Vivência e expectativas de doulas em região brasileira de fronteira / Experience and expectations of doulas in a Brazilian border region

RESUMO O estudo buscou compreender a vivência e as expectativas das doulas que atuam ou atuaram em dois municípios de região de fronteira: Foz do Iguaçu e Cascavel, Paraná, Brasil. Tratou-se de uma pesquisa qualitativa pautada no referencial da Fenomenologia Social. A coleta das informações deu-se por entrevistas com roteiro semiestruturado em língua portuguesa. As entrevistas foram feitas on-line. Os resultados foram classificados em seis categorias: motivação para tornar-se doula, conhecimento sobre o papel da doula, o cotidiano das doulas, abarcando as subcategorias de experiências exitosas e desafios da atividade na região de fronteira, a invisibilidade da doulagem, as expectativas enquanto doulas frente ao cenário obstétrico e o esperado da sua atuação profissional. O estudo permitiu compreender a vivência das doulas e o conhecimento do papel da sua função no Sistema Único de Saúde (SUS), no setor privado e em partos domiciliares, evidenciando a importância da atuação multiprofissional. Foram ponderadas resistências no cenário obstétrico por desconhecimento dos profissionais da assistência sobre o papel da doula. Em relação à atuação na região de fronteira, as doulas relataram o acompanhamento de mulheres paraguaias no Brasil e, com menos frequência, no Paraguai. As barreiras culturais e linguísticas foram destacadas como obstáculos para o exercício profissional em outro país.

ABSTRACT The study sought to understand the experience and expectations of doulas who worked or worked in two municipalities in the border region: Foz do Iguaçu and Cascavel, Paraná, Brazil. This was a qualitative research based on the framework of Social Phenomenology. The collection of information took place through interviews with a semi-structured script in Portuguese. The interviews were done online. The results were classified into six categories: motivated to become a doula, knowledge about the role of the doula, the daily life of the doulas, covering the subcategories of successful experiences and challenges of the activity in the border region, the invisibility of the doula, the expectations as doulas facing the obstetric scenario and what is expected of their professional performance. The study made it possible to understand the experience of doulas and knowledge of the role of their role in the Unified Health System (SUS), in the private sector and in home births, highlighting the importance of multidisciplinary action. Resistance in the obstetric scenario was considered due to the lack of knowledge on the part of care professionals about the role of the doula. Regarding work in the border region, the doulas reported accompanying Paraguayan women in Brazil and, less frequently, in Paraguay. Cultural and linguistic barriers were highlighted as reasons that make professional practice in another country unfeasible.

The emotional experience of mothers of children with haemophilia: maternal guilt, effective coping strategies and resilience within the haemophilia community.

INTRODUCTION: Mothers of children with haemophilia (CWH) experience guilt related to this genetic condition. Several factors contributing to maternal guilt have been identified, but the scope and extent of guilt have not previously been quantified. AIM: This study provides insight into the experience of mothers of CWH and how they perceive and manage guilt. It then identifies the most common and helpful coping mechanisms. METHODS: Between May and October 2021, we distributed an anonymous electronic survey to mothers of CWH. The Parent Experience of Child Illness measured maternal guilt, the PROMIS Parent Proxy for Life Satisfaction measured perception of their child's life satisfaction and additional questions explored specific guilt factors and coping strategies. RESULTS: Eighty-seven mothers responded to the survey. Forty percent of mothers experienced increased guilt. The most common reasons for guilt included putting their child through pain during infusions and passing on the affected X chromosome. Perceived life satisfaction, increased age and genetic counselling were associated with less guilt. The most common coping strategies involved utilizing social support, self-education and connecting with other mothers in the community. CONCLUSION: Some mothers experienced increased feelings of guilt, illustrating the need for providers to tactfully provide anticipatory guidance and counselling. Tangible manifestations of haemophilia were more likely to trigger feelings of guilt than familial factors. Community immersion was beneficial, as other mothers in the community served as a source of social and educational support. Most mothers did not report guilt, illustrating the adaptability and resilience of the haemophilia community.

Preventive Care Utilization among Rural versus Urban Women 12 Months Prior to Pregnancy.

