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BMJ Case Rep ; 14(6)2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099451


A late preterm infant was born to a diabetic mother on a background of reduced fetal movements and a poor CTG. It was noted immediately at birth that there was pathology in both upper limbs. Targeted investigation led to the diagnosis of bilateral upper limb arterial thromboses. Prompt assessment and multidisciplinary discussion led to an individualised management plan resulting in a positive outcome.

Nascimento Prematuro , Trombose , Feminino , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Parto , Gravidez
BMJ Open ; 11(6): e047040, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059509


OBJECTIVES: We compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births. DESIGN: We used population linked data from New South Wales, Australia (2001-2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age. RESULTS: Of 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years. CONCLUSION: IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.

Cesárea , Web Semântica , Austrália , Criança , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido , New South Wales/epidemiologia , Parto , Gravidez
Reprod Health ; 18(1): 115, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108001


BACKGROUND: Delivery is a critical moment for pregnant women and babies, and careful monitoring is essential throughout the delivery process. The partograph is a useful tool for monitoring and assessing labour progress as well as maternal and foetal conditions; however, it is often used inaccurately or inappropriately. A gap between practices and evidence-based guidelines has been reported in Cambodia, perhaps due to a lack of evidence-based knowledge in maternity care. This study aims to address to what extent skilled birth attendants in the first-line health services in Cambodia have knowledge on the management of normal delivery, and what factors are associated with their level of knowledge. METHODS: Midwives and nurses were recruited working in maternity in first-line public health facilities in Phnom Penh municipality, Kampong Cham and Svay Rieng provinces. Two self-administered questionnaires were applied. The first consisted of three sections with questions on monitoring aspects of the partograph: progress of labour, foetal, and maternal conditions. The second consisted of questions on diagnostic criteria, normal ranges, and standard intervals of monitoring during labour. A multiple linear regression analysis was performed to identify relationships between characteristics of the participants and the questionnaire scores. RESULTS: Of 542 eligible midwives and nurses, 523 (96%) participated. The overall mean score was 58%. Only 3% got scores of more than 90%. Multivariate analysis revealed that 'Kampong Cham province', 'younger age', and 'higher qualification' were significantly associated with higher scores. Previous training experience was not associated with the score. Substantial proportions of misclassification of monitoring items during labour were found; for example, 61% answered uterine contraction as a foetal condition, and 44% answered foetal head descent and 26% answered foetal heart rate as a maternal condition. CONCLUSION: This study found that knowledge was low on delivery management among skilled birth attendants. Previous training experience did not influence the knowledge level. A lack of understanding of physiology and anatomy was implied. Further experimental approaches should be attempted to improve the knowledge and quality of maternity services in Cambodia.

Parto Obstétrico/normas , Monitorização Fetal/instrumentação , Tocologia/normas , Parto , Cuidado Pós-Natal , Monitorização Uterina/instrumentação , Adulto , Camboja/epidemiologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Serviços de Saúde Materna , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Gravidez
Rev Bras Enferm ; 74(4): e20200397, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105639


OBJECTIVE: Evaluate the association between early pregnant hospitalization and the use of obstetric interventions and cesarean delivery route. METHODS: Cross-sectional study, with 758 women selected at the time of childbirth. It was assumed as early hospitalization when the woman was admitted to the hospital having less than 6 cm of cervical dilation. Logistic regression models were constructed in order to estimate the odds ratio for each obstetric intervention, adjusted by sociodemographic and obstetric variables. RESULTS: 73.22% of women were early hospitalized. On average, they had 1.97 times the chance to undergo Kristeller's maneuver, 2.59 and 1.80 times the chance to receive oxytocin infusion and analgesia, respectively, and 8 times more chances to having their children by cesarean delivery when compared to women that had timely hospitalization. CONCLUSION: Early hospitalized women were submitted to a higher number of obstetric intervention and had increased chances of undergoing cesarean sections.

