Medical record bias in documentation of obstetric and neonatal clinical quality of care indicators in Uganda.

OBJECTIVE: To achieve a high quality of care (QoC), accurate measurements are needed. This study evaluated the validity of QoC data from the medical records for childbirth deliveries and assessed whether medical records can be used to evaluate the efficacy of interventions to improve QoC. STUDY DESIGN AND SETTING: This study was part of a larger study of QoC training program in Uganda. Study data were collected in two phases: (1) validation data from 321 direct observations of deliveries paired with the corresponding medical records; (2) surveillance data from 1,146 medical records of deliveries. Sensitivity, specificity, and predictive values were used to measure the validity of the medical record from the validation data. Quantitative bias analysis was conducted to evaluate QoC program efficacy in the surveillance data using prevalence ratio and odds ratio. RESULTS: On average, sensitivity (84%) of the medical record was higher than the specificity (34%) across 11 QoC indicators, showing a higher validity in identifying the performed procedure. For 5 out of 11 indicators, bias-corrected odds ratios and prevalence ratios deviated significantly from uncorrected estimates. CONCLUSION: The medical records demonstrated poor validity in measuring QoC compared with direct observation. Using the medical record to assess QoC program efficacy should be interpreted carefully.

Identifying optimal labor and delivery nurse staffing: The case of cesarean births and nursing hours.

BACKGROUND: Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. PURPOSE: We examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing. METHODS: This retrospective descriptive study used hours of productive nursing time per delivery as the treatment variable to determine direct nursing time per delivery and its impact on the likelihood of a C-section. For comparisons, we also assessed the likelihood of augmentations and of inductions, as well as the number of neonatal intensive care unit (NICU) hours per birth. We limited our sample to those births between 37 and 42 weeks of gestation. Two complimentary models (the quadratic and piecewise regressions) distinguishing optimal staffing patterns from ineffective staffing patterns were developed. The study was implemented in eleven hospitals that are part of a large, integrated healthcare system in the Southwest. DISCUSSION: While a simple linear regression of the likelihood of a C-section on nursing hours per delivery indicated no statistically distinguishable effect, our 'optimal staffing' model indicated that nurse staffing hours employed by using a large sample of hospitals were actually minimizing C-sections (robustness checks are provided using similar model comparisons for the likelihood of augmentation and induction, and NICU hours). Where the optimal staffing models did not appear to be effective for augmentations, inductions, and NICU hours, we found significant differences between facilities (i.e., significant fixed effects for hospitals). In all specifications, we also controlled for weeks of gestation, race, sex of the child, and mother's age.

Secondary Traumatic Stress Among Labor and Delivery Nurses.

PURPOSE: To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system. STUDY DESIGN AND METHODS: Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked. RESULTS: N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support. CLINICAL IMPLICATIONS: This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.

Maternity Nurses' Responses to Maternal Early Warning Criteria.

OBJECTIVE: The purpose of this study was to assess the influence of nursing care on implementing perinatal risk-appropriate care in the context of maternal early warning criteria. DESIGN: Medical record review and survey of maternity nurses in a three-hospital system in Wisconsin with two level I hospitals and 1 level III hospital. PARTICIPANTS: Seven maternity nurses from the level III hospital conducted the medical record reviews and all maternity staff nurses from two level I hospitals were invited to complete the survey. MEASUREMENTS: All medical records in 2017 that met these inclusion criteria: hypertension, sepsis, preeclampsia, hemorrhage, low Apgar scores, and transport were reviewed to assess identification and response time for maternal early warning signs using the Nurses Contribution to Maternal Mortality Worksheet. The survey included questions about influences on the nurses' confidence when interpreting early warning indicators. RESULTS: Thirty-two medical records met inclusion criteria and were reviewed. The number of maternal early warning signs recorded ranged from one to four, with a mean of 1.75 indicators. Eighty percent of records documented increased evaluation as a nursing response to the maternal early warning signs. Time-lapse between notifying a provider and bedside evaluation was less than 15 minutes in 54% of cases. Of the 31 eligible nurses, 18 completed the survey (58% response rate). Personal knowledge (90%) was reported by nurses as being the greatest influence on nursing confidence. Sixty-nine percent of nurses reported not receiving patient information from team members at the transporting hospital. CONCLUSION: A systematic record review by frontline nurses can monitor identification and response to maternal early warning signs. Feedback on patient transports can reinforce nurses' decision-making that has the potential to improve responsiveness to clinical warning signs.

