A&N nos ciclos e eventos de vida: cenário e recomendações para gestantes

Com o objetivo de apoiar a prática do cuidado individual na Atenção Primária à Saúde, o Ministério da Saúde vêm desenvolvendo uma série de iniciativas para a qualificação do pré-natal e produziu um fascículo do Protocolo de Uso do Guia Alimentar para a População Brasileira na Orientação Alimentar de Gestantes. Nessa fase é particularmente relevante o consumo de uma grande variedade de alimentos in natura e minimamente processados além de muita água, para suprir a necessidade de nutrientes fundamentais para esse evento da vida. A alimentação saudável na gestação favorece o bom desenvolvimento fetal, a saúde e o bem-estar da gestante, além de prevenir o surgimento de agravos, como diabetes gestacional, hipertensão e ganho de peso excessivo. Para uma orientação alimentar mais adequada, é essencial que o profissional de saúde esteja atento a aspectos relacionados à vulnerabilidade social e renda, à rede de apoio, à idade da gestante e às condições de trabalho da pessoa gestante atendida. Outros fatores que necessitam de atenção no período gestacional são as alterações fisiológicas e sintomatologias que podem influenciar o consumo alimentar nesse evento da vida. Além disso, o acompanhamento do cenário alimentar e nutricional realizado por meio das consultas de pré-natal e acompanhamento do ganho de peso é uma ação preventiva de agravos relacionados à má nutrição e a curva de ganho de peso gestacional, disponível na caderneta de saúde da gestante é uma importante ferramenta na rotina de trabalho dos profissionais e equipes de saúde.

Guía de práctica clínica para la prevención y manejo de la enfermedad hipertensiva del embarazo / Clinical practice guideline for the prevention and management of hypertensive disease in pregnancy

Proveer recomendaciones clínicas basadas en evidencia para la prevención y el manejo de la enfermedad hipertensiva del embarazo (EHE) en el Seguro Social de Salud (EsSalud) del Perú. En la presente GPC se formularon 11 recomendaciones (6 fuertes y 5 condicionales) que respondieron las preguntas clínicas definidas en el alcance de la GPC, acompañadas de 32 puntos de BPC y 3 flujogramas que abordan temas de prevención, tratamiento y seguimiento de la EHE.

Progress and barriers towards maternal and neonatal tetanus elimination in the remaining 12 countries: a systematic review.

This systematic review assessed the progress and barriers towards maternal and neonatal tetanus elimination in the 12 countries that are yet to achieve elimination, globally. Coverage of at least 80% (the coverage level required for elimination) was assessed among women of reproductive age for five factors: (1) at least two doses of tetanus toxoid-containing vaccine, (2) protection at birth, (3) skilled birth attendance, (4) antenatal care visits, and (5) health facility delivery. A scoping review of the literature and data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys provided insights into the barriers to attaining maternal and neonatal tetanus elimination. Findings showed that none of the 12 countries attained at least 80% coverage for women of reproductive age receiving at least two doses of tetanus toxoid-containing vaccine or protection at birth according to the data from Demographic and Health Surveys or Multiple Indicator Cluster Surveys. Barriers to maternal and neonatal tetanus elimination were mostly related to health systems and socioeconomic factors. Modification to existing maternal and neonatal tetanus elimination strategies, including innovations, will be required to accelerate maternal and neonatal tetanus elimination in these countries.

Antenatal care

This guideline covers the routine antenatal care that women and their babies should receive. It aims to ensure that pregnant women are offered regular check-ups, information and support. We have also published a guideline on postnatal care, which covers the topics of emotional attachment and baby feeding. The guideline uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but who are pregnant. Similarly, where the term 'parents' is used, this should be taken to include anyone who has main responsibility for caring for a baby.

The increasing use of the WHO Safe Childbirth Checklist: lessons learned at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, Cameroon.

