The impact of severe perinatal events on maternity care providers: a scoping review.

BACKGROUND: Severe events during the perinatal period can be experienced as traumatic by pregnant women, their partners or others who are closely involved. This includes maternity care providers who can be affected by being involved in or observing these events. This may have an impact on their personal well-being and professional practice, influencing quality of care. The aim of this study is to map research investigating the impact of severe events during the perinatal period on maternity care providers, and how these experiences affect their well-being and professional practice. METHOD: A scoping review following the manual of the Joanna Briggs Institute was undertaken. The electronic bibliographic databases included PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, Cochrane, Scopus, Web of Science and databases for grey literature. Records passing the two-stage screening process were assessed, and their reference lists hand searched. We included primary research papers that presented data from maternity care professionals on the impact of severe perinatal traumatic events. A descriptive content analysis and synthesis was undertaken. RESULTS: Following a detailed systematic search and screening of 1,611 records, 57 papers were included in the scoping review. Results of the analysis identified four categories, which highlighted the impact of traumatic perinatal events on maternity care providers, mainly midwives, obstetricians and nurses: Traumatic events, Impact of traumatic events on care providers, Changes in care providers' practice and Support for care providers; each including several subcategories. CONCLUSION: The impact of traumatic perinatal events on maternity care providers ranged from severe negative responses where care providers moved position or resigned from their employment in maternity care, to responses where they felt they became a better clinician. However, a substantial number appeared to be negatively affected by traumatic events without getting adequate support. Given the shortage of maternity staff and the importance of a sustainable workforce for effective maternity care, the impact of traumatic perinatal events requires serious consideration in maintaining their wellbeing and positive engagement when conducting their profession. Future research should explore which maternity care providers are mostly at risk for the impact of traumatic events and which interventions can contribute to prevention.

A multidisciplinary evaluation, exploration, and advancement of the concept of a traumatic birth experience.

BACKGROUND: Understanding a woman's traumatic birth experience benefits from an approach that considers perspectives from various fields of healthcare and social sciences. AIM: To evaluate and explore the multidisciplinary perspectives surrounding a traumatic birth experience to form a theory and to capture its structure. METHODS: A multidisciplinary advanced principle-based concept analysis was conducted, including the following systematic steps: literature review, assessment of concept maturity, principle-based evaluation, concept exploration and advancement, and formulating a multidisciplinary concept theory. We drew on knowledge from midwifery, psychology, childbirth education, bioethics, obstetric & gender violence, sociology, perinatal psychiatry, and anthropology. RESULTS: Our evaluation included 60 records which were considered as 'mature'. Maturity was determined by the reported concept definition, attributes, antecedents, outcomes, and boundaries. The four broad principles of the philosophy of science epistemology, pragmatics, linguistics, and logic illustrated that women live in a political, and cultural world that includes social, perceptual, and practical features. The conceptual components antecedents, attributes, outcomes, and boundaries demonstrated that a traumatic birth experience is not an isolated event, but its existence is enabled by social structures that perpetuate the diminished and disempowered position of women in medical and institutionalised healthcare regulation and management. CONCLUSION: The traumatic childbirth experience is a distinctive experience that can only occur within a socioecological system of micro-, meso-, and macro-level aspects that accepts and allows its existence and therefore its sustainability - with the traumatic experience of the birthing woman as the central construct.

The social conception of space of birth narrated by women with negative and traumatic birth experiences.

