Parto domiciliar planejado assistido por enfermeira obstétrica: significados, experiências e motivação para essa escolha / Parto domiciliario planificado asistido por enfermera obstétrica: significados, experiencias y motivación para esta elección / Planned home birth assisted by a midwife nurse: meanings, experiences and motivation for this choice

RESUMO Objetivo: compreender os significados e experiências de mulheres que vivenciaram o parto domiciliar planejado assistido por enfermeira obstétrica e a motivação (das mulheres) para essa escolha. Metodologia: estudo qualitativo, exploratório e descritivo, com 16 mulheres, realizado por meio de entrevista semiestruturada e analisado pelos pressupostos da análise temática de conteúdo. Resultados: as mulheres vivenciaram o parto com tranquilidade, autonomia e respeito, escolheram as posições e as pessoas de sua preferência. O parto teve significado de vitória e de libertação, cuja experiência foi descrita como inesquecível, fantástica, intensa e protagonizada pela mulher. O descontentamento com o modelo de assistência vigente, a participação em grupo de gestantes, o acesso a informações e a vivência de violência obstétrica anterior motivaram as mulheres a optarem pelo parto domiciliar. Considerações finais: as experiências das mulheres convergem para o exercício da autonomia e respeito à individualidade. Evidencia-se o protagonismo das mulheres que vivenciaram um parto natural e livre de intervenções. A assistência obstétrica foi centrada nas necessidades da parturiente, proporcionou confiança, segurança, tranquilidade e respeito às suas escolhas. Aponta-se a necessidade de ampliar a assistência ao parto por enfermeiras obstétricas às mulheres que desejam o parto domiciliar planejado. Políticas públicas de assistência ao parto podem viabilizar isso.

RESUMEN Objetivo: comprender los significados y las experiencias de las mujeres que vivieron el parto domiciliario planificado asistido por enfermera obstétrica y la motivación (de las mujeres) para esta elección. Metodología: estudio cualitativo, exploratorio y descriptivo, con 16 mujeres, realizado a través de entrevista semiestructurada y analizado por los supuestos del análisis de contenido temático. Resultados: las mujeres experimentaron el parto con tranquilidad, autonomía y respeto, eligieron las posiciones y las personas de su preferencia. El parto tuvo un significado de victoria y liberación, cuya experiencia se describió como inolvidable, fantástica, intensa y protagonizada por la mujer. La insatisfacción con el modelo de atención actual, la participación en grupo de mujeres embarazadas, el acceso a informaciones y la experiencia de violencia obstétrica anterior motivaron a las mujeres a optar por el parto domiciliario. Consideraciones finales: las experiencias de las mujeres convergen para el ejercicio de la autonomía y respeto a la individualidad. Se evidencia el protagonismo de las mujeres que experimentaron un parto natural y libre de intervenciones. La atención obstétrica se centró en las necesidades de la parturienta, proporcionó confianza, seguridad, tranquilidad y respeto con sus elecciones. Se señala la necesidad de ampliar la atención al parto por enfermeras obstétricas a las mujeres que desean el parto domiciliario planificado. Las políticas públicas de atención al parto pueden hacer esto posible.

ABSTRACT Objective: to understand the meanings and experiences of women who dealt with planned home birth assisted by a nurse midwife and the motivation (of these women) for this choice. Methodology: qualitative, exploratory and descriptive study, with 16 women, performed by means of semi-structured interviews and analyzed by the assumptions of thematic content analysis. Results: the women experienced childbirth with tranquility, autonomy and respect, and they chose the positions and people of their preference. Childbirth had a meaning of victory and liberation, whose experience was described as unforgettable, fantastic, intense and carried out by the woman. The dissatisfaction with the current model of care, the participation in a group for pregnant women, the access to information and the experience of previous obstetric violence motivated women to choose home birth. Final considerations: the women's experiences converge towards the exercise of autonomy and respect for individuality. The leading role of women who experienced a natural birth and free of interventions, should be highlighted. Obstetric care was focused on the parturient woman's needs, provided confidence, security, tranquility and respect for her choices. There is a need to expand childbirth care provided by nurse midwives to women who wish to have a planned home birth. Public policies for childbirth care can make this possible.

