Feature Article-The International Childbirth Initiative: Twelve Steps to Safe and Respectful MotherBaby-Family Maternity Care.

In 2019, the International MotherBaby Childbirth Organization (IMBCO) and the International Federation of Gynecology and Obstetrics (FIGO) released The International Childbirth Initiative (ICI): Twelve Steps to Safe and Respectful MotherBaby-Family Maternity Care. The 12 steps reflect the most recent evidence and understanding of what constitutes safe, respectful maternity care. This column presents the 12 steps and describes the process for developing the ICI.

Risk management-Evaluation of healthcare professionals' reasoning about and understanding of maternity care.

AIM: To evaluate healthcare professionals' explanations of the prerequisites for safe maternity care and understanding of risk management, including the underlying reasons for decision-making intended to ensure safe care. BACKGROUND: Risk management focuses on maintaining and promoting safe care by identifying circumstances that place childbearing women at risk of harm, thus reducing risks. METHODS: A hermeneutic action research approach was chosen. Through a series of focus group sessions, we uncovered healthcare professionals' explanations of risk management. RESULTS: One overriding theme emerged; the consequences of what managers do or fail to do constitute the meaning of taking responsibility for team collaboration to provide safe care. Inadequate support, resources and staff shortages have consequences, such as inability to concentrate on team communication and collaboration, leading to the risk of unsafe care. CONCLUSION: Communication constitutes a prerequisite for both team collaboration and risk management. Thus, communication is linked to the ability of managers and healthcare professionals to provide safe care. IMPLICATIONS FOR NURSING MANAGEMENT: In terms of safety management, nurse managers have a significant role in and responsibility for supporting communication training, developing guidelines and providing the prerequisites for interprofessional team reflection.

Competências para o cuidado de mulheres no parto e nascimento mobilizadas em egressos de um curso nacional de especialização em enfermagem obstétrica / Skills for the care of women in childbirth mobilized in graduates of a national specialization course in obstetric nursing

A atenção obstétrica no Brasil e no mundo vivenciou consideráveis progressos, a exemplo da redução da razão de mortalidade e taxas de morbidade materna e neonatal. A enfermagem obstétrica é apontada como uma das profissões potenciais para mudança do modelo obstétrico vigente no Brasil. No entanto, desafios ainda persistem para a efetivação do modelo humanizado e para a atuação da enfermagem, e um deles está no quantitativo de profissionais formados, preparados e qualificados para tal. Compreendendo este desafio, a Escola de Enfermagem da Universidade Federal de Minas Gerais, com financiamento do Ministério da Saúde e vinculado à Rede Cegonha, desenvolve o Curso de Especialização em Enfermagem Obstétrica (CEEO), em parceria com Instituições Federais de Ensino Superior (IFES) de todas as regiões do país. O Curso objetivou a formação de especialistas com atuação em serviços públicos de atenção obstétrica, que além de seguir marcos legais e políticos nacionais para a certificação, adotou as Competências Essenciais (CE) para o exercício básico da obstetrícia como referência. Neste contexto, esta dissertação teve por objetivo identificar as competências mobilizadas por enfermeiros trabalhadores egressos de um curso nacional de especialização em Enfermagem Obstétrica. Esta pesquisa é um recorte de um estudo maior intitulado "Especialização em Enfermagem Obstétrica: avaliação do processo de desenvolvimento e efeitos do curso na perspectiva da formação-intervenção", não experimental, descritiva e de abordagem quantitativa, com uso de banco de dados. Os locais da pesquisa foram as IFES que sediaram o CEEO II ­ Rede Cegonha que ocorreu durante o período de Outubro de 2016 a Janeiro de 2019. Os participantes foram trabalhadores especializandos que concluíram o curso em janeiro de 2019. A coleta de dados foi realizada por meio de dois questionários autoaplicáveis: um referente aos dados sócio demográficos e informações profissionais e o segundo sobre as CE. Os dados foram analisados por meio de estatística descritiva e analítica. Os resultados apontaram para um alto escore de competência e confiança nos domínios relacionados ao trabalho de parto, parto, nascimento e cuidados com o recém-nascido. As competências com maiores escores estavam relacionadas à amamentação, cuidados com o RN em sala de parto e fisiologia do trabalho de parto e as competências com menores escores relacionadas às emergências e urgências obstétricas. Os maiores escores eram dos profissionais com menor tempo de atuação na área, que assistiram entre 20 e 39 partos, que participaram de cursos e eventos nos últimos anos e que prestava assistência em partos na instituição em que atuava. Os resultados evidenciaram que o CEEO II ­ Rede Cegonha contribuiu para a formação de um quantitativo de profissionais qualificados e competentes para atenção obstétrica no e para o SUS e para o fortalecimento das capacidades institucionais, uma vez que investiu na força de trabalho com foco nas necessidades dos serviços e competências de campo, aumentando seus poderes de agir e rumo às mudanças efetivas no modo de ofertarem o cuidado.(AU)