BACKGROUND: Safe childbirth remains a daunting challenge, particularly in low-middle income countries, where most pregnancy-related deaths occur. Cameroon's maternal mortality rate, estimated at 529 per 100,000 live births in 2017, is significantly high. The WHO Safe Childbirth Checklist (SCC) was designed to improve the quality of care provided to pregnant women during childbirth. The SCC was implemented at the Yaoundé Gynaeco-Obstetric and Paediatric Hospital to improve the quality of care during childbirth. METHODS: This study was a retrospective study to determine the adoption rate of the SCC and its association with maternal (eclampsia, perineal tears, and postpartum haemorrhage) and neonatal (stillbirth, neonatal asphyxia and neonatal death) complications. Data were collected 6 months after the introduction of the SCC. Multivariate binary logistic regression was used to analyse the association between the use of the SCC and maternofoetal complications. RESULTS: Out of 1611 deliveries conducted, 1001 records were found, giving a retrieval rate of 62%. Twenty-five records were excluded. During the study period, the checklists were used in 828 of 976 clinical notes, with an adoption rate of 84.8% and a utilization rate of 93.9% at 6 months. Severe preeclampsia/eclampsia was associated with the non-use of the SCC (2.1 vs 5.4%, p = 0.041). Stillbirth, neonatal asphyxia, and neonatal death rates were not significantly different between the checklist and non-checklist groups. However, for all neonatal outcomes, the proportion of complications was lower when the checklist was used. CONCLUSION: The use of the SCC was associated with significantly reduced pregnancy complications, especially for reducing the rates of severe pre-eclampsia/eclampsia. The use of the SCC increased to 93.9% of all deliveries within 6 months. We advocate for the use of the WHO Safe Childbirth Checklist in maternity units.

Impact of a maternal and newborn health results-based financing intervention (RBF4MNH) on stillbirth: a cross-sectional comparison in four districts in Malawi.

BACKGROUND: Malawi implemented a Results Based Financing (RBF) model for Maternal and Newborn Health, "RBF4MNH" at public hospitals in four Districts, with the aim of improving health outcomes. We used this context to seek evidence for the impact of this intervention on rates of antepartum and intrapartum stillbirth, taking women's risk factors into account. METHODS: We used maternity unit delivery registers at hospitals in four districts of Malawi to obtain information about stillbirths. We purposively selected two districts hosting the RBF4MNH intervention and two non-intervention districts for comparison. Data were extracted from the maternity registers and used to develop logistic regression models for variables associated with fresh and macerated stillbirth. RESULTS: We identified 67 stillbirths among 2772 deliveries representing 24.1 per 1000 live births of which 52% (n = 35) were fresh (intrapartum) stillbirths and 48% (n = 32) were macerated (antepartum) losses. Adjusted odds ratios (aOR) for fresh and macerated stillbirth at RBF versus non-RBF sites were 2.67 (95%CI 1.24 to 5.57, P = 0.01) and 7.27 (95%CI 2.74 to 19.25 P < 0.001) respectively. Among the risk factors examined, gestational age at delivery was significantly associated with increased odds of stillbirth. CONCLUSION: The study did not identify a positive impact of this RBF model on the risk of fresh or macerated stillbirth. Within the scientific limitations of this non-randomised study using routinely collected health service data, the findings point to a need for rigorously designed and tested interventions to strengthen service delivery with a focus on the elements needed to ensure quality of intrapartum care, in order to reduce the burden of stillbirths.

Guideline No. 416: labour, delivery, and postpartum care for people with physical disabilities

To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada. This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline. Safe and compassionate care for people with physical disabilities who are giving birth. Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth. A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations). Maternal-fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities.

Challenges in migrant women's maternity care in a high-income country: A population-based cohort study of maternal and perinatal outcomes.

INTRODUCTION: This study aims to explore maternal and perinatal outcomes of migrant women in Iceland. MATERIAL AND METHODS: This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5-minute Apgar <7, neonatal intensive care unit admission and perinatal mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) for maternal and perinatal outcomes were calculated using logistic regression models. RESULTS: A total of 8158 migrant women gave birth during the study period: 4401 primiparous and 3757 multiparous. Overall, migrant women had higher adjusted ORs (aORs) for episiotomy (primiparas: aOR 1.43, 95% CI 1.26-1.61; multiparas: 1.39, 95% CI 1.21-1.60) and instrumental births (primiparas: 1.14, 95% CI 1.02-1.27, multiparas: 1.41, 95% CI 1.16-1.72) and lower aORs of induction of labor (primiparas: 0.88, 95% CI 0.79-0.98; multiparas: 0.74, 95% CI 0.66-0.83), compared with Icelandic women. Migrant women from countries with a high Human Development Index score (≥0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland (<0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency cesarean and postpartum hemorrhage. CONCLUSIONS: Women's citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women.