Desejando parir naturalmente: perspectiva de mulheres sobre o parto domiciliar planejado com uma enfermeira obstétrica / Wanting to give birth naturally: women's perspective on planned homebirth with a nurse midwife / Deseando parir naturalmente: perspectiva de mujeres sobre el parto domiciliario planificado con una enfermera obstétrica

Objetivo: descrever a escolha do parto domiciliar planejado acompanhado por enfermeira obstétrica em um centro urbano de grande porte, na perspectiva de mulheres brasileiras. Métodos: estudo qualitativo guiado pela Grounded Theory. Foram entrevistadas dez mulheres com idade entre 20 e 41 anos que tiveram parto domiciliar planejado acompanhadas por enfermeiras obstétricas. As participantes foram recrutadas por meio de rede social, acessando um grupo de mulheres que escreveram sobre seu parto domiciliar. Resultados: Emergiram duas categorias: Não vendo possibilidade de parir naturalmente no ambiente hospitalar e Pensando na segurança do parto domiciliar planejado. O hospital representou vários aspectos desfavoráveis como intervenções desnecessárias e solidão. As mulheres consideravam o lar um lugar seguro para parir, conectado aos cuidados de enfermeiras obstétricas. Conclusão: há mulheres que não desejam parir no hospital, preferindo parir em casa e do ponto de vista dos direitos humanos e dos cuidados desmedicalizados, as enfermeiras obstétricas devem apoiar as mulheres nessa sua decisão.

Objective: to describe the choice of planned homebirth attended by a nurse midwife in a large urban centre, from the perspective of Brazilian women. Methods: in this Grounded Theory study, ten women aged 20 to 41 years, who had a planned homebirth accompanied by a nurse midwife, were interviewed. Participants were recruited through a social network by accessing a group of women who wrote about their homebirth. Results: two categories emerged: seeing no possibility of giving birth naturally in the hospital environment; and thinking about the safety of a planned homebirth. Hospital represented several unfavourable aspects, such as unnecessary interventions and loneliness. Women thought of home as a safe place to give birth, connected with nurse midwife care. Conclusion: there are women who do not wish to give birth in hospital, but prefer to give birth at home and, from the point of view of human rights and de-medicalized care, nurse midwives should support women in their decision.

Objetivo: describir la elección del parto domiciliario planificado con enfermera obstétrica en un gran centro urbano, desde la perspectiva de mujeres brasileñas. Métodos: estudio cualitativo guiado por la Grounded Theory. Se entrevistó a diez mujeres entre 20 y 41 años que tuvieron parto domiciliario planificado, siendo acompañadas de enfermeras obstétricas. Las participantes fueron reclutadas a través de red social, accediendo a un grupo de mujeres que escribieron sobre su parto en domicilio. Resultados: surgieron dos categorías: las que no veían posibilidad de dar a luz naturalmente en el hospital y las que pensaron en la seguridad del parto domiciliario planificado. El hospital representó varios aspectos desfavorables como intervenciones innecesarias y soledad. Las mujeres consideraban que el hogar era un ambiente seguro para dar a luz, vinculado al cuidado de enfermeras obstétricas. Conclusión: hay mujeres que no desean dar a luz en el hospital, prefieren hacerlo en casa y, desde el punto de vista de los derechos humanos y de los cuidados sin la intervención de un médico, las enfermeras obstétricas deben apoyarlas en esa decisión.

Trajectories of obstetric nurses in the care of planned home childbirth: oral history / Trayectorias de enfermeras obstétricas en el cuidado del parto domiciliario planificado: historia oral / Trajetórias de enfermeiras obstetras no atendimento ao parto domiciliar planejado: história oral

ABSTRACT Objective: To describe the trajectory of the insertion of obstetric nurses in the care of planned home childbirth in Rio Grande do Sul. Method: An exploratory and qualitative study, with application of thematic oral history. Thirteen obstetric nurses who worked in planned home childbirth in the state participated in the study. Data was collected from December 2019 to March 2020 through interviews and analyzed based on a thematic content analysis. Results: Two categories emerged: 1) Personal, training and professional experiences that encouraged obstetric nurses to enter planned home childbirth; and 2) The search for autonomy, freedom, protagonism and respect in the care of delivery and birth as stimuli for the insertion of obstetric nurses in the planned home childbirth. Conclusion: Personal, training and professional experiences and dissatisfaction with hospital obstetric care in the state, considered interventionist and physician-centered, encouraged obstetric nurses to enter planned home childbirth.

