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1.
Rev. enferm. UERJ ; 29: e56113, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224567

RESUMO

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.


Assuntos
Humanos , Feminino , Gravidez , Adulto , Parto Domiciliar/enfermagem , Parto Normal/enfermagem , Enfermeiras Obstétricas , Gestantes/psicologia , Segurança do Paciente , Parto Domiciliar/psicologia , Parto Normal/psicologia
4.
PLoS One ; 16(4): e0249224, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886560

RESUMO

BACKGROUND: Birth cultures have been transforming in recent years mainly affecting birth care and its socio-political contexts. This situation has affected the feeling of well-being in women at the time of giving birth. AIM: For this reason, our objective was to analyse the social meaning that women ascribe to home births in the Chilean context. METHOD: We conducted thirty semi-structured interviews with women living in diverse regions ranging from northern to southern Chile, which we carried out from a theoretical-methodological perspective of phenomenology and situated knowledge. Qualitative thematic analysis was used to analyse the information collected in the field work. FINDINGS: A qualitative thematic analysis produced the following main theme: 1) Home birth journeys. Two sub-categories: 1.1) Making the decision to give birth at home, 1.2) Giving birth: (re)birth. And four sub-categories also emerged: 1.1.1) Why do I need to give birth at home? 1.1.2) The people around me don't support me; 1.2.1) Shifting emotions during home birth, 1.2.2) I (don't) want to be alone. CONCLUSION: We concluded that home births involve an intense and diverse range of satisfactions and tensions, the latter basically owing to the sociocultural resistance surrounding women. For this reason, they experienced home birth as an act of protest and highly valued the presence of midwives and their partners.


Assuntos
Parto Domiciliar/psicologia , Mães/psicologia , Adulto , Chile , Diversidade Cultural , Feminino , Humanos , Entrevistas como Assunto , Pessoa de Meia-Idade , Tocologia , Gravidez , Cônjuges/psicologia
6.
BMC Pregnancy Childbirth ; 21(1): 25, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413193

RESUMO

BACKGROUND: Globally, approximately 15 million babies are born preterm every year. Complications of prematurity are the leading cause of under-five mortality. There is overwhelming evidence from low, middle, and high-income countries supporting kangaroo mother care (KMC) as an effective strategy to prevent mortality in both preterm and low birth weight (LBW) babies. However, implementation and scale-up of KMC remains a challenge, especially in lowincome countries such as Ethiopia. This formative research study, part of a broader KMC implementation project in Southern Ethiopia, aimed to identify the barriers to KMC implementation and to devise a refined model to deliver KMC across the facility to community continuum. METHODS: A formative research study was conducted in Southern Ethiopia using a qualitative explorative approach that involved both health service providers and community members. Twenty-fourin-depth interviewsand 14 focus group discussions were carried out with 144study participants. The study applied a grounded theory approach to identify,examine, analyse and extract emerging themes, and subsequently develop a model for KMC implementation. RESULTS: Barriers to KMC practice included gaps in KMC knowledge, attitude and practices among parents of preterm and LBW babies;socioeconomic, cultural and structural factors; thecommunity's beliefs and valueswith respect to preterm and LBW babies;health professionals' acceptance of KMC as well as their motivation to implement practices; and shortage of supplies in health facilities. CONCLUSIONS: Our study suggests a comprehensive approach with systematic interventions and support at maternal, family, community, facility and health care provider levels. We propose an implementation model that addresses this community to facility continuum.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Recém-Nascido de Baixo Peso , Recém-Nascido Prematuro , Método Canguru/psicologia , Adulto , Agentes Comunitários de Saúde , Cultura , Etiópia , Família/psicologia , Feminino , Grupos Focais , Clínicos Gerais , Teoria Fundamentada , Parto Domiciliar/psicologia , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Modelos Teóricos , Mães , Preferência do Paciente , Pediatras , Pesquisa Qualitativa , Encaminhamento e Consulta
7.
Women Birth ; 34(4): 396-404, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32636161

