Tecnologias não invasivas de cuidado utilizadas por enfermeiras obstétricas: contribuições terapêuticas / Tecnologías de atención no invasiva utilizadas por las enfermeras obstétricas: contribuciones terapêuticas / Non-invasive care technologies used by obstetric nurses: therapeutics contributions

Resumo Objetivo descrever as contribuições terapêuticas da utilização de tecnologias não invasivas de cuidado, oferecidas por enfermeiras obstétricas, durante o trabalho de parto. Método estudo qualitativo e descritivo, com oito enfermeiras obstétricas da casa de parto do Rio de Janeiro. Os dados foram coletados de setembro a dezembro de 2018, através de entrevistas semiestruturadas, e submetidos à técnica de análise temática. Resultados para aliviar a dor e promover relaxamento, recorrem ao estímulo à participação do acompanhante e à respiração consciente, à aplicação da massagem, à promoção do ambiente acolhedor e ao uso da água morna e dos óleos essenciais. Para ativar o trabalho de parto, auxiliar na descida da apresentação e correção do posicionamento fetal, incentivam posicionamentos verticalizados e movimentos corporais, com alguns instrumentos. Conclusões e implicações para a prática tecnologias não invasivas de cuidado possuem contribuições terapêuticas e conformam um cuidado desmedicalizado, respeitoso e centrado na mulher, que promove a autonomia feminina.

Resumen Objetivo describir las contribuciones terapéuticas de la utilización de tecnologías de atención no invasivas que ofrecen las enfermeras obstétricas durante el trabajo de parto. Método estudio cualitativo y descriptivo, con ocho enfermeras obstétricas de una casa de partos de Río de Janeiro. Los datos fueron recolectados de septiembre a diciembre de 2018, a través de entrevistas semiestructuradas, y sometidos a la técnica de análisis temático. Resultados para aliviar el dolor y favorecer la relajación, se recurre a fomentar la participación del acompañante y la respiración consciente, la aplicación de masajes, la promoción de un ambiente acogedor y el uso de agua tibia y aceites esenciales. Para activar el trabajo de parto, facilitan en el descenso de la presentación y corrección del posicionamiento fetal, fomentan las posiciones verticales y los movimientos corporales, con algunos instrumentos. Conclusiones e implicaciones para la práctica las tecnologías de atención no invasiva tienen aportes terapéuticos y conforman un cuidado desmedicalizado, respetuoso y centrado en la mujer que promueve la autonomía femenina.

Abstract Objective to describe the therapeutics contributions of the use of non-invasive care technologies offered by obstetric nurses during labor. Method a qualitative and descriptive study, with eight obstetric nurses from a birthing center in Rio de Janeiro. Data were collected from September to December 2018, through semi-structured interviews, and subjected to thematic analysis technique. Results to relieve pain and promote relaxation, they resort to encouraging the companion's participation and conscious breathing, the application of massage, the promotion of a supportive environment and the use of warm water and essential oils. To activate labor, assist in descending the presentation and correction of fetal positioning, they encourage vertical positioning and body movements, with some instruments. Conclusions and implications for practice non-invasive care technologies have therapeutic contributions and form a not medicalized, respectful and women-centered care that promotes female autonomy.

Percepciones y deseos sobre el parto en gestantes a término en Zamora / Perceptions and wishes about delivery of full-term pregnant women in Zamora

OBJETIVO: Describir las percepciones y deseos sobre el parto en un grupo de gestantes a término de Zamora. MÉTODO: Estudio cualitativo de carácter fenomenológico. Participantes y ámbito de estudio: embarazadas de 37-38 semanas, centros de salud Zamora Sur y Santa Elena (Zamora). Recogida de datos: entrevistas semiestructuradas, hasta llegar a saturación de datos (16 entrevistas). Análisis de datos: análisis de contenido temático. RESULTADOS: Los sentimientos maternos variaron desde la alegría hasta el miedo o el estrés. Las entrevistadas manifestaron no sentirse capaces de soportar el dolor del parto. Las necesidades que sintieron como más importantes fueron contar con apoyo y acompañamiento en el parto (sobre todo de su pareja) y recibir buen trato de los sanitarios. CONCLUSIONES: La importancia y la repercusión del parto para la mujer no solo atiende al ámbito biológico, sino en gran medida también al mental, al emocional y al social. En él intervienen múltiples factores que lo condicionan: los sentimientos maternos, su capacidad de afrontar el dolor del parto, sus necesidades, sus cambios realizados, el apoyo con el que cuentan y los profesionales sanitarios que atienden a la mujer

