Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.707
BMJ ; 367: l5517, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615781


OBJECTIVES: To investigate the effectiveness of routine ultrasonography in the third trimester in reducing adverse perinatal outcomes in low risk pregnancies compared with usual care and the effect of this policy on maternal outcomes and obstetric interventions. DESIGN: Pragmatic, multicentre, stepped wedge cluster randomised trial. SETTING: 60 midwifery practices in the Netherlands. PARTICIPANTS: 13 046 women aged 16 years or older with a low risk singleton pregnancy. INTERVENTIONS: 60 midwifery practices offered usual care (serial fundal height measurements with clinically indicated ultrasonography). After 3, 7, and 10 months, a third of the practices were randomised to the intervention strategy. As well as receiving usual care, women in the intervention strategy were offered two routine biometry scans at 28-30 and 34-36 weeks' gestation. The same multidisciplinary protocol for detecting and managing fetal growth restriction was used in both strategies. MAIN OUTCOME MEASURES: The primary outcome measure was a composite of severe adverse perinatal outcomes: perinatal death, Apgar score <4, impaired consciousness, asphyxia, seizures, assisted ventilation, septicaemia, meningitis, bronchopulmonary dysplasia, intraventricular haemorrhage, periventricular leucomalacia, or necrotising enterocolitis. Secondary outcomes were two composite measures of severe maternal morbidity, and spontaneous labour and birth. RESULTS: Between 1 February 2015 and 29 February 2016, 60 midwifery practices enrolled 13 520 women in mid-pregnancy (mean 22.8 (SD 2.4) weeks' gestation). 13 046 women (intervention n=7067, usual care n=5979) with data based on the national Dutch perinatal registry or hospital records were included in the analyses. Small for gestational age at birth was significantly more often detected in the intervention group than in the usual care group (179 of 556 (32%) v 78 of 407 (19%), P<0.001). The incidence of severe adverse perinatal outcomes was 1.7% (n=118) for the intervention strategy and 1.8% (n=106) for usual care. After adjustment for confounders, the difference between the groups was not significant (odds ratio 0.88, 95% confidence interval 0.70 to 1.20). The intervention strategy showed a higher incidence of induction of labour (1.16, 1.04 to 1.30) and a lower incidence of augmentation of labour (0.78, 0.71 to 0.85). Maternal outcomes and other obstetric interventions did not differ between the strategies. CONCLUSION: In low risk pregnancies, routine ultrasonography in the third trimester along with clinically indicated ultrasonography was associated with higher antenatal detection of small for gestational age fetuses but not with a reduced incidence of severe adverse perinatal outcomes compared with usual care alone. The findings do not support routine ultrasonography in the third trimester for low risk pregnancies. TRIAL REGISTRATION: Netherlands Trial Register NTR4367.

Doenças do Recém-Nascido , Ultrassonografia Pré-Natal , Adolescente , Índice de Apgar , Análise por Conglomerados , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Incidência , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Recém-Nascido Pequeno para a Idade Gestacional , Tocologia/métodos , Tocologia/estatística & dados numéricos , Países Baixos/epidemiologia , Mortalidade Perinatal , Gravidez , Resultado da Gravidez/epidemiologia , Terceiro Trimestre da Gravidez , Gravidez na Adolescência , Ultrassonografia Pré-Natal/métodos , Ultrassonografia Pré-Natal/estatística & dados numéricos
Int J Gynaecol Obstet ; 147(2): 140-146, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31571230