The completion of partograms: knowledge, attitudes and practices of midwives in a public health obstetric unit in Bloemfontein, South Africa.

INTRODUCTION: most maternal and 24.3% of infant deaths occur during childbirth. Interventions during childbirth may reduce maternal and neonatal deaths. The Guidelines for maternity care in South Africa (2015) stipulates that all observations during labour should be recorded on a partogram. The objective of this study was to assess the knowledge and attitudes of nursing personnel and to evaluate their practices of completing partograms at National District Hospital, South Africa. METHODS: a two-phase, quantitative, cross-sectional, descriptive study design was used. In phase 1, the knowledge and attitudes of midwives and nurses were evaluated. Midwives and nurses completed anonymous, self-administered questionnaires that assessed their knowledge and attitudes. In Phase 2, partogram practices were measured by assessing completed partograms using a data collection tick sheet. RESULTS: twelve of the 17 nursing personnel completed the questionnaires. More than 90% of participants answered basic partogram knowledge questions correctly, but only two thirds knew the criteria for obstructive labour and just more than half that for foetal distress. Participants displayed a positive attitude toward the use of partograms. Of the 171 randomly selected vaginal deliveries during the study period, only 57.1% delivered with a completed partogram. Most elements of foetal monitoring and progress of labour scored above 80%, however, for maternal monitoring scored poorly in 26.4% of cases. CONCLUSION: although 71.4% of partograms scored more than 75% for completion, the critical components that influence maternal and foetal death, like the identification of foetal distress, maternal wellbeing and progress of labour, were lacking.

Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study.

BACKGROUND: Efforts to expand access to institutional delivery alone without quality of care do not guarantee better survival. However, little evidence documents the quality of childbirth care in Ethiopia, which limits our ability to improve quality. Therefore, this study assessed the quality of and barriers to routine childbirth care signal functions during intra-partum and immediate postpartum period. METHODS: A sequential explanatory mixed method study was conducted among 225 skilled birth attendants who attended 876 recently delivered women in primary level facilities. A multi stage sampling procedure was used for the quantitative phase whilst purposive sampling was used for the qualitative phase. The quantitative survey recruitment occurred in July to August 2018 and in April 2019 for the qualitative key informant interview and Focus Group Discussions (FGD). A validated quantitative tool from a previous validated measurement study was used to collect quantitative data, whereas an interview guide, informed by the literature and quantitative findings, was used to collect the qualitative data. Principal component analysis and a series of univariate and multivariate linear regression analysis were used to analyze the quantitative data. For the qualitative data, verbatim review of the data was iteratively followed by content analysis and triangulation with the quantitative results. RESULTS: This study showed that one out of five (20.7%, n = 181) mothers received high quality of care in primary level facilities. Primary hospitals (ß = 1.27, 95% CI:0.80,1.84, p = 0.001), facilities which had staff rotation policies (ß = 2.19, 95% CI:0.01,4.31, p = 0.019), maternal involvement in care decisions (ß = 0.92, 95% CI:0.38,1.47, p = 0.001), facilities with maternal and newborn health quality improvement initiatives (ß = 1.58, 95% CI:0.26, 3.43, p = 0.001), compassionate respectful maternity care training (ß = 0.08, 95% CI: 0.07,0.88, p = 0.021), client flow for delivery (ß = 0.19, 95% CI:-0.34, -0.04, p = 0.012), mentorship (ß = 0.02, 95% CI:0.01, 0.78, p = 0.049), and providers' satisfaction (ß = 0.16, 95% CI:0.03, 0.29, p = 0.013) were predictors of quality of care. This is complemented by qualitative research findings that poor quality of care during delivery and immediate postpartum related to: work related burnout, gap between providers' skill and knowledge, lack of enabling working environment, poor motivation scheme and issues related to retention, poor providers caring behavior, unable translate training into practice, mismatch between number of provider and facility client flow for delivery, and in availability of essential medicine and supplies. CONCLUSIONS: There is poor quality of childbirth care in primary level facilities of Tigray. Primary hospitals, facilities with staff rotation, maternal and newborn health quality improvement initiatives, maternal involvement in care decisions, training on compassionate respectful maternity care, mentorship, and high provider satisfaction were found to have significantly increased quality of care. However, client flow for delivery service is negatively associated with quality of care. Efforts must be made to improve the quality of care through catchment-based mentorship to increase providers' level of adherence to good practices and standards. More attention and thoughtful strategies are required to minimize providers' work-related burnout.