OBJECTIVE: To describe perceptions and wishes regarding childbirth in a group of full-term pregnant women in Zamora. METHOD: Qualitative study of phenomenological character. Participants and scope of study: pregnant women (37-38 weeks), Zamora Sur and Santa Elena health centres (Zamora, Spain). Data collection: semi-structured interviews, until data saturation (16 interviews). Data analysis: analysis of thematic content. RESULTS: The maternal feelings varied from joy to fear or stress. The interviewees said they did not feel capable of enduring the pain of childbirth. The needs that they felt most important were having support and accompaniment during delivery (especially of their partner) and receiving good treatment from the healthcare workers. CONCLUSIONS: The importance and repercussion of childbirth for women are not only biological, but also largely mental, emotional and social. It is conditioned by multiple factors: maternal feelings, their ability to deal with the pain of childbirth, their needs, the changes they have made, the support they have and the health professionals who care for them

Reduction of labour pain with back massage

Labour is the process of opening and thinning of the cervix and the foetus descending into the birth canal. Pain in the first stage of labour is due to cervical dilatation, lower uterine segments, the presence of opposing prisoners, the pull and injury to the muscle tissue and ligaments that support the structure above. Back massage technique is one of the methods to reduce labour pain. The purpose of this study is to determine the effect of back massage on the reduction of labour pain during the active phase. This type of research uses a quasi-experimental design with a non-equivalent control group. The sample of this research was 31 women who were taken by accidental sampling at BPM Yusida Edward Palembang. The instrument used was an observation sheet to measure labour pain. The results of univariate analysis of most mothers experienced severe pain 48.4%, moderate pain 44.4%, pain very severe 3.2% and after back massages most of the mothers felt moderate pain 71%, mild pain 16%, severe pain 13%. Bivariate data analysis techniques used the Kolmogorov-Smirnov normality test and paired sample T-test. The conclusion of this study is that back massage influences the reduction of labour pain during the active phase. Therefore, it is recommended for health workers, especially midwives, to improve the quality of childbirth care services using back massage techniques to reduce labour pain in the first stage

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Reviewing pain management options for patients in active labor.

Pain perception and preferences for pain management are unique to each woman in labor. This article provides an overview of the physiology of labor pain, discusses available nonpharmacologic and pharmacologic approaches to managing pain during active labor, and discusses potential benefits and risks for each option.

The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial.

OBJECTIVE: This study was conducted to investigate the effects of cognitive behavioral techniques using virtual reality on birth pain. DESING: This study was planned as a double blind randomized controlled experimental study. SETTING AND PARTICIPANTS: It was conducted with 273 pregnant women who were randomized between July 2016 and June 2019 at maternity hospital located in eastern Anatolia, Turkey. METHODS: The study included 5 groups. (A: videos of newborn photographs with classical music, B: the video of the newborn photograph album, C: an introductory film of Turkey, D: only classical music, E: routine hospital care). The data were collected by using the "Personal Information Form", "Visual Analogue Scale", "Verbal Rating Scale" and "Virtual Reality". FINDINGS: Groups show homogeneity in terms of demographic and obstetric variables. It was found that mean Visual Analogue Scale posttest mean score of the group A was 4.98 ± 1.69; group B 4.96 ± 1.72; group C 5.96 ± 2.05; group D 5.60 ± 1.63 and group E 6.38 ± 1.86. Mean Verbal Rating Scale posttest score was found that group A was 2.64 ± 0.73, group B 2.70 ± 0.87, group C 3.18 ± 1.14, group D was 2.80 ± 0.86 and group E was 3.96 ± 1.01. It was obtained that the groups' mean Visual Analogue Scale and Verbal Rating Scale posttest mean scores was statistically significant (p<0.05). CONCLUSION: In this study, all cognitive techniques applied with virtual reality reduced labor pain during the active phase of labor. Especially the video of newborn photographs with classical music and newborn photograph album have been found more effective than other interventions evaluated in reducing labor pain. IMPLICATIONS FOR PRACTICE: Midwives can use these techniques to reduce birth pain.