Cesárea/estatística & dados numéricos , Parto Obstétrico , Hospitalização/estatística & dados numéricos , Trabalho de Parto , Assistência Perinatal/estatística & dados numéricos , Protocolos Clínicos , Estudos Transversais , Feminino , Humanos , Enfermagem Obstétrica , Parto , Gravidez
Rev Bras Enferm ; 74(4): e20200404, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105640


OBJECTIVE: To understand how information about Planned Home Birth motivates or discourages women's decisions on this location of birth. METHOD: Descriptive exploratory study, qualitative approach. Data collection carried out from February to April 2019, through semi-structured interviews with 14 women and documentary sources. The data were analyzed using Bardin's content analysis process, with the help of ATLAS.ti 8.0. RESULTS: The motivations for choosing Planned Home Birth are: respect for the autonomy and natural process of childbirth and delivery, support from a partner and trust in professionals. Aspects that discourage this choice are fear of complications, the need for a hospital medical structure, opinions that value risk. CONCLUSION: Women's choices are based not only on information, but also on how that information is processed. This study demonstrated that the perception pertaining to the safety of Planned Home Birth is essential for making this decision.

Comportamento de Escolha , Tomada de Decisões , Parto Domiciliar , Motivação , Adulto , Feminino , Humanos , Entrevistas como Assunto , Parto , Gravidez , Pesquisa Qualitativa
BMJ Open ; 11(6): e044928, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135036


OBJECTIVES: This study aimed to investigate the continuum of care (CoC) completion rate in maternal, neonatal and child health and its associated factors among mothers in two ecological regions in Nepal. DESIGN: This was a community-based, cross-sectional study, for which data were collected through face-to-face interviews using a structured questionnaire. Multiple logistic regression analyses were conducted to determine the associated factors. SETTING: This was carried out in two rural districts of Nepal, in different regions: one in the hills (Dhading) and another in the flatlands called Terai (Nawalparasi). The data were collected between July and December 2016. PARTICIPANTS: Mothers who gave birth within a year before this study were included as participants. In total, there were 1803 participants. AN OUTCOME MEASURE: The outcome of this study was measured by the CoC completion rate when a mother completes four antenatal check-ups, deliver at a health facility and receives postnatal care within 24 hours of delivery. RESULTS: The CoC completion rates were 41% in Dhading and 28% in Nawalparasi. In Dhading, shorter travel time to a health facility and higher wealth quintiles were associated with a better CoC completion rate. In Nawalparasi, the CoC completion rate was affected by parity and decision-making for pregnancy care. CONCLUSIONS: The CoC completion rate was low in both districts in Nepal. However, factors associated with the CoC completion rate varied by district. Differences in these factors might be reflected by geographical and socioeconomic conditions and the characteristics of household decision making in these districts.

Serviços de Saúde Materna , Criança , Continuidade da Assistência ao Paciente , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Nepal , Parto , Período Pós-Parto , Gravidez , Cuidado Pré-Natal , População Rural
BMJ Open ; 11(6): e046433, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135044


OBJECTIVES: To explore how the time of delivery influences childbirth experience. DESIGN: A retrospective cohort study. SETTING: Childbirth in the four Helsinki and Uusimaa Hospital District hospitals, Finland, from 2012 to 2018. PARTICIPANTS: 105 847 childbirths with a singleton live fetus. MAIN OUTCOME MEASURES: Childbirth experience measured by Visual Analogue Scale (VAS). RESULTS: The major difference in average childbirth experience measured by VAS was between primiparas (8.03; 95% CI 8.01 to 8.04) and multiparas (8.47; 95% CI 8.45 to 8.48). Risk ratio (RR) of the low VAS (≤5) was 2.3 when primiparas were compared with multiparas. Differences in VAS between distinct periods were found in two stages: annual and time of day. The decrease in VAS from 2012-2016 to 2017-2018 in primiparas was from 7.97 (95% CI 7.95 to 7.99) to 7.80 (95% CI 7.77 to 7.83) and from 2014-2016 to 2017-2018 in multiparas from 8.60 (95% CI 8.58 to 8.61) to 8.49 (95% CI 8.47 to 8.52). Corresponding RRs of low VAS were 1.3 for primiparas and 1.2 for multiparas. Hourly differences in VAS were detected in primiparas between office hours 08:00-15:59 (7.97; 95% CI 7.94 to 7.99) and other times (night 00:00-07:59; 7.91; 95% CI 7.88 to 7.94; and evening 16:00-23:59; 7.90; 95% CI 7.87 to 7.92). In multiparas differences in VAS were detected between evening (8.52; 95% CI 8.50 to 8.54) and other periods (night; 8.56; 95% CI 8.54 to 9.58; and office hours; 8.57; 95% CI 8.55 to 8.59). CONCLUSION: The maternal childbirth experience depended on the time of delivery. Giving birth during the evening led to impaired childbirth experience in both primiparas and multiparas, compared with delivery at other times. The impact of labour induction on childbirth experience should be further examined. The reorganisation of delivery services and the reduction of birth preparations might affect annual VAS. VAS is a simple method of measuring the complex entity of childbirth experience, and our results indicate its ability to capture temporal variation.