BACKGROUND: Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. AIM: To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. METHODS: A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. FINDINGS: Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. DISCUSSION/CONCLUSION: The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

La fotografía y el duelo perinatal. Revisión de la literatura / Photography and perinatal grief. Literature review

Objetivo: Analizar el uso de la fotografía como intervención profesional de las matronas ante una pérdida perinatal, y su impacto en el proceso de duelo de las parejas atendidas. Metodología: Revisión bibliográfica en cinco bases de datos (PubMed, Scopus, Medline, CUIDEN y Cuidatge) y páginas web de asociaciones de madres en duelo españolas. Resultados: De los 169 artículos iniciales, 10 fueron seleccionados según los criterios de inclusión propuestos. Los artículos muestran que la fotografía puede constituir un recuerdo positivo de los momentos vividos con la criatura fallecida. Conclusiones: La fotografía puede utilizarse como recurso de apoyo al tránsito de la familia en su duelo perinatal. Estos recursos están influenciados en gran medida por el contexto sociocultural; se necesita más investigación sobre el impacto que pueden tener en la salud mental materna. La matrona puede ser una profesional referente en la realización de las fotografías, si cuenta con la formación necesaria. (AU)

Objective: To analyse the use of photography in miscarriage and stillbirth by midwives, and their impact on couples who suffer the death of a baby. Methodology: We conducted a literature review in 5 databases (PubMed, Scopus, Medline, CUIDEN and Cuidatge), and web sites of mothers’ in grief Spanish associations. Results: 169 papers were identified, only 10 articles met all requirements and were included in the review. The studies analysed show photography could offer a positive memento for parents. Conclusions: Pictures could end up to be a positive memento for parents. Rituals are greatly influenced by the social and cultural background. More evidence is needed to determine the impact care has on maternal mental health. Midwives can aid the pictures’ taking. (AU)

Bienestar mental perinatal: el miedo como emoción movilizadora de técnicas de resiliencia / Perinatal mental wellbeing: fear as a mobilizing emotion for resilience techniques

Objetivo: Analizar las experiencias en torno a los sentimientos y emociones de las gestantes como eje movilizador, y las estrategias resilientes desarrolladas durante el periodo de pandemia y pospandemia de COVID-19 en España. Personas/Material y método: Diseño cualitativo, fenomenológico. Se realizaron entrevistas semiestructuradas a mujeres que dieron a luz en pandemia y pospandemia en España. Resultados: El miedo estaba presente en todas las narrativas, ocasionando un cambio en las expectativas. Asímismo, destaca el carácter multifactorial que llevó a las gestantes a tomar decisiones y acciones que nunca se habían planteado. El miedo a la falta de seguridad física, a la aceptación social o a la violencia obstétrica obstaculizaron la experiencia positiva del nacimiento. A pesar de la situación de vulnerabilidad a la que se enfrentaron, como respuesta adoptaron técnicas de resiliencia. Conclusiones: El miedo es una emoción frecuente en la gestación y parto –acentuada en pandemia–; sin embargo, puede transformarse en la medida en que existen ciertas características de las mujeres y del entorno. Las diversas técnicas resilientes permiten resignificar positivamente emociones no gratas. El buen trato, la empatía y la información son aspectos que propician experiencias positivas. (AU)

Objective: To analyze the experiences around the feelings and emotions of pregnant women as a mobilizing axis and the resilience strategies developed during the pandemic and post-pandemic period by COVID-19 in Spain. Persons/Materials and method: Qualitative, phenomenological design. Semi-structured interviews were conducted with women who gave birth during pandemic and post-pandemic periods in Spain. Results: Fear was present in all narratives, which caused a change in expectations. Likewise, the multifactorial nature that led them to make decisions and take actions they had never considered before stands out. Fear of lack of physical security, social acceptance or obstetric violence hindered the positive birth experience. Despite the vulnerable situation they faced, in their response they adopted resilience techniques. Conclusions: Fear is a frequent emotion in gestation and childbirth - accentuated in pandemic - however it can be transformed to the extent that certain characteristics of the women and the environment exist. The different resilience techniques allow us to positively re-signify unpleasant emotions. Good treatment, empathy and information are aspects that promote positive experiences. (AU)

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)

Construcción del género y sexualidad en la primera infancia: rol de la matrona en Chile / Construction of gender and sexuality in early childhood: role of the midwife in Chile