RESUMO

BACKGROUND: In Australia there have been regulatory and insurance changes negatively affecting homebirth. AIM: The aim of this study is to explore the characteristics, needs and experiences of women choosing to have a homebirth in Australia. METHODS: A national survey was conducted and promoted through social media networks to women who have planned a homebirth in Australia. Data were analysed to generate descriptive statistics. FINDINGS: 1681 surveys were analysed. The majority of women indicated a preference to give birth at home with a registered midwife. However, if a midwife was not available, half of the respondents indicated they would give birth without a registered midwife (freebirth) or find an unregistered birthworker. A further 30% said they would plan a hospital or birth centre birth. In choosing homebirth, women disclosed that they wanted to avoid specific medical interventions and the medicalised hospital environment. Nearly 60% of women reported at least one risk factor that would have excluded them from a publicly funded homebirth programme. Many women described their previous hospital experience as traumatic (32%) and in some cases, leading to a diagnosis of post-traumatic stress disorder (PTSD, 6%). Only 5% of women who reported on their homebirth experience considered it to be traumatic (PTSD, 1%). The majority of these were associated with how they were treated when transferred to hospital in labour. CONCLUSION: There is an urgent need to expand homebirth options in Australia and humanise mainstream maternity care. A potential rise in freebirth may be the consequences of inaction.


Assuntos
Acesso aos Serviços de Saúde , Parto Domiciliar/estatística & dados numéricos , Enfermeiras Obstétricas/psicologia , Adulto , Austrália , Feminino , Parto Domiciliar/psicologia , Hospitais , Humanos , Trabalho de Parto , Serviços de Saúde Materna , Tocologia , Parto , Gravidez , Inquéritos e Questionários
8.
Women Birth ; 34(2): 122-127, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32057663

RESUMO

PROBLEM: There is a knowledge gap regarding women's experiences of coping with labour pain when not soliciting or not having access to pharmacological pain relief. BACKGROUND: How women manage labour pain is complex, multifaceted and only the woman giving birth can assess the experienced pain. Women in the Nordic countries planning for a homebirth have little or no access to pharmacologic pain relief during labour. AIM: The aim of this study was to explore how women experience and work with labour pain when giving birth in their own home. METHODS: Quantitative and qualitative data was prospectively collected and altogether 1649 women with a planned homebirth answered closed and open-ended questions about labour pain and birth experience. RESULTS: While labour pain was often experienced as positive or very positive, the intensity was experienced as severe or the worst imaginable pain. Two main themes arose from the womens´ descriptions of their birth experience regarding labour pain: An encounter with extremes and Being in charge at home. DISCUSSION: Women perceived labour pain as severe but manageable and were dedicated to completing the birth at home. Being at home enabled the women to exercise autonomy and work with labour pain on their own terms, together with the midwife and support persons. CONCLUSIONS: This study provides knowledge about women's experiences of labour pain in a home birth setting who used varying strategies to work with labour pain. This is a subject that should be explored further since results could also apply to facility-based birth settings.


Assuntos
Parto Domiciliar/estatística & dados numéricos , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Manejo da Dor/métodos , Adaptação Psicológica , Adulto , Feminino , Parto Domiciliar/psicologia , Humanos , Tocologia , Parto , Gravidez , Inquéritos e Questionários
9.
BMC Pregnancy Childbirth ; 20(1): 633, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076867

RESUMO

BACKGROUND: Having a birth attendant with midwifery skills during childbirth is an effective intervention to reduce maternal and early neonatal morbidity and mortality. Nevertheless, many women in Ethiopia still deliver a baby at home. The current study aimed at exploring and describing reasons why women do not use skilled delivery care in North West Ethiopia. METHODS: This descriptive explorative qualitative research was done in two districts of West Gojjam Zone in North West Ethiopia. Fourteen focus group discussions (FGDs) were conducted with pregnant women and mothers who delivered within one year. An inductive thematic analysis approach was employed to analyse the qualitative data. The data analysis adhered to reading, coding, displaying, reducing, and interpreting data analysis steps. RESULTS: Two major themes client-related factors and health system-related factors emerged. Factors that emerged within the major theme of client-related were socio-cultural factors, fear of health facility childbirth, the nature of labour, lack of antenatal care (ANC) during pregnancy, lack of health facility childbirth experience, low knowledge and poor early care-seeking behaviour. Under the major theme of health system-related factors, the sub-themes that emerged were low quality of service, lack of respectful care, and inaccessibility of health facility. CONCLUSIONS: This study identified a myriad of supply-side and client-related factors as reasons given by pregnant women, for not giving birth in health institution. These factors should be redressed by considering the specific supply-side and community perspectives. The results of this study provide evidence that could help policymakers to develop strategies to address barriers identified, and improve utilisation of skilled delivery service.