Trabalho de Parto Induzido , Parto , Estudos de Coortes , Feminino , Finlândia , Humanos , Gravidez , Estudos Retrospectivos
Rev. SPAGESP ; 22(1): 39-53, ene.-jun. 2021. tab
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1155513


A ansiedade materna é um tema relevante de pesquisa no âmbito da relação mãe-bebê, pois esse sentimento pode trazer repercussões para mãe e o desenvolvimento do bebê. Este estudo de casos múltiplos, de caráter qualitativo, teve como objetivo investigar a ansiedade materna em mães de bebês de seis a 10 meses, buscando identificar sua repercussão na díade mãe-bebê. Os achados demonstraram a presença de complicações na gravidez e no pós-parto e de eventos estressantes durante esses períodos. Em todos os casos analisados, observou-se ansiedade materna na gravidez e nos primeiros cuidados com o bebê. Sentimentos como medo, angústia, dúvidas e preocupações, relatados pelas mães, desencadearam comportamentos ansiosos, refletindo na relação mãe-bebê. A partir dos relatos deste estudo, observa-se a importância do apoio para o empoderamento das mães, para que elas assumam o papel materno com mais confiança. Salienta-se a necessidade de intervenções desde a gestação para o manejo da ansiedade materna, bem como práticas de educação em saúde visando à promoção da saúde mental materno-infantil

Maternal anxiety is an important topic of research regarding the mother-child relationship because this feeling can impact the mother and the baby's development. This qualitative study, of a multiple-case design, aimed to investigate maternal anxiety in mothers of babies aged between six and 10 months, trying to identify its impact on the mother-child dyad. The findings showed the occurrence of complications in pregnancy and the postpartum period and stressful events during these periods. In all analyzed cases, the presence of maternal anxiety during pregnancy and the newborn early care was verified. Feelings such as fear, anguish, doubts, and concerns, reported by mothers, triggered anxious behaviors, reflecting on the mother-baby relationship. From the reports of this study, the importance of support for the empowerment of mothers was observed, so that they can assume the maternal role with more confidence. It points out the need for intervention programs since pregnancy for the management of maternal anxiety, as well as health education practices aiming to promote maternal and child mental health.

La ansiedad materna es un tema relevante de investigación en el ámbito de la relación madre-hijo, ya que este sentimiento puede tener repercusiones en la madre y en el desarrollo del bebé. Este estudio cualitativo, de casos múltiples, investigó la ansiedad materna en madres de niños de seis a 10meses, buscando identificar su impacto en la díada madre-hijo. Los resultados revelaron la presencia de complicaciones en el embarazo y en el posparto, y de eventos estresantes durante estos momentos. En los casos analizados, se observó ansiedad materna durante el embarazo y en el cuidado temprano del bebé. Sentimientos como el miedo, la angustia, las dudas y las preocupaciones, relatados por las madres, desencadenaron comportamientos ansiosos, reflejándose en la relación madre-bebé. A partir de los informes de este estudio se observa la importancia del apoyo para el empoderamiento de las madres, para que asuman ese rol con más confianza. Son necesarias intervenciones desde el embarazo para el tratamiento de la ansiedad materna, así como prácticas de educación con la finalidad de promoción de la salud mental materna y infantil.

Humanos , Feminino , Adulto , Ansiedade , Complicações na Gravidez , Terapêutica , Comportamento , Educação em Saúde , Parto , Período Pós-Parto , Relações Mãe-Filho
Proc Biol Sci ; 288(1950): 20210286, 2021 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-33975480


The evolutionary benefits of reproductive seasonality are often measured by a single-fitness component, namely offspring survival. Yet different fitness components may be maximized by different birth timings. This may generate fitness trade-offs that could be critical to understanding variation in reproductive timing across individuals, populations and species. Here, we use long-term demographic and behavioural data from wild chacma baboons (Papio ursinus) living in a seasonal environment to test the adaptive significance of seasonal variation in birth frequencies. We identify two distinct optimal birth timings in the annual cycle, located four-month apart, which maximize offspring survival or minimize maternal interbirth intervals (IBIs), by respectively matching the annual food peak with late or early weaning. Observed births are the most frequent between these optima, supporting an adaptive trade-off between current and future reproduction. Furthermore, infants born closer to the optimal timing favouring maternal IBIs (instead of offspring survival) throw more tantrums, a typical manifestation of mother-offspring conflict. Maternal trade-offs over birth timing, which extend into mother-offspring conflict after birth, may commonly occur in long-lived species where development from birth to independence spans multiple seasons. Our findings therefore open new avenues to understanding the evolution of breeding phenology in long-lived animals, including humans.