RESUMEN Objetivo: Describir la trayectoria de la inserción de enfermeras obstétricas en el cuidado del parto domiciliario planificado en Rio Grande do Sul. Método: Estudio exploratorio y cualitativo, con aplicación de historia oral temática. Trece enfermeras obstétricas que trabajaron en el parto domiciliario planificado en el estado participaron en el estudio. Los datos se recopilaron entre diciembre de 2019 y marzo de 2020, a través de entrevistas, y se analizaron sobre la base del análisis de contenido temático. Resultados: Surgieron dos categorías: 1) Experiencias personales, formativas y profesionales que alentaron a las enfermeras obstétricas a entrar en el parto domiciliario planificado; y 2) La búsqueda de la autonomía, la libertad, el protagonismo y el respeto en el cuidado del parto y el nacimiento como propulsores para la inserción de enfermeras obstétricas en el parto domiciliario planificado. Conclusión: Experiencias personales, formativas y profesionales y descontento con la atención obstétrica hospitalaria en el estado, considerada intervencionista y centrada en el médico, impulsaron la entrada de las enfermeras obstétricas en el parto domiciliario planificado.

RESUMO Objetivo: Descrever a trajetória da inserção de enfermeiras obstetras no atendimento ao parto domiciliar planejado no Rio Grande do Sul. Método: Estudo exploratório, qualitativo, com aplicação da história oral temática. Participaram treze enfermeiras obstetras que atuavam no parto domiciliar planejado no estado. Os dados foram coletados de dezembro/2019 a março/2020, por meio de entrevistas, e analisados com base na análise temática de conteúdo. Resultados: Emergiram duas categorias: 1) Experiências pessoais, formativas e profissionais que impulsionaram as enfermeiras obstetras a ingressarem no parto domiciliar planejado; e 2) A busca por autonomia, liberdade, protagonismo e respeito na atenção ao parto e nascimento como propulsores para a inserção das enfermeiras obstetras no parto domiciliar planejado. Conclusão: As experiências pessoais, formativas e profissionais e o descontentamento com a atenção obstétrica hospitalar no estado, considerada intervencionista e centrada no médico, foram propulsores para as enfermeiras obstetras inserirem-se no parto domiciliar planejado.

Newborn Screening Knowledge and Attitudes Among Midwives and Out-of-Hospital-Birth Parents.

Midwifery and nursing are collaborative partners in both education and practice. Understanding needs and barriers to clinical services such as newborn screening is essential. This study examined knowledge and attitudes of midwives and out-of-hospital-birth parents about newborn blood spot screening (NBS). Descriptive and cross-sectional surveys were distributed to midwives and out-of-hospital-birth parents from birth center registries and the Utah Health Department of Vital Records. Seventeen midwife surveys (response rate: 17%) and 113 parent surveys (response rate: 31%) were returned. Most midwives and out-of-hospital-birth parents reported satisfactory knowledge scores about NBS. Only 5% of parents (n = 6) did not participate in NBS. Most midwives reported that NBS is important and encouraged patients to consider undergoing NBS. Some concerns included the lack of education for both midwives and out-of-hospital patients and the trauma and accuracy of the heel prick soon after birth. Both midwives and out-of-hospital-birth parents expressed a need for improved NBS education. Additional studies are needed to ascertain whether this trend is seen with similar populations throughout the United States, to further elucidate the factors that drive NBS nonparticipation, and to develop educational resources for midwives and their patients.

Cuidados de la placenta y seguridad del recién nacido en el nacimiento Lotus / Placenta care and newborn safety in Lotus Birth