In the whole world midwifery had considerable progress, for example the decrease of mortality and rates of maternal and neonatal morbidity. The midwives are pointed out as one of the potential professional to change the Brazilian obstetric model. However there are challenges that still persist for the implementation of the humanized model and for the performance of nursing, and one of them is the number of prepared and contemplated professionals to offer assistance. In this context, the Nursing School of the Federal University of Minas Gerais, with funding from the Ministry of Health and linked to the Rede Cegonha strategy, develops the Specialization Course in Obstetric Nursing (CEEO), in partnership with Federal Institutions of Higher Education (IFES) at all regions of the country. The course aimed to educate nurses from public health services in nursing obstetrics, adopting the essential competences (CE) for the basic exercise of obstetrics as a reference. In this context, this dissertation aimed to identify the competencies mobilized by the graduated nurses of a national course of specialization in Obstetric Nursing. This research is a part of larger study "Specialization in Obstetric Nursing: evaluation of the process of development and effects in the perspective of training-intervention", a non-experimental, descriptive study with quantitative approach, using database. The research places were the IFES that hosted CEEO II ­ Rede Cegonha from October 2016 to January 2019. Data were collected through two self-applied questionnaires: one given to socio-demographic data and professional information and the second on CE. Data were analyzed using descriptive and analytical statistics. The results pointed to a high score of competence and confidence in data on labor, delivery care and care of the newborn. The competencies with higher scores were related to breastfeeding, care of newborns in the delivery room and physiology of labor, and those with lower scores related to emergencies and obstetric emergencies. The highest scores were from professionals with less time in the area, who attended between 20 and 39 births, who participated in courses and events in the last years and those who assist deliveries at the institution they work. The results showed that CEEO contributed to the formation of a number of qualified and competent professionals for obstetric care in and for the National Health System and for the strengthening of institutional capacities, since it invested in the workforce of health professional focusing on the needs of the services and field competencies, increasing their powers of action and towards the effective changes in offering care.(AU)

Quality of care provided in two Scottish rural community maternity units: a retrospective case review.

BACKGROUND: Women in Scotland with uncomplicated pregnancies are encouraged by professional bodies and national guidelines to access community based models of midwife-led care for their labour and birth. The evidence base for these guidelines relates to comparisons of predominantly urban birth settings in England. There appears to be little evidence available about the quality of the care during the antenatal, birth and post birth periods available for women within the Scottish Community Maternity Unit (CMU) model. The research aim was to explore the safety and effectiveness of the maternity services provided at two rural Community Maternity Units in Scotland, both 40 miles by main road access from a tertiary obstetric unit. METHODS: Following appropriate NHS and University ethical approval, an anonymous retrospective review of consecutive maternity records for all women who accessed care at the CMUs over a 12 month period (June 2011 to May 2012) was undertaken in 2013 -14. Data was extracted using variables chosen to provide a description of the socio-demographics of the cohort and the process and outcomes of the care provided. Data were analysed using descriptive statistics. RESULTS: Regarding effectiveness, the correct care pathway was allocated to 97.5% of women, early access to antenatal care achieved by 95.7% of women, 94.8% of women at one CMU received continuity of carer and 78.6% of those clinically eligible accessed care in labour. 11.9% were appropriately transferred to obstetrician-led care antenatally and 16.9% were transferred in labour. All women received one-to one care in labour and 67.1% of babies born at the CMUs were breastfed at birth. Regarding safety, severe morbidity for women was rare, perineal trauma of 3rd degree tear occurred for 0.3% of women and 1.0% experienced an episiotomy. Severe post partum haemorrhage occurred for 0.3% of women. Babies admitted to the Neonatal unit were discharged within 48 hrs. CONCLUSION: These findings support the recommendations of professional bodies and national guidelines. Maternity service provision at rural CMUs achieved a consistently high standard of safety and effectiveness when measured against national standards and international evidence.

Control prenatal y su impacto en la mortalidad materna: Análisis de una tendencia, 1994-2004: Cali, Colombia / Prenatal control and its impact on reducing maternal deaths: Trend analysis, 1994-2004: Cali, Colombia

Objetivo: analizar el comportamiento de las razones de mortalidad materna en la ciudad de Cali (Colombia) durante dos décadas, 1985 a 2004, a la luz de indicadores de desarrollo social y organización de los servicios de atención a la gestante. Metodología: se utiliza como marco conceptual el modelo canadiense propuesto por Laframboise y Lalonde en 1974, para explicar la contribución de los servicios de salud en la disminución de las tasas de mortalidad materna. Resultados: a partir de 1994 se inició un descenso sostenido de la mortalidad materna, que se ha mantenido hasta el 2004. Durante este período no se evidenció un mejoramiento cuantitativo significativo de los indicadores de desarrollo social y económico de la ciudad de Cali. Las altas coberturas de atención prenatal (97%) y del parto institucional (98%), junto con un sistema eficiente de referencia y contrareferencia, se mantuvieron estables. El control de los procesos de mejoramiento de la calidad de la atención prenatal, con evaluaciones y ajustes periódicos, y la participación permanente de ginecobstetras en el nivel primario de atención, constituyeron los hitos primordiales de las intervenciones realizadas en la red de servicios públicos de atención. Discusión: los factores de riesgo intervenidos en la atención prenatal, la alta cobertura institucional de atención del parto y una red de referencia y contrareferencia de pacientes, oportuna y eficiente, parecen ser responsables de la disminución del 80% de las muertes, según el cálculo de Guzmán en 1986.

