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1.
Rev. enferm. UERJ ; 29: e53642, jan.-dez. 2021.
Artigo em Inglês, Português | LILACS | ID: biblio-1224513

RESUMO

Objetivo: descrever os cuidados domiciliares prestados por parteiras tradicionais durante a assistência ao parto. Método: estudo qualitativo conduzido por meio do método da História Oral Temática, realizado com 16 parteiras em nove municípios do Cariri cearense. A coleta de dados ocorreu entre julho e dezembro de 2015 por meio de entrevista semiestruturada, os relatos foram transcritos, textualizados e transcriados. Resultados: as parteiras prestavam cuidados familiares, assistência ao parto vaginal, cuidados com o recém-nascido e no puerpério imediato. Usavam chás e orações como adjuvantes do seu ofício. Conclusão: o cuidado das parteiras na assistência ao parto centralizava-se nas necessidades da mulher e da família, sendo, em alguns casos, extensivo à casa. As parteiras conheciam os sinais e sintomas do trabalho de parto e agiam nas possíveis intercorrências.


Objective: to describe home care provided by traditional midwives during childbirth care. Method: this qualitative study, using the Thematic Oral History method, was conducted with 16 midwives from nine municipalities in Cariri, Ceará. Data were collected from July to December 2015 through semi-structured interviews, the reports were transcribed, textualized and transcreated. Results: midwives provided family care, vaginal delivery care, newborn care and immediate postpartum care. They used teas and prayers as an adjuncts to their craft. Conclusion: childbirth care by midwives centered on the women's and families' needs and, in some cases, extended to the home. Midwives knew the signs and symptoms of labor and acted on possible complications.


Objetivo: describir los cuidados domiciliarios brindados por parteras tradicionales durante la atención al parto. Método: estudio cualitativo conducido mediante el método de Historia Oral Temática, realizado con 16 parteras en nueve municipios de Cariri en Ceará. La recolección de datos se realizó entre julio y diciembre de 2015 a través de entrevistas semiestructuradas; los relatos fueron transcritos, textualizados y transcreados. Resultados: las parteras brindaron atención familiar, asistencia en el parto vaginal, cuidados al recién nacido y en el puerperio inmediato. Usaban tés y oraciones como complemento de su oficio. Conclusión: el cuidado de las parteras en la atención al parto se centraba en las necesidades de la mujer y de la familia, extendiéndose, en algunos casos, al hogar. Las parteras conocían los signos y síntomas del trabajo de parto y actuaban sobre las posibles complicaciones.


Assuntos
Humanos , Feminino , Idoso , Idoso de 80 Anos ou mais , Assistência Perinatal , Parto Domiciliar , Assistência Domiciliar , Tocologia , Trabalho de Parto , Pesquisa Qualitativa , Período Pós-Parto
2.
Rev Lat Am Enfermagem ; 29: e3431, 2021.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-34495185

RESUMO

OBJECTIVE: to examine the usage and content of the Global Alliance for Nursing and Midwifery (GANM) discussion forum in relation to nursing and midwifery education and practice. METHOD: a qualitative conventional content analysis was performed. Subject lines from 1689 discussion board threads were extracted and used as the unit of analysis. A-priori codes were developed based on topical relevance (e.g. maternal health) and typical discussion board usage (e.g. announcing educational opportunities). Emerging codes were further identified while coding the data (e.g. infectious diseases). RESULTS: the GANM discussion forum was used most frequently for information exchange (43.8%), such as dissemination of new information on evidence-based practice, and to announce educational opportunities (24.8%). The most frequently discussed topics were nursing (14.2%; e.g. the role of nurses in primary care, nursing education, etc.) and maternal health (13.8%; e.g. postpartum care, maternal mortality, etc.). Infectious diseases were discussed in 9% of threads, 40% of which concerned the current coronavirus pandemic. CONCLUSION: findings reinforce the utility of the GANM as a platform for professional development and continuing education. As a platform for disseminating empirical research, the GANM can be leveraged to have an influence on real-world, evidence-based practice.