Tecnologias de cuidado para o alívio da dor na parturição / Care techniques for pain relief in birthing / Tecnologías de cuidado para el alivio del dolor en la partición

Objetivo: este estudo objetivou conhecer as tecnologias de cuidado no alívio da dor no processo de parturição em um hospital de ensino. Método: pesquisa qualitativa e descritiva com 10 puérperas internadas em uma unidade materno-infantil no período de maio a junho de 2017. Os dados foram coletados por meio de entrevistas individuais e analisados conforme a Proposta Operativa de Minayo. Resultados: as puérperas que usaram as tecnologias de alívio da dor no processo de parturição julgaram como excelente e de grande valia os métodos para o alívio da dor. Conclusão: conclui-se que estas tecnologias são importantes para a autonomia e protagonismo da mulher e a vivência positiva do seu processo de parturição, sendo fundamental o investimento em outros métodos de alívio da dor, de modo a qualificar e tornar o parto mais prazeroso e menos traumatizante

Objective: this study aimed to identify the care technologies in pain relief in the birthing process in a teaching hospital. Method: qualitative and descriptive research, in which ten women in labor were hospitalized in a hospital maternal unit, from May to June 2017. Data were collected through individual interviews and analyzed according to Minayo's Operative Proposal. Results: postpartum women who used pain relief technologies in the birthing process considered the methods of pain relief as excellent and of great value. Conclusion: we concluded that these technologies are important for the autonomy and protagonism of women and the positive experience of their process of birthing, recognizing the importance of investing in other methods of pain relief, in order to qualify and make birthing process more pleasurable and less traumatic

Objetivo: este estudio objetivó conocer las tecnologías de cuidado en el alivio del dolor en el proceso de parturición en un hospital de enseñanza. Método: investigación cualitativa y descriptiva, en la que participaron diez puérperas internadas en una unidad materna hospitalaria, en el período de mayo a junio de 2017. Los datos fueron recolectados a través de entrevistas individuales, y analizados conforme a la Propuesta Operativa de Minayo. Resultados: las puérperas que usaron las tecnologías de alivio del dolor en el proceso de parturiado juzgaron como excelente y de gran valor los métodos para el alivio del dolor. Conclusión: se concluye que estas tecnologías son importantes para la autonomía y protagonismo de la mujer y la vivencia positiva de su proceso de parturión, siendo importantes inversiones en otros métodos de alivio del dolor, para calificar y hacer el parto más placentero y menos traumatizante

A Quality Improvement Initiative to Reduce Opioid Consumption after Cesarean Birth.

BACKGROUND: One in 300 opioid naïve women become addicted to opiates after cesarean birth. After cesarean, women are often prescribed more opiates at discharge than necessary, resulting in increased opportunity for diversion. PURPOSE: To improve use of comfort strategies and nonopioid medications to decrease the amount of opioids required postoperatively and prescribed at discharge, in women who gave birth via cesarean. METHODS: An interdisciplinary workgroup was convened to assess data on opioid use, prescribing practices at discharge, and nurses' use of alternative comfort strategies from January to March 2018. A comfort bundle was designed to include standardized use of preoperative acetaminophen, postoperative comfort education, simethicone, postoperative gum chewing, and abdominal binders. Nurses and healthcare providers were educated on the initiative. Data were reevaluated and compared with preintervention data assessing for improvement and adherence to the bundle components. RESULTS: There was a 61% reduction in morphine milliequivalents given to women after cesarean birth between the first quarter in 2018 and the fourth quarter in 2018. Comparing March with December, 2018 data, adherence to each bundle component improved. The percentage of women receiving less than 20 tabs of oxycodone at discharge increased from 26.3% to 96.7%. IMPLICATIONS FOR NURSING PRACTICE: Nurses should evaluate comfort options provided after cesarean birth and educate women about use of nonopioid pain relief strategies. A standardized process to address pain and comfort after cesarean birth may decrease exposure to opioids while maintaining comfort.

Effect of Change in Position and Back Massage on Pain Perception during First Stage of Labor.