Objective: analysing the statistical data regarding maternal deaths in Cali (Colombia) during two consecutive decades (1985-2004) and correlating outcomes with environmental and social indicators. Methodology: the Canadian Laframboise conceptual model was used for explaining how health service organisation and other aspects of medical care play a part in decreasing maternal mortality rates. Results: maternal deaths in Cali have been decreasing since 1994. No significant quantitative variations in environmental and/or social indicators for Cali were detected from 1994-2004. High prenatal control (97%) and institutional delivery coverage (98%) remained stable, together with an efficient referral and counter-referral system. Improving prenatal attention quality through periodic evaluation and adjustment and obstetrician/gynaecologists’ ongoing participation in first-level attention were the highlights of public attention service network intervention. Discussion: prenatal risk factors, broad institutional coverage for a quality motherhood care programme and an efficient referral system have all contributed towards reducing maternal deaths by nearly 80 (taking Guzmán’s 1986 calculation as reference point).

Maternidade segura: relato de experiência de uma nova prática em Natal/RN - Brasil / Safe maternity: an experience report of a new practice in Natal/RN-Brazil / Maternidad segura: relato de experiencia de una nueva práctica en Natal/RN-Brasil

Trabalho descritivo do tipo relato de experiência, desenvolvido na Maternidade Escola Januário Cicco da Universidade Federal do Rio Grande do Norte (MEJC/UFRN) em Natal/RN desde 1996, onde cinco enfermeiras iniciaram mudanças em suas práticas profissionais a partir da implantação do Projeto de "Curso de Especialização em Enfermagem Obstétrica - Habilidades de Enfermagem Midwifery para uma Maternidade Segura." O Projeto tem como objetivos, diminuir ou eliminar riscos às mulheres que desejam engravidar e/ou ter filhos e garantir uma assistência humanizada durante a gravidez, trabalho de parto, parto, pós-parto e nascimento. Estes objetivos deverão ser alcançados através de profissionais mais conscientes que lidam com o complexo de valores, decisões e ações, envolvendo o processo saúde/doença relacionados à mulher no ciclo grávido puerperal. Foram criados Padrões de Qualidade na Assistência à Admissão, Trabalho de Parto, Parto, Pós-Parto, Recém-Nascido e Visita Domiciliar de até 1 mês de vida. Desde sua implantação, o Projeto já vislumbra algumas mudanças no serviço, na participação ativa do enfermeiro no processo do nascimento, proporcionando, fundamentalmente, satisfação à parturiente e aos profissionais envolvidos nesse Projeto.

This is a descritive work of the experience report type developed in the Januário Cicco School Maternity/UFRN in Natal/Rn since 1996, when five nurses gegun changes in her professional practices, through of yeh Project of "Especialization of Obstetric Nursing: Nursing Midwifery Skills for a Safe Maternity" The objectives of the study are to reduce or to eliminate risks for the women that wish to stay pregnant and/or to have kids and to guarantee na humaning assistance during pregnant, delivey, pos-natal and chilbirth that will be obtain through of conscious professionals that works with value complex, decisions and actions, involving the health/ill, process related of the woman in the pregnant pos-natal cycle. Were created Standards of Quality in the Admission Assistance, Labour, Delivery, Pos-Natal, Chilbirth and Domiciliare Visit until one month of life. Since it implantation, the Project already shows some changes in the service the active participation of the nurse in the childbirth process, offering, essencialy, satisfaction at the parturient and to the professionals involves in the Project.

Trabajo descritivo de lo tipo relato de la experiencia, desenvuelto en la Maternidad Escuela Januario Cicco de la Universidad Federal del Rio Grande del Norte (MEJC/UFRN) en Natal/RN desde 1996, cual cinco enfermeras iniciaram mudanças en su practicas profesionales a partir de la implantación de lo Proyecto del "Curso de Especializacion en Enfermería Obstetra: Habilidades de Enfermería Midwifery para una Maternidad Segura." Al Proyecto tiene como objetivos, diminuir ou eliminar ríeseos en las mujeres que desejan engravidar ou tener niños y grarntir una asistencia humanizada durante la gravidez, trabajo de parto, parto, sobreparto y nacimiento. Estes objetivos deverão ser alcanzados através de los profesionales mais conscientes que lidan con los complexos de los valores, decisiones y acciones, envolvendo el proceso salud/enfermidad relacionados a la mujer en lo ciclo grávido puerperal. Foram criados Padrones de Qualidad en la Assistência de la Admisione, Trabajo de Parto, Parto, Sobreparto, Recien-Nascido y Visita Domiciliaria ate uno mês de vida. Desde su implantacione, el Proyecto ja visualiza algunas mudanças en lo serviço, en la participación activa de lo enfermero en el proceso de lo nacimiento, proporcionando, fundamentalmente, satisfacion a la pareja y los profesionales envolvidos en esse Proyecto.