OBJETIVO: revisar la evidencia científica referente a los cuidados de la placenta y a la seguridad del recién nacido en el nacimiento Lotus. MÉTODO: revisión narrativa. Se llevaron a cabo diferentes estrategias de búsqueda en las siguientes bases de datos y plataformas: Pubmed, Cochrane, Ovid, Scielo, Cuiden, Clinical key, BMJ, Metas de Enfermería y Google Scholar. Palabras usadas: Lotus birth, umbilical non severance, cord clamping, care, safety, nacimiento Lotus. Filtros: 2016-2020, sobre cuidados placenta y seguridad recién nacido, estudios epidemiológicos. RESULTADOS: se localizaron 169 documentos. Se seleccionaron seis artículos. En dos artículos se trataban los cuidados de la placenta que eran lavadas con agua tibia en las primeras horas, secadas y envueltas en paños de tejidos naturales, usando sales y hierbas aromáticas para acelerar el proceso de secado, y dejándola a la altura del recién nacido. En los otros cuatro documentos se describían seis casos de complicaciones infecciosas que se resolvieron con antibioterapia, en madres que habían presentado bolsa rota prolongada, cultivos vaginales positivos y ausencia de antibioterapia periparto. DISCUSIÓN: el Lotus birth es una práctica infrecuente, asociada tradicionalmente al parto domiciliario, que se va introduciendo en el medio hospitalario. Es escasa la evidencia disponible sobre los cuidados de la placenta en el nacimiento Lotus y la seguridad de esta práctica para los recién nacidos

OBJECTIVE: to review the scientific evidence regarding placenta care and newborn safety in Lotus Birth. METHODS: a narrative review. Different search strategies were conducted in the following databases and platforms: Pubmed, Cochrane, Ovid, Scielo, Cuiden, Clinical key, BMJ, Metas de Enfermería and Google Scholar. Terms used: Lotus Birth, umbilical non severance, cord clamping, care, safety, nacimiento lotus. Filters: 2016-2020, on placenta care and newborn safety, epidemiological studies. RESULTS: in total. 169 documents were located. Six articles were selected. Two articles discussed placenta care: they were washed with warm water during the first hours, dried and wrapped in natural fabric cloths, using salts and aromatic plants to accelerate the drying process, and placed at the same height as the newborn. The other four documents described six cases of infectious complications, which were solved with antibiotic therapy, in mothers who had presented prolonged broken sac, positive vaginal cultures, and lack of peripartal antibiotic therapy. DISCUSSION: Lotus Birth is a rare practice, traditionally associated with home births, which has been increasingly introduced in the hospital setting. There is limited evidence available about placenta care in Lotus Birth, and the safety of this practice for newborns

Planned home births: The role of the primary care NP.

Over the past 15 years, there has been a steady resurgence of planned home births in the US. Multiple factors may impact health outcomes for mother and baby. NPs have the opportunity to provide reliable information to women to help ensure a safe delivery and to optimize care for the neonate.

(In)seguridad del parto en el domicilio: una revisión bibliográfica / (Un)safety of home birth: a literature review

OBJETIVO: Analizar el concepto de seguridad sobre el parto en el domicilio en la literatura científica. METODOLOGÍA: Revisión bibliográfica en 5 bases de datos, PubMed, Scopus, WoS, CINAHL y Cochrane Library, con 3 combinaciones booleanas: «patient safety AND home childbirth»; «safety AND home childbirth»; «risk AND home childbirth». RESULTADOS: De un total de 4.647 artículos, 30 cumplían con los criterios de inclusión. Categorías principales: 1) riesgo de muerte; 2) escenario del parto; 3) modelo consensuado. CONCLUSIONES: La literatura científica que aborda el concepto de seguridad del parto en el domicilio está atravesada por nociones de riesgo y mortalidad. Ambas son determinantes al momento de tomar la decisión y decretar un lugar idóneo para el nacimiento. No obstante, la evidencia científica determina estándares de seguridad para llevar a cabo el parto en el domicilio: bajo riesgo obstétrico, acompañamiento de una matrona experta y un sistema de transferencia sanitaria bien integrado

OBJECTIVE: To analyze the concept of home birth safety in the scientific literature.METHODOLOGY: Bibliographic review in five databases: PubMed, Scopus, WoS, CINAHL and Cochrane Library, with three Boolean combinations: «patient safety AND home childbirth»; «safety AND home childbirth»; «risk AND home childbirth». RESULTS: From a total of 4.647 articles, 30 were selected that met the inclusion criteria, emerging three main categories: 1) risk of death; 2) childbirth scenario; 3) model agreed upon. CONCLUSIONS: The scientific literature that addresses the concept of home birth safety is mainly traversed by risk and mortality. Both are decisive when making the decision and decree an ideal place for the birth to take place. However, the scientific evidence determines the conditions to carry out the delivery at home under safety standards, these are: under obstetric risk, the accompaniment of an expert midwife and a health transfer system well integrated to the home

Predictors of midwives' intention to provide planned home birth services to low-risk women: A theory of planned behaviour approach.