Introduction: Pregnancy-related mortality in the United States occurs in 32.3 per 100,000 live births. Rural maternal mortality rates were even higher, and these patients were less likely to receive routine care. The purpose of this cross-sectional study was to compare primary and prenatal care and health behaviors among perinatal mothers living in rural and urban Kansas. Methods: Data were collected from 1,971 pregnant women who participated in Phase 8 Pregnancy Risk Assessment Monitoring System (PRAMS) for Kansas between 2016 and 2018. Respondent location (urban or rural based on NIH classification) was abstracted from birth certificates and frequencies of healthcare visits and secondary healthcare variables were compared. Results: Most respondents (75.1%, n = 1,481) resided in an urban area. Most (84.4%, n = 1,664) women were Caucasian, and the largest category (31.1%, n = 613) was 25 to 29 years old. More urban women reported visiting an obstetrician/gynecologist within 12 months before pregnancy than rural women (p < 0.0001). Urban women reported attending pre-pregnancy dental visits (p = 0.019) and teeth cleanings (p = 0.004) more than rural women. Of the 35.7% of respondents (n = 516) who reported receiving pre-pregnancy counseling on folic acid, prenatal vitamins, or multivitamins, 78.9% (n = 407) resided in an urban area. Conclusions: Rural women reported fewer routine primary and prenatal care behaviors compared to their urban counterparts. Efforts are needed to improve access to obstetrician/gynecologist services, especially for women in rural areas.

Body Appreciation, Depressive Symptoms, and Self-Esteem in Pregnant and Postpartum Brazilian Women.

Background: During pregnancy and the postpartum period, women experience tremendous biopsychosocial changes in a short period of time. Poor body appreciation, depressive symptoms, and low self-esteem during the perinatal period may cause negative consequences for both the mother and the infant's physiological and psychological health. The aim of this study was to analyze the differences in body appreciation, depressive symptoms, and self-esteem between the three gestational trimesters and the postpartum period. Methods: Participants (N = 1,423 pregnant and postpartum Brazilian women), aged between 18 and 42 years old (M = 29.22; SD = ±5.72), answered questionnaires on body appreciation, depressive symptoms, and self-esteem. BMI was self-reported. Descriptive and nonparametric covariance analysis were performed, comparing women who were in the first, second, and third trimesters and the postpartum period. Results: Body appreciation was significantly higher among women in the third trimester compared to those in the first and second trimester. However, it was lower for women in all three gestational trimesters than for those in the postpartum. There was no difference in self-esteem during pregnancy, but it was significantly lower in the postpartum group. Similarly, depressive symptoms did not vary through pregnant groups but it was significantly higher in the postpartum group. Conclusions: The results showed that the postpartum period can be a difficult experience for women. They presented poor body appreciation and lower self-esteem and higher depressive symptoms compared to the pregnancy period. Therefore, it is necessary for public health policies to support women in this period, preserving their mental health and making this experience more positive.

Intrapartum respectful maternity care practices and its barriers in Eastern India.

Background: Respectful maternal care (RMC) is increasingly recognized globally as critical to improving the quality of maternity care as women deserve respectful and dignified care. Numerous women face disrespectful maternal care during labor and delivery, especially in low- and middle-income countries, which dissuades them from seeking institutional care. Women, the consumers of care, are better positioned to report on the level of respectful care they receive. Health care workers' perspectives on barriers to delivering respective maternity care are seldom explored. Thus, this study aims to assess the levels of respectful maternity care and its barriers. Methods: This cross-sectional study assesses the level of RMC and its barriers in the labor room of tertiary care hospital in Odisha among 246 women selected by consecutive sampling technique by a questionnaire. Results: More than one-third of women reported good RMC. Although women rated high in domains of environment, resources, dignified care, and non-discrimination, non-consented care and non-confidential care were poorly rated. Barriers that adversely affect the delivery of RMC perceived by health care workers were lack of resources, staffing, uncooperative mother, communication issues, privacy issues, lack of policies, workload, and language problems. There was a significant association of RMC with age, education, occupation, and income. In contrast, residence, marital status, number of children, antenatal visit, type of institute of antenatal care, mode of delivery, and gender of health care provider were not associated with RMC. Conclusion: Given the above findings, we recommend vigorous efforts to improve the institutional policies, resources, training, and supervision of health care professionals on women's rights during childbirth to strengthen the quality of care for positive birth experiences.

Perceived facilitating and hindering factors to exclusive breastfeeding among Latin American immigrant women living in Colmenar Viejo (Community of Madrid, Spain).

The way in which an infant is breastfed by a migrant woman reflects her bio-psycho-social circumstances and her process of cultural transformation and adaptation to the host country. Exploring facilitating and hindering factors to exclusive breastfeeding (EBF) of immigrant mothers in Spain is essential for the development of guidelines that protect EBF. The aim of this qualitative study is to explore the factors perceived as facilitating or hindering EBF during the first six months of the baby's life by Latin American women living in Colmenar Viejo, a city in the Community of Madrid (Spain). We carried out in-depth semi-structured face-to-face interviews between December 2018 and February 2019 with 11 Latin American mothers who were recruited through key informants and snowball sampling. We audio-recorded the interviews, transcribed them, and performed content analysis to examine the data. EBF was facilitated by the mother and her family having information about its benefits, lower economic expenses, family and healthcare system support, certain popular and spiritual beliefs, and the mother's acculturation process in Spanish society. The hindering factors identified were the perception of EBF as a sacrifice, incompatible with working life, with unsightly and painful consequences for the mother, insufficient to nourish the baby and ineffective after some months, poorly supported by the broader social environment and the healthcare system. EBF was restricted by certain popular beliefs, associated with a stigma if abandoned, and linked to less economically favored social classes. Some of these hindering or facilitating factors are similar to those present in the original Latin American society or the receiving Spanish society. EBF is a complex process, with satisfactory and suffering stages, regulated by beliefs and experiences. EBF must be promoted intersectorally by governmental, health and societal actors considering the biological, psychological, social, and cultural characteristics of the mother and her community.