Assuntos
Parto Obstétrico/psicologia , Parto Domiciliar/psicologia , Tocologia/estatística & dados numéricos , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Adulto , Cultura , Parto Obstétrico/estatística & dados numéricos , Etiópia , Medo , Feminino , Grupos Focais , Parto Domiciliar/estatística & dados numéricos , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Fatores Socioeconômicos
10.
BMC Pregnancy Childbirth ; 20(1): 357, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522158

RESUMO

BACKGROUND: Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Women's stories can be a very powerful way of informing health services about the impact of the care they receive and can promote practice change. The aim of this study is to examine Jordanian women's experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. METHOD: A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. RESULTS: Women's birth experiences differed across settings and generations and were represented in the four themes: 'Birth at home: a place of comfort and control'; 'Public Hospital: you should not have to suffer'; 'Private Hospital: buying control' and 'Australian maternity care: a mixed experience'. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. CONCLUSIONS: The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced in different settings, providing insights into the institutional management and social context of birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women had no support and were treated disrespectfully. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system.


Assuntos
Trabalho de Parto/psicologia , Parto/psicologia , Adolescente , Adulto , Idoso , Austrália , Entorno do Parto , Feminino , Parto Domiciliar/psicologia , Hospitais Privados , Hospitais Públicos , Humanos , Jordânia , Dor do Parto/psicologia , Serviços de Saúde Materna , Pessoa de Meia-Idade , Preferência do Paciente , Gravidez , Privacidade , Pesquisa Qualitativa , Adulto Jovem
11.
Midwifery ; 88: 102755, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32497819

RESUMO

OBJECTIVE: The aim of the study was to explore hospital-based midwives' experiences of providing publicly-funded homebirth services in Australia. DESIGN: A qualitative descriptive study using a constructivist grounded theory methodology was undertaken. SETTING: Five different states or territories of Australia where publicly-funded homebirth services were operating. PARTICIPANTS: Interviews were conducted with 21 midwives and midwifery managers from eight different public hospitals who had recent experience of working in, or with, publicly-funded homebirth models. FINDINGS: Witnessing undisturbed birth in the home setting transformed midwives' attitudes towards birth. Following exposure to homebirth, many midwives felt they were seeing undisturbed birth for the first time. This led them to question their current understanding of physiological birth and develop a new awareness of the powerful influence that the environment has on labouring women. This new understanding resulted in changes to their practice. KEY CONCLUSIONS: For midwives accustomed to working in hospital settings, exposure to homebirth deepened their understanding of physiological birth, resulting in a perspective transformation and subsequent shift in practice. IMPLICATIONS FOR PRACTICE: Exposure to homebirth may motivate midwives to alter their practice in both home and hospital settings in order to shift the power dynamic between women and caregivers and protect women from unnecessary disturbance during labour.


Assuntos
Parto Domiciliar/normas , Enfermeiras Obstétricas/psicologia , Adulto , Idoso , Atitude do Pessoal de Saúde , Austrália , Feminino , Teoria Fundamentada , Parto Domiciliar/métodos , Parto Domiciliar/psicologia , Humanos , Entrevistas como Assunto/métodos , Pessoa de Meia-Idade , Enfermeiras Obstétricas/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
12.
BMC Pregnancy Childbirth ; 20(1): 270, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375691

RESUMO

BACKGROUND: In low and middle-income countries, pregnancy and delivery complications may deprive women and their newborns of life or the realization of their full potential. Provision of quality obstetric emergency and childbirth care can reduce maternal and newborn deaths. Underutilization of maternal and childbirth services remains a public health concern in Tanzania. The aim of this study was to explore elements of the local social, cultural, economic, and health systems that influenced the use of health facilities for delivery in a rural setting in Northwest Tanzania. METHODS: A qualitative approach was used to explore community perceptions of issues related to low utilization of health facilities for childbirth. Between September and December 2017, 11 focus group discussions were conducted with women (n = 33), men (n = 5) and community health workers (CHWs; n = 28); key informant interviews were conducted with traditional birth attendants (TBAs; n = 2). Coding, identification, indexing, charting, and mapping of these interviews was done using NVIVO 12 after manual familiarization of the data. Data saturation was used to determine when no further interviews or discussions were required. RESULTS: Four themes emerge; self-perceived obstetric risk, socio-cultural issues, economic concerns and health facility related factors. Health facility delivery was perceived to be crucial for complicated labor. However, the idea that childbirth was a "normal" process and lack of social and cultural acceptability of facility services, made home delivery appealing to many women and their families. In addition, out of pocket payments for suboptimal quality of health care was reported to hinder facility delivery. CONCLUSION: Home delivery persists in rural settings due to economic and social issues, and the cultural meanings attached to childbirth. Accessibility to and affordability of respectful and culturally acceptable childbirth services remain challenging in this setting. Addressing barriers on both the demand and supply side could result in improved maternal and child outcomes during labor and delivery.