Assuntos
Educação em Enfermagem , Tocologia , Feminino , Humanos , Gravidez
3.
Cad Saude Publica ; 37(8): e00076320, 2021.
Artigo em Português | MEDLINE | ID: mdl-34495091

RESUMO

In several countries, primary care for pregnant women is performed by obstetric nurses and/or midwives. In Brazil's Supplementary Health System (private health insurance and out-of-pocket care), coverage of prenatal care is mandatory and is performed by medical obstetricians. The objective of this study is to conduct a cost-effectiveness analysis, comparing clinical outcomes and costs associated with the incorporation of prenatal care by obstetric nurses and midwives in the Supplementary Health System, from the perspective of the operator of health plans as the payment source. A decision tree was built, based on data from a Cochrane Collaboration meta-analysis that showed a reduction in the risk of premature birth in the group of normal-risk pregnant women accompanied by obstetric nurses and midwives. The analysis only considered the direct medical costs covered by health plan operators for essential appointments and tests, according to the prevailing Ministry of Health protocol. The study assumed equal unit costs of consultations by medical professionals and applied an increase in the overall cost of prenatal tests associated with medical follow-up, based on data from the literature. Incremental cost-effective ratio was estimated at -BRL 10,038.43 (savings of BRL 10,038.43) per premature birth avoided. This result was consistent with the sensitivity analyses, with savings associated with the substitution ranging from -BRL 2,544.60 to -BRL 31,807.46 per premature death avoided. In conclusion, prenatal care provided by obstetric nurses and midwives was superior to that provided by medical obstetricians for the prevention of premature birth, besides resulting in cost savings.


Assuntos
Tocologia , Enfermeiras e Enfermeiros , Brasil , Análise Custo-Benefício , Feminino , Humanos , Gravidez , Gestantes , Cuidado Pré-Natal
4.
Br J Nurs ; 30(16): 970-974, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34514831

RESUMO

This aim of this article is to explore the current position of evidence-based practice (EBP) in nursing. The article provides an overview of the historical context and emergence of EBP with an outline of the EBP process. There is an exploration of the current challenges facing the nursing profession as it endeavours to adopt EBP into care delivery, along with actions to address these challenges. There will also be a discussion on how to integrate EBP into undergraduate nursing curricula as academic institutions implement the Future nurse standards of proficiency from the Nursing and Midwifery Council.


Assuntos
Bacharelado em Enfermagem , Tocologia , Estudantes de Enfermagem , Currículo , Enfermagem Baseada em Evidências , Prática Clínica Baseada em Evidências , Feminino , Humanos , Gravidez , Inquéritos e Questionários
5.
Women Birth ; 34(5): e482-e492, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34420764

RESUMO

PROBLEM: In jurisdictions where midwifery and nursing are autonomous and separate health care professions, little is known about how they collaborate during the delivery of perinatal health care services. BACKGROUND: Midwifery became a regulated profession in the province of Nova Scotia, Canada in 2009. Since regulation, midwives and nurses have worked together at three models sites for the delivery of midwifery services and perinatal care. QUESTION: How do midwives and nurses collaborate during the provision of birthing care in Nova Scotia, Canada? METHODS: This was an instrumental case study guided by feminist poststructuralism. Individual interviews of 17 participants were audio-recorded and transcribed verbatim. Twenty-five documents were reviewed, and field notes were gathered. Feminist poststructuralist discourse analysis was used. FINDINGS: Midwives and nurses collaborated well together. Participants described how positive collaborative experiences could influence a new way for midwives and nurses to work together. In this paper we present the theme Moving forward: A Modern Model for Nurses and Midwives working together, and its sub-themes of 1)'The birthing culture has changed' and 2) 'Allies and advocates'. DISCUSSION: Within the global context of strengthening midwifery and nursing, this study illustrated the potential for developing formal, collaborative perinatal models of care led by midwife and nurse teams to address inequities in perinatal health care services. CONCLUSION: Midwives and nurses need more opportunities to collaborate and to build professional relationships. Establishing a midwife-led and nurse supported model of care may transform existing perinatal health care values, beliefs, and practices.


