in maternal mortality, this has occurred at the expense of a dehumanization of care, led by unattended childbirth. General objective: To implement a model of humanized care in perinatal health, in the public maternity hospital in the Department of Rocha, Uruguay, between 2014 and 2016. Specific objectives: Generate training opportunities for all the staff of the Maternity Hospital, raise awareness among pregnant women and their partners about reproductive rights, particularly during pregnancy, delivery and postpartum, evaluate the results of the change in care through a before and after approach and a qualitative study of the perception of the participating actors. Methodology: A quasi-experimental study with before and after measurements was developed to evaluate the effects of implementing a humanization of maternal health care program. A survey was conducted in the puerperium to assess compliance with the humanized care protocol. Stake-holder perceptions were assessed through in depth interviews and group interviews. Results: We observed a downward trend in the proportion of caesarean sections, an increase in follow-up during labor, a slight increase in skin-to-skin contact compared to baseline and in non-overlapping positions during labor, improvements in perineum management, and significant commitment to the proposal by users and their families.

Introdução: A noção de humanização da assistência médica aparece como conseqüência do avanço das tecnologias médicas. Embora o parto institucional tenha levado a uma redução da mortalidade materna, isto ocorreu às custas de uma desumanização dos cuidados, liderada pelo parto desacompanhado. Objetivo geral: implementar um modelo de atendimento humanizado em saúde perinatal, na maternidade pública do Departamento de Rocha, no Uruguai, entre 2014 e 2016. Objetivos específicos: gerar oportunidades de treinamento para toda a equipe da Maternidade Hospitalar, conscientizar as mulheres grávidas e seus parceiros sobre os direitos reprodutivos, particularmente durante a gravidez, parto e pós-parto, avaliar os resultados da mudança nos cuidados através de uma abordagem antes e depois e um estudo qualitativo da percepção dos atores participantes. Metodologia: Foi desenvolvido um estudo quase experimental com medições antes e depois para avaliar os efeitos da implementação de um programa de humanização da assistência à saúde materna. Foi realizada uma pesquisa no puerpério para avaliar a conformidade com o protocolo de cuidados humanizados. As percepções das partes interessadas foram avaliadas através de entrevistas em profundidade e entrevistas em grupo. Resultados: Observamos uma tendência de queda na proporção de cesarianas, um aumento no acompanhamento durante o trabalho, um leve aumento no contato pele a pele em relação à linha de base e em posições não superpostas durante o trabalho, melhorias na gestão do períneo e um compromisso significativo com a proposta por parte dos usuários e suas famílias.

Strengthening the Evidence for Maternal and Child Health: Implementing the New Performance Measurement Framework for the Title V Maternal and Child Health Block Grant.

PURPOSE: The Health Resources and Services Administration's Maternal and Child Health Bureau (HRSA MCHB) developed a three-tiered performance measure framework for the Title V Maternal and Child Health Block Grant program (MCH Title V). The third tier, evidence-based/informed strategy measures (ESMs) are developed by states to address National Performance Measures (NPM) goals. To support states' efforts, MCHB funded the "Strengthen the Evidence for Maternal and Child Health" (STE) to: (1) define the concept of evidence for the field with an emphasis on strength; (2) identify available evidence for each NPM, (3) translate ESM research for use at the state level; and (4) provide technical assistance (TA) to states to facilitate implementation. DESCRIPTION: The program conducted evidence reviews defining an "evidence continuum" emphasizing a continuum of strength, provided individual and group TA to MCH Title V grantees, launched a TA referral system, and reviewed state ESMs to assess use of evidence-based/informed strategies. ASSESSMENT: Ten evidence reviews identified multiple strategies as having "emerging" or "moderate" evidence. TA reached all MCH Title V programs, encompassing 59 US states and jurisdictions, and the TA referral system effectively partnered with MCHB resources. All MCH Title V states and territories submitted ESMs for the Block Grant program's first year reporting requirement. CONCLUSION: STE is the first program to review available evidence on effective strategies addressing NPMs for MCH Title V. Identifying actionable next steps responsive to state needs will be a key factor for continued implementation of ESMs and achieving improvements in MCH.

Levels of Maternal Care in the United States: An Assessment of Publicly Available State Guidelines.

Background: Recent increases in maternal mortality and severe maternal morbidity highlight the need to improve systems for safe maternity care. We sought to identify whether publicly available state perinatal guidelines incorporate levels of maternal care (LoMC) criteria. Materials and Methods: We searched websites for 50 U.S. states and Washington, D.C. for LoMC guidelines. The Health Resources and Services Administration's Title V Program directors confirmed/updated search results through January 2018. Data abstracted included: (1) definitions of levels; (2) provider types; (3) facility capabilities and services; and (4) programmatic responsibilities as promoted in the 2015 Society for Maternal/Fetal Medicine and American College of Obstetricians and Gynecologists consensus document on LoMC. Results: LoMC guidelines were identified for 17 states; 12 defined four levels and five defined three levels of care. In Level I, 14/17 states specified obstetric provider availability for every birth and five specified an available surgeon to perform emergency cesareans. Fourteen states specified the availability of blood bank and laboratory services at all times. In the highest level (III or IV), 16/17 state guidelines specified a maternal/fetal medicine specialist; all but two specified anesthesia providers or services. Ten states referenced availability of an onsite intensive care unit in their highest level. All 17 state guidelines specified maternal transport and referral systems. Conclusions: Only one-third of states have publicly available perinatal guidelines incorporating LoMC criteria. Definitions, criteria, and nomenclature varied. Lack of LoMC guidelines with standardized criteria limits monitoring and evaluation of regionalized systems of maternal care.