Traumatic childbirth experiences: practice-based implications for maternity care professionals from the woman's perspective.

OBJECTIVE: To explore women's traumatic childbirth experiences in order to make maternity care professionals more aware of women's intrapartum care needs. METHOD: A qualitative exploratory study with a constant comparison/grounded theory design was performed. Thirty-six interviews were conducted with women who had given birth in a Dutch birth setting. FINDINGS: Three themes, playing a profound role in the occurrence of traumatic birth experiences, emerged: (i) lack of information and consent - maternity care professionals' unilateral decision making during intrapartum care, lacking informed-consent. (ii) feeling excluded - women's mal-adaptive response to the healthcare professionals's one-sided decision making, leaving women feeling distant and estranged from the childbirth event and the experience. (iii) discrepancies - inconsistency between women's expectations and the reality of labour and birth - on an intrapersonal level. CONCLUSION: Women's intrapartum care needs cohere with the concept of woman-centred care, including personalised care and reflecting humanising values. Care should include informed consent and shared decision-making. Maternity care professionals need to continuously evaluate whether the woman is consistently part of her own childbearing process. Maternity care professionals should maintain an ongoing dialogue with the woman, including women's internalised ideas of birth.

'InUTERO': The effectiveness of an educational half day stillbirth awareness workshop for maternity care providers.

BACKGROUND: There is a disconnect between what maternity care providers consider should be done and what they actually do with respect to talking with their pregnant clients about reducing their risk of stillbirth. This suggests that they would benefit from receiving up-to-date knowledge about stillbirth, alongside education that provides them with strategies for talking about stillbirth with pregnant women. OBJECTIVES: To gain an understanding of maternity care provider (obstetricians and midwives) knowledge of stillbirth and determine whether delivering a half day workshop improves knowledge and results in intention to change practice. DESIGN: A pre-post intervention study. SETTING: Maternity care providers (Obstetricians, Midwives) working in the northern areas of Tasmania, Australia were asked, via questionnaire, about their knowledge of stillbirth both before and after attending a half-day workshop. PARTICIPANTS: Maternity care providers (n = 51) attended the workshop and 30 (59%) completed both the pre-workshop and post-workshop surveys. METHODS: A four hour interactive workshop grounded in understanding the stillbirth experience. Participants were given up-to-date information about stillbirth risks and current prevention research as well as provided with an actionable step wise approach to talking about stillbirth prevention in pregnancy. RESULTS: Stillbirth knowledge scores (total of 8-points) significantly increased following the workshop (pre: mean = 2.9 ± 1.5; post: mean = 4.7 ± 1.4 points, t 29 = 7.9, <0.001). Before the workshop, only 20% of participants responded that they "always" or usually" discussed the possibility stillbirth occurring with pregnant women in their care whereas, after the workshop, nearly all (88%) indicated that they planned to "always" discuss stillbirth with their pregnant clients. CONCLUSIONS: Attending a stillbirth awareness for prevention education workshop resulted in significant knowledge improvement and self-reported intention to change practice in a group of Australian maternity care providers. While these results are promising, further study is needed to determine the presence and extent of actual practice change following such education.

Obstetric Nursing in best practices of labor and delivery care.

OBJECTIVE: to evaluate the association of Obstetric Nursing in the best practices of delivery and birth care in maternity hospitals. METHOD: a cross-sectional study, with 666 women selected for delivery. Parturition obstetric practices performed by professionals were categorized into: clearly useful practices that should be encouraged, practices that are clearly harmful or ineffective and that should be eliminated and practices used inappropriately at the time of parturition. RESULTS: clearly useful practices were used in greater proportions in the hospitals that had Obstetric Nursing working, while clearly harmful practices and those used inappropriately were practiced in smaller proportions in hospitals that had Obstetric Nursing, both with statistical difference. CONCLUSION: institutions with Obstetric Nursing adopt better practices of delivery and birth care, based on scientific evidence, when compared to those that do not act.

A Proactive Approach to Quantification of Blood Loss in the Perinatal Setting.