Assuntos
Parto Obstétrico/psicologia , Instalações de Saúde , Parto/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Agentes Comunitários de Saúde , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Parto Domiciliar/psicologia , Humanos , Serviços de Saúde Materna , Tocologia , Gravidez , Pesquisa Qualitativa , População Rural , Fatores Socioeconômicos , Inquéritos e Questionários , Tanzânia
13.
BMC Pregnancy Childbirth ; 20(1): 309, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429857

RESUMO

BACKGROUND: Incidences of unassisted home birthing practices have been increasing in Malaysia despite the accessibility to safe and affordable child birthing facilities. We aimed to explore the reasons for women to make such decisions. METHODS: Twelve women participated in in-depth interviews. They were recruited using a snowballing approach. The interviews were supported by a topic guide which was developed based on the Theory of Planned Behaviour and previous literature. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. RESULTS: Women in this study described a range of birthing experiences and personal beliefs as to why they chose unassisted home birth. Four themes emerged from the interviews; i) preferred birthing experience, ii) birth is a natural process, iii) expressing autonomy and iv) faith. Such decision to birth at home unassisted was firm and steadfast despite the possible risks and complications that can occur. Giving birth is perceived to occur naturally regardless of assistance, and unassisted home birth provides the preferred environment which health facilities in Malaysia may lack. They believed that they were in control of the birth processes apart from fulfilling the spiritual beliefs. CONCLUSIONS: Women may choose unassisted home birth to express their personal views and values, at the expense of the health risks. Apart from increasing mothers' awareness of the possible complications arising from unassisted home births, urgent efforts are needed to provide better birth experiences in healthcare facilities that resonate with the mothers' beliefs and values.


Assuntos
Comportamento de Escolha , Parto Domiciliar/psicologia , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Malásia , Pessoa de Meia-Idade , Parto/psicologia , Gravidez , Pesquisa Qualitativa
14.
Cien Saude Colet ; 25(4): 1433-1444, 2020 Mar.
Artigo em Português | MEDLINE | ID: mdl-32267444

RESUMO

Planned home birth (PHB) has grown in Brazil, especially in large urban centers, in the face of women's dissatisfaction with the current obstetric system. International studies have demonstrated the security of PHB, but national production about this area is still limited. Thus, this study aimed to review the national bibliographic production about PHB between 2008 and 2018, in order to compile data related to PHB in Brazil. After survey, 18 studies were included in the review, and then subdivided into the following categories: "Maternal and neonatal outcomes of PHB", "Feelings, motivation and personal characteristics of women that choose PHB", "Perception of professionals that practice PHB" and "Theoretical approach to PHB". It was concluded that the PHB has grown between privileged portions of Brazilian population, representing the important practice of women's autonomy, presenting itself as a safe alternative place of birth, with a high degree of satisfaction of women and families. However, this model of assistance presents itself as a limited option, since the PHB is not offered by the Health System, still unaccessible to most of women in the country.