Parto , Reprodução , Animais , Feminino , Gravidez , Primatas , Estações do Ano
Artigo em Russo | MEDLINE | ID: mdl-34037350


OBJECTIVE: To study the characteristics of the rehabilitation potential of children with outcomes of perinatal intraventricular hemorrhages, depending on the lesion of the brain associated with hemorrhages. MATERIALS AND METHODS: One hundred and eighty-two children with outcomes of perinatal brain lesions were examined using a scale for assessment of the rehabilitation potential. RESULTS: Lower overall rates of rehabilitation potential were found in children under 3 years of age with ventricular and cerebral cortex lesions (p=0.001) and in children over 3 years of age who had intraventricular hemorrhages and subcortical nuclei lesions (p=0.002). More severe sensory impairments were found in children under and over 3 years of age with intraventricular hemorrhages and lesions of the trunk (p=0.002 and p<0.001, respectively), the cortex (p<0.001and p=0.002, respectively), the periventricular region of the brain (p=0.097 and p=0.041, respectively) and subcortical nuclei (p=0.662 and p=0.004, respectively). CONCLUSION: The combination of perinatal intraventricular hemorrhages with lesions of the subcortical nuclei and the cerebral cortex leads to the most serious consequences, while the combination with lesions of these areas and the trunk, the periventricular area leads to more severe sensory motor deficits in children.

Encéfalo , Hemorragia Cerebral , Criança , Pré-Escolar , Feminino , Humanos , Parto , Gravidez
BMC Ecol Evol ; 21(1): 101, 2021 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049500


BACKGROUND: Elongated rostra play an important role in the egg-laying of weevils, and its emergence plays a key role in the adaptive radiation of weevils. Eucryptorrhynchus scrobiculatus Motschulsky and E. brandti Harold co-occur on the same only host Ailanthus altissima, while their oviposition sites are different. In order to understand the adaptation between the rostra of the two weevils and their oviposition sites, the structural differentiation of the rostra in E. scrobiculatus and E. brandti was compared. RESULTS: The present study reveals that: (1) The rostra length of E. scrobiculatus and E. brandti was found to be correlated with body size, larger weevils have a correspondingly longer rostrum. The increase of rostra length may be a byproduct of larger weevils. (2) There were significant differences in the external shape of the two rostra, especially the shape of the mandibles of the mouthparts at the apex of the rostra used to excavate an oviposition cavity. (3) There was no difference in the size of the abductor muscles that control the extension of the mandibles, but there were significant differences in the size of the adductor muscles that control the contraction of the mandibles. CONCLUSIONS: These structural differences reflect the functional potential ovipositional tactics of rostra, which is considered to be a response to the ecological demands of egg deposition, and also provide new insights into the coexistence of two weevil species in the same host A. altissima.

Ailanthus , Gorgulhos , Aclimatação , Animais , Feminino , Oviposição , Parto , Gravidez
Online braz. j. nurs. (Online) ; 20: e20216455, 05 maio 2021. ilus
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1224607


OBJETIVO: Desenvolver e validar o conteúdo do Resultado de Enfermagem (RE) "Satisfação da Cliente: Processo de Parto". MÉTODO: Estudo metodológico de validação de conteúdo do RE por nove especialistas, utilizando-se o Índice de Validade de Conteúdo (IVC) em 33 puérperas. RESULTADOS: A versão final do RE foi composta por 25 indicadores. O IVC foi maior ou igual a 0,8 para todos os critérios avaliados para a maioria dos indicadores após a segunda avaliação das especialistas. DISCUSSÃO: O RE "Satisfação da cliente: Processo de Parto" foi definido como "extensão da percepção positiva das mulheres quanto aos cuidados prestados pela equipe de saúde durante o processo do parto". CONCLUSÃO: Considera-se que o uso dos RE da Nursing Outcomes Classification embora recente na nossa prática assistencial, representa uma possibilidade para avaliar cuidados relacionados ao processo de parto.