OBJECTIVE: To explore the knowledge of Developmental Origins of Health and Disease (DOHaD) concepts among midwives and obstetricians and to identify barriers and facilitators for clinicians to engage women and their partners before or early in pregnancy on risk factors associated with DOHaD, and thus to embed the concept of DOHaD in routine clinical practice. METHODS: A qualitative study using semi-structured interviews will be conducted in Ghana, India, Pakistan, Brazil, the UK, and USA in collaboration with the International Confederation of Midwives and the International Federation of Obstetricians and Gynecologists. Participants will be contacted via email and telephone interviews will be conducted until data saturation followed by inductive thematic analysis. RESULTS: Findings from this exploratory study will provide new knowledge about the perspectives of midwives and obstetricians on DOHaD and their role in preventing the intergenerational passage of non-communicable disease (NCD) risk and improving preconception care. CONCLUSION: This study will help us understand the current use of DOHaD principles in international maternity care and how this can be improved. Bringing DOHaD to clinical practice will help healthcare practitioners adopt a long-term approach in the prevention of NCDs and childhood obesity and will help women to enter pregnancy in optimum health.

Conhecimentos, Atitudes e Prática em Saúde , Tocologia/métodos , Obstetrícia/métodos , Cuidado Pré-Concepcional/métodos , Brasil , Feminino , Gana , Humanos , Índia , Tocologia/educação , Obstetrícia/educação , Paquistão , Gravidez , Pesquisa Qualitativa , Melhoria de Qualidade
Metas enferm ; 22(7): 49-55, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184099


Objetivo: analizar las costumbres y prácticas ancestrales en el cuidado de la mujer tseltal embarazada de tres comunidades de Chilón (Chiapas, México). Método: estudio cualitativo, etnográfico, descriptivo. Esta investigación se realizó en el sureste de México, en el estado de Chiapas, con un grupo de mujeres embarazadas tseltales, pertenecientes a tres comunidades de la región (Tulijá, Tseltal y Chol). Son comunidades indígenas en donde aún se rigen por usos y costumbres, por ello la figura de las matronas fue fundamental, ya que a través del consentimiento y aprobación de ellas como líderes de las comunidades se logró el acercamiento a las mujeres embarazadas. La técnica utilizada para la recogida de información fue la entrevista semiestructurada. El análisis del discurso permitió señalar conceptos y asignar códigos para generar categorías y subcategorías. Resultados: se reclutaron siete mujeres embarazadas entre las 20 y 38 semanas de gestación. Edad entre 17-42 años. El 100% pertenecía a la etnia tseltal. En el análisis del discurso emergieron dos categorías: "Creencias y prácticas durante el embarazo" y "La matrona, mujer sabia en el cuidado de la embarazada". Conclusiones: las mujeres gestantes tseltales tienen sus propias prácticas ancestrales de cuidado, no solo cuidan el cuerpo físico, sino tratan de guardar un equilibrio con la naturaleza, las emociones y el espíritu. El cuidado se basa en prácticas preventivas. De acuerdo a su cosmovisión, el estudio de estos saberes y prácticas integradas en la mujer embarazada tseltal, sensibiliza sobre la actuación enfermera para mejorar las competencias culturales

Objective: to analyze the ancient customs and practices regarding the care of tseltal pregnant women, from three Chilon communities (Chiapas, Mexico). Method: a qualitative, ethnographic, descriptive study. This research was conducted in South East Mexico, in the state of Chiapas, with a group of pregnant tseltal women, from three communities in the Tulija, Tseltal and Chol regions. These are native communities still ruled by uses and practices; therefore, the profile of midwives was essential, because an approach to pregnant women was possible through their consent and approval as community leaders. The technique used for collecting information was semi-structured interviews. Discourse analysis allowed to highlight concepts and assign codes in order to generate categories and subcategories. Results: seven pregnant women were recruited, within the 17-to-42 age range and on their 20th to 38th week of pregnancy; 100% of them belonged to the tseltal ethnic group. Two categories emerged within the discourse analysis: "Beliefs and practices during pregnancy", and "The midwife, a wise woman in pregnancy care". Conclusions: pregnant tseltal women have their own ancient practices of care: they won't only look after the physical body, but also try to keep in balance with nature, emotions and spirit. Care is based upon preventive practices. According to their worldview, the study of this knowledge and practices integrated in the pregnant tseltal woman creates awareness about the action of the nursing staff in order to improve cultural skills