OBJECTIVE: Planned home birth may increase women's access to skilled midwives in all settings. Using theory to understand and predict midwives' intention regarding planned home birth services is rare. Therefore, using the theory of planned behaviour, we determined the factors associated with midwives' intention to provide planned home birth services to low-risk women. DESIGN: This cross-sectional study adopted a quantitative approach and a survey. Stratified random sampling was used to recruit 226 midwives in Sokoto, Nigeria. Data-including descriptive statistic and multiple linear regression analyses-were analysed using SPSS 23 and significant was set at 0.05. SETTING: Ten public health facilities in Sokoto, northwestern Nigeria. PARTICIPANTS: Among all 460 midwives (women aged 20-60 years), working in the maternity wards of health facilities in Sokoto, a sample of 226 midwives was calculated using a power of 0.80 and a 95% confidence interval. FINDINGS: The multiple linear regression analyses confirmed that the major factors associated with midwives' intention to provide planned home birth services were midwives' attitude towards planned home birth (p < .001) and midwives' previous experience with planned home birth practice (p = .008). CONCLUSIONS AND IMPLICATIONS: The theory of planned behaviour is a useful framework for identifying factors that affect midwives' intention to provide planned home birth services. While future research may employ a qualitative approach to explore other factors, planned home birth education campaigns should target information that enhances positive attitude and encourages midwives to provide planned home birth services.

A opção pelo parto domiciliar planejado: uma opção natural e desmedicalizada / Choosing the home planned childbirth: a natural and drug-free option / Opción para el parto hogar planificada: una elección natural y desmedicalizada

Objetivo: Analisar com base no referencial teórico de Dorothy Smith, a opção de mulheres pelo parto domiciliar planejado com fator de segurança e conforto para a mulher. Métodos: Estudo etnográfico institucional, com 17 mulheres que pariram no domicílio no período de 2008 a 2010 no município do Rio de Janeiro, aplicando entrevista semiestruturada na coleta dos dados, analisados conforme a análise temática articuladas com a teoria de Dorothy Smith. Resultados: A expressão do parto natural faz-se presente nas concepções das mulheres, expressando, em maior conforto e liberdade, uma relação de confiança com o profissional de saúde, transmitindo uma segurança para a opção do parto domiciliar. Conclusão: Concluiu-se que o encontro com o referencial ratifica a conscientização e o fortalecimento da mulher, que se empodera em defesa ao acesso da informação, e uma relação saudável com o profissional de saúde

Objective: The study's purpose has been to analyze, based on Dorothy Smith's theoretical framework, the women's choice for the home planned childbirth as a safety factor, as well as a women's comfort issue. Methods: It is an institutional ethnographic study with 17 women who gave birth at home over the period from 2008 to 2010 in Rio de Janeiro city by applying a semi-structured interview in the data collection, and then analyzed according to the thematic analysis articulated with Dorothy Smith's Theory. Results: The expression of natural childbirth is present in the women's conceptions, expressing through greater comfort and freedom a relationship of trust with the health professional, thus conveying security towards the home childbirth option. Conclusion: It was concluded that the encounter with the referential ratifies both awareness and empowerment of the women, who in turn get empowered toward the defense of access to information, and also toward a healthy relationship with the health professional

Objetivo: Analizar basa en el marco teórico de Dorothy Smith, la elección de las mujeres para el factor de parto en casa planeado de seguridad y comodidad para la mujer. Métodos: Estudio etnográfico Institucional com 17 mujeres que dieron a luz en el hogar en el período de 2008 a 2010 em la ciudad de Río de Janeiro la aplicación de entrevistas semiestructuradas para recopilar datos, y analizados de acuerdo con el análisis temático articulado con la teoría de Dorothy Smith. Resultados: La expresión de parto natural está presente en las concepciones de la mujer, que expresa uma mayor comodidad y libertad, una relación de confianza con el profesional de la salud, transmitiendo una seguridad para la opción de parto en casa. Conclusión: Se concluye que la reunión con el punto de referencia confirma la sensibilización y capacitación de las mujeres, que faculta, en defensa de acceso a la información, y una relación sana con el profesional de la salud

Historia de las enfermeras obstétricas: importancia de sus cuidados en la atención al parto / The History of Obstetric Nurses and Importance of their Care in Childbirth

