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1.
Rev. Esc. Enferm. USP ; 53: e03464, Jan.-Dez. 2019.
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1020376

RESUMO

RESUMEN Objetivo Explorar la construcción social que sobre violencia obstétrica han elaborado mujeres Tének y Náhuatl de México. Método Estudio cualitativo-sociocrítico, mediante gupos focales se profundizó en las experiencias de parto de quienes vivieron un parto en el periodo 2015-2016. Resultados Participaron 57 mujeres. Mediante análisis de discurso se identificó que las participantes no poseen suficiente información sobre violencia obstétrica y/o derechos sexuales y reproductivos, lo que las imposibilita para asociar sus experiencias negativas al término legal "violencia obstétrica". Sus discursos corresponden en su mayoría a lo que desde el marco legal se ha denominado "violencia obstétrica", sin embargo, experiencias como el ayuno prolongado o el uso de tecnologías para la invasión de su intimidad fueron narradas como algo que conciben violento y que no se ha incorporado dentro del término legal. Conclusión Múltiples acciones que atentan contra los derechos humanos de las mujeres tienen lugar dentro de las salas de parto, la mayor parte no son identificadas por las usuarias, puesto que no han construido socialmente la imagen de la violencia obstétrica, ello no las hace menos susceptibles sin embargo, a sentirse agredidas y denigradas en sus partos.


RESUMO Objetivo Explorar a construção social que as mulheres Tének e Náhuatl do México elaboraram sobre a violência obstétrica. Método Estudo qualitativo-sociocrítico; por meio de grupos focais, houve um aprofundamento nas experiências de parto daquelas que passaram por um parto no período de 2015 a 2016. Resultados Participaram 57 mulheres. Mediante análise do discurso, foi identificado que as participantes não possuem informação suficiente sobre violência obstétrica e/ou direitos sexuais e reprodutivos, o que as impossibilita de associar suas experiências negativas ao termo legal "violência obstétrica". Seus discursos correspondem na sua maioria ao que, a partir do marco legal, foi denominado "violência obstétrica"; entretanto, experiências como jejum prolongado ou uso de tecnologias para a invasão da sua intimidade foram narradas como algo que concebem ser violento e que não foi incorporado ao termo legal. Conclusão Múltiplas ações que atentam contra os direitos humanos das mulheres têm lugar dentro das salas de parto, a maior parte não é identificada pelas usuárias, visto que não construíram socialmente a imagem da violência obstétrica, mas isso não as faz menos suscetíveis de sentir-se agredidas e denegridas nos seus partos.


ABSTRACT Objective To explore the social construction of obstetric violence developed by Tenek and Nahuatl women in Mexico. Method Qualitative, socio-critical study conducted through focal groups in which were deepened the childbirth experiences lived in the period 2015-2016. Results Participation of 57 women. Through discourse analysis, it was identified that participants do not have enough information about obstetric violence and/or sexual and reproductive rights. This makes the association of their negative experiences with the legal term "obstetric violence" impossible. Most of their speeches correspond to the legal denomination of "obstetric violence". Experiences like prolonged fasting or the use of technologies for invading their privacy were narrated like situations they perceive as violent, but have not been incorporated within the legal term. Conclusion Multiple actions against women's human rights take place within delivery rooms. Most remain unidentified by users, since they have not socially constructed the image of obstetric violence. However, that fact does not make them less susceptible to feel attacked and denigrated during their childbirth experiences.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Salas de Parto , Parto , População Indígena , Violência contra a Mulher , México , Grupos Focais , Pesquisa Qualitativa , Enfermagem Obstétrica
2.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
4.
Pediatrics ; 144(3)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399490