OBJECTIVE: To develop and validate the content of the Nursing Result (RE) "Customer Satisfaction: The Delivery Process". METHOD: Methodological study of RE content validation by nine specialists, using the Content Validity Index (CVI) in 33 puerperal women.   RESULTS: The final version of the RE was composed of 25 indicators. The CVI was greater than or equal to 0.8 for all criteria evaluated for most indicators after the second evaluation of the specialists.  DISCUSSION:  The RE "Customer Satisfaction: Delivery Process" was defined as "an extension of the positive perception of women regarding the care provided by the health team during the delivery process". CONCLUSION:  It is considered that the use of RE nursing outcomes classification although recent in our care practice, represents a possibility to evaluate care related to the delivery process.

OBJETIVO: Desarrollar y validar el contenido del Resultado de Enfermería (RE) "Satisfacción del cliente: Proceso de parto". MÉTODO: Estudio metodológico de validación de contenido de la RE por nueve especialistas, utilizando el Índice de Validez de Contenido (IVC) en 33 puérperas. RESULTADOS: La versión final del RE estuvo compuesta por 25 indicadores. El IVC fue mayor o igual a 0.8 para todos los criterios evaluados para la mayoría de los indicadores luego de la segunda evaluación por parte de los especialistas. DISCUSIÓN: El RE "Satisfacción del cliente: proceso del parto" se definió como "una extensión de la percepción positiva de la mujer sobre la atención brindada por el equipo de salud durante el proceso del parto". CONCLUSIÓN: Se considera que el uso de la RE de la Nursing Outcomes Classification, aunque reciente en nuestra práctica asistencial, representa una posibilidad para evaluar la atención relacionada con el proceso del parto.

Humanos , Feminino , Revisão por Pares , Satisfação do Paciente , Parto , Período Pós-Parto , Terminologia Padronizada em Enfermagem
BMC Pregnancy Childbirth ; 21(1): 355, 2021 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947349


BACKGROUND: Although labor induction is a commonly used procedure in obstetrical care, there are limited data on its psycho-emotional effects on the woman. This study analysed the expectations and experiences of women in different routes of labor induction. The study's primary aim was to compare women's delivery experience if induced by orally administrated misoprostol (OMS) compared with misoprostol vaginal insert (MVI). Secondly, an evaluation of women's general satisfaction with induced labor was made, and factors associated with a negative experience. METHODS: Primiparous women (n = 196) with a singleton fetus in cephalic presentation, ≥ 37 weeks of gestation, with a Bishop's score ≤ 4 planning labor induction were randomly allocated to receive either OMS (Cytotec®) or MVI (Misodel®). Data were collected by validated questionnaires, the Wijma Delivery Expectation/Experience Questionnaire (A + B). The pre-labor part of the survey (W-DEQ version A) was given to participants to complete within 1 hour before the start of induction, and the post-labor part of the questionnaire (W-DEQ version B) was administered after birth and collected before the women were discharged from hospital. RESULTS: It was found that 11.8% (17/143) reported a severe fear of childbirth (W-DEQ A score ≥ 85). Before the induction, women with extreme fear had 3.7 times increased risk of experiencing labor induction negatively (OR 3.7 [95% CI, 1.04-13.41]). CONCLUSION: No difference was identified between OMS and MVI when delivery experience among women induced to labor was analysed. Severe fear of childbirth before labor was a risk factor for a negative experience of labor induction. TRIAL REGISTRATION: Clinical trial register number NCT02918110 . Date of registration on May 31, 2016.

Trabalho de Parto Induzido/psicologia , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Administração Intravaginal , Administração Oral , Adulto , Medo , Feminino , Humanos , Recém-Nascido , Masculino , Parto/psicologia , Gravidez , Fatores de Risco , Inquéritos e Questionários
Online braz. j. nurs. (Online) ; 20: e20216483, 05 maio 2021.
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1223160


OBJETIVO: Compreender as expectativas e vivências de mulheres primíparas no parto. MÉTODO: Trata-se de um estudo descritivo, qualitativo tendo como referencial teórico o Interacionismo Simbólico. A coleta de dados ocorreu por meio de oficinas, entrevista semiestruturada no pré e pós-parto. Os dados foram analisados por meio de análise de conteúdo. RESULTADOS: Participaram do estudo 11 mulheres no pré-parto e oficina e 05 no pós-parto. Foram identificadas duas categorias: Parto: experiência marcante; e Entre expectativas e vivências. DISCUSSÃO: Nas expectativas e na realidade, no momento do parto, estiveram presentes significados construídos e modificados pelas interações com profissionais e rede social. CONCLUSÃO: A vivência do parto pode ressignificar paradigmas culturais e sociais. A valorização das técnicas relacionais qualifica a assistência na direção da construção de significados e experiências.