Trends in maternal body mass index in Northern Ireland: a cross-sectional and longitudinal study.

OBJECTIVES: Explore (1) associations between maternal body mass index (BMI), demographic and clinical characteristics, (2) longitudinal trends in BMI, (3) geographical distributions in prevalence of maternal overweight and obesity. DESIGN: Retrospective population-based study. SETTING: Linked, anonymised, routinely collected healthcare data and official statistics from Northern Ireland. PARTICIPANTS: All pregnancies in Northern Ireland (2011-2017) with BMI measured at ≤16 weeks gestation. METHODS: Analysis of variance and χ2 tests were used to explore associations. Multiple linear regression was used to explore longitudinal trends and spatial visualisation illustrated geographical distribution. Main outcomes are prevalence of overweight (BMI ≥25 kg/m2) and obesity (BMI ≥30 kg/m2). RESULTS: 152 961 singleton and 2362 multiple pregnancies were included. A high prevalence of maternal overweight and obesity in Northern Ireland is apparent (singleton: 52.4%; multiple: 48.3%) and is increasing. Obesity was positively associated with older age, larger numbers of previous pregnancies and unplanned pregnancy (p<0.001). BMI category was also positively associated with unemployment (35% in obese class III vs 22% in normal BMI category) (p<0.001). Higher BMI categories were associated with increased rate of comorbidities, including hypertension (normal BMI: 1.8% vs obese III: 12.4%), diabetes mellitus (normal BMI: 0.04% vs obese III: 1.29%) and mental ill-health (normal BMI: 5.0% vs obese III: 11.8%) (p<0.001). Prevalence of maternal obesity varied with deprivation (most deprived: 22.8% vs least deprived: 15.7%) (p<0.001). Low BMI was associated with age <20 years, nulliparity, unemployment and mental ill-health (p<0.001). CONCLUSIONS: The prevalence of maternal BMI >25 kg/m2 is increasing over time in Northern Ireland. Women are entering pregnancy with additional comorbidities likely to impact their life course beyond pregnancy. This highlights the need for prioritisation of preconception and inter-pregnancy support for management of weight and chronic conditions.

Decálogo en ginecología y obstetricia / Decalogue in Gynecology and Obstetrics

Resumen La temática en salud de la mujer toca demasiados aspectos, desde el nacimiento hasta la senectud. Hay ciertas afecciones que están relacionadas con el sexo biológico, pero también con problemas de sexualidad, desigualdad social y muchos tipos de violencia. Por ello se requiere analizar y adaptar la información en materia de salud, para implementar acciones hacia la población objetivo. Si bien en primera instancia la atención médica involucra la salud física, se han vuelto equiparables la salud mental y la social. Con el enfoque en este grupo de riesgo, se integran lineamientos prácticos, normas e información científica actualizada, para explicar las principales medidas que debe tomar cualquier mujer en todo el curso de su vida, y con ello mantener un estado de salud satisfactorio, buscar atención oportuna en ginecología y obstetricia, ademís de poder definir el plan de seguimiento médico personalizado. Se presentan herramientas prácticas mediante la exposición de un decálogo, denominados mandamientos, que sirven tanto para el médico como para la paciente, a fin de favorecer el bienestar físico, mental y social; sin perder la connotación de los distintos grupos etarios, así como lo alusivo a la función reproductiva y el ciclo gestacional.

Abstract The subject of women's health touches too many aspects, from birth to old age. There are certain conditions that are related to biological sex, but also to problems of sexuality, social inequality, and many types of violence. Therefore, it is necessary to analyze and adapt the information on health, to implement actions towards the target population. Although at first instance medical care involves physical health, mental and social health have become comparable. Focusing on this risk group, practical guidelines, standards and updated scientific information are integrated to explain the main measures that any woman should take throughout her life, and thereby maintain a satisfactory state of health, seek care in Gynecology and Obstetrics, in addition to being able to define the personalized medical follow-up plan. Practical tools are presented through the exposition of a decalogue, called commandments, which serve both the doctor and the patient, in order to promote physical, mental and social well-being; without losing the connotation of the different age groups, as well as the allusion to the reproductive function and the gestational cycle.