Know-do gaps in obstetric and newborn care quality in Uganda: a cross-sectional study in rural health facilities.

OBJECTIVES: Variable and inadequate quality of maternity care is a critical factor in persistently high rates of maternal and neonatal mortality in Uganda. We investigated whether provider quality of care deviates from knowledge and the factors associated with these 'know-do gaps' in Ugandan maternity facilities. METHODS: Data were collected from 109 providers in 40 facilities. Quality was measured using direct observations of intrapartum care, and scores were based on the percentage of essential care actions provided out of a 20-item validated quality index. Knowledge was measured based on the percentage of items that providers reported knowing to do using vignette surveys. The know-do gap was the difference between knowledge and quality. Multivariable models were used to assess the association between provider- and facility-level characteristics and knowledge, quality and know-do gaps. RESULTS: The average quality score was 45%, with quality varying widely within and across providers. The mean knowledge score was 70%, yielding a mean know-do gap of 25%. Know-do gaps were largest for practices related to infection control, vitals monitoring, and prevention of postpartum haemorrhage. The association between quality and knowledge scores was positive but small (P = 0.08), so know-do gaps were largest for providers with the highest knowledge scores. Greater provider training was positively associated with knowledge (P = 0.005) but not with quality (P = 0.60). Having 10 or more years of work experience was associated with higher quality scores (5.3, 95%CI: 0.6 to 10.1), while higher patient volumes were associated with lower quality scores (-2.2, 95%CI: -3.7 to - 0.07). None of the factors of provider motivation, cadre, availability of essential medicines and supplies or facility staffing were associated with quality or know-do gaps. CONCLUSIONS: Our results indicate that, in Uganda, gaps between knowledge and quality do not appear to be explained by factors such as lack of motivation, education, training or supplies. Gaps are particularly large for essential practices related to prevention of postpartum haemorrhage, a leading cause of maternal mortality in Uganda and similar settings.

Maternal and child health in the context of COVID-19 pandemic: evidence, recommendations and challenges / A saúde materno-infantil no contexto da pandemia de COVID-19: evidências, recomendações e desafios

Abstract Objectives: to present the main evidence, recommendations and challenges for maternal and child health in the context of COVID-19 pandemic. Methods: narrative review of national and international documents and reflections on the theme. Results: the coexistence ofpregnancy/puerperium and COVID-19 infection establishes many challenges. It is extremely important that the conduct should be individually adopted, covering all aspects of health in the mother-child binomial, estimating risks and benefits of each decision. Until now, it is recognized that natural childbirth should be encouraged and breastfeeding maintained, if adequate hygienic-sanitary care is ensured. Cesarean delivery and the isolation and separation of the mother-child contact without breastfeeding, will only be eligible when the clinical status of the mother or child is critical. The child must be included in all stages of health care, as this commonly asymptomatic group plays an important role in the family's transmissibility of the disease. Routine immunization should be provided, as well as clinical assistance when necessary, and families must be assisted in favor of their well-being. Conclusion: at the moment, it is not possible to measure the consequences of this new pandemic on maternal and child health, demanding attention to its evolution and new evidences about the implications in mother and child care.