Objetivo: Identificar los elementos asociados a la construcción del género en la primera infancia y determinar las intervenciones educativas en salud sexual de la matrona en Chile.Método: Revisión bibliográfica en diferentes bases de datos académicas (CINAHL, PubMed, Web of Science, LILACS, Dialnet y Scielo), complementada con sitios web institucionales de Chile.Resultados: Emergieron cuatro categorías centrales: 1) contexto familiar; 2) contexto escolar; 3) contexto social, y 4) rol del profesional matrón/matrona en las intervenciones educativas en salud sexual.Las autoras no presentan conflicto de intereses en este artículo.Conclusión: La construcción del género en la primera infancia se produce en contextos familiares a través de los cuidadores principales: en contextos educativos mediante la función docente, y en contextos sociales a través de los medios de comunicación y actividades lúdicas. Sin embargo, los contextos familiares y educativos refieren no estar suficientemente preparados para abordar la sexualidad en esta etapa. Aunque el profesional matrón/matrona no ha podido involucrarse aún en la primera infancia, a pesar de lo señalado por las entidades nacionales, su rol puede ser fundamental, tanto por su preparación académica como por su experiencia técnica. (AU)

Objective: To identify the elements associated with the construction of gender in early childhood and determine the educational interventions in sexual health of the midwife in Chile.Method: Bibliographic review in academic databases (CINAHL, PubMed, Web of Science, LILACS, Dialnet and Scielo), complemented with institutional websites of Chile.Results: Four central categories emerged: 1) family context; 2) school context; 3) social context, and 4) role of the professional midwife in educational interventions in sexual health.Conclusion: The construction of gender in early childhood occurs in family contexts, through the main caregivers; in educational contexts, through the teaching function; and in social contexts, through the media and recreational activities. However, family and educational contexts refer to not being sufficiently prepared to deal with sexuality at this stage. Although the professional midwife has not yet been able to become involved in early childhood, despite what has been pointed out by national entities, his role can be fundamental, both for his academic preparation and technical experience. (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.

Experiencia del embarazo y parto en casa durante la pandemia de Covid-19 / Experience of pregnancy and home birth during the Covid-19 pandemic

En los últimos años, se ha mostrado un creciente interés por dar a luz en entornos seguros, aunque menos medicalizados, como son las salas de atención al "parto natural" que ya funcionan en algunos hospitales. Sin embargo, la opción de parir en casa, en caso de embarazo de bajo riesgo, no está contemplada en el sistema sanitario público de salud. A raíz de la pandemia del Covid, ha aumentado la demanda de parto en casa y en Cataluña se ha triplicado. Con la intención de profundizar en la decisión del lugar donde dar a luz, se entrevista en profundidad a una mujer primípara durante el confinamiento. El relato sigue un hilo conductor: inicio de la gestación, vivencias durante el embarazo, aparición de la pandemia y el final del parto. Conclusión: la elección de parir en casa, en el caso que nos ocupa, se forja a partir de constatar la imposibilidad de cumplir con su deseo de un parto natural dada la situación generada por la Pandemia de COVID-19. La información facilitada por las matronas ha sido clave en el empoderamiento para la toma de esta decisión. (AU)

In recent years, there has been a growing interest in giving birth in safe environments, although less medicalized, such as the "natural delivery" rooms that already operate in some hospitals. However, the option of giving birth at home is not contemplated within the public health system for low-risk pregnancies. As a result of the Covid pandemic, the demand for home birth has increased and in Catalonia it has tripled. With the intention of deepening the decision of where to give birth, a primiparous woman is interviewed in depth during confinement. The story follows a common thread: the beginning of pregnancy, experiences during pregnancy, the onset of the pandemic and the end of childbirth. Conclusion: the choice to give birth at home, in the present case, it is forged after verifying the impossibility of fulfilling her desire for a natural childbirth due the situation generated by the COVID-19 Pandemic. The information provided by midwives has been a key in empowering she in order to make this decision. (AU)

The COVID-19 Pandemic in Spain: Experiences of Midwives on the Healthcare Frontline.