RESUMO

BACKGROUND: In 2011, the Neonatal Resuscitation Program (NRP) added consideration of continuous positive airway pressure (CPAP) for spontaneously breathing infants with labored breathing or hypoxia in the delivery room (DR). The objective of this study was to determine if DR-CPAP is associated with symptomatic pneumothorax in infants 35 to 42 weeks' gestational age. METHODS: We included (1) a retrospective birth cohort study of neonates born between 2001 and 2015 and (2) a nested cohort of those born between 2005 and 2015 who had a resuscitation call leading to admission to the NICU and did not receive positive-pressure ventilation. RESULTS: In the birth cohort (n = 200 381), pneumothorax increased after implementation of the 2011 NRP from 0.4% to 0.6% (P < .05). In the nested cohort (n = 6913), DR-CPAP increased linearly over time (r = 0.71; P = .01). Administration of DR-CPAP was associated with pneumothorax (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 4.4-6.8); the OR was higher (P < .001) in infants receiving 21% oxygen (OR: 8.5; 95% CI: 5.9-12.3; P < .001) than in those receiving oxygen supplementation (OR: 3.5; 95% CI: 2.5-5.0; P < .001). Among those with DR-CPAP, pneumothorax increased with gestational age and decreased with oxygen administration. CONCLUSIONS: The use of DR-CPAP is associated with increased odds of pneumothorax in late-preterm and term infants, especially in those who do not receive oxygen in the DR. These findings could be used to clarify NRP guidelines regarding DR-CPAP in late-preterm and term infants.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/efeitos adversos , Salas de Parto , Pneumotórax/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco
5.
Ital J Pediatr ; 45(1): 95, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375123

RESUMO

BACKGROUND: Sudden unexpected postnatal collapse of presumably healthy neonates during early skin-to-skin contact is a rare, yet recognized occurrence, associated with a high risk of mortality and morbidity. A survey was conducted in 2012 in 30 delivery wards throughout Piedmont and the Aosta Valley to evaluate the environmental and logistical aspects that could be linked to SUPC. The survey was again conducted in 2016 in 28 delivery wards in Piedmont and the Aosta Valley in order to evaluate organizational improvements introduced after ministerial indications and recommendations by the Italian Society of Neonatology were published in 2014, in light of new findings regarding the phenomenon. METHODS: A questionnaire specifically asking about the organization of delivery wards, and surveillance or supervision during early skin-to-skin contact, was sent to all of the hospitals taking part in the survey in both 2012 and 2016. The collected data were elaborated anonymously and the statistical analysis was performed by using the two by two table. RESULTS: In 2012, 28 out of 30 delivery wards in Piedmont and Aosta, with a total of 31,074 newborns out of 35,435, were evaluated in all of the environmental and logistical aspects that might be cause for SUPC to occur. An identical survey was taken again in 2016; 26 out of 28 wards participated with a total of 27,484 newborns out of 30,339. In 2012, early skin-to-skin contact took place immediately in all the delivery rooms in 27 wards, and soon after in the post-partum room in one; in 11 out of 28 wards there was early skin-to-skin contact in the operating theater itself, following caesarean sections (11/26 in 2016). Routine newborn care was given after 3 h in 8 delivery wards (7/26 in 2016); after 2 h in 12 (7/26 in 2016); after 1 h in 2 (4/26 in 2016); after 30 min in 3 (2/26 in 2016); after 10 min in 1 (0/26 in 2016); after 1 or 2 min in 1 (0/26 in 2016) and at any time in one ward (6/26 in 2016). CONCLUSION: Periodic surveys of delivery wards are useful for the assessment of all the aspects and risk factors that need to be changed in order to implement safe early skin-to-skin contact.


Assuntos
Salas de Parto/organização & administração , Método Canguru , Morte Súbita do Lactente/prevenção & controle , Feminino , Humanos , Recém-Nascido , Itália/epidemiologia , Estudos Longitudinais , Gravidez , Morte Súbita do Lactente/epidemiologia , Inquéritos e Questionários
7.
Artigo em Inglês | MEDLINE | ID: mdl-30979005