OBJECTIVE: To educate nurses and physicians on changing practice from visual estimation of blood loss to quantification of blood loss (QBL) and to replace estimation of blood loss with QBL for at least 85% of vaginal births during a 3-month period. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: A midwestern U.S. urban community hospital with 1,200 annual births, where postpartum blood loss was being measured by using visual estimation. PARTICIPANTS: A convenience sample of 43 intrapartum nurses and 17 physicians. INTERVENTION/MEASUREMENTS: A goal was set to use the QBL method for at least 85% of vaginal births for 3 consecutive months. Study participants were surveyed at baseline to assess their knowledge of the QBL method; they then received a 10-minute educational presentation by the clinical nurse specialist (CNS) on QBL. The CNS attended births on both 12-hour shifts to give support, evaluate correct use of the new drapes, and answer questions. Midway through the project, a brief survey was distributed to participants for their feedback. The CNS conducted a chart audit to determine the compliance rate for the QBL process. RESULTS: Data analysis indicated an average 89% compliance rate with the QBL process for the time period studied. CONCLUSION: Education on the QBL method increased nurses' and physicians' awareness of the importance of using this method as the new standard of care for assessment of postpartum blood loss. Accuracy of postpartum blood loss measurement is critical to help prevent maternal morbidity and mortality. Nurses play a key role in the development and implementation of practice changes to use QBL measurement.

Nurses- puerperal mothers interaction: searching for cultural care.

OBJECTIVE: To identify the importance of the cultural care dimension in the nurse-puerperal mother interaction. METHOD: Qualitative study based on content analysis. To collect data, 36 semi structured interviews were applied (21 nurses and 15 women who had recently given birth). The participants' free and informed consent was ensured and all ethical requirements were respected. Data analysis was supported by NVivo 10 software. RESULTS: The following categories were considered the most relevant: (i) nurses' attitudes that puerperal mothers consider crucial in health care provision; (ii) nurses' cultural competence; (iii) language resources used by nurses in their interaction with people from other cultures; (iv) the limitations that were observed during nurses-new mothers interactions. CONCLUSION: Evidence shows that, generally speaking, nurses claim to provide personalized health care assistance. However data revealed that the kind of interaction observed between nurses and women who had just given birth has not always been the most effective and that the former often show they lacked the appropriate cultural competence to deal with the latter's expectations and needs.

Nurses- puerperal mothers interaction: searching for cultural care / Interacción enfermeras y madres: en la búsqueda de un cuidado cultural / Interação enfermeiros e puérperas: na procura de um cuidado cultural

ABSTRACT Objective: To identify the importance of the cultural care dimension in the nurse-puerperal mother interaction. Method: Qualitative study based on content analysis. To collect data, 36 semi structured interviews were applied (21 nurses and 15 women who had recently given birth). The participants' free and informed consent was ensured and all ethical requirements were respected. Data analysis was supported by NVivo 10 software. Results: The following categories were considered the most relevant: (i) nurses' attitudes that puerperal mothers consider crucial in health care provision; (ii) nurses' cultural competence; (iii) language resources used by nurses in their interaction with people from other cultures; (iv) the limitations that were observed during nurses-new mothers interactions. Conclusion: Evidence shows that, generally speaking, nurses claim to provide personalized health care assistance. However data revealed that the kind of interaction observed between nurses and women who had just given birth has not always been the most effective and that the former often show they lacked the appropriate cultural competence to deal with the latter's expectations and needs.

RESUMEN Objetivo: identificar la dimensión de la competencia cultural en la interacción entre enfermeras y mujeres que hayan dado a luz recientemente. Método: estudio cualitativo basado en el análisis de contenidos. En la recopilación de datos se utilizó la entrevista semiestructurada. Han participado 21 enfermeras y 15 madres en un total de 36 entrevistas. Se aseguró el consentimiento previo, libre e informado de todos los participantes y todos los requisitos éticos fueron respetados. El análisis de datos fue apoyado por el programa NVivo 10. Resultados: las siguientes categorías fueron destacadas: (i) actitudes de las enfermeras que las madres creen ser indispensables en el proceso de cuidar; ii) el ejercicio de la competencia cultural; iii) los recursos lingüísticos utilizados por las enfermeras en la interacción con personas de otras culturas; iv) restricciones y problemas observados en las interacciones entre enfermeras y madres. Conclusión: se concluye que, en general, las enfermeras afirman que cuidan de sus pacientes de manera personalizada. Todavía, los datos revelaron que las interacciones entre enfermeras y madres son a menudo poco eficaces y a las enfermeras les resulta difícil demostrar su competencia cultural.