Resumo Objetivos: apresentar as principais evidências, recomendações e desafios à saúde materno-infantil no contexto da pandemia de COVID-19. Métodos: revisão narrativa de documentos nacionais e internacionais e reflexões sobre a temática. Resultados: a coexistência da gestação/puerpério e infecção por COVID-19 impõe muitos desafios. A conduta adotada deve ser de caráter individual, abrangendo todos os aspectos de saúde do binômio mãe-filho, estimando os riscos e benefícios de cada decisão. Até o momento, reconhece-se que o parto natural deve ser incentivado e a amamentação mantida, desde que assegurados os cuidados higienicossanitários. O parto cirúrgico e o isolamento com separação do contato mãe-filho, sem amamentação, serão elegíveis para casos em que o quadro clínico da mãe ou da criança seja crítico. A criança deve ser incluída em todas as etapas do cuidado em saúde, pois esse grupo comumente assintomático desempenha papel importante na transmissibilidade familiar da doença. Deve-se propiciar a imunização de rotina, oportunizar a assistência clínica, quando necessária, e auxiliar as famílias em prol do bem-estar. Conclusão: o atual momento ainda não nos permite mensurar as consequências dessa nova pandemia no âmbito da saúde materno-infantil, demandando atenção à sua evolução e novas evidências acerca das implicações no cuidado ao binômio mãe-filho.

Optimizing Health And Well-Being For Women And Children.

The health and well-being of childbearing women and children in the US should set a world standard. However, women and children in the US experience higher rates of morbidity and mortality than women and children in almost all other industrialized countries, with marked racial and ethnic disparities. The unfolding effects of the coronavirus disease 2019 (COVID-19) pandemic have highlighted such disparities. In this article, which is part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we draw on a life-course framework to highlight promising interventions and recommend key improvements in programs and policies to optimize health and well-being among women and children in the US. The recommendations address ensuring access, transforming health care, and addressing social and environmental determinants.

Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health.

OBJECTIVE: To evaluate the use of analgesia during labor in women who had a vaginal birth and to determine the factors associated with its use. METHODS: A secondary analysis was performed of the WHO Multicountry Survey on Maternal and Newborn Health, a cross-sectional, facility-based survey including 359 healthcare facilities in 29 countries. The prevalence of analgesia use for vaginal birth in different countries was reported according to the Human Development Index (HDI). Sociodemographic and obstetric characteristics of the participants with and without analgesia were compared. The prevalence ratios were compared across countries, HDI groups, and regions using a design-based χ2 test. RESULTS: Among the 221 345 women who had a vaginal birth, only 4% received labor analgesia, mainly epidural. The prevalence of women receiving analgesia was significantly higher in countries with a higher HDI than in countries with a lower HDI. Education was significantly associated with increased use of analgesia; nulliparous women and women undergoing previous cesarean delivery had a significantly increased likelihood of receiving analgesia. CONCLUSION: Use of analgesia for women undergoing labor and vaginal delivery was low, specifically in low-HDI countries. Whether low use of analgesia reflects women's desire or an unmet need for pain relief requires further studies.

Assessment of the validity of the measurement of newborn and maternal health-care coverage in hospitals (EN-BIRTH): an observational study.