RESUMEN Introducción: la mayoría de los informes antiguos señalan que casi todos los partos eran atendidos por mujeres y que este arte era enseñado de una mujer a otra. Su rol ha existido desde el inicio mismo de la civilización, basada en la relación de confianza y de complicidad que son capaces de establecer con la mujer y la familia durante los cuidados en el parto. Objetivo: distinguir la importancia del rol de la enfermera obstétrica para la prestación de cuidados durante el parto. Métodos: se realizó una revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de documentos, se consideraron tesis de doctorado, maestría, artículos originales y de revisión publicados entre 2005 y 2015 en español e inglés. La búsqueda fue realizada en las bases de datos SciELO y Google académico de enero a marzo de 2016, las palabras clave utilizadas fueron: "historia", "comadronas", "enfermeras obstétricas" y "funciones". Tras la identificación de los estudios pre-seleccionados, se llevó a cabo la lectura de los títulos, resumen y palabras clave, comprobando la pertinencia con el estudio. Conclusión: el recorrido por la historia y evolución de la enfermería obstétrica permitió reconocer el valor de las comadronas en la prestación de cuidados así como su influencia en la evolución de esta especialidad con el surgimiento de la Enfermería(AU)

ABSTRACT Introduction: Reports from the past times mostly note that almost all deliveries were attended by women and that this art was taught from woman to woman. Their role has existed since the very beginning of civilization, based on the relationship of trust and complicity they are capable of establishing with the woman and the family during childbirth care. Objective: To distinguish the importance of the obstetric nurse role for the provision of childbirth care. Methods: A systematic bibliographic review was carried out to develop a reflexive-critical analysis of the content of documents. We considered doctoral dissertations and master's degree theses, as well as original and review articles published between 2005 and 2015 in both Spanish and English. The search was made in the databases SciELO and Academic Google, from January to March 2016. The key words used were: historia [history], comadronas [midwives], enfermera obstétrica [obstetric nurses], and funciones [functions]. After the identification of the pre-selected studies, the titles, summary and key words were read, verifying the pertinence with the study. Conclusion: The review throughout the history and evolution of obstetric nursing allowed recognizing the value of midwives in the provision of care as well as their influence on the evolution of this specialty with the appearance of nursing(AU)

La partería tradicional / Traditional midwifery

RESUMEN Introducción: Las parteras tradicionales apoyan en la atención del parto humanizado, lo cual les permite a las mujeres en trabajo de parto controlar la situación y tomar sus propias decisiones. Objetivo: Describir las prácticas de la partería tradicional en tres regiones del Departamento del Magdalena, Colombia. Métodos: Estudio descriptivo transversal, enfoque cuantitativo, desarrollado con 15 parteras de los municipios de Santa Marta, Ariguaní y Fundación, departamento del Magdalena, los datos fueron recolectados utilizando un cuestionario estructurado y validado, aplicado en el primer semestre de 2016. La muestra fue tomada a conveniencia, dado al nivel de accesibilidad de las investigadoras con las parteras se pudo obtener 5 parteras de cada población, para un total de 15. Los datos cuantitativos fueron analizados utilizando estadística descriptiva (distribución porcentual y media). Resultados: El 54 por ciento se encontraba entre los 50 y 80 años de edad, vivían en zona rural 80 por ciento, tenían entre 30 y 60 años de experiencia como parteras 53 por ciento, todas son mujeres (100 por ciento) y sabían leer y escribir, 93 por ciento hablaba español, solo el 7 por ciento hablaba la lengua nativa, 47 por ciento aprendió a atender partos por tradición familiar, el 25 por ciento aprendió sola, el 20 por ciento aprendió a atender partos por medio de otra persona y el 8 por ciento aprendió por medio de un curso de capacitación. Conclusión: La partería en esta región continúa transfiriéndose de generación en generación, teniendo prácticas tradicionales como el uso de tomas después de la atención del parto(AU)