RESUMO Objetivo: Identificar a dimensão do cuidado cultural na interação entre enfermeiras e puérperas. Método: Estudo qualitativo assente na análise de conteúdo. Na colheita de dados se utilizou a entrevista semiestruturada, a 21 enfermeiras e 15 puérperas num total de 36 entrevistadas. Se assegurou o consentimento livre e esclarecido bem como respeitaram-se todos os requisitos éticos. A análise de dados foi suportada pelo NVivo 10. Resultados: Destacaram-se as categorias: (i) Atitudes das enfermeiras que as puérperas reconhecem imprescindíveis no processo de cuidar; (ii) Exercitar a competência cultural; (iii) Recursos linguísticos utilizados pelas enfermeiras na interação com pessoas de outras culturas; (iv) Constrangimentos manifestados nas interações enfermeiras e puérperas. Conclusão: Conclui-se que apesar das enfermeiras, ao nível discursivo, afirmarem que cuidam de forma personalizada, os dados revelaram que nem sempre as enfermeiras foram eficazes nas interações com as puérperas, de forma a demonstrarem a competência cultural, num estadio considerado culturalmente consciente.

Automated Mandatory Bolus vs. Basal Infusion for Maintenance of Epidural Analgesia During Labor.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

Basic, High-Risk, and Critical Care Intrapartum Nursing: Clinical Competencies and Education Guide, 6th edition.

This education guide provides a framework for educational content and skills verification for nurses who care for women and their newborns in basic, high-risk, and critical care obstetric settings.

Management of Extracorporeal Membrane Oxygenation for Obstetric Patients: Concerns for Critical Care Nurses.

Critical care nurses are faced with many challenges, and one that is particularly stressful is caring for obstetric patients. This care can become more complex when the obstetric patient requires extracorporeal membrane oxygenation. It is imperative that critical care nurses have knowledge about this unique population, the expected physical changes of pregnancy, and the management of extracorporeal membrane oxygenation. Obstetric patients present unique challenges, and care is focused on the woman and her family. The purpose of this paper is to provide information for critical care nurses regarding care of obstetric patients who receive extracorporeal membrane oxygenation.

Análise do preenchimento do partograma como boa prática obstétrica na monitorização do trabalho de parto / Analysis of partogram completion as good obstetric practice in the monitoring of labor / Análisis del llenado del partograma como buena práctica obstétrica en la monitorización del trabajo de parto

Objetivo: Analizar el llenado del partograma realizado por profesionales que prestan asistencia al trabajo de parto en un hospital escolar referencia materno-infantil del Valle del São Francisco. Métodos: Se trata de un estudio descriptivo documental, retrospectivo y transversal de abordaje cuantitativo realizado por medio del análisis de 191 prontuarios de parturientas asistidas en la Institución en el año 2015. Los datos fueron analizados en el SPSS versión 20. Resultados: Mostraron que sólo 40, El 6% de los prontuarios tenían registro de apertura del partograma, el análisis de las variables verificadas en el momento de la apertura del partograma permitió identificar que el 99,5% se inició en la fase activa del trabajo de parto. A pesar de un buen registro en su apertura, los datos muestran que el proceso de monitoreo del trabajo de parto aún es poco eficaz, pues el 59,2% tuvo apenas un solo registro. Conclusión: la utilización del partograma como una buena práctica obstétrica todavía es poco utilizada en esta maternidad, se hace necesario considerar su registro como una herramienta en el monitoreo del trabajo de parto para promover una asistencia adecuada como recomienda el Ministerio de Salud

Objective: Analyzing the partograph filling performed by professionals who provide assistance to the labor in a teaching hospital that is a maternal and child healthcare reference in the Vale do São Francisco. Methods: This is a descriptive, retrospective and transversal study with a quantitative approach. There were analyzed 191 medical records of assisted mothers in the institution during the year 2015. The data were analyzed in SPSS program version 20. Results: The results showed that only 40.6% of patient records had a record of parturition, and the analysis of the variables verified at the time of the start of the partogram identified that 99.5% of the records were started in the active phase of labor. Despite of a good record in the start of partograph, the data show that the process of monitoring of labor is still not veryeffective, because 59.2% of the partographs had only a single record. Conclusion: The use of partograph as a good obstetric practice is still little used in this maternity, it is necessary to consider the partogram registration as a tool in the monitoring of labor to promote adequate assistance as it is recommended by the Brazilian Ministry of Health