Assuntos
Bibliometria , Parto Domiciliar/estatística & dados numéricos , Atitude do Pessoal de Saúde , Brasil , Episiotomia/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Parto Domiciliar/psicologia , Humanos , Recém-Nascido , Motivação , Paridade , Preferência do Paciente/estatística & dados numéricos , Satisfação do Paciente , Transferência de Pacientes/estatística & dados numéricos , Autonomia Pessoal , Gravidez , Resultado da Gravidez , Fatores Socioeconômicos
15.
Sex Reprod Healthc ; 25: 100511, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32283477

RESUMO

AIM: This study was aimed at describing Norwegian women's motivations and preparations for freebirth. METHODS: This qualitative study involved 12 individual interviews conducted face to face or via Skype with women from different parts of Norway. The material was analysed using qualitative content analysis inspired by Graneheim and Lundman. RESULTS: Three categories describing the women's motivations and preparations for freebirth were identified. Unsatisfied with the care offered today described how the women thought that hospitals did not support normal birth and made an inadequate homebirth offer. The category earlier uncomplicated and traumatic births influence freebirth choices described two different dimensions of motivations for freebirth. Trust in one's own knowledge and capacity referred to how women viewed birth as a natural process, their faith in themselves, how this view and faith influenced their preparation and how they gained knowledge about the birth process to prepare. An overall theme emerged: deep trust in birth as a natural process and the women's own capacity to give birth embedded in distrust of the maternity care system. CONCLUSION: This study showed that motivations for freebirth were embedded in overall dissatisfaction with today's maternity care, the inadequate homebirth offer and deep trust in the women's own capacity to give birth.


Assuntos
Tomada de Decisões , Conhecimentos, Atitudes e Prática em Saúde , Parto Domiciliar/psicologia , Motivação , Adulto , Feminino , Humanos , Serviços de Saúde Materna/normas , Noruega/epidemiologia , Gravidez , Pesquisa Qualitativa , Confiança
16.
BMC Pregnancy Childbirth ; 20(1): 254, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345236

RESUMO

BACKGROUND: Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system - that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. METHOD: This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. RESULTS: The core category was 'wanting the best and safest,' which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was 'finding a better way'. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. CONCLUSION: Shortfalls in the Australian maternity care system is the major contributing factor to women's choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk.


Assuntos
Parto Domiciliar/métodos , Parto Domiciliar/psicologia , Motivação , Parto/psicologia , Adulto , Austrália , Escolaridade , Feminino , Teoria Fundamentada , Maternidades/normas , Humanos , Gravidez
17.
BMC Pregnancy Childbirth ; 20(1): 250, 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345240

RESUMO

BACKGROUND: South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan. METHODS: A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data. RESULTS: Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p < 0.001). The participants who had an institutional delivery were younger (mean age 23.3 years old) than those who had home deliveries (mean age 25.6 years). Any previous payments made for delivery in the health facility doubled the risk of home delivery (p = 0.021). Women were more likely to plan and prepare for home delivery than for institutional delivery and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health staff and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. Unofficial payments such as soap and sweets were reported as routine expectations and another major barrier to institutional delivery. CONCLUSION: Interventions to stop unofficial payments and discrimination based on socio-economic status and to increase access to ANC, delivery services and PNC are needed.


Assuntos
Parto Obstétrico/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Parto Domiciliar/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Pessoal Administrativo/psicologia , Adolescente , Adulto , Criança , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Pessoal de Saúde/psicologia , Acesso aos Serviços de Saúde , Parto Domiciliar/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Materna/normas , Organizações , Gravidez , Pesquisa Qualitativa , Fatores Socioeconômicos , Sudão do Sul/etnologia , Adulto Jovem
18.
Ciênc. Saúde Colet ; 25(4): 1433-1444, abr. 2020. tab
Artigo em Português | LILACS | ID: biblio-1089505

RESUMO

Resumo O parto domiciliar planejado (PDP) tem crescido cada vez mais no Brasil, especialmente nos grandes centros urbanos, frente à crescente insatisfação das mulheres com o sistema obstétrico hospitalar vigente. Estudos internacionais demonstram a segurança do PDP, porém a produção nacional ainda é limitada nesta área. Desta maneira, este estudo objetivou revisar a produção bibliográfica nacional acerca de parto domiciliar entre os anos de 2008 e 2018, a fim de compilar dados relacionados ao PDP no Brasil. Após levantamento, 18 estudos foram incluídos na revisão, sendo subdivididos nas seguintes categorias: "Desfechos maternos e neonatais dos PDP", "Sentimentos, motivação e perfis associados à escolha pelo PDP", "Percepção dos profissionais que atendem PDP" e "Abordagem teórica do PDP". Concluiu-se que o PDP tem crescido entre parcelas privilegiadas da população, representando importante prática de exercício da autonomia da mulher em contraponto ao modelo obstétrico vigente, apresentando-se como alternativa segura de local de parto, com alto grau de satisfação para as mulheres e famílias. Este modelo de assistência, entretanto, apresenta-se como opção limitada, uma vez que o PDP não é oferecido pelo Sistema Único de Saúde, ainda inacessível para a maioria das mulheres no país.