BACKGROUND: Labor is one of the most painful events in a women's life. Frequent change in positions and back massage may be effective in reducing pain during the first stage of labor. AIM: The focus of this study was to identify the impact of either change in position or back massage on pain perception during first stage of labor. DESIGN: A quasi-experimental study. SETTING: Teaching hospital, Kurdistan Region, Iraq, November 2014 to October 2015. SUBJECTS: Eighty women were interviewed as a study sample when admitted to the labor and delivery area and divided into three groups: 20 women received frequent changes in position (group A), 20 women received back massage (Group B), and 40 women constituted the control group (group C). METHODS: A structured interview questionnaire to collect background data was completed by the researcher in personal interviews with the mothers. The intervention was performed at three points in each group, and pain perception was measured after each intervention using the Face Pain Scale. RESULTS: The mean rank of the difference in pain scores among the study groups was as follows after the first, second, and third interventions, respectively: group A-52.33, 47.00, 49.2; group B-32.8, 30.28, 30.38; group C-38.44, 42.36, 41.21. There were significant differences between groups A, B, and C after the first, second, and third interventions (p1 = .011, p2 = .042, p3 = .024). CONCLUSIONS: Back massage may be a more effective pain management approach than change in position during the first stage of labor.

Análisis etnográfico del intervencionismo en la atención perinatal / Ethnographic analysis of the perinatal care interventionism

Objetivo principal: analizar los factores culturales que determinan el intervencionismo de la atención perinatal en un área de salud de la Región de Murcia. Metodología: se desarrolló una investigación cualitativa con enfoque etnográfico. Se realizaron dos grupos de discusión a profesionales, dieciocho entrevistas etnográficas en profundidad a puérperas y observación participante en atención primaria y hospital de referencia del área de estudio. Resultados principales: los resultados se circunscribieron a las representaciones ideológicas del dolor en la gestante, la incertidumbre del riesgo del proceso perinatal, y el hospital como espacio de seguridad y eje del intervencionismo. Conclusión: la alta demanda de la analgesia epidural por las embarazadas y la oferta sistemática por los profesionales, la incertidumbre del riesgo durante el embarazo, la representación del hospital como espacio de seguridad y control durante el parto, y la endoculturación de la mujer en el circuito asistencial serán factores determinantes en el intervencionismo de la atención perinatal

Objective: To analyse the cultural facts that determine the perinatal interventionism in a Health Area of Murcia Region. Methods: A qualitative research with ethnographic approach was carried out in this research by using both focus group to professionals and eighteen in depth interviews to women who were in postpartum period. These methods were complemented by carrying out a participant observation in both primary health care and hospital. Results: Three central themes emerged from narratives: pregnant women's ideologic representations about pain, the uncertainty of the risk of the perinatal process, the hospital: security environment and axis of the interventionism. Conclusions: the determinant facts about the interventionism of the perinatal care are related to the high demand for epidural analgesia from pregnant women and its systematic offer provided by professionals, the uncertainty of the risk during the pregnancy, the hospital representation as a safe place during childbirth, and the pregnancy women's enculturation that takes place through circuit of care

Satisfação das puérperas atendidas em um centro de parto normal / Satisfaction of puerperal women attended in a normal birth center

Objetivo: analisar a satisfação das puérperas atendidas em um Centro de Parto Normal. Método: estudo qualitativo, descritivo e exploratório, realizado com 20 puérperas. Os dados foram produzidos por entrevistas semiestruturadas, guiadas por um roteiro com perguntas abertas e fechadas, gravadas e transcritas na íntegra, e analisados pela técnica de Análise de Conteúdo na modalidade Análise Temática. Os resultados foram apresentados em categorias temáticas. Resultados: constatou-se satisfação das puérperas com a assistência recebida, sobretudo pelo apoio contínuo das enfermeiras obstetras, uso de tecnologias não invasivas para alívio da dor, estímulo à autonomia e direito à acompanhante. Enalteceram ainda o ambiente por ser privativo, seguro e calmo. Conclusão: as puérperas mostraram-se satisfeitas em relação ao atendimento oferecido pelo Centro de Parto Normal devido à adesão às boas práticas preconizadas pela Organização Mundial de Saúde, legitimando-se como local apropriado para o parto e nascimento.

Women's autonomy in the process of labour and childbirth: integrative literature review. / Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura.

OBJECTIVE: To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. METHOD: The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. RESULTS: The main practices that favoured the exercise of women's autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. CONCLUSION: There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

The Effect of Acupressure Applied to Point LI4 on Perceived Labor Pains.