Humanos , Feminino , Gravidez , Adulto , Cultura , Gravidez/etnologia , Enfermeiras Obstétricas , Competência Cultural , México , Gestantes , Análise Qualitativa , Tocologia/ética , Enfermagem Transcultural , Grupos Étnicos , Natureza
Stud Health Technol Inform ; 264: 1743-1744, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438322


A non-commercial knowledge base providing assessments of fetal risks of medicinal drugs is a useful tool in the everyday work of midwives. The information is freely available on the internet, and according to a questionnaire study, nearly 95% of the midwives are familiar with the database, 30% use the information weekly, and 80% express that it affects their medical decisions. A vast majority of the midwives also state that it is time-saving.

Tocologia , Feminino , Humanos , Bases de Conhecimento , Gravidez , Cuidado Pré-Natal , Inquéritos e Questionários
BMC Health Serv Res ; 19(1): 551, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387583


BACKGROUND: During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS: The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS: Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION: The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.

Atitude do Pessoal de Saúde , Pessoas com Deficiência , Pessoal de Saúde/psicologia , Cuidado Pré-Natal/normas , Adolescente , Adulto , Áustria , Feminino , Humanos , Relações Interprofissionais , Pessoa de Meia-Idade , Tocologia , Mães/psicologia , Complicações do Trabalho de Parto/terapia , Gravidez , Complicações na Gravidez/terapia , Transtornos Puerperais/terapia , Pesquisa Qualitativa , Adulto Jovem
Women Birth ; 32(5): 427-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326382


BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.

Continuidade da Assistência ao Paciente , Serviços de Saúde do Indígena , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Tocologia/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Parto/etnologia , Adulto , Austrália , Características Culturais , Feminino , Humanos , Obstetrícia , Gravidez , Fumar
Women Birth ; 32(5): 391-403, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31345660


BACKGROUND: Birth on Country is often assumed as relevant to Aboriginal women in rural/remote locations and not usually associated with urban environments. In Western Australia, one third of the Aboriginal population live in the greater metropolitan area. We wanted to know Aboriginal women's experiences of on Country urban births. METHODS: Indigenous qualitative data collection and analysis methods were used to learn about Aboriginal women's stories of contemporary and past experiences of maternity care and cultural practices associated with Birth on Country. RESULTS: Aboriginal Birthing, Senior and Elder women consistently reported ongoing cultural practices associated with childbirth including knowledge sharing across generations and family support, observance of extended family present at the time of or shortly after birth, and how their cultural security was improved when Aboriginal staff were present. Also noted, were the inflexibility of health systems to meet their needs and midwives lack of cultural awareness and understanding of the importance of Aboriginal kinship. CONCLUSION: The Birthing on Noongar Boodjar project Aboriginal women's data represents four generations of women's stories, experiences and expressions of childbearing, which highlighted that maternity care changes across time have failed to acknowledge and support Aboriginal women's cultural needs during childbearing. In terms of on Country urban birth, the women collectively expressed a strong desire to maintain cultural practices associated with childbirth, including birthing close to home (on Country); having family acknowledged and included throughout the perinatal period; and, having access to Aboriginal midwives, nurses, doctors, and other health care workers to support their cultural security.

Parto Obstétrico/métodos , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Adulto , Idoso , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Pessoal de Saúde , Humanos , Tocologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto/etnologia , Gravidez , Pesquisa Qualitativa , População Rural , Austrália Ocidental
Women Birth ; 32(5): 412-426, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31262706