Características sociodemográficas que influyen en el embarazo en la adolescencia / Sociodemographic characteristics that influence pregnancy in adolescence

Introducción: el embarazo en la adolescencia constituye un alarmante problema de salud; describir las características que influyen en su aparición permite desarrollar actividades de promoción de salud encaminadas a mejorar dicha situación. Objetivo: describir las características sociodemográficas que influyen el embarazo en la adolescencia. Métodos: estudio observacional, descriptivo, de corte transversal en gestantes adolescentes pertenecientes al Policlínico Docente "7 de noviembre" del municipio Majibacoa durante el año 2020. El universo estuvo constituido por 34 gestantes adolescentes; se trabajó con la totalidad de estas. Se analizaron las variables: edad materna, características sociodemográficas, factores de riesgo familiares, factores de riesgo sociales y económicos y deserción escolar. Resultados: el 55,9% de las gestantes tenía entre 18 y 19 años. El 47% tenían nivel preuniversitario, el 52,9% eran estudiantes; el 67,6% se encontraban en unión y la mayoría tuvo su primera relación sexual después de los 14 años (58,8%). El 32,4% de las gestantes adolescentes eran hijas de madres con algún embarazo en la adolescencia. Se observó con mayor preponderancia el per cápita familiar bajo como factor de riesgo socioeconómico (43,8%). El 58,8% abandonaron sus estudios. Conclusiones: el inicio precoz de las relaciones sexuales, el antecedente de madres con embarazos en la adolescencia, el per cápita familiar bajo favorecen la aparición de una gestación en la adolescencia, donde la mayoría de las veces estas deciden abandonar sus estudios.

Introduction: teenage pregnancy constitutes an alarming health problem; Describing the characteristics that influence its appearance allows the development of health promotion activities aimed at improving this situation. Objective: to describe the sociodemographic characteristics that influence pregnancy in adolescence. Methods:observational, descriptive, cross-sectional study in pregnant teenagers belonging to the Teaching Polyclinic "7 de Noviembre" of the Majibacoa municipality during the year 2020. The universe consisted of 34 pregnant teenagers; all of these were worked on. The variables were analyzed: maternal age, sociodemographic characteristics, family risk factors, social and economic risk factors, and school dropout. Results: 55,9% of the pregnant women were between 18 and 19 years old. 47% had a pre-university level, 52,9% were students; 67,6% were in union and the majority had their first sexual intercourse after the age of 14 (58,8%). 32,4% of the adolescent pregnant women were the daughters of mothers with some pregnancy in adolescence. Low family per capita is exhibited with greater preponderance as a socio-economic risk factor (43,8%). 58,8% dropped out of their studies. Conclusions: the early initiation of sexual relations, the antecedent of mothers with teenage pregnancies, the low family per capita favor the appearance of a pregnancy in adolescence, where most of the time they decide to abandon their studies

Evidências de validade da escala de Bienestar Materno en Situación de Parto / Evidencias de validez de la Escala de Bienestar Materno en Situación de Parto / Validity evidence of the Bienestar Materno en Situación de Parto scale

Resumo Objetivo: Descrever o processo de adaptação transcultural e as evidências de validade e confiabilidade da versão brasileira da Escala de Bienestar Materno en Situación de Parto . Métodos: Estudo do tipo metodológico realizado por meio das etapas de tradução, retrotradução, avaliação por comitê de juízes, pré-teste e validação. O processo de validação incluiu a participação de 500 puérperas que realizaram parto vaginal. Foram realizadas análises fatoriais exploratórias e confirmatórias. Resultados: Após a análise dos juízes, foram aplicadas as alterações sugeridas e todos os itens apresentaram concordância entre os avaliadores acima de 80%. A análise fatorial exploratória e confirmatória indicaram um ajuste satisfatório do modelo com três dimensões e bons índices de confiabilidade (alpha = 0,95 e ômega = 0,94). Conclusão: A versão brasileira abreviada da Escala de Bienestar Materno en Situación de Parto é uma escala de 16 itens que apresenta boas evidências de validade e confiabilidade.

Resumen Objetivo: Describir el proceso de adaptación transcultural y las evidencias de validez y fiabilidad de la versión brasileña de la Escala de Bienestar Materno en Situación de Parto. Métodos: Estudio metodológico realizado mediante las etapas de traducción, retrotraducción, evaluación por comité de jueces, prueba piloto y validación. El proceso de validación incluyó la participación de 500 puérperas que tuvieron parto vaginal. Se realizaron análisis factoriales exploratorios y confirmatorios. Resultados: Después del análisis de los jueces, se aplicaron las modificaciones sugeridas y todos los ítems presentaron concordancia entre los evaluadores superior al 80 %. Los análisis factoriales exploratorios y confirmatorios indicaron un ajuste satisfactorio del modelo con tres dimensiones y buenos índices de fiabilidad (alfa = 0,95 y omega = 0,94). Conclusión: La versión brasileña abreviada de la Escala de Bienestar Materno en Situación de Parto es una escala que presenta buenas evidencias de validez y fiabilidad.