Controlling labor pain is one of the basic goals for caregivers during the birthing process. There are many pharmacological and nonpharmacological methods that are used for controlling pain and helping the mother to cope with pain and have a favorable labor. The study was planned as a randomized, controlled experimental study to detect the effect of acupressure applied to Point LI4 on perceived labor pains. The study sample comprised 88 pregnant women (44 acupressure group, 44 control group), who complied with the study guidelines, agreed with the conditions of the study, and signed the informed consent. Acupressure was applied to the study group when cervical dilatation reached 4 to 5 cm and again when cervical dilation was 7 to 8 cm. Acupressure was applied to Point LI4 on both the hands at the same time from the beginning to the end of the contraction (16 times). Evaluation with the visual analog scale was made 6 times: when the pregnant woman was first admitted to the hospital, before and after acupressure, and within 2 hours after delivery. The control group received routine care. There were statistically significant differences between the groups in subjective labor pain scores (P < .0001). There was a significant difference between the groups in terms of total duration of labor. As shown from our study, applying acupressure to Point LI4 was found to be effective in decreasing the perception of labor pains and shortening the labor (P < .05). Mothers were pleased with this treatment, but they found it insufficient to control their pain.

Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura / Autonomía femenina en el proceso de parto y nacimiento: revisión integradora de la literatura / Womens autonomy in the process of labour and childbirth: integrative literature review

RESUMO Objetivo Identificar as evidências disponíveis na produção científica acerca das práticas de assistência à saúde que interferem no exercício da autonomia das mulheres brasileiras no processo de parto e nascimento. Método A busca dos artigos foi desenvolvida nas bases de dados LILACS, Scopus e PubMed, no período entre 1996 e 2015, tendo como eixo orientador a questão norteadora e os critérios de exclusão, sendo selecionados 22 artigos como corpus de análise. Resultados Foram evidenciadas como práticas que favorecem o exercício da autonomia feminina: práticas assistenciais extra-hospitalares; práticas assistenciais de apoio e conforto; e práticas assistenciais educativas. Em contrapartida, revelaram-se como práticas limitantes ao exercício da autonomia: práticas assistenciais autoritárias; práticas assistenciais padronizadas ou rotineiras; práticas assistenciais que intensificam a sensação dolorosa do parto; e prática assistencial impessoal e fria. Conclusão Revelou-se uma situação de alerta relativa ao grande descompasso existente entre o cotidiano assistencial e as recomendações ministeriais.

RESUMEN Objetivo Identificar la evidencia disponible en la literatura científica acerca de las prácticas de atención de salud que interfieren con el ejercicio de la autonomía de las mujeres brasileñas en el proceso de parto y el nacimiento. Método La búsqueda de artículos se desarrolló en las bases de datos LILACS, Scopus y en PubMed, en el período comprendido entre 1996 y 2015, con el principio rector de los rectores criterios de interrogación y exclusión, y seleccionó 22 artículos como un corpus de análisis. Resultados Hemos puesto de relieve las prácticas que favorecen el ejercicio de la autonomía de la mujer: las prácticas de atención ambulatoria; prácticas de apoyo y consuelo; prácticas educativas y atención. Por el contrario se han demostrado como una limitación del ejercicio práctico de la autonomía: las prácticas de atención autoritarias; prácticas de cuidados estandarizados o de rutina; cuidado prácticas que mejoran la sensación dolorosa del parto; y la práctica de la atención impersonal y fría. Conclusión Se puso de manifiesto una situación de alerta en el gran desajuste entre su vida cotidiana y recomendaciones ministeriales.

ABSTRACT Objective To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. Method The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. Results The main practices that favoured the exercise of women’s autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. Conclusion There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

La estimulación eléctrica nerviosa transcutánea (TENS). El manejo del dolor durante el proceso de parto / Transcutaneous electrical nerve stimulation (TENS) for pain management during labor

En la actualidad, la analgesia epidural se perfila como el método farmacológico más empleado en obstetricia para el manejo del dolor durante el parto, pero esta técnica no está exenta de riesgos. Existen métodos no farmacológicos que se pueden utilizar alternativamente o en sinergia con la analgesia epidural, que no presentan efectos adversos sobre los resultados materno-fetales y que pueden ayudar a paliar el dolor. Entre estos métodos se encuentra la estimulación eléctrica nerviosa transcutánea (TENS). La TENS es una técnica fisioterapéutica especialmente indicada durante el periodo de dilatación, en el inicio del trabajo del parto, y mientras la mujer no percibe un dolor muy intenso. Su uso en el parto es relativamente reciente y controvertido. A pesar de ser bien recibido por mujeres y matronas, su eficacia no está demostrada claramente. Así pues, organismos como la Sociedad Española de Ginecología y Obstetricia o el Ministerio de Sanidad, Servicios Sociales e Igualdad, consideran esta terapia como un mecanismo de alivio del dolor no farmacológico de ineficacia demostrada en la fase activa del parto. Las mujeres deben tener la opción de elegir los métodos de alivio de dolor que quieren emplear en cualquier etapa de su parto. Los profesionales sanitarios son los responsables de conocer, investigar y trabajar con los diferentes métodos, ofreciendo a la gestante información adecuada y basada en evidencia científica sobre ellos (AU)