BACKGROUND: Midwives look after women during pregnancy, childbirth and puerperium. In Spain, the first wave of COVID was particularly virulent. There are few studies about the experiences of midwives providing care during the COVID pandemic and very few have been undertaken in the countries of southern Europe such as Spain. This article sets out to take a more in-depth look at the experiences of midwives who were on the frontline of care during the early months of the COVID-19 pandemic as well as to identify new needs and resilience strategies that can help midwives. METHODS: A qualitative methodology of phenomenological tradition was used, interviewing 10 midwives from primary care, hospital and independent care. RESULTS: After content analysis, three central categories emerged: (a) cascade of emotions; (b) professional occupation and concern for the women; (c) resisting the day-to-day; resilience and resistance strategies. CONCLUSIONS: Despite the difficulties, midwives are concerned about the loss of rights and autonomy and about the increased vulnerability of women. Midwives have become aware of the power they have in their actions both in health management and administration, as well as in the care of women, creating strategies to provide dignified care to their users.

Birth cultures: A qualitative approach to home birthing in Chile.

BACKGROUND: Birth cultures have been transforming in recent years mainly affecting birth care and its socio-political contexts. This situation has affected the feeling of well-being in women at the time of giving birth. AIM: For this reason, our objective was to analyse the social meaning that women ascribe to home births in the Chilean context. METHOD: We conducted thirty semi-structured interviews with women living in diverse regions ranging from northern to southern Chile, which we carried out from a theoretical-methodological perspective of phenomenology and situated knowledge. Qualitative thematic analysis was used to analyse the information collected in the field work. FINDINGS: A qualitative thematic analysis produced the following main theme: 1) Home birth journeys. Two sub-categories: 1.1) Making the decision to give birth at home, 1.2) Giving birth: (re)birth. And four sub-categories also emerged: 1.1.1) Why do I need to give birth at home? 1.1.2) The people around me don't support me; 1.2.1) Shifting emotions during home birth, 1.2.2) I (don't) want to be alone. CONCLUSION: We concluded that home births involve an intense and diverse range of satisfactions and tensions, the latter basically owing to the sociocultural resistance surrounding women. For this reason, they experienced home birth as an act of protest and highly valued the presence of midwives and their partners.

Methods and Success Factors of Induced Lactation: A Scoping Review.

BACKGROUND: Induced lactation enables a woman who has not given birth to breastfeed a child. Lactation may be induced through both pharmacological and non-pharmacological methods, although the desired outcome cannot always be achieved. RESEARCH AIMS: The aims of this scoping review was to assess the different methods used to induce lactation, as well as the factors related to sucking the breast effectively and the production of human milk. METHODS: We searched five databases from June 2019-February 2020 for studies referring to methods and factors related to breast suckling and/or the volume of milk produced after inducing lactation, using the following search terms and Boolean operators: breastfeeding AND induced lactation AND adoptive mothers OR surrogate mothers OR female homosexuality OR non-gestating. The final review included a total of 24 articles. RESULTS: Pharmacological methods were not always used to produce milk, although breast stimulation was essential. The age of the child, interference due to bottle feeding, breast stimulation, and the support received were important factors in the induction of lactation. There were several factors that may account for the differences between developing and higher income countries in methods of induced lactation and the amount of milk that study participants produced. There was no consensus over whether previous pregnancy and/or breastfeeding experience influenced induced lactation. CONCLUSION: Health professionals need to have adequate knowledge about induction methods, the preferences of each woman, and the reasons for inducing lactation, to provide proper assistance. However, the lack of standardization about induction of lactation makes it difficult.

Postpartum perineal pain and dyspareunia related to each superficial perineal muscle injury: a cohort study.