Abstract Objective: To describe the process of cross-cultural adaptation and validity and reliability evidence of the Brazilian version of the Bienestar Materno en Situación de Parto scale (Maternal Well-being in Childbirth Scale). Methods: This is a methodological study carried out through translation, back-translation, assessment by a committee of judges, pre-test, and validation. Validation included participation of 500 mothers who underwent vaginal childbirth. Exploratory and confirmatory factor analyzes were performed. Results: After analysis by judges, the suggested changes were applied, and all items showed agreement among evaluators above 80%. Exploratory and confirmatory factor analysis indicated a satisfactory fit of the model with three dimensions and good reliability indexes (alpha = 0.95 and omega = 0.94). Conclusion: The short Brazilian version of the Bienestar Materno en Situación de Parto scale is a 16-item scale that presents good validity and reliability evidence.

Factores de riesgo de Bajo peso al nacer / Risk factors for low birth weight

RESUMEN Fundamento: el bajo peso al nacer es un problema mundial en el contexto de la salud, ya que pueden presentar serias repercusiones. Objetivo: caracterizar los factores de riesgo asociados al bajo peso al nacer y al nacimiento pretérmino. Métodos: se realizó un estudio transversal descriptivo del bajo peso al nacer, en el policlínico Pedro Borrás Astorga de Pinar del Río durante los años 2015 al 2019. Hubo 1 640 nacimientos en el período y se trabajó con el total de bajo peso al nacer. Se utilizó la estadística descriptiva y los resultados se reflejaron en tablas. Resultados: el índice de bajo peso fue de 5,2 % y el año de mayor índice fue el 2019. El estado civil que prevaleció fue el soltero. Frecuente en las edades extremas de la vida fundamentalmente en las adolescentes y los riesgos médicos maternos previos fueron los antecedentes de parto con bajo peso al nacer, de hipertensión arterial, de bajo peso preconcepcional. Los riesgos médicos durante el embarazo fueron los trastornos hipertensivos, las anemias, amenaza de aborto o parto pretérmino. Prevaleció el parto trans-pelviano entre 28 y 41 semanas, el pretérmino y la restricción del crecimiento intrauterino y el peso mayor de 1 501 gramos. Conclusiones: los resultados mostraron que el bajo peso al nacer constituye una problemática aún sin resolver, asociada a diversos factores de riesgo. Intervenir en la identificación precoz y oportuna de ellos constituye una necesidad, lograr modificar estos proporcionará bienestar materno infantil.

ABSTRACT Background: low birth weight is a world health problem with serious repercussions. Objective: to characterize the risk factors of low birth weight and preterm birth. Methods: a descriptive cross sectional study on low birth weight at the Pedro Borrás Astorga Polyclinic in Pinar del Rio was carried out during the years 2015 to 2019. During that period the number of births was 1,640, of which 85 with low birth weight were studied using descriptive statistics. The results were summarized in tables. Results: the low birth weight rate was 5.2%, with the highest rate in 2019. The predominant civil status of mothers was single. Most of them were of the extreme ages of life, mainly adolescents. The main maternal risks were history of low birth weight delivery, high blood pressure, and low preconception weight. The medical risks during pregnancy were hypertension, anemia, and risk of abortion or preterm birth. In these women prevailed the vaginal delivery at 28 to 41 weeks, mostly preterm, intrauterine growth restriction, and new born weight over 1501 grams. Conclusions: these results show that low birth weight is still an unsolved health problem, related to different risk factors. Interventions for early detection are needed in order to modify them and achieve maternal, fetal and child wellbeing.

Experiences of sharing, learning and caring: Peer support in a Finnish group of mothers.

Mothers' peer groups constitute a form of communal support that affords potential benefits but has received little attention in Finland. At present, only a few studies have investigated the support provided by peer groups of mothers. This article explores mothers' experiences of peer support in a Finnish peer group. First, the data gathered in 2015 comprise data from thematic interviews with 23 mothers participating in peer group activities. Second, the data include written notes gathered during participant observation in the group's 12 meetings, two outings and summer camp. The data were analysed by utilising a phenomenological-hermeneutic approach, and three themes representing mothers' experiences were identified: (a) sharing of experiences, (b) learning from experiences and (c) experiences of mutual caring. By exploring relationships among these themes, this study found that the sharing of experiences is a starting point for learning and caring among mothers. These findings suggest that the sharing of experiences is a crucial part of peer support because it results in learning and caring. Versatile support can be enabled by strengthening the preconditions for sharing.