Currently, epidural analgesia is considered the most used method for pain management during labor, but this technique could have side effects. There are non-pharmacological methods that can be used alternatively or in synergy with epidural analgesia, without adverse effects on maternal and fetal outcomes. These methods include transcutaneous electrical nerve stimulation (TENS). TENS is a physiotherapy technique particularly suitable for the dilation period, during the first state of labor, and while women does not perceive a very intense pain. The use in childbirth is recent and controversial. Despite being well received by women and midwives, their effectiveness has not been clearly demonstrated. Organizations such as the Spanish Society of Gynaecology and Obstetrics and the Department of Health, consider this therapy an inefficient non-pharmacological mechanism for pain relief in the active stage of labor. Women should have the option to choose any pain relief mathod in any stage of their process. Health professionals are the responsible to know, investigate and work with these different methods, offering to pregnant women, adequate information, which must be based on scientific evidence (AU)

Experiences and perceptions of Ghanaian midwives on labour pain and religious beliefs and practices influencing their care of women in labour.

BACKGROUND: Beliefs surrounding pain during childbirth has biblical foundations that contribute to labour pain being viewed as a natural phenomenon. Contemporary health care promotes evidence-based labour pain management but the faith of the midwife may influence her midwifery practice regarding labour pain management. Therefore this study sought to gain in-depth insight into the experiences and perceptions of midwives regarding labour pain and the religious beliefs and practices influencing their care of women in labour in Ghana. METHODS: The design of the study was an interpretive phenomenology using individual in-depth interviews. The study participants were 27 Ghanaian female midwives of various religious backgrounds. Interviews were conducted in English, audio-taped and transcribed verbatim. Colaizzi's qualitative analysis procedures were employed concurrently with data collection. RESULTS: Three major themes were generated: religious beliefs about labour pain, religious practices in labour and religious artefacts used in labour. The midwives' faith and their experiences during their midwifery practice were inter-connected. The midwives believed labour pain was natural and religious practices are important to prevent complications. Religious artefacts used in labour included anointing oil and water, necklaces, rubber bands, bracelets, stickers and beads. CONCLUSION: It is important that midwives provide an enabling environment for women in labour to practice their faith and they should employ context-appropriate strategies to effectively manage labour pain that takes into account the religious beliefs and practices of women.

Perceptions of labour pain management of Dutch primary care midwives: a focus group study.

BACKGROUND: Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour. METHODS: We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management. RESULTS: We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role. CONCLUSION: Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.

Cuidados de enfermagem à mulher com dor do parto: transformações a partir da pesquisa-ação participativa / Nursing care for women with pain in childbirth: changes from participatory action research

Evidências científicas apontam o excesso de intervenções prejudiciais na atenção às mulheres durante o parto, causando desconforto e dor. O uso de métodos não invasivos e não farmacológicos para alívio da dor do parto implica na participação efetiva da equipe de enfermagem. Objetivo geral: transformar o cuidado de enfermagem às mulheres durante o parto, por meio da utilização de métodos não farmacológicos para alívio da dor. Objetivos específicos: sensibilizar profissionais de enfermagem para o cuidado à mulher com dor do parto; analisar a percepção das profissionais de enfermagem sobre o parto; descrever o conhecimento sobre o cuidado às mulheres por meio do uso de métodos não farmacológicos de alívio da dor e construir coletivamente uma proposta de estratégias para a utilização de métodos não farmacológicos para alívio da dor do parto. Metodologia: estudo descritivo de natureza qualitativa utilizando a abordagem da pesquisa-ação participativa em saúde. Participaram do estudo 18 profissionais de enfermagem de um hospital na Bahia. Os dados foram organizados no software Atlas.ti, categorizados e analisados. Resultados: As participantes percebem o parto normal como experiência positiva; a dor do parto foi descrita como intensa, porém naturalizada; conhecem métodos não farmacológicos de alívio da dor e o definem como um cuidado qualificado. Bola, cavalinho, massagem, banho, deambulação, musicoterapia e aromaterapia foram os métodos mais citados e também utilizados pelas participantes. As dificuldades para realização do cuidado são insuficiência de pessoal; ambiente inadequado; despreparo de profissionais e de acompanhantes; e dificuldade na interação da equipe. As estratégias desenvolvidas foram: oficina de capacitação para o uso dos métodos não farmacológicos de alívio da dor, alocação de espaço destinado ao uso dos métodos pelas mulheres em trabalho de parto, elaboração e divulgação local de tecnologias educativas sobre estes métodos. Ao final da pesquisa, verificamos que o total de mulheres atendidas que utilizaram métodos não farmacológicos para alívio da dor dobrou, em relação à média dos seis meses anteriores, passando de 10% para 23%. Conclusão: A experiência evidencia a importância da utilização da abordagem participativa como mediadora de transformações nas práticas de cuidado em saúde, tanto do ponto de vista da melhoria da qualidade do cuidado prestado às mulheres, como na criação e fortalecimento de vínculos entre as profissionais. A pesquisa possibilitou, ainda, aprofundamento da integração ensino-serviço e maior inserção social do Programa de Pós-graduação em Enfermagem.(AU)