ABSTRACT Introduction: Traditional midwives support humanized delivery, which allows women in labor to control the situation and make their own decisions. Objective: To describe the practices of traditional midwifery in three regions of Magdalena Department, Colombia. Methods: Cross-sectional descriptive study, with a quantitative approach, developed with 15 midwives from the municipalities of Santa Marta, Ariguaní, and Fundación, Magdalena Department. The data were collected using a structured and validated questionnaire, applied in the first semester of 2016. The sample was taken at convenience, given the researchers' level of accessibility with the midwives. Five midwives from each population could be obtained, for a total of 15. The quantitative data were analyzed using descriptive statistics (percentage and average distribution). Results: 54 percent were at age 50-80 years, 80 percent lived in rural areas, 53 percent had 30-60 years of experience as midwives, all are women (100 percent) and knew how to read and write, 93 percent spoke Spanish, only 7 percent spoke the native language, 47 percent learned how to assist births by family tradition, 25 percent learned by themselves, 20 percent learned how to assist births through another person, and 8 percent learned by means of a training course. Conclusion: Midwifery in this region continues to be transferred from generation to generation, having traditional practices, such as the use of intakes after delivery care(AU)

A cosmopolítica da gestação, do parto e do pós-parto: autoatenção e medicalização entre os índios Munduruku / The cosmopolitics of pregnancy, childbirth and postpartum: self-attention and medicalization among Munduruku Indians

A pesquisadora Raquel Paiva Dias-Scopel, do Instituto Leônidas e Maria Deane (ILMD/Fiocruz Amazônia), levanta questões sobre a valorização e respeito à diversidade étnica e cultural dos povos indígenas e a difícil interface com o processos de medicalização e do direito ao acesso aos serviços de saúde biomédicos. O livro é parte da Coleção Saúde dos Povos Indígenas, da Editora Fiocruz e partiu da tese de doutorado defendida em 2014 no Programa de Pós-Graduação em Antropologia Social da Universidade Federal de Santa Catarina (UFSC). Foi publicado pela primeira vez em 2015 pela Associação Brasileira de Antropologia com o título A Cosmopolítica da Gestação, Parto e Pós-Parto: práticas de autoatenção e processo de medicalização entre os índios Munduruku. No prefácio da primeira edição, sua orientadora, a doutora em antropologia e professora titular da UFSC, Esther Jean Langdon, ressalta que o conceito fundamental deste livro é da autoatenção, que aponta para o reconhecimento da autonomia e da criatividade da coletividade, principalmente da família, como núcleo que articula os diferentes modelos de atenção ou cuidado da saúde.

Confiando na experiência: perspectiva de mulheres que pariram em domicilio acompanhadas por enfermeira obstétrica / Relying on experience: perspective of women who gave birth at home accompanied by obstetric nurse

Trata-se de uma pesquisa descritiva, qualitativa, com a utilização da Grounded Theory, na perspectiva do Interacionismo Simbólico. O objetivo geral foi: analisar a concepção de segurança do parto, a partir do processo de interação social de mulheres que pariram em domicílio acompanhadas por uma enfermeira obstétrica, e os significados por ela atribuídos. Foram objetivos específicos: identificar os fatores que atribuíram segurança no parto entre mulheres que tiveram seu parto acompanhado no domicílio por enfermeiras obstétricas e analisar a experiência de segurança no parto para mulheres que pariram acompanhadas por enfermeira obstétrica. O estudo procedeu-se no município do Rio de Janeiro, mediante a seleção e convite às mulheres através rede social Facebook, no grupo de mulheres/mães Santa Mãe. As entrevistas semiestruturadas foram realizadas no ambiente domiciliar das participantes. Apenas uma foi realizada em ambiente público. A coleta e análise dos dados aconteceram no período de março a setembro de 2017, observando as exigências da Resolução 510/2016 do Conselho Nacional de Saúde. Foram formados quatro grupos amostrais, com mulheres que pariram no domicílio, pelo menos uma vez, acompanhadas por enfermeira obstétrica. Da análise comparativa constante dos dados emergiram três categorias: Querendo parir naturalmente; Decidindo pelo parto domiciliar planejado com enfermeira obstétrica e Definindo uma enfermeira obstétrica experiente. Essas categorias, em sua articulação, levaram à identificação da categoria central que norteia o modelo teórico explicativo como sendo: Confiando na experiência da enfermeira como critério de segurança na escolha por um parto domiciliar planejado. Evidenciou-se que a concepção de segurança relacionada à confiança, no parto domiciliar planejado, se origina através das relações e interações que as mulheres desenvolvem com os objetos sociais, com os fenômenos e com as outras pessoas, no âmbito de seu núcleo social. O contexto em que as mulheres parecem encontrar segurança é o ambiente domiciliar por este ser mais propicio ao aprimoramento da confiança e vínculo na relação com a enfermeira. A sensação de parir em domicilio está atrelada à noção de pertencimento e protagonismo no seu parto. Com isso, este estudo nos mostra que a relação de confiança entre a mulher e a enfermeira obstétrica, bem como o respeito por suas escolhas e a manutenção do seu protagonismo, proporcionaram segurança no parto domiciliar planejado. A concepção de segurança no parto para as mulheres significou estar em um ambiente de protagonismo. As enfermeiras obstétricas são profissionais capacitadas em compartilhar com as mulheres, seus conhecimentos a respeito da fisiologia do trabalho de parto e parto, e do uso de tecnologias não-invasivas de cuidado, permitindo, assim, a participação delas na construção de seu protagonismo e empoderamento.