Objetivo: Analisar o preenchimento do partograma realizado por profissionais que prestam assistência ao trabalho de parto em um hospital escola referência materno infantil do Vale do São Francisco. Método: Tratase de um estudo descritivo documental, retrospectivo e transversal de abordagem quantitativa realizada por meio da análise de 191 prontuários de parturientes assistidas na Instituição no ano de 2015. Os dados foram analisados no SPSS versão 20. Resultados: Mostraram que apenas 40,6% dos prontuários tinham registro de abertura do partograma. A análise das variáveis verificadas no momento da abertura do partograma permitiu identificar que 99,5% foram iniciados na fase ativa do trabalho de parto. Apesar de um bom registro na sua abertura, os dados mostram que o processo de monitoramento do trabalho de parto ainda é pouco eficaz, pois 59,2% tiveram apenas um único registro. Conclusão: A utilização do partograma como uma boa prática obstétrica ainda é pouco utilizada nesta maternidade; faz-se necessário considerar seu registro como uma ferramenta no monitoramento do trabalho de parto para promover uma assistência adequada como recomenda o Ministério da Saúde

Obstetric Nursing in best practices of labor and delivery care / Enfermería Obstétrica en las buenas prácticas de la asistencia al parto y el nacimiento / Enfermagem Obstétrica nas boas práticas da assistênciaao parto e nascimento

ABSTRACT Objective: to evaluate the association of Obstetric Nursing in the best practices of delivery and birth care in maternity hospitals. Method: a cross-sectional study, with 666 women selected for delivery. Parturition obstetric practices performed by professionals were categorized into: clearly useful practices that should be encouraged, practices that are clearly harmful or ineffective and that should be eliminated and practices used inappropriately at the time of parturition. Results: clearly useful practices were used in greater proportions in the hospitals that had Obstetric Nursing working, while clearly harmful practices and those used inappropriately were practiced in smaller proportions in hospitals that had Obstetric Nursing, both with statistical difference. Conclusion: institutions with Obstetric Nursing adopt better practices of delivery and birth care, based on scientific evidence, when compared to those that do not act.

RESUMEN Objetivo: evaluar la asociación de la Enfermería Obstétrica en las buenas prácticas de la asistencia al parto y el nacimiento en maternidades. Método: estudio transversal, con 666 mujeres seleccionadas con ocasión de la realización del parto. Las prácticas obstétricas realizadas por los profesionales que asistían al proceso de parturición se clasificaron en: prácticas claramente útiles y que deben ser estimuladas, prácticas claramente perjudiciales o ineficaces y que deben ser eliminadas y prácticas utilizadas de modo inapropiado en el parto. Resultados: las prácticas claramente útiles fueron utilizadas en mayores proporciones en los hospitales que poseían la Enfermería Obstétrica actuante, mientras prácticas claramente perjudiciales y aquellas usadas de modo inapropiado fueron practicadas en menores proporciones en hospitales que poseían la Enfermería Obstétrica, ambas con diferencia estadística. Conclusión: las instituciones con Enfermería Obstétrica adoptan mejores prácticas de atención al parto y nacimiento, basadas en evidencias científicas, cuando comparadas a las que no actúa.

RESUMO Objetivo: avaliar a associação da Enfermagem Obstétrica nas boas práticas da assistência ao parto e nascimento em maternidades. Método: estudo transversal, com 666 mulheres selecionadas por ocasião da realização de parto. As práticas obstétricas realizadas pelos profissionais que assistiam o processo de parturição foram categorizadas em: práticas claramente úteis e que devem ser estimuladas, práticas claramente prejudiciais ou ineficazes e que devem ser eliminadas e práticas usadas de modo inapropriado no momento de parturição. Resultados: práticas claramente úteis foram utilizadas em maiores proporções nos hospitais que possuíam a Enfermagem Obstétrica atuante, enquanto práticas claramente prejudiciais e aquelas usadas de modo inapropriado foram praticadas em menores proporções em hospitais que possuíam a Enfermagem Obstétrica, ambas com diferença estatística. Conclusão: instituições com Enfermagem Obstétrica adotam melhores práticas de atenção ao parto e nascimento, baseadas em evidências científicas, quando comparadas às que ela não atua.