Práticas obstétricas hospitalares e suas repercussões no bem-estar materno / Prácticas obstétricas hospitalarias y sus repercusiones en el bienestar materno / Hospital obstetric practices and their repercussions on maternal welfare

RESUMO Objetivo Analisar a associação das práticas assistenciais realizadas por profissionais obstétricos com os níveis de bem-estar/mal-estar materno. Método Estudo quantitativo, realizado em uma Unidade de Pré-Parto/Parto/Pós-parto de um Hospital de Ensino com puérperas de parto normal. Foi realizada associação entre as práticas obstétricas e os níveis de bem-estar/mal-estar materno. Resultados Participaram 104 puérperas. As práticas obstétricas que trouxeram mal-estar as parturientes e que obtiveram significância estatística foram: realização de amniotomia (p=0,018), realização de episiotomia (p=0,05), adoção de posições horizontalizadas no período expulsivo (p=0,04), a não utilização de tecnologias não invasivas de cuidado (p=0,029) e o não contato pele a pele mãe-filho (p=0,002). Para a maioria das mulheres, a presença de acompanhante favoreceu o bem-estar, mesmo não tendo uma associação significativamente estatística. Após a realização de regressão logística a não realização de amniotomia foi a única variável que se mostrou significância no bem-estar materno. Conclusão Práticas obstétricas humanizadas têm maior potencial de promover bem-estar materno. Nota-se a importância da enfermeira obstétrica na realização de práticas que proporcionam maior bem-estar às parturientes.

RESUMEN Objetivo Analizar la asociación de las prácticas asistenciales realizadas por profesionales obstétricos con los niveles de bienestar/malestar materno. Método Estudio cuantitativo, realizado en una Unidad de Preparto/Parto/Posparto de un Hospital de Ensino con mujeres puerperales Fue realizada asociación entre las prácticas obstétricas y los niveles de bienestar/malestar materno. Resultados Participaron 104 mujeres puerperales. Las prácticas obstétricas que han traído malestar para las parturientas y que han tenido significancia estadística fueran: realización de amniotomía (p=0,018), realización de episiotomía (p=0,05), adopción de posiciones horizontales en el período expulsivo (p=0,04), la no utilización de las tecnologías no invasivas de cuidado (p=0,029) y el no contacto piel a piel entre madre y hijo (p=0,002). Para la mayoría de las mujeres, la presencia de acompañantes ha favorecido bienestar, mismo sin tener una asociación increíblemente estadística. Después de la realización de la regresión logística no hacer la realización de amniotomía fue la única variable que presentó significancia en el bienestar materno. Conclusión Prácticas obstétricas humanizadas tienen mayor potencial de causar bienestar materno. La enfermera obstétrica en la realización de prácticas que proporcionan mayor bienestar para las mujeres puerperales es de extrema importancia.

ABSTRACT Objective To analyze the association of care practices performed by obstetric professionals with maternal welfare/malaise levels. Method A quantitative study conducted in a Prepartum/Childbirth/Postpartum Unit of a Teaching Hospital with puerperal women who underwent vaginal births. An association was performed between obstetric practices and maternal welfare/malaise levels. Results There were 104 puerperal women who participated. Obstetric practices which caused mothers to feel unwell and which obtained statistical significance were: amniotomy (p = 0.018), episiotomy (p = 0.05), adoption of horizontal positions in the expulsive period (p = 0.04), the non-use of non-invasive care technologies (p = 0.029), and non-skin-to-skin contact between mother and child (p = 0.002). For most women, the presence of a companion favored welfare, even though it did not have a statistically significant association. After performing logistic regression, non-performance of amniotomy was the only variable which showed significance in maternal welfare. Conclusion Humanized obstetric practices have greater potential to promote maternal welfare. The importance of obstetric nurses conducting practices which provide greater welfare to mothers is emphasized.

Humanized practices of obstetric nurses: contributions in maternal welfare / Prácticas humanizadas de la enfermera obstétrica: contribuciones al bienestar materno / Práticas humanizadas da enfermeira obstétrica: contribuições no bem-estar materno

ABSTRACT Objective: To analyze the practice of obstetric nurses operating in a prenatal/delivery/postpartum unit of a university hospital in Mato Grosso and the maternal welfare resulted from the care provided in this scenario. Method: Study with a quantitative approach, carried out in a prenatal/delivery/postpartum unit of a university hospital in Cuiabá, Mato Grosso. The data were collected through the Scale of Maternal Welfare in Delivery Situation 2, and the study included 104 recent mothers in the period from June to September 2016. The data were analyzed in Epi Info version 7. Results: The results indicate that the practice of obstetric nurses is based on the humanization of labor and childbirth, however, the presence of invasive and unnecessary practices in the service did not influence the level of maternal welfare, which was optimum for 76% of the women. Conclusion: The lack of information might make the women less critical and, therefore, influence the evaluation of the care received