This is a descriptive and qualitative research using the Grounded Theory methodology, from the perspective of Symbolic Interactionism. The general objective was to analyze the conception of safety in childbirth, based on the social interaction process of women who gave birth at home accompanied by an obstetric nurse, and the meanings attributed by her. Specific objectives were: to identify the factors that bring safety to the childbirth women who gave birth at home accompanied by obstetric nurse; to analyze the experience of safety in childbirth for women who gave birth at home accompanied by obstetric nurse. The study was carried out in the city of Rio de Janeiro, through the selection and invitation to women through social network Facebook, in the group of women / mothers, Santa Mãe. The semi-structured interviews were carried out in the home environment of the participants. Only one was held in a public environment. The data collection and analysis took place from March to September 2017, observing all the requirements on ethics stated by Resolution 510/2016 of the National Health Council. Four sample groups were set up with women who gave birth at home at least once, accompanied by obstetric nurse. From the comparative data analysis three categories raised: Wanting to give birth naturally; Deciding on planned home birth with an obstetric nurse; Defining an experienced obstetric nurse. These categories, in their articulation, led to the identification of the core category that guides the explanatory theoretical model as being: Relying on the experience of the nurse as a safety criterion in the choice for a planned home birth. It was evidenced that the conception of safety related to confidentiality in a planned home birth raises through the relationships and interactions that women develop with social objects, with phenomena and with other people within their social group. Home environment is the context where women seem to feel safe, because it is more conducive to improving trustiness and bonding in the relationship with the nurse. The sensation of giving birth at home is linked to the feeling of belonging and protagonism in her childbirth. Thus, this study shows that the relationship of trustiness between the woman and the obstetric nurse, as well as the respect for woman's choices and the maintenance of the woman as protagonist, provided safety in the planned home birth. The conception of safety in childbirth, for these women, meant being in an environment where they are protagonists of their childbirth. Obstetric nurses are professionals able to share with women their knowledge about the physiology of labor and delivery and the use of non-invasive care technologies, allowing them to participate in building their protagonism and empowerment.

Consequences of delivery at home in a woman without prenatal care.

This is a case report of a 39-year-old multigravida woman without allopathic prenatal care who, after three previous caesarean sections, attempted to deliver her fourth child at home with the help of a direct entry midwife. During labour, fetal movement and fetal heart tones became undetectable, at which time the patient was referred by the midwife to the hospital. The patient was diagnosed with uterine rupture, bladder rupture and fetal demise; she was rushed to emergency surgery. The patient's lack of allopathic prenatal care, attempt of vaginal birth after three previous caesarean sections, coupled with her desire for delivery at home, led to her complicated course. The patient related that she was never made aware that attempting a home birth after three prior caesarean sections put her at increased risk for complications, and she was also unaware that midwives could have varying levels of training.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Midwifery: home and away.

The challenges faced by birthing women and maternity healthcare professionals in developing countries cannot not be over estimated. The experience of a midwife in a rural Tanzanian hospital described in this article gives a small insight into these challenges. With intermittent electricity, no running water, three beds, 20 births per day and lack of midwifery or obstetric education, morbidity and mortality rates are high, and teaching is difficult. Conversely, where monitoring is minimalistic and time limits are not applied, 'normal birth' is truly the norm and the trust in women to grow and birth their babies is consistent and commendable. Reflection upon midwifery in developing countries can help inform attitudes and practice in the UK.