BACKGROUND: Culturally secure care is considered foundational for good perinatal outcomes for Indigenous women. It is unknown what literature reports on whether Indigenous women giving birth in urban areas receives appropriate cultural care. The aim of this scoping review was to examine and summarise relevant evidence which reports on culturally secure care for Indigenous women using urban maternity services at any time during the perinatal period. METHODS: Ten journal databases plus grey literature and theses databases were searched for relevant material dated 1986-2018. Articles were included if they were about Indigenous women from Australia, New Zealand, Canada or the USA; care was provided anytime during the perinatal period, in an urban area; and cultural security (or variations of this term) were used. RESULTS: 6856 titles and abstracts were screened, of these: 25 studies, 15 grey literature documents and 9 theses matched the search criteria. Studies were mostly qualitative (13/25) and from Australia (18/25). Studies showed women's access to and experiences of culturally secure maternity care in urban areas as variable. The grey literature originated from Australia (8/15); New Zealand (4/15); and Canada (3/15); while theses were from Canada (7/9) and Australia (2/9). CONCLUSION: The scoping review results showed substantial qualitative evidence on Indigenous women's experience during the perinatal period in urban areas. In-depth analysis of these studies is required to inform future practice and policy on what works and what needs improvement. Culturally secure midwifery care shows promising results.

Assistência à Saúde Culturalmente Competente , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Tocologia/métodos , Assistência Perinatal , Austrália , Canadá , Competência Cultural , Assistência à Saúde/métodos , Feminino , Humanos , Nova Zelândia , Parto , Gravidez , População Urbana
Women Birth ; 32(5): 383-390, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31257181


BACKGROUND: This case study explores the four pregnancy and birthing journeys of Wiradjuri & Ngemba-Wayilwan woman, Fleur Magick Dennis. Fleur provides a personal account of her journeys and relates them to socio-cultural issues surrounding her life during these times. Fleur experienced her first birth in hospital and her three next births at different locations out of hospital on Wiradjuri Country. Fleur is able to show that her personal wellbeing & healing and that of her family & community is linked to her having been able to birth according to her spiritual & cultural beliefs. The midwife for Fleur's third and fourth pregnancy, Hazel Keedle, then provides a brief account of her experiences supporting Fleur in her choices and explores the impact of these births on her midwifery and personal life.

Continuidade da Assistência ao Paciente , Parto Domiciliar , Tocologia , Mães/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Satisfação Pessoal , Austrália , Centros de Assistência à Gravidez e ao Parto , Feminino , Hospitais , Humanos , Gravidez
Rev. enferm. UFSM ; 9: [19], jul. 15, 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1024241


Objetivo: conhecer a percepção de enfermeiras obstetras sobre o modelo e prática assistencial em uma maternidade filantrópica. Método: estudo qualitativo com 13 enfermeiras obstetras que trabalham em uma maternidade mineira, coleta de dados de setembro de 2015 a fevereiro de 2016 por meio de entrevista semiestruturada, utilizando-se Análise de Conteúdo. Resultados: emergiram como categorias: Atuação pautada na humanização e nas boas práticas; Autonomia para atuar; Profissional de referência para tomada de decisões; Atuação em equipe e Modelo de atuação. Discussão: verificou-se que as enfermeiras atuam com autonomia em equipe, não nomeiam um modelo de assistência e apontam a demanda de serviço e o modelo tecnocrático como dificultadores. Considerações finais: apoio e suporte dos gestores são importantes para a atuação das profissionais, contribuindo para um trabalho autônomo. Apesar dos avanços, ainda há desafios a serem superados tanto no âmbito da equipe e comunicação, quanto do suporte dos gestores.

Objective: to identify the perception of obstetric nurses about the healthcare model and practice in a philanthropic maternity hospital. Method: qualitative study of 13 obstetric nurses working in a Minas Gerais maternity hospital. Researchers used semi-structured interviews for data collection which took place from September 2015 to February 2016. Data analysis used content analysis. Results: the following categories emerged: Performance based on humanization and good practices; Professional autonomy; Professional mentoring during decision making; Teamwork and Performance Model. Discussion: research revealed that nurses are autonomous and work as a team; they did not single out a healthcare model and identified work demand and technocratic model as obstacles. Final considerations: management support is important for the professionals' performance since it contributes to autonomy at work. Despite the progress made, there are still challenges both in terms of staff and communication, as well as management support