Assuntos
Tocologia , Enfermeiras e Enfermeiros , Criança , Feminino , Feminismo , Humanos , Recém-Nascido , Nova Escócia , Assistência Perinatal , Gravidez
6.
Br J Nurs ; 30(15): 900-908, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379470

RESUMO

BACKGROUND: Nurses, midwives and other health professionals who return to practice come from a range of backgrounds and return for a variety of reasons. Much of the research on return to practice concerns programme provision rather than returnee experience. AIM: This qualitative study focused on the experiences of nursing, midwifery and allied health students undertaking a return to practice programme at a higher education institute. It interpreted the perceptions of the student experience of returning to clinical practice following a lapse in professional registration. METHODS: Data collection methods were qualitative and involved focus groups. Findings were analysed using thematic analysis. FINDINGS: Several themes and subthemes emerged from the data, including 'the importance of returnee identity' and 'challenges and barriers'. Findings demonstrated different approaches to and influences on returnees' learning journeys. CONCLUSION: Previous knowledge, skills and experience were often hidden from view and hard to explain although crucial to returnee success.


Assuntos
Educação Continuada em Enfermagem , Tocologia , Estudantes de Enfermagem , Reeducação Profissional , Grupos Focais , Humanos , Aprendizagem , Tocologia/educação , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Pesquisa Qualitativa , Estudantes de Enfermagem/psicologia
7.
BMJ Open ; 11(8): e047072, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34341045

RESUMO

OBJECTIVES: To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures. DESIGN AND SETTING: The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years. PARTICIPANTS: Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up. COST MEASURES: Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach. OUTCOME MEASURES: Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios. RESULTS: Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only 'cost-effective' in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was 'cost-effective' in all scenarios except at 3 months scenario. CONCLUSIONS: The midwives' only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives' and dentists' combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide. TRIAL REGISTRATION NUMBER: ACTRN12612001271897; Post-results.


Assuntos
Tocologia , Austrália , Análise Custo-Benefício , Assistência Odontológica , Feminino , Humanos , Saúde Bucal , Gravidez
8.
Rev Bras Enferm ; 74(suppl 4): e20200689, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34406273

RESUMO

OBJECTIVES: to identify the reasons for the prevalence of the technocratic model in obstetric care from the perspective of health professionals. METHODS: Grounded Theory. Study approved by two Research Ethics Committees and conducted by theoretical sampling, from July 2015 to June 2017. Twenty-nine interviews were conducted with health professionals from two maternity hospitals in the Southern Region of Brazil. Data collection and analysis was performed alternately; and analysis by open, axial, and selective coding/integration. RESULTS: the technocratic model still persists because the assistance is performed in a mechanized way, centered on the professionals. There is a lack of systematization of care, and under-dimensioning of the nursing staff. FINAL CONSIDERATIONS: obstetric nurses need to review their performance in obstetric centers, the internal organization, the dimensioning of nursing professionals, and become protagonists of care. Investment in academic training/updating the knowledge of midwifery professionals, based on scientific evidence and user-centered care is necessary.


Assuntos
Tocologia , Feminino , Teoria Fundamentada , Pessoal de Saúde , Maternidades , Humanos , Gravidez , Prevalência , Pesquisa Qualitativa
10.
BMC Med Educ ; 21(1): 432, 2021 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-34399743

RESUMO

BACKGROUND: Concerns are being expressed around the lack of diversity at higher levels of clinical academia. This study aimed to explore experiences and challenges associated with combining clinical academic careers with family life. METHODS: Qualitative data were gathered from participants from 4 NHS Trusts and 2 universities in the East Midlands of England using online surveys and semi-structured interviews. RESULTS: The survey was completed by 67 nurses, midwives and allied health professionals, and 73 medical clinical academic trainees. Interviews were conducted with 16 participants from each group including equal numbers of men and women. Caring responsibilities differed between the two study populations. Medical clinical academic trainees were younger and either had young children or were yet to start a family. In contrast, nurses, midwives and allied health professionals tended to be older when they embarked on a clinical academic career and often waited until their children were school-age or older. Similar concerns were raised regarding working part-time and childcare, and how their career prospects might be affected in terms of fulfilling promotion criteria and being able to relocate for work purposes. The occupation of their partners also featured in participants' experiences; those who shared childcare with someone who worked 'regular' hours, appeared to be better supported to combine a clinical academic career with family life. Gender stereotyping was identified in some reported experiences highlighting a need for appropriate mentorship and for positive role models who were able to demonstrate that it is possible to survive and thrive as a clinical academic with family responsibilities. CONCLUSIONS: Although people manage to find ways to successfully combine clinical academic roles with family life, findings highlight a need to identify ways of supporting and encouraging trainees with caring responsibilities to ensure that they remain on the clinical academic pathway.