Abstract Planned home birth (PHB) has grown in Brazil, especially in large urban centers, in the face of women's dissatisfaction with the current obstetric system. International studies have demonstrated the security of PHB, but national production about this area is still limited. Thus, this study aimed to review the national bibliographic production about PHB between 2008 and 2018, in order to compile data related to PHB in Brazil. After survey, 18 studies were included in the review, and then subdivided into the following categories: "Maternal and neonatal outcomes of PHB", "Feelings, motivation and personal characteristics of women that choose PHB", "Perception of professionals that practice PHB" and "Theoretical approach to PHB". It was concluded that the PHB has grown between privileged portions of Brazilian population, representing the important practice of women's autonomy, presenting itself as a safe alternative place of birth, with a high degree of satisfaction of women and families. However, this model of assistance presents itself as a limited option, since the PHB is not offered by the Health System, still unaccessible to most of women in the country.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Bibliometria , Parto Domiciliar/estatística & dados numéricos , Paridade , Fatores Socioeconômicos , Brasil , Resultado da Gravidez , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Transferência de Pacientes/estatística & dados numéricos , Satisfação do Paciente , Autonomia Pessoal , Episiotomia/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Parto Domiciliar/psicologia , Motivação
19.
Midwifery ; 86: 102705, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32200282

RESUMO

OBJECTIVE: The aim of this study was to gain knowledge regarding how Norwegian nulliparous women experience planned home birth and why they choose this route of giving birth. DESIGN: A qualitative approach was used, and the study data were derived from semi-structured individual interviews, which were analysed through systematic text condensation. PARTICIPANTS: Ten Norwegian women aged nineteen to thirty-nine years were interviewed. They had each gone through with a successful planned home birth of their first child within the last two years. These women all resided in the middle, western and eastern areas of Norway. A certified midwife was present throughout the labour and birth, and no transfer to the hospital was necessary. FINDINGS: The following two main themes were identified: 'inner motivation' and 'giving birth in safe surroundings'. The women in this study had a strong inner faith in the normal physiological processes of labour and birth and had educated and prepared themselves carefully for their planned home birth. To be able to enter one's own inner world was considered crucial for labour, and the trusting relationship they had with their midwife made this possible. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.


Assuntos
Parto Domiciliar/normas , Paridade , Gestantes/psicologia , Adulto , Feminino , Parto Domiciliar/psicologia , Parto Domiciliar/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Noruega , Satisfação do Paciente , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
20.
Public Health Nurs ; 37(3): 422-438, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32215962

RESUMO

AIMS: Exploring social and health care representations of home birth by conducting an integrative review of the literature. DESIGN: Integrative Literature Review. DATA SOURCES: The search was based on the following keywords: "birth, home," "home birth," "childbirth, home." And the terms: "planned home birth," and "empowerment women homebirth" (in English). "partos en casa," and "partos domiciliarios" (in Spanish) in the following databases: Biomedical Central, Cochrane Library, Dialnet, DOAJ, Lilacs, PubMed, Scopus, Scielo, and Web of Science. REVIEW METHODS: A total of 156 publications dated between 2004 and 2017 were initially obtained and a total of 41 articles were finally selected according to the criteria of inclusion, methodological rigor, and researchers' triangulation. RESULTS: Four dimensions of the issue emerged out of the 41 articles analyzed: (a) the Dimension of "Empowerment in Childbirth;" (b) the Dimension of "Comparative Socio-Medical Childbirth Studies;" (c) the "Institutional Dimension of Childbirth;" (d) the "Cultural Dimension of Childbirth." CONCLUSION: From the health management perspective, home birth is not widely accepted today as a valid and safe alternative. However, women's social representations indicate an interest in returning to birth at home as a response to the excessive medicalization and institutionalization of childbirth, and value highly its autonomy and comfort.


Assuntos
Pessoal de Saúde/psicologia , Parto Domiciliar/psicologia , Feminino , Parto Domiciliar/efeitos adversos , Humanos , Gravidez
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