OBJECTIVE: To understand expectations and experiences related to childbirth in primiparous women. METHODS: Descriptive and qualitative study that applied symbolic interactionism as a theoretical framework. Data were collected during workshops with the pregnant participants, and by semi-structured interviews carried out before and after childbirth. Content analysis was used to analyze the gathered information. RESULTS: Eleven pregnant women and five postpartum women participated in the study. Two categories were identified: Childbirth: a remarkable experience; and Among expectations and experiences. DISCUSSION: Meanings developed and modified by interactions with professionals and social networks were present during childbirth, in both expectations and reality. CONCLUSION: Experiencing childbirth can resignify cultural and social paradigms. Recognizing relational techniques can improve quality of care by the inclusion of the development of meanings and experiences.

OBJETIVO: Comprender las expectativas y vivencias del parto en mujeres primerizas. MÉTODO: Se trata de un estudio descriptivo, cualitativo, cuyo referencial teórico fue el Interaccionismo Simbólico. Los datos fueron recolectados mediante talleres y entrevistas semiestructuradas aplicadas antes y después del parto. Datos analizados utilizando análisis de contenido. RESULTADOS: Participaron del estudio 11 mujeres en el preparto y el taller, y 5 en el posparto. Fueron identificadas dos categorías: Parto: experiencia trascendente; y Expectativas y vivencias. DISCUSIÓN: En las expectativas en la realidad, al momento del parto estuvieron presentes significados construidos y modificados por las interacciones con los profesionales y con la red social. CONCLUSIÓN: La vivencia del parto puede resignificar paradigmas culturales y sociales. La valoración de las técnicas relacionales califica la atención en el camino a la construcción de significados y experiencias.

Humanos , Feminino , Gravidez , Trabalho de Parto/psicologia , Parto/psicologia , Gestantes/psicologia , Emoções , Interacionismo Simbólico , Saúde da Mulher , Pesquisa Qualitativa , Período Pós-Parto
BMC Pregnancy Childbirth ; 21(1): 304, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33863306


BACKGROUND: Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania. METHODS: The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics. RESULTS: More than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96-99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82-97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman's status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p < 0.001), greet women respectfully (p < 0.001), and try to make them more comfortable (p = 0.003). Higher proportions of women who gave birth at intervention sites reported being "very satisfied" with the care they received (p < 0.001), and that the staff were "very kind" (p < 0.001) and "very encouraging" (p < 0.001). CONCLUSION: Birth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women's experience of birth and the maternity ward environment overall.

Instalações de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Parto/psicologia , Adolescente , Adulto , Parto Obstétrico/psicologia , Feminino , Amigos/psicologia , Humanos , Relações Interpessoais , Trabalho de Parto/psicologia , Pessoa de Meia-Idade , Projetos Piloto , Gravidez , Qualidade da Assistência à Saúde/estatística & dados numéricos , Tanzânia , Adulto Jovem
BMC Pregnancy Childbirth ; 21(1): 312, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879074


BACKGROUND: In Manitoba, Canada, low-income pregnant women are eligible for the Healthy Baby Prenatal Benefit, an unconditional income supplement of up to CAD $81/month, during their latter two trimesters. Our objective was to determine the impact of the Healthy Baby Prenatal Benefit on birth and early childhood outcomes among Manitoba First Nations women and their children. METHODS: We used administrative data to identify low-income First Nations women who gave birth 2003-2011 (n = 8209), adjusting for differences between women who received (n = 6103) and did not receive the Healthy Baby Prenatal Benefit (n = 2106) with using propensity score weighting. Using multi-variable regressions, we compared rates of low birth weight, preterm, and small- and large-for-gestational-age births, 5-min Apgar scores, breastfeeding initiation, birth hospitalization length of stay, hospital readmissions, complete vaccination at age one and two, and developmental vulnerability in Kindergarten. RESULTS: Women who received the benefit had lower risk of low birth weight (adjusted relative risk [aRR] 0.74; 95% CI 0.62-0.88) and preterm (aRR 0.77; 0.68-0.88) births, and were more likely to initiate breastfeeding (aRR 1.05; 1.01-1.09). Receipt of the Healthy Baby Prenatal Benefit was also associated with higher rates of child vaccination at age one (aRR 1.10; 1.06-1.14) and two (aRR 1.19; 1.13-1.25), and a lower risk that children would be vulnerable in the developmental domains of language and cognitive development (aRR 0.88; 0.79-0.98) and general knowledge/communication skills (aRR 0.87; 0.77-0.98) in Kindergarten. CONCLUSIONS: A modest unconditional income supplement of CAD $81/month during pregnancy was associated with improved birth outcomes, increased vaccination rates, and better developmental health outcomes for First Nations children from low-income families.