RESUMO

Background: Infections acquired during labour and delivery are a significant cause of maternal and child morbidity and mortality. Adherence to hand hygiene protocols is a critical component of infection prevention strategies, but few studies have closely examined the hand hygiene of health care providers with sufficient detail to understand infection risks and prioritize prevention strategies. Methods: This observational study was conducted in six healthcare facilities in Nigeria. In each, five women were observed from the onset of labour through to delivery of the placenta. Hand hygiene infection risk was estimated for all procedures requiring aseptic technique compared against adherence to proper hand hygiene protocol and potential recontamination events. Results: Hands were washed with soap and sterile gloves applied with no observed recontamination before only 3% of all observed procedures requiring aseptic technique. There was no significant difference in hygiene compliance between midwives and doctors nor facilities or states. Adherence to proper hygiene protocol was observed more in morning compared to afternoon and night shifts. Conclusions: This study highlights that hand hygiene remains a barrier to delivering high-quality and safe care in health facilities. Improving hygiene practices during labour and delivery will require strategies that extend beyond infrastructure provision.


Assuntos
Infecção Hospitalar/prevenção & controle , Salas de Parto/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/normas , Higiene das Mãos/normas , Pessoal de Saúde/psicologia , Controle de Infecções/métodos , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Gravidez
8.
PLoS One ; 14(4): e0215150, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970001

RESUMO

OBJECTIVES: To assess premedication practices before tracheal intubation of premature newborns in the delivery room (DR). STUDY DESIGN: From the national population-based prospective EPIPAGE 2 cohort in 2011, we extracted all live born preterms intubated in the DR in level-3 centers, without subsequent circulatory resuscitation. Studied outcomes included the rate and type of premedication, infants' and maternities' characteristics and survival and major neonatal morbidities at discharge from hospital. Univariate and multivariate analysis were performed and a generalized estimating equation was used to identify factors associated with premedication use. RESULTS: Out of 1494 included neonates born in 65 maternities, 76 (5.1%) received a premedication. Midazolam was the most used drug accounting for 49% of the nine drugs regimens observed. Premedicated, as compared to non premedicated neonates, had a higher median [IQR] gestational age (30 [28-31] vs 28 [27-30] weeks, p<10-3), median birth weight (1391 [1037-1767] vs 1074 [840-1440] g, p<10-3) and median 1-minute Apgar score (8 [6-9] vs 6 [3-8], p<10-3). Using univariate analyses, premedication was significantly less frequent after maternal general anesthesia and during nighttime and survival without major morbidity was significantly higher among premedicated neonates (56/73 (81.4%) vs 870/1341 (69.3%), p = 0.028). Only 10 centers used premedication at least once and had characteristics comparable to the 55 other centers. In these 10 centers, premedication rates varied from 2% to 75%, and multivariate analysis identified gestational age and 1-minute Apgar score as independent factors associated with premedication use. CONCLUSION: Premedication rate before tracheal intubation was only 5.1% in the DR of level-3 maternities for premature neonates below 34 weeks of gestation in France in 2011 and seemed to be mainly associated with centers' local policies.


Assuntos
Doenças do Prematuro/prevenção & controle , Midazolam/uso terapêutico , Pré-Medicação/métodos , Peso ao Nascer , Estudos de Coortes , Salas de Parto , Feminino , França/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Doenças do Prematuro/epidemiologia , Intubação Intratraqueal , Masculino , Morbidade , Gravidez , Estudos Retrospectivos , Fatores de Risco
9.
Pediatrics ; 143(3)2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30819969
13.
Biomed Res Int ; 2019: 5984305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30733962