BACKGROUND: Progress in reducing maternal and neonatal deaths and stillbirths is impeded by data gaps, especially regarding coverage and quality of care in hospitals. We aimed to assess the validity of indicators of maternal and newborn health-care coverage around the time of birth in survey data and routine facility register data. METHODS: Every Newborn-BIRTH Indicators Research Tracking in Hospitals was an observational study in five hospitals in Bangladesh, Nepal, and Tanzania. We included women and their newborn babies who consented on admission to hospital. Exclusion critiera at admission were no fetal heartbeat heard or imminent birth. For coverage of uterotonics to prevent post-partum haemorrhage, early initiation of breastfeeding (within 1 h), neonatal bag-mask ventilation, kangaroo mother care (KMC), and antibiotics for clinically defined neonatal infection (sepsis, pneumonia, or meningitis), we collected time-stamped, direct observation or case note verification data as gold standard. We compared data reported via hospital exit surveys and via hospital registers to the gold standard, pooled using random effects meta-analysis. We calculated population-level validity ratios (measured coverage to observed coverage) plus individual-level validity metrics. FINDINGS: We observed 23 471 births and 840 mother-baby KMC pairs, and verified the case notes of 1015 admitted newborn babies regarding antibiotic treatment. Exit-survey-reported coverage for KMC was 99·9% (95% CI 98·3-100) compared with observed coverage of 100% (99·9-100), but exit surveys underestimated coverage for uterotonics (84·7% [79·1-89·5]) vs 99·4% [98·7-99·8] observed), bag-mask ventilation (0·8% [0·4-1·4]) vs 4·4% [1·9-8·1]), and antibiotics for neonatal infection (74·7% [55·3-90·1] vs 96·4% [94·0-98·6] observed). Early breastfeeding coverage was overestimated in exit surveys (53·2% [39·4-66·8) vs 10·9% [3·8-21·0] observed). "Don't know" responses concerning clinical interventions were more common in the exit survey after caesarean birth. Register data underestimated coverage of uterotonics (77·9% [37·8-99·5] vs 99·2% [98·6-99·7] observed), bag-mask ventilation (4·3% [2·1-7·3] vs 5·1% [2·0-9·6] observed), KMC (92·9% [84·2-98·5] vs 100% [99·9-100] observed), and overestimated early breastfeeding (85·9% (58·1-99·6) vs 12·5% [4·6-23·6] observed). Inter-hospital heterogeneity was higher for register-recorded coverage than for exit survey report. Even with the same register design, accuracy varied between hospitals. INTERPRETATION: Coverage indicators for newborn and maternal health care in exit surveys had low accuracy for specific clinical interventions, except for self-report of KMC, which had high sensitivity after admission to a KMC ward or corner and could be considered for further assessment. Hospital register design and completion are less standardised than surveys, resulting in variable data quality, with good validity for the best performing sites. Because approximately 80% of births worldwide take place in facilities, standardising register design and information systems has the potential to sustainably improve the quality of data on care at birth. FUNDING: Children's Investment Fund Foundation and Swedish Research Council.

Guideline: infant feeding in areas of Zika virus transmission - 2 ed

In 2018, the World Health Assembly, through resolution WHA71.9 on infant and young child feeding, affirmed that "the protection, promotion and support of breastfeeding contributes substantially to the achievement of the Sustainable Development Goals on nutrition and health and is a core element of quality health care" recognized that "appropriate, evidence-based and timely support of infant and young child feeding in emergencies saves lives, protects child nutrition, health and development and benefits mothers and families". The World Health Assembly requested WHO "to continue to update and generate evidence-based recommendations". WHO recommends exclusive breastfeeding for infants 0­6 months of age and continued breastfeeding to 2 years and beyond. WHO interim guidance published during the Zika virus outbreak was based on a limited volume of evidence under an emergency process during a Public Health Emergency of International Concern. Subsequent rapid advice and a WHO toolkit for supporting people affected by complications associated with Zika virus recommended that mothers with possible or confirmed Zika virus infection or exposure continue to breastfeed, since the benefits of breastfeeding outweigh any potential risk of Zika virus infection through breastmilk. Concerns about possible Zika virus transmission during breastfeeding remain, since the virus has been detected in breast-milk samples. It is not clear whether breast-milk from women with Zika virus has enough viral load or infectivity to lead to infection among infants. Also, during breastfeeding, other bodily fluids could be exchanged, such as sweat and blood, in addition to breast-milk. There are also concerns related to the transmission of Zika virus infection from the mother to the fetus during pregnancy. Zika virus infection during pregnancy can result in microcephaly and other congenital anomalies among affected infants, known as congenital Zika syndrome. Zika virus infection is also associated with other complications, including preterm birth and miscarriage. An increased risk of nervous system complications is associated with Zika virus infection among children, including Guillain-Barré syndrome, neuropathy and myelitis. Infants with congenital Zika syndrome may have a decline in nutritional status owing to hypotonia, abnormal metabolic demands because of spasticity and difficulties feeding. Among the latter, infants with congenital Zika syndrome are especially affected by dysphagia, difficulty feeding, gastroesophageal reflux and delayed gastric emptying. There are certain modifications to feeding depending on the spectrum of manifestations and their severity, which may include postural correction, adjustment of the environment and thickening feeds, among others, as age appropriate. Support for the caregivers of infants with congenital Zika syndrome may aid the infants in achieving improved growth and nutritional status, attaining developmental milestones and enhancing the quality of life. WHO published guidelines for screening, assessment and management of neonates and infants with complications associated with Zika virus exposure in utero in 2016. Although there is no longer an outbreak, Zika virus transmission continues in some areas. As of July 2019, 87 countries and territories across four of the six WHO regions (African Region, Region of the Americas, SouthEast Asia Region and Western Pacific Region) had evidence of autochthonous mosquito-borne Zika virus transmission. It is important to have a standard guideline as part of efforts to manage infant feeding in areas where there is transmission as the data about long-term outcomes associated with Zika virus infection among infants are becoming available.