RESUMEN Objetivo: Analizar la práctica de enfermeras obstétricas actuantes en una unidad de pre-parto/parto/posparto de un hospital universitario del estado de Mato Grosso y el bienestar materno resultante de la asistencia en esa situación. Método: Estudio de abordaje cuantitativo, realizado en una unidad de pre-parto/parto/posparto de un hospital universitario de Cuiabá, Mato Grosso. Los datos fueron recolectados por medio de la Escala de Bienestar Materno en Situación de Parto 2, y el estudio abarcó 104 puérperas en el período de junio a septiembre de 2016. Se analizaron los datos en el software Epi Info versión 7. Resultados: Los resultados indican que la práctica de las enfermeras obstétricas se basa en la humanización del parto y del nacimiento; sin embargo, la presencia de prácticas invasivas e innecesarias en el servicio no influenció el nivel de bienestar materno, que se mostró bueno para el 76% de las mujeres. Conclusión: La falta de información puede hacer que las mujeres sean menos críticas y, por tanto, influir en la evaluación de la asistencia recibida.

RESUMO Objetivo: Analisar a prática de enfermeiras obstétricas atuantes em uma unidade de pré-parto/parto/pós-parto de um hospital universitário do estado de Mato Grosso e o bem-estar materno resultante da assistência nesse cenário. Método: Estudo de abordagem quantitativa, realizado em uma unidade de pré-parto/parto/pós-parto de um hospital universitário de Cuiabá, Mato Grosso. Os dados foram coletados por meio da Escala de Bem-Estar Materno em Situação de Parto 2, e o estudo abrangeu 104 puérperas no período de junho a setembro de 2016. Os dados foram analisados no programa Epi Info versão 7. Resultados: Os resultados indicam que a prática das enfermeiras obstétricas está pautada na humanização do parto e nascimento, contudo, a presença de práticas invasivas e desnecessárias no serviço não influenciou o nível de bem-estar materno que foi ótimo para 76% das mulheres. Conclusão: A falta de informação pode tornar as mulheres menos críticas e, consequentemente, influenciar a avaliação da assistência recebida

Major Determinants of Maternal Near-Miss and Mortality at the Maternity Teaching Hospital, Erbil city, Iraq.

OBJECTIVES: To find out the major determinants of maternal near-miss (NM)and maternal deaths (MDs) in Erbil city, Iraq, by comparative analysis of maternal NMs and MDs. METHODS: We conducted a hospital-based cross-sectional study in the Maternity Teaching Hospital in Erbil city from 1 June to 31 December 2013. All MDs and NMs that occurred in the hospital during the study period were included in the study. Systematic identification of all eligible women was done. This identification included a baseline assessment of the severe pregnancy-related complications using the World Health Organization NM criteria. RESULTS: Severe preeclampsia and postpartum hemorrhage (PPH) constituted the highest proportions of complications in women with potentially life-threatening conditions (PLTCs) (30.5% and 30.0%, respectively). The highest mortality indexes were those for ruptured uterus (16.7) and severe complications of placenta previa (14.2). Factors that were significantly associated with MD (compared to NM) were hepatic dysfunction (p = 0.046), multiple/unspecified disorders (p = 0.003), arrival as an emergency condition by ambulance (p = 0.015), and history of previous cesarean section (p = 0.013). CONCLUSIONS: Severe preeclampsia and PPH are the main complications that lead to PLTCs. Factors found to be associated with MDs are hepatic dysfunction, multiple/unspecified disorders, arrival as an emergency condition by ambulance, and history of a previous cesarean section.

Postpartum Pain in the Community Among Migrant and Non-migrant Women in Canada.

International migrant women of childbearing age represent a large proportion of immigrants to high-income countries, yet research focusing on their postpartum health is limited. We investigated predictive factors for breast and non-breast pain 1 week post-birth in migrant and non-migrant women in Canada. Among migrant women, difficulty accessing health services; being from a middle-or high-income country; poor functionality in English and French; living with the father of their infant; and having no regular care provider were predictive of breast pain. Among non-migrant women, difficulties accessing health services, multiparity and prenatal education were predictive of breast pain, while receiving an epidural and having no regular care provider were predictive of non-breast pain. Among both groups, difficulties accessing health services and having no regular care provider were predictive of breast pain, while second degree or higher perineal tearing was predictive of non-breast pain. Migration-specific indicators should be considered in postpartum care planning.

Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.

BACKGROUND: Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers' knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria. METHODS: This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers - and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0. RESULTS: Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their 'Standing Order'; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community. CONCLUSION: Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres. TRIAL REGISTRATION: NCT01911494 .

At the crossroads: the health and welfare of new mothers.