Renda/estatística & dados numéricos , Canadenses Indígenas/estatística & dados numéricos , Cuidado Pré-Natal/economia , Aleitamento Materno/estatística & dados numéricos , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Manitoba , Parto , Pobreza , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
Z Geburtshilfe Neonatol ; 225(2): 97, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33873230

Parto , Feminino , Humanos , Gravidez
Complement Ther Clin Pract ; 43: 101380, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33858797


BACKGROUND: Hypnosis in labour and childbirth is a complex intervention. Both qualitative and quantitative assessment methods have been used, but have targeted different outcomes. We followed a synergistic approach and a reconciliation strategy to further understand and evaluate this intervention. METHODS: A mixed-method analysis of quantitative and qualitative evidence was conducted. The assessment of efficacy was based on a recent Cochrane review (9 trials, 2954 women randomised). Four qualitative studies and 4 case studies were included. RESULTS: The outcomes addressed by the qualitative studies (mostly concerning maternal experiences) and in the quantitative studies (mostly concerning analgesic use) overlapped slightly. Discrepancies across results from the two study types suggested that response shift issues could occur. CONCLUSION: Patient-centred instruments exploring response shift issues would be of great value. Hypnosis can be presented as a technique enabling patients to have a positive birth experience.

Hipnose , Trabalho de Parto , Parto Obstétrico , Família , Feminino , Humanos , Parto , Gravidez
Artigo em Inglês | MEDLINE | ID: mdl-33924137


BACKGROUND: In recent years, higher than the recommended rate of oxytocin use has been observed among low-risk women. This study examines the relationship between oxytocin administration and birth outcomes in women and neonates. METHODS: A retrospective analysis of birth and neonatal outcomes for women who received oxytocin versus those who did not. The sample included 322 women with a low-risk pregnancy. RESULTS: Oxytocin administration was associated with cesarean section (aOR 4.81, 95% CI: 1.80-12.81), instrumental birth (aOR 3.34, 95% CI: 1.45-7.67), episiotomy (aOR 3.79, 95% CI: 2.20-6.52) and length of the second stage (aOR 00:18, 95% CI: 00:04-00:31). In neonatal outcomes, oxytocin in labor was associated with umbilical artery pH ≤ 7.20 (OR 3.29, 95% CI: 1.33-8.14). Admission to neonatal intensive care unit (OR 0.56, 95% CI: 0.22-1.42), neonatal resuscitation (OR 1.04, 95% CI: 0.22-1.42), and Apgar score <7 (OR 0.48, 95% CI: 0.17-1.33) were not associated with oxytocin administration during labor. CONCLUSIONS: Oxytocin administration during labor for low-risk women may lead to worse birth outcomes with an increased risk of instrumental birth and cesarean, episiotomy and the use of epidural analgesia for pain relief. Neonatal results may be also worse with an increased proportion of neonates displaying an umbilical arterial pH ≤ 7.20.

Cesárea , Ocitocina , Feminino , Humanos , Recém-Nascido , Ocitocina/efeitos adversos , Parto , Gravidez , Ressuscitação , Estudos Retrospectivos
Matern Child Health J ; 25(6): 860-869, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33909205


OBJECTIVE: To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health. STUDY DESIGN: We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020-May 11, 2020) to a pre-pandemic response period (January 1, 2020-March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery. RESULTS: Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD. CONCLUSION: Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color.

Ansiedade/psicologia , COVID-19 , Atenção à Saúde/organização & administração , Parto/psicologia , Satisfação Pessoal , Adulto , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Pandemias , Período Pós-Parto , Gravidez , SARS-CoV-2 , Adulto Jovem