Qualidade da assistência ao parto e sua relação com a duração do aleitamento materno exclusivo entre mulheres usuárias do Sistema Único de Saúde no município de Ribeirão Preto/SP / Quality of childbirth care and its relationship with the duration of exclusive breastfeeding among women users of the Unified Health System in the city of Ribeirão Preto / SP

O aleitamento materno exclusivo é a mais sábia estratégia natural de vínculo, afeto, proteção e nutrição para a criança é recomendado pela Organização Mundial da Saúde até o sexto mês de vida da criança. Realizou-se um estudo longitudinal prospectivo, observacional, analítico e quantitativo que avaliou a assistência perinatal em uma maternidade de risco comum de um município do interior paulista, à luz das Boas Práticas de Atenção ao Parto e Nascimento. Utilizou-se o escore de Bologna, que combina as cinco práticas recomendadas pela OMS, a soma dessas cinco avaliações representa a qualidade da assistência, escore varia de 0 a 5, e no grupo estudado o escore médio foi de 3,1 segundo os dados coletados das 104 participantes do estudo. Na aplicação do escore de Bologna, os resultados encontrados sobre a qualidade avaliada mostraram que quanto mais próximo de 5, melhor a qualidade. A associação foi estatisticamente significativa (p<0.05) para o profissional enfermeiro na assistência perinatal e a condição de consumo de leite materno exclusivo nos 30 dias pós parto, das 78 mulheres entrevistadas, 62 delas tinham sido atendidas por enfermeiras, sendo que 100% destas consideravam o leite materno o único alimento oferecido a criança, comparado as 18 mulheres que não tiveram assistência da enfermeira, (14) 87,5% dessas mulheres responderam que consideravam o leite materno como único alimento oferecido. Os resultados indicam que a maternidade atingir padrões de qualidade condizentes com um modelo de atendimento viável recomendado pela OMS. Demonstrou-se também que o parto atendido pelo profissional enfermeiro, determinou que houvesse maiores escores de qualidade na assistência e que aumentassem o tempo de aleitamento materno exclusivo

Exclusive breastfeeding is the wisest natural strategy of bonding, affection, protection and nutrition for the child and is recommended by the World Health Organization until the child's sixth month of life. A prospective, observational, analytical and quantitative longitudinal study was carried out, and that evaluated perinatal care in a maternity hospital of common risk in a municipality in the interior of São Paulo, in the light of Good Practices in Childbirth and Birth Care. The Bologna score was used, which combines the five practices recommended by the WHO, the sum of these five assessments represents the quality of care, the score ranges from 0 to 5, and in the studied group the average score was 3.1 according to the data collected from the 104 study participants. When applying the Bologna Score, the results found on the quality assessed were closer to 5, the better quality. The association was statistically significant (p <0.05) for the professional nurse in perinatal care and the condition of exclusive breast milk consumption in the 30 days postpartum, of the 78 women interviewed, 62 of them had been attended by nurses, 100% of whom they considered breast milk as the only food offered to the child, compared to the 18 women who did not have assistance from the nurse, (14) 87.5% of these women answered that they considered breast milk as the only food offered. The results indicate that motherhood reaches quality standards consistent with a viable care model recommended by WHO. It was also shown that the delivery attended by the professional nurse, determined that there were higher scores on quality of care and that they increase the time of exclusive breastfeeding

WHO recommendations on maternal and newborn care for a positive postnatal experience