RESUMO

Introduction: Avoiding intubation and promoting noninvasive modes of ventilator support including continuous positive airway pressure (CPAP) in preterm infants minimizes lung injury and optimizes neonatal outcomes. Discharge home on oxygen is an expensive morbidity in very preterm infants (VPI) with lung disease. In 2007 a standardized bundle was introduced for VPI admitted to the neonatal care unit (NICU) which included delayed cord clamping (DCC) at birth and noninvasive ventilation as first-line cardiorespiratory support in the delivery room (DR), followed by bubble CPAP upon NICU admission. Objective: Our goal was to evaluate the risk of (1) intubation and (2) discharge home on oxygen after adopting this standardized DR bundle in VPI born at a regional perinatal center and treated in the NICU over a ten-year period (2008-2017). Materials and Methods: We compared maternal and neonatal demographics, respiratory care processes and outcomes, as well as neonatal mortality and morbidity in VPI (< 33 weeks gestation) and extremely low birth weight (ELBW, < 1000 g) subgroup for three consecutive epochs: 2008-2010, 2011-2013, and 2014-2017. Results: Of 640 consecutive inborn VPI, 55% were < 1500 g at birth and 23% were ELBW. Constant through all three epochs, DCC occurred in 83% of VPI at birth. There was progressive increase in maternal magnesium during the three epochs and decrease in maternal antibiotics during the last epoch. Over the three epochs, VPI had less risk of DR intubation (23% versus 15% versus 5%), NICU intubation (39% versus 31% versus 18%), and invasive ventilation (37% versus 30% versus 17%), as did ELBW infants. Decrease in postnatal steroid use, antibiotic exposure, and increase in early colostrum exposure occurred over the three epochs both in VPI and in ELBW infants. There was a sustained decrease in surfactant use in the second and third epochs. There was no significant change in mortality or any morbidity in VPI; however, there was a significant decrease in pneumothorax (17% versus 0%) and increase in survival without major morbidity (15% versus 41%) in ELBW infants between 2008-2010 and 2014-2017. Benchmarked risk-adjusted rate for oxygen at discharge in a subgroup of inborn VPI (401-1500 g or 22-31 weeks of gestation) is 2.5% (2013-2017) in our NICU compared with > 8% in all California NICUs and > 10% in all California regional NICUs (2014-2016). Conclusion: Noninvasive strategies in DR and NICU minimize risk of intubation in VPI without adversely affecting other neonatal or respiratory outcomes. Risk-adjusted rates for discharge home on oxygen remained significantly lower for inborn VPI compared with rates at regional NICUs in California. Reducing intubation risk in ELBW infants may confer an advantage for survival without major morbidity. Prenatal magnesium may reduce intubation risk in ELBW infants.


Assuntos
Salas de Parto , Recém-Nascido Prematuro/fisiologia , Unidades de Terapia Intensiva Neonatal , Intubação Intratraqueal , Ventilação não Invasiva , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido de Peso Extremamente Baixo ao Nascer/fisiologia , Masculino , Oxigênio , Gravidez , Fatores de Risco
16.
J Perinat Neonatal Nurs ; 33(1): 52-60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676462

RESUMO

Primary cesarean birth increases a woman's risk for hemorrhage, infection, pain, and cesarean births with subsequent pregnancies. A woman may experience difficulties with breastfeeding, bonding, and incorporating the newborn into the family structure. One urban, academic hospital in the Midwest participated in the American College of Nurse-Midwives Healthy Birth Initiative: Reducing Primary Cesarean Births Project. The project purpose was to reduce the rate of cesarean births in nulliparous, term, singleton, and vertex pregnancies. Strategies employed included use of intermittent auscultation, upright labor positioning, early labor lounge, one-to-one labor support, and team huddles. The baseline nulliparous, term, singleton, vertex cesarean rate in 2015 was 29.3%. In 2016, after 1 year of implementation of the project, the hospital decreased nulliparous, term, singleton, vertex cesarean rate to 26.1%-a reduction of 10%. In 2017, the rate was decreased to 25.3%-a reduction by 3.7%.


Assuntos
Cesárea/estatística & dados numéricos , Salas de Parto/organização & administração , Idade Gestacional , Trabalho de Parto/fisiologia , Equipe de Assistência ao Paciente/organização & administração , Seleção de Pacientes , Centros Médicos Acadêmicos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Comunicação Interdisciplinar , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Prevalência , Pesquisa Qualitativa , Medição de Risco , Nascimento a Termo , Estados Unidos
17.
Pediatrics ; 143(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30602545

RESUMO

BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks' gestation. METHODS: Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre-quality improvement cohort (QIC) (January 2014-September 2015) were compared with post-QIC (October 2015-December 2016). RESULTS: Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders. CONCLUSIONS: Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.