Assuntos
Pessoal Técnico de Saúde , Tocologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Mentores , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários
11.
BMC Health Serv Res ; 21(1): 858, 2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34425804

RESUMO

BACKGROUND: All evidence-based knowledge and improvement strategies for quality care must be implemented so patients can benefit from them. In Germany, national expert standards (NES) contribute to quality care in nursing and midwifery. The NES defines for several action levels a dedicated level of quality, which is operationalized by structure, process, and outcome (SPO) criteria. An NES to promote normal childbirth was developed and implemented in 2014. The first action level involves midwife-led antenatal consultation (ML-AC) being conducted in a structured way. Most implementation processes aim to accomplish sustainability, but implementation studies rarely use definitions or a theory of sustainability, even when assessing sustainability. This lack led to the assumption that intervention sustainability after implementation is still a largely unexplored domain. The aim of this study is to investigate the sustainability of midwife-led antenatal consultation (ML-AC) implemented at two hospitals, in Germany. METHODS: In a qualitative approach, 34 qualitative interviews were conducted (between March and October 2017) using semi-structured interview guides. All interviews were transcribed verbatim, anonymized and analyzed thematically using framework method. Four groups of stakeholders in two hospitals offering ML-AC were interviewed: managers (n = 8), midwives conducting ML-AC (n = 10), pregnant women who attended ML-AC (n = 8), and physicians working in obstetrics (n = 8) at the hospitals. RESULTS: The interviewees identified key benefits of ML-AC on a personal and unit level, e.g., reduced obstetric interventions, easier admission processes. Furthermore, the participants defined key requirements that are needed for routinized and institutionalized ML-AC, such as allocating working time for ML-AC, and structural organization of ML-AC. All study participants saw a need to establish secure long-term funding. Additionally, the interviewed staff members stated that ML-AC topics need evaluating and adapting in the future. CONCLUSIONS: Implementing ML-AC in the hospital setting has led to manifold benefits. However, reimbursement through the health care system will be needed to sustain ML-AC. Hospitals implementing ML-AC will need to be aware that adaptations of the NES are necessary to accomplish routinization and institutionalization. After initial implementation, sustaining ML-AC will generally require on-going monitoring and evaluating of benefits, routinization/institutionalization and further development.


Assuntos
Tocologia , Feminino , Hospitais , Humanos , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa , Encaminhamento e Consulta
12.
Nurse Educ Today ; 106: 105066, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34340195

RESUMO

BACKGROUND: Reform to Competency-based curricula, a standard for training health professionals of the 21st century, requires rigorous planning for successful implementation. However, although the reform defines the direction of the schools and quality of their products, it lacks in planning and prominence which could lead to the failure and waste of resources. OBJECTIVE: To explore the processes of planning reform to Competency-based curricula in undergraduate nursing and midwifery education in Rwanda. DESIGN: This study adopted a qualitative approach to give detailed descriptions and explanations of the phenomenon. Ethics approval and permissions were obtained before data collection. SETTINGS: The data was collected on two campuses of the University of Rwanda offering undergraduate nursing and midwifery programs. PARTICIPANTS: 17 staff participated in this study. METHODS: The data was collected through in-depth individual interviews of staff including four administrators and leaders, seven people occupying both academic management and teaching posts, and six educators. The data was analysed by the researchers following Corbin and Strauss' grounded theory through open coding, axial coding, and selective coding. RESULTS: Emerged categories were: (a) Establishment of a curriculum development team, (b) sourcing of curriculum development experts, (c) situational analysis, (d) curriculum development, and (e) preparation of stakeholders. CONCLUSION: Well-planned reform to Competency-based curricula leads to successful implementation through the involvement of different stakeholders from the beginning.


Assuntos
Bacharelado em Enfermagem , Tocologia , Estudantes de Enfermagem , Currículo , Feminino , Humanos , Gravidez , Pesquisa Qualitativa
13.
Glob Health Action ; 14(1): 1905304, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34402771

RESUMO

A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population.