Scientific evidence points to the excess of harmful interventions in the care of women during labor, causing discomfort and pain. Noninvasive, non-pharmacological labor pain relief methods are recommended by the Ministry of Health, especially in the last five years. To its use is necessary the adoption of a model of care for women with appreciation for natural labor and inclusion of nurses in care management services to normal delivery, resulting in the effective participation of the nursing team. However, research in Brazil show low use of nonpharmacological strategies to relieve labor pain, like the hospital study. So, it is configured as a study problem: how nursing professionals can change their practice in the care of women with pain in labor using non-pharmacological methods? Overall objective: to transform nursing care to women during labor, through the use of non-pharmacological methods of pain relief. Specific objectives: to sensitize the nursing professionals to care for women with pain in labor; describe the perception of nursing professionals on delivery; describe knowledge about care for women through the use of non-pharmacological methods of pain relief, and build collectively an strategy proposes for the use of non-pharmacological methods for pain relief in labor. Methodology: A descriptive qualitative study using the approach of participatory action research in health. Study participants were 18 nursing professionals from a hospital in Bahia. Data were organized in Atlas.ti software, categorized and analyzed using thematic content analysis. Results: The participants perceive normal labor as a positive experience; labor pain has been described as intense, but naturalized; They know nonpharmacological methods of pain relief and define it as a skilled care. Ball, horse, massage, bathing, walking, music therapy and aromatherapy were the most frequent methods, also used by participants. The difficulties for the realization of care are insufficient staff; inadequate environment; unpreparedness of professionals and companios; and difficulty in team interaction. The actions were: sensitization and training workshops to equip professionals to the use of non-pharmacological methods of pain relief, space allocation to meet women who wished to use these methods during labor, development of educational technologies on use these methods. At the end of the survey, we found that the total number of women attending who used non-pharmacological methods for relief of pain doubled, compared to the average of the preceding six months, from 10% to 23%. Conclusion: The experience highlights the importance of using participatory approach as a mediator of changes in health care practices, for both points of view of improving the quality of care provided to women, as in the creation and strengthening of links between professionals. The research also resulted in a deeper integration between teaching and service and greater social inclusion of the Post-Graduate Nursing.(AU)

Cuidados de enfermagem à mulher com dor do parto: transformações a partir da pesquisa-ação participativa / Nursing care for women with pain in childbirth: changes from participatory action research / Cuidados de enfermería para las mujeres con dolor en el parto: cambios con respecto a la investigación-accíon participativa