BACKGROUND: Institutionalized practice is failing to keep pace with cultural change in regard to gendered expectations. After the birth of an infant there are high rates of marital breakdown, high rates of anxiety and depression, and issues related to identity. OBJECTIVES/AIMS: The aim was to gauge how a sample of Australian women were travelling through the Transition to Parenthood. METHODS/DESIGN: A qualitative study of 16 women who had their first child in 2004/2005. While using a non-probability sample, selection involved steps to promote diversity of background. RESULTS/FINDINGS: One half of the interviewees had difficulties in their relationship with husband/partner, for some this was traumatic. Most did not raise these concerns with their health nurse and spoke of a need to become 'selfless'. CONCLUSION: Early years health services need to be reviewed so as respond to issues raised by the TtoP, and include a focus on the social and cultural context of birth.

Factors associated with anemia in children under three years of age in Perú: analysis of the Encuesta Demográfica y de Salud Familiar, ENDES, 2007-2013.

INTRODUCTION: Despite the reduction of poverty in Perú, the prevalence of anemia in the country remains high.  OBJECTIVE: To identify socio-demographic, child and maternal-child care factors associated with anemia in children between 6 and 35 months in Perú.  MATERIALS AND METHODS: We conducted an analytical and descriptive study that included registered data from the national survey on demography and family health, 2007-2013, on children between 6 and 35 months old, including the measurement of blood hemoglobin. Anemia was confirmed by hemoglobin-altitude corrected values below 11 mg/dl. We used multivariate logistic regression models to assess potential associated factors for anemia.  RESULTS: Anemia prevalence was high (47.9%). Twelve factors were independently associated with anemia in children: Socio-demographic factors such as living outside Lima and Callao, in a low socioeconomic household, and having an adolescent mother with low education level; child-related factors as being male, younger than 24 months of age, and having fever in the previous two weeks, and maternal-child care factors such as lack of prenatal control in the first trimester of pregnancy, lack or short period of iron supplementation during pregnancy, house delivery, anemia detection at the moment of the survey, and lack of intestinal anti-parasite preventive treatment in the child.  CONCLUSIONS: The analysis of survey data provided valuable information about factors associated with anemia in children between 6 and 35 months, which can be used to increase the coverage and effectiveness of maternal-child care practices.

Prácticas de cuidado y su influencia durante la gestación en Tunja, Colombia / Care practices and its influence during pregnancy in the city of Tunja, Colombia

Introducción: durante la gestación se realizan prácticas de cuidado que influyen en el binomio madre-hijo. Objetivo: identificar el cuidado que realiza la gestante para sí y para su hijo por nacer. Métodos: estudio descriptivo de corte transversal, participaron 130 gestantes en segundo y tercer trimestre de embarazo, sin enfermedades asociadas, en la ciudad de Tunja, Colombia, durante el 2014. Se aplicó el instrumento de prácticas de cuidado que realizan consigo mismo y con el hijo por nacer, validado por la Universidad Nacional de Colombia. Se utilizaron las categorías mala, regular y buena práctica. Los datos se procesaron utilizando estadística descriptiva (frecuencias absolutas, porcentajes, promedios, desviaciones estándar, valores mínimo y máximo). Resultados: los hallazgos encontrados en la dimensión de estimulación prenatal revelan como el 39,23 por ciento de la muestra, estimula al feto colocándole música. El 80,00 por ciento de las gestantes nunca estimula al hijo con luz a través del abdomen, la estimulación táctil mostró una buena práctica. La actividad física constituyó una buena práctica que ayuda a mantener un peso adecuado y a prepararse para el trabajo de parto, el 50,00 por ciento, realiza actividad física 30 minutos a la semana. Existe déficit en el consumo de alimentos esenciales durante el embarazo. Conclusiones: en la muestra de estudio hubo déficit en la realización de prácticas de cuidado necesarias para la adecuada salud materna, fetal y neonatal, evidenciando la necesidad de desarrollar estrategias con base en los contextos y entornos propios de la gestante por parte del personal de salud que brinda atención en el cuidado materno(AU)

Introduction: During pregnancy care practices which affect the mother and child are realized. Objective: To identify the mother takes care for themselves and their unborn child. Methods: Cross-sectional study, 130 pregnant women participated in second and third trimester of pregnancy, with no associated in the city of Tunja, Colombia during 2014. illnesses instrument care practices engaged himself and the son was applied by birth, validated by the National University of Colombia. the poor, fair and good practice categories were used. Data were analyzed using descriptive statistics (absolute frequencies, percentages, means, standard deviations, minimum and maximum values). Results: The findings in the dimension of prenatal stimulation revealed as 39,23 percent of the sample, placing music stimulates the fetus. 80,00 percent of pregnant women never encourages the child to light through the abdomen, tactile stimulation showed a good practice. Physical activity was a good practice that helps maintain a healthy weight and prepare for labor, 50,00 percent physically active 30 minutes a week. There deficit in the consumption of essential foods during pregnancy. Conclusions: This study evidenced the need to develop strategies based on their own contexts and environments of the mother by the staff as there is a deficit in the experiments of care necessary for proper maternal, fetal and neonatal health, evidencing providing health care in maternal care(AU)