Assuntos
Educação em Enfermagem , Tocologia , Currículo , Etiópia , Docentes de Enfermagem , Feminino , Humanos , Gravidez
14.
Artigo em Inglês | MEDLINE | ID: mdl-34360168

RESUMO

The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI -7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0-10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.


Assuntos
Serviços de Saúde Materna , Tocologia , Obstetrícia , Feminino , Humanos , Parto , Gravidez , Gestantes , Cuidado Pré-Natal
15.
BMC Health Serv Res ; 21(1): 789, 2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34376210

RESUMO

BACKGROUND: This study, undertaken in Rwanda, aimed to investigate health professionals' experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. METHODS: A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS). RESULTS: Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy. CONCLUSIONS: Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.


Assuntos
Tocologia , Obstetrícia , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Pessoal de Saúde , Humanos , Gravidez , Ruanda , Ultrassonografia Pré-Natal
16.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371909

RESUMO

With an growing number of people on a strict plant-based diet, its potential effect on pregnancy and lactation becomes increasingly important. It is, however, unclear how obstetric caregivers currently handle and think about a strict plant-based diet in pregnancy. The aim of the study was therefore to evaluate the self-reported knowledge and advice given by Dutch obstetric caregivers and dietitians when treating pregnant women on a strict plant-based diet. A cross-sectional study was performed by sending an online survey to Dutch midwife practices, obstetricians, and dietitian practices. Descriptive statistics are reported. A total of 121 midwives, 179 obstetricians, and 111 dietitians participated in this study. The majority of midwives (80.2%) and obstetricians (93.9%) considered a strict plant-based diet to be a significant risk factor for nutrient deficiency during pregnancy. Maternal dietary preferences, including a potential strict plant-based diet, were discussed at the first prenatal appointment by 59.5% of midwives and 24.1% of obstetricians. A self-reported lack of knowledge concerning the strict plant-based diet was mentioned by 66.1% of midwives and 75.4% of obstetricians. Obstetric caregivers mostly considered the identification of this dietary habit and subsequent referral to a dietitian or a reliable website as optimal care for pregnant women on the strict plant-based diet. However, only 38.7% of dietitians indicated to have sufficient knowledge to counsel these women. Although obstetric caregivers thought that a strict plant-based diet in pregnancy may lead to increased risks of nutritional deficiencies, the majority report to have insufficient knowledge to provide adequate advice. Only a minority referred these women to dietitians, of whom a minority indicated to have adequate knowledge on this specific diet. These results suggest that current care is suboptimal for an increasing number of pregnant women. Women on a strict plant-based diet could benefit from increased knowledge about this topic among obstetric caregivers and dietitians, as well as from clear guidelines regarding this diet during pregnancy.


Assuntos
Dieta Vegetariana , Fenômenos Fisiológicos da Nutrição Materna , Tocologia , Estado Nutricional , Nutricionistas , Obstetrícia , Cuidado Pré-Natal , Adulto , Atitude do Pessoal de Saúde , Competência Clínica , Aconselhamento , Estudos Transversais , Dieta Vegetariana/efeitos adversos , Comportamento Alimentar , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Valor Nutritivo , Equipe de Assistência ao Paciente , Gravidez , Medição de Risco , Fatores de Risco , Resultado do Tratamento
17.
Cochrane Database Syst Rev ; 7: CD013321, 2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34231203

RESUMO

BACKGROUND: Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia. OBJECTIVES: To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. SEARCH METHODS: In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. SELECTION CRITERIA: We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. DATA COLLECTION AND ANALYSIS: We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. MAIN RESULTS: We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence).  Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence). AUTHORS' CONCLUSIONS: The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.