The postnatal period, defined here as the period beginning immediately after the birth of the baby and extending up to six weeks (42 days), is a critical time for women, newborns, partners, parents, caregivers and families. Yet, during this period, the burden of maternal and neonatal mortality and morbidity remains unacceptably high, and opportunities to increase maternal well-being and to support nurturing newborn care have not been fully utilized. Postnatal care services are a fundamental component of the continuum of maternal, newborn and child care, and key to achieving the Sustainable Development Goals (SDGs) on reproductive, maternal and child health, including targets to reduce maternal mortality rates and end preventable deaths of newborns. In line with the SDGs and the Global Strategy for Women's, Children's and Adolescents' Health, and in accordance with a human rights-based approach, postnatal care efforts must expand beyond coverage and survival alone to include quality of care. This guideline aims to improve the quality of essential, routine postnatal care for women and newborns with the ultimate goal of improving maternal and newborn health and well-being. It recognizes a "positive postnatal experience" as a significant end point for all women giving birth and their newborns, laying the platform for improved short- and long-term health and well-being. A positive postnatal experience is defined as one in which women, newborns, partners, parents, caregivers and families receive information, reassurance and support in a consistent manner from motivated health workers; where a resourced and flexible health system recognizes the needs of women and babies, and respects their cultural context. This is a consolidated guideline of new and existing recommendations on routine postnatal care for women and newborns receiving facility- or community-based postnatal care in any resource setting. It provides a comprehensive set of recommendations for care during the postnatal period, focusing on the essential package that all women and newborns should receive, with due attention to quality of care; that is, the provision and experience of care. This guideline updates and expands upon the 2014 WHO recommendations on postnatal care of the mother and newborn, and complements existing WHO guidelines on the management of postnatal complications.

Methods to measure effects of social accountability interventions in reproductive, maternal, newborn, child, and adolescent health programs: systematic review and critique.

BACKGROUND: There is no agreed way to measure the effects of social accountability interventions. Studies to examine whether and how social accountability and collective action processes contribute to better health and healthcare services are underway in different areas of health, and health effects are captured using a range of different research designs. OBJECTIVES: The objective of our review is to help inform evaluation efforts by identifying, summarizing, and critically appraising study designs used to assess and measure social accountability interventions' effects on health, including data collection methods and outcome measures. Specifically, we consider the designs used to assess social accountability interventions for reproductive, maternal, newborn, child, and adolescent health (RMNCAH). DATA SOURCES: Data were obtained from the Cochrane Library, EMBASE, MEDLINE, SCOPUS, and Social Policy & Practice databases. ELIGIBILITY CRITERIA: We included papers published on or after 1 January 2009 that described an evaluation of the effects of a social accountability intervention on RMNCAH. RESULTS: Twenty-two papers met our inclusion criteria. Methods for assessing or reporting health effects of social accountability interventions varied widely and included longitudinal, ethnographic, and experimental designs. Surprisingly, given the topic area, there were no studies that took an explicit systems-orientated approach. Data collection methods ranged from quantitative scorecard data through to in-depth interviews and observations. Analysis of how interventions achieved their effects relied on qualitative data, whereas quantitative data often raised rather than answered questions, and/or seemed likely to be poor quality. Few studies reported on negative effects or harms; studies did not always draw on any particular theoretical framework. None of the studies where there appeared to be financial dependencies between the evaluators and the intervention implementation teams reflected on whether or how these dependencies might have affected the evaluation. The interventions evaluated in the included studies fell into the following categories: aid chain partnership, social audit, community-based monitoring, community-linked maternal death review, community mobilization for improved health, community reporting hotline, evidence for action, report cards, scorecards, and strengthening health communities. CONCLUSIONS: A wide range of methods are currently being used to attempt to evaluate effects of social accountability interventions. The wider context of interventions including the historical or social context is important, as shown in the few studies to consider these dimensions. While many studies collect useful qualitative data that help illuminate how and whether interventions work, the data and analysis are often limited in scope with little attention to the wider context. Future studies taking into account broader sociopolitical dimensions are likely to help illuminate processes of accountability and inform questions of transferability of interventions. The review protocol was registered with PROSPERO (registration # CRD42018108252).