Assuntos
Salas de Parto/normas , Recém-Nascido Prematuro/fisiologia , Melhoria de Qualidade/normas , Ressuscitação/normas , Adulto , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/epidemiologia , Displasia Broncopulmonar/terapia , Estudos de Coortes , Salas de Parto/tendências , Feminino , Humanos , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/terapia , Masculino , Gravidez , Melhoria de Qualidade/tendências , Ressuscitação/métodos , Ressuscitação/tendências , Estudos Retrospectivos
18.
Semin Perinatol ; 43(1): 35-43, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30578145

RESUMO

As major stakeholders in the labor and delivery suite, obstetric anesthesiologists are frequently called upon to provide their unique skill sets and expertise to the management of postpartum hemorrhage, whether anticipated or not. Essential contributions of the anesthesia team ideally begin in the antenatal period with referral of women at high risk of postpartum hemorrhage to an outpatient obstetric anesthesia clinic where a tailored plan for both urgent or scheduled delivery for women with an anticipated complex delivery can be formulated. Maternal safety can be greatly improved if comorbidities are identified early and strategies to address these issues are proposed and known by the obstetric anesthesia team. Participation of the obstetric anesthesiology team is crucial in the development of systematic approaches that are customized to each institution and should comprise the creation and dissemination of algorithms and guidelines that are anesthesia specific, including detailed protocols for the labor and delivery unit and operating rooms, at large. Because management of postpartum hemorrhage requires a coordinated team effort, and may not always be planned, the anesthesia team should be prepared at all times to provide the appropriate anesthetic management and advanced cardiovascular support. The involvement of the anesthesia team should not only be limited to the immediate intrapartum period, but should also extend to the postpartum period where adequate anesthetic/analgesic plans will enhance maternal safety and recovery.


Assuntos
Anestesia Obstétrica/métodos , Parto Obstétrico/métodos , Hemorragia Pós-Parto/terapia , Protocolos Clínicos , Salas de Parto , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Segurança do Paciente , Gravidez , Garantia da Qualidade dos Cuidados de Saúde
20.
J Clin Nurs ; 28(3-4): 703-710, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29775991

RESUMO

OBJECTIVE AND AIMS: Using a queer phenomenological approach, the objective of this philosophical analysis was to explore the transgender experience in highly gendered clinical areas, such as the birth unit, and make recommendations on how to provide perinatal care that is inclusive of gender diversity within these areas. This study aims to describe a hypothetical clinical experience to provide insight on the institutional barriers that currently exist and to provide nurses and midwives with pragmatic strategies to enhance gender-diverse care in general and gendered clinical areas. BACKGROUND: Currently, general healthcare providers are not sufficiently educated on how to care for and meet the needs of people who identify as lesbian, gay, bisexual, trans, queer or questioning and other communities (LGBTQ+). This vulnerable population continually faces stigma, discrimination and marginalisation, which act as barriers to accessing healthcare services. Although transgender people often have difficulty accessing health care in general settings, they experience an even greater challenge within traditionally gendered clinical care areas. DESIGN: Queer phenomenology was used to guide a critical philosophical analysis of hypothetical case reflecting a clinical scenario regarding a transgender man's experience in labour and birth. DISCUSSION: Healthcare professionals often provide insufficient care to transgender persons, inadvertently leading to further marginalisation of this vulnerable population. Special consideration to provide gender-diverse care throughout the perinatal period is needed. Structures and supports are essential to enhance the care from providers in attending to the unique needs of transgender individuals and reduce oppressive effects from heteronormative environments. RELEVANCE TO CLINICAL PRACTICE: Nurses and midwives are leading exemplars of providing person-centred care and are capable of advocating for equitable care amongst all populations to influence systemic change. Strategies for implementing changes that address LGBTQ+ health needs and specific recommendations for providing gender-diverse care in the perinatal settings are discussed.


Assuntos
Atitude do Pessoal de Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Pessoas Transgênero , Cuidado Pré-Natal/métodos , Pessoas Transgênero/psicologia , Salas de Parto , Feminino , Identidade de Gênero , Acesso aos Serviços de Saúde/normas , Humanos , Trabalho de Parto/psicologia , Masculino , Assistência Centrada no Paciente , Gravidez , Estigma Social
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