Assuntos
Medo/psicologia , Parto/psicologia , Transtornos Fóbicos/terapia , Analgesia Epidural/psicologia , Analgesia Epidural/estatística & dados numéricos , Analgesia Obstétrica/psicologia , Analgesia Obstétrica/estatística & dados numéricos , Terapia pela Arte , Viés , Cesárea/psicologia , Cesárea/estatística & dados numéricos , Terapia Cognitivo-Comportamental , Aconselhamento , Depressão/epidemiologia , Feminino , Humanos , Tocologia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
J Adv Nurs ; 77(10): 4246-4253, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34288043

RESUMO

AIM: The aim of this scoping review is to map the range of policy-related evidence influencing maternal health outcomes and determine the cultural and contextual factors influencing maternal health in Myanmar, a low-income, fragile setting. DESIGN: Eligible studies identified will include maternal health-related policies, policy documents and research. All types of health-related policies aimed at targeting population health and well-being influencing maternal mortality and morbidity will be considered. METHODS: This scoping review has been developed using the Joanna Briggs Institute recommendations. The database search will include MEDLINE, CINAHL, Web of Science, Cochrane Library and the grey literature. Documents published in English and Burmese in the past 10 years will be included. Numerical data will be extracted and summarized in diagrammatic form, and a descriptive format will be used to present narrative accounts. Funding approval was granted by the Economic and Social Research Council in January 2020. This protocol was registered with OSF registries (Open-ended Registration) on 30 March 2021. DISCUSSION: Little is known about which strategies work best as there is less evidence related to health policy and contextual factors in which maternal health care is delivered in fragile, low-income settings. Understanding the context of maternal health is key to the planning and implementation of effective maternal health services designed to address women's needs. IMPACT: This review will map the range of policy-related evidence influencing maternal health outcomes in Myanmar and will underpin future large-scale research in other low-income and fragile settings. The results of this scoping review will provide recommendations for developing and improving practice and education for nurses and midwives working in resource-restricted contexts.


Assuntos
Serviços de Saúde Materna , Tocologia , Feminino , Política de Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Pobreza , Gravidez , Literatura de Revisão como Assunto
19.
Eur J Obstet Gynecol Reprod Biol ; 264: 150-154, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34303075

RESUMO

OBJECTIVE: Consent on the labour ward is a complex and controversial topic which is poorly understood. Consenting labouring women is recognised as challenging and problematic, and thus, it is uncertain that pregnant women experience true informed consent during labour. This project aims to explore healthcare professionals' views and experiences of consent practice on the labour ward. DESIGN: Qualitative research performed in a tertiary hospital labour ward in Central London with 5500 patients annually. Eleven obstetricians and seven midwives participated. In-depth one-on-one semi-structured interviews were conducted, and the data were analysed by thematic analysis. RESULTS: Three themes were identified: 1) The value of women's choice: healthcare professionals framed consent as an agreement process rather than an exercise of choice. Implicit paternalism was evident with some healthcare professionals imposing their own recommendations upon patients. 2) Communicating risk: many participants viewed full risk communication, including extremely rare risk disclosure as their duty to ensure the validity of obstetric consent despite the risk of overwhelming women. 3) Law and professional practice: many healthcare professionals lacked knowledge of the implications to practice of current law. CONCLUSION: Healthcare professionals' experiences of consent on the labour ward reflect uncertainties and ambiguities in consent practice such that it sometimes falls short of legal and professional requirements. Difficulties in discussing risk with women in an appropriate way at an appropriate time threatens the lawfulness of consent. If consent is to remain as the legal standard of autonomy, we recommend the provision of specialist training to assist professionals in providing timely consultation dialogues which endorse women's right to choose.


Assuntos
Trabalho de Parto , Tocologia , Atenção à Saúde , Feminino , Humanos , Consentimento Livre e Esclarecido , Gravidez , Pesquisa Qualitativa
20.
Artigo em Inglês | PAHO-IRIS | ID: phr-54531

RESUMO

Dear Editor: In recognition of the newly gained prominence and visibility of health professionals in the fight against the COVID-19 pandemic, the World Health Organization has made 2021 the International Year of Health and Care Workers, after having designated 2020 as the International Year of the Nurse and the Midwife. Nurses are essential at the different levels of health care, following best practices, offering timely information and action in health, and coordinating and managing care and services. However, investment in nursing professionals has proven to be insufficient; efforts must be made to strengthen leadership and optimize this workforce for an effective response to the health needs of the population.


Assuntos
COVID-19 , Infecções por Coronavirus , Tocologia , Enfermeiras Obstétricas , Enfermeiras e Enfermeiros , Enfermagem , Pandemias , Coronavirus
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