OBJECTIVE: To assess the association between superficial perineal muscle trauma and perineal pain and dyspareunia. MATERIALS AND METHODS: Prospective cohort study of 405 women with a spontaneous vaginal birth comparing an intact perineum and first-degree perineal trauma group (n = 205) with a second-degree perineal trauma and episiotomy group (n = 200). Perineal pain was measured at 2 days, 10 days, 7 weeks, 3 months and 6 months postpartum. Dyspareunia was assessed at 7 weeks, 3 months and 6 months postpartum. RESULTS: All second-degree perineal traumas and episiotomies involved damage to the bulbospongiosus muscle (BSM), but not always to the superficial transverse perineal muscle (STPM). In case of second-degree trauma or episiotomy, the odds of pain at 10 days and dyspareunia at 6 months postpartum were four- and five-fold greater, respectively, than if the perineum had remained intact or suffered a first-degree perineal trauma [OR 4.4 (95% CI: 2.8-6.9) and OR 5.5 (95% CI: 2.8-10.9), respectively]. When comparing injuries where > 50% BSM ± STPM against those with < 50% BSM torn, pain was significantly higher at 10 days postpartum [OR 1.9 (95% CI: 1.1-3.6], with no difference at 7 weeks, while dyspareunia was significantly higher at 6 months postpartum [OR 3.3 (95% CI: 1.4-7.8)]. There was no difference in perineal pain or dyspareunia when comparing first-degree with < 50% BSM traumas. CONCLUSION: When perineal muscle trauma encompasses > 50% BSM ± STPM, perineal pain and dyspareunia persisted until 10 days and 6 months postpartum, respectively.

Exploring social and health care representations about home birth: An Integrative Literature Review.

AIMS: Exploring social and health care representations of home birth by conducting an integrative review of the literature. DESIGN: Integrative Literature Review. DATA SOURCES: The search was based on the following keywords: "birth, home," "home birth," "childbirth, home." And the terms: "planned home birth," and "empowerment women homebirth" (in English). "partos en casa," and "partos domiciliarios" (in Spanish) in the following databases: Biomedical Central, Cochrane Library, Dialnet, DOAJ, Lilacs, PubMed, Scopus, Scielo, and Web of Science. REVIEW METHODS: A total of 156 publications dated between 2004 and 2017 were initially obtained and a total of 41 articles were finally selected according to the criteria of inclusion, methodological rigor, and researchers' triangulation. RESULTS: Four dimensions of the issue emerged out of the 41 articles analyzed: (a) the Dimension of "Empowerment in Childbirth;" (b) the Dimension of "Comparative Socio-Medical Childbirth Studies;" (c) the "Institutional Dimension of Childbirth;" (d) the "Cultural Dimension of Childbirth." CONCLUSION: From the health management perspective, home birth is not widely accepted today as a valid and safe alternative. However, women's social representations indicate an interest in returning to birth at home as a response to the excessive medicalization and institutionalization of childbirth, and value highly its autonomy and comfort.

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.

Effectiveness and Safety of Acupuncture and Moxibustion in Pregnant Women with Noncephalic Presentation: An Overview of Systematic Reviews.

BACKGROUND: Breech presentation at the time of delivery is 3.8-4%. Fetuses that maintain a noncephalic presentation beyond 32 weeks will have a lower probability of spontaneous version before labor. Given the increasing interest in exploring the use of complementary medicine during pregnancy and childbirth, the moxibustion technique, a type of traditional Chinese medicine, could be another option to try turning a breech baby into a cephalic presentation. OBJECTIVES: To review the evidence from systematic reviews (SR) on the efficacy and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation. MAIN RESULTS: Our SR synthesizes the results from five clinical trials on pregnant women with a singleton noncephalic presentation. There is evidence that moxibustion reduces the number of noncephalic presentations at the time of birth compared with no treatment. The adverse effects that acupuncture and moxibustion can cause seem to be irrelevant. Most SRs agree that there are no adverse effects directly related to acupuncture and moxibustion. CONCLUSIONS: Even though the results obtained are positive and the five reviews conclude that moxibustion reduces the number of noncephalic presentations at birth (alone or combined with postural techniques or acupuncture), there is considerable heterogeneity between them. Better methodologically designed studies are required in the future to reaffirm this conclusion.