Objetivo: conocer la percepción de las enfermeras obstétricas sobre la práctica y el modelo de atención en una maternidad de beneficencia. Método: estudio cualitativo con 13 enfermeras obstétricas de una maternidad de Minas Gerais; los datos, recogidos de septiembre de 2015 a febrero de 2016 en entrevistas semiestructuradas, se analizaron según el análisis de contenido. Resultados: se identificaron las siguientes categorías: Desempeño basado en la humanización y en las buenas prácticas; Autonomía para trabajar; Coaching para la toma de decisiones; Trabajo en equipo y Modelo de desempeño. Discusión: las enfermeras actúan con autonomía, en equipo, no mencionaron ningún modelo de atención; la demanda de servicios y el modelo tecnocrático representaban obstáculos. Consideraciones finales: el respaldo de la gerencia es fundamental para el desempeño profesional y contribuye a que se trabaje con autonomía. Aún hay retos por superar, tanto a nivel de equipos y comunicación como de respaldo de la gerencia.

Humanos , Prática Profissional , Autonomia Profissional , Tocologia , Enfermagem Obstétrica
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 921-924, jul.-set. 2019.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005399


Objetivo: avaliar o impacto da sensibilização no setor e a adesão ao protocolo de sepse em unidade de tocoginecologia. Método: Trata-se de uma pesquisa-ação no período de janeiro a março de 2016, com 63 profissionais que trabalham em unidade de tocoginecologia de um hospital de alta complexidade. Resultados: 51% dos profissionais receberam o treinamento sobre o protocolo de sepse e, após, 50% dos pacientes que tinham critérios de Síndrome da resposta inflamatória Sistêmica (SIRS) foram incluídos no protocolo de sepse, sendo que o desfecho de três destes foi alta hospitalar e dois foram transferidos para UTI devido sepse grave. O tempo médio de administração do antibiótico foi cinquenta minutos, da solicitação do hemograma foi 46,25 minutos e do resultado do lactato foi acima de trinta minutos. Conclusão: Ainda há necessidade de melhoria em relação à adesão pela equipe de enfermagem para implantação de medidas de combate à sepse

Objetivo: evaluar el impacto de la sensibilización en el sector y la adhesión al protocolo de sepsis en unidad de tocoginecología. Método: Se trata de una investigación-acción en el período de enero a marzo/2016, con 63 profesionales que trabajan en unidad de tocoginecología de un hospital de alta complejidad. Resultados: 51% de los profesionales recibieron el entrenamiento sobre el protocolo de sepsis y después, 50% de los pacientes que tenían criterios de SIRS fueron incluidos en el protocolo de sepsis, siendo el desenlace de 03 de ellas, fue alta hospitalaria y 02 fueron transferidas a UTI Debido a la sepse grave. El tiempo promedio de administración del antibiótico fue de 50 minutos, de la solicitud del hemograma fue 46,25 minutos y el resultado del lactato fue de más de 30 minutos. Conclusión: Aún hay necesidad de mejora en relación a la adhesión por el equipo de Enfermería para implantación de medidas de combate a la sepsis

Objective: to evaluate the impact of the sensitization in the sector and adherence to the protocol of sepsis in a unit of tocoginecology. Method: This is an action research from January to March/2016, with 63 professionals working in a tocoginecology unit of a highly complex hospital. Results: 51% of the professionals received training on the sepsis protocol and after that, 50% of the patients who had SIRS criteria were included in the sepsis protocol, and the outcome of 03 of these was hospital discharge and 02 were transferred to the ICU Due to severe sepsis. The mean time of administration of the antibiotic was 50 minutes, the request of the blood count was 46.25 minutes and the result of the lactate was over 30 minutes. Conclusion: There is still a need for improvement regarding adherence by the Nursing team to implement measures to combat sepsis

Humanos , Masculino , Feminino , Gravidez , Adulto , Complicações Infecciosas na Gravidez/prevenção