Evidências científicas apontam o excesso de intervenções prejudiciais na atenção às mulheres durante o parto, causando desconforto e dor. O uso de métodos não invasivos e não farmacológicos para alívio da dor do parto implica na participação efetiva da equipe de enfermagem. Objetivo geral: transformar o cuidado de enfermagem às mulheres durante o parto, por meio da utilização de métodos não farmacológicos para alívio da dor. Objetivos específicos: sensibilizar profissionais de enfermagem para o cuidado à mulher com dor do parto; analisar a percepção das profissionais de enfermagem sobre o parto; descrever o conhecimento sobre o cuidado às mulheres por meio do uso de métodos não farmacológicos de alívio da dor e construir coletivamente uma proposta de estratégias para a utilização de métodos não farmacológicos para alívio da dor do parto. Metodologia: estudo descritivo de natureza qualitativa utilizando a abordagem da pesquisa-ação participativa em saúde. Participaram do estudo 18 profissionais de enfermagem de um hospital na Bahia. Os dados foram organizados no software Atlas.ti, categorizados e analisados. Resultados: As participantes percebem o parto normal como experiência positiva; a dor do parto foi descrita como intensa, porém naturalizada; conhecem métodos não farmacológicos de alívio da dor e o definem como um cuidado qualificado. Bola, cavalinho, massagem, banho, deambulação, musicoterapia e aromaterapia foram os métodos mais citados e também utilizados pelas participantes. As dificuldades para realização do cuidado são insuficiência de pessoal; ambiente inadequado; despreparo de profissionais e de acompanhantes; e dificuldade na interação da equipe. As estratégias desenvolvidas foram: oficina de capacitação para o uso dos métodos não farmacológicos de alívio da dor, alocação de espaço destinado ao uso dos métodos pelas mulheres em trabalho de parto, elaboração e divulgação local de tecnologias educativas sobre estes métodos. Ao final da pesquisa, verificamos que o total de mulheres atendidas que utilizaram métodos não farmacológicos para alívio da dor dobrou, em relação à média dos seis meses anteriores, passando de 10% para 23%. Conclusão: A experiência evidencia a importância da utilização da abordagem participativa como mediadora de transformações nas práticas de cuidado em saúde, tanto do ponto de vista da melhoria da qualidade do cuidado prestado às mulheres, como na criação e fortalecimento de vínculos entre as profissionais. A pesquisa possibilitou, ainda, aprofundamento da integração ensino-serviço e maior inserção social do Programa de Pós-graduação em Enfermagem.(AU)

O cuidado de enfermagem vivenciado por mulheres durante o parto na perspectiva da humanização / Nursing care experienced by women during the child-birth in the humanization perspective / La asistencia de enfermaría experimentado por las mujeres durante el parto en perspectiva de humanización

Objetivo: conhecer as vivências das puérperas sobre o cuidado de enfermagem durante o trabalho de parto e parto no que tange a humanização. Método: estudo exploratório-descritivo com abordagem qualitativa, realizado com doze mulheres que aguardavam atendimento em um serviço especializado de Minas Gerais. As informações foram coletadas a partir de um roteiro semiestruturado e analisadas pela Técnica de Análise de conteúdo na modalidade Temática. Resultados: as vivências das puérperas sobre a atuação humanizada da enfermagem são ambíguas, destacam-se a comunicação e o emprego de técnicas não farmacológicos para alívio da dor, todavia, constatam-se a realização de procedimentos provenientes do modelo biomédico. Conclusão: evidenciou-se a necessidade de reformulação na assistência de enfermagem à mulher no parto em prol de ações que reduzam intervenções desnecessárias e devolva à mulher o seu protagonismo.(AU)

Objective: to know the mothers' experiences about the nursing care during the child-birth labor and childbirth regarding the humanization. Method: an exploratory-descriptive study with qualitative approach, conducted with twelve women who were waiting for attendance in a specialized service from Minas Gerais. The information were collected through a semi-structured guide and analyzed by the technique analyzing the contents in the theme mode. Results: the mothers' experiences about the humanized nursing act are ambiguous, and it is noteworthy the communication and the job of the no-pharmacological techniques for the pain relief, however, were found the procedures performances coming from the biomedical model. Conclusion: it was evident the needs for a reformulation in the child-birth nursing assistance to women in favor of actions reducing unnecessary interventions and giving back to the women her main role.(AU)

Objetivo: conocer las experiencias de las madres sobre los cuidados de enfermería durante el parto en relación a la humanización. Método: estudio cualitativo exploratorio-descriptivo, realizado con doce mujeres en espera de tratamiento en un servicio especializado de Minas Gerais. Se recogió a la información de un guión semi-estructurado y analizado por la técnica de análisis de contenido en el modo temático. Resultados: las experiencias de las madres sobre el desempeño humanizado de la enfermería son ambiguos, destacamos la comunicación y el uso de técnicas no farmacológicas para aliviar el dolor, sin embargo, se dan cuenta para llevar a cabo los procedimientos del modelo biomédico. Conclusión: se demostró la necesidad de reformular los cuidados de enfermería para las mujeres en parto a favor de acciones para reducir las intervenciones innecesarias y devolver a la mujer su papel.(AU)