El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo / The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study

Objetivo: Conocer a través de las narraciones de las matronas de Atención Primaria los factores que obstaculizan o contribuyen a la detección y el abordaje de la violencia de género durante el embarazo, así como sus propuestas de mejora para tal fin. Método: Estudio cualitativo con un enfoque fenomenológico interpretativo. Se hicieron entrevistas semiestructuradas a las 12 matronas que trabajan en los centros de Atención Primaria de L’Hospitalet de Llobregat (Barcelona). Resultados: Las dificultades en la detección se relacionan con el sistema de visitas, el contexto de las mujeres y barreras del propio profesional como el miedo. Destacan como factores facilitadores el seguimiento en el control del embarazo y la relación de confianza con la matrona. Las propuestas de mejora se relacionan con la formación y el uso de procedimientos seguros y fiables. Conclusiones: Sería deseable poner en marcha acciones de mejora, tales como ampliar la formación y consensuar un circuito interno de trabajo que incluya instrumentos objetivos de ayuda de la detección, la coordinación con otros servicios y la forma ética, y legalmente adecuada de registro en la historia clínica

Aim: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. Method: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12 midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). Results: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. Conclusions: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record

The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study. / El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo.

AIM: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. METHOD: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). RESULTS: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. CONCLUSIONS: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record.

Acupuntura y moxibustión para embarazadas con presentación no cefálica. Estrategias de intervención y revisión de la literatura / Acupuncture and moxibustion for pregnant women with non-cephalic presentation. Intervention strategies and literature review

Objetivo: Realizar una evaluación de la evidencia científica publicada y explorar las estrategias e intervenciones más adecuadas en la presentación no cefálica con acupuntura o moxibustión. Método: Búsqueda bibliográfica realizada entre los años 2003 y 2018 con las palabras clave «acupuntura», «moxibustión», «presentación de nalgas» y «presentación no cefálica» en las bases de datos PubMed, Cinahl, WoS, Medline y CENTRAL. Resultados: Finalmente se seleccionaron 15 artículos que cumplían con los criterios de inclusión. La moxibustión es eficaz para conseguir la versión a cefálica en las embarazadas con feto en presentación no cefálica en el tercer trimestre de gestación. Los países asiáticos son los que obtienen resultados con mayor éxito (96,7%), respecto a los países occidentales (53,6-75,4%). Discusión: La revisión de la bibliografía nos ofrece una buena evidencia científica en relación con la efectividad de la moxibustión en el punto de acupuntura V67, en la versión del feto a una presentación cefálica. En la gran mayoría de los estudios se ha observado una mejora en la versión del feto en los grupos que aplicaron la técnica de moxibustión en V67 respecto al grupo control, en que no se había aplicado la técnica. Conclusión: En la actualidad, el uso de la moxibustión para la versión cefálica de una presentación no cefálica es un procedimiento de interés tanto para los profesionales sanitarios como para las gestantes, ya que es una técnica efectiva, segura y de fácil aplicación

Objective: To carry out an evaluation of the published scientific evidence and to explore the most appropriate strategies and interventions in the non-cephalic presentation with acupuncture or moxibustion. Method: Bibliographic search was carried out between 2003 and 2018 with the keywords «acupuncture», «moxibustion», «breech presentation», «non-cephalic presentation», in the databases PubMed, Cinahl, WoS, Medline and CENTRAL. Results: Finally, 15 articles were selected that met the inclusion criteria. Moxibustion is effective to achieve the cephalic version in pregnant women with a fetus in non-cephalic presentation in the third trimester of pregnancy. The Asian countries have the most successful results (96.7%) in relation to those in the West (between 53.6 and 75.4%). Discussion: The review of the literature offers us good scientific evidence regarding the effectiveness of moxibustion in V67, in the fetus version of a cephalic presentation. In the vast majority of studies, an improvement in the version of the fetus was observed in the groups that applied the moxibustion technique in V67 in relation to the control group, which had not applied the technique. Conclusion: At present, the use of moxibustion for the cephalic version of a non-cephalic presentation is a procedure of interest for health workers and pregnant women, since it is an effective, safe and easy to apply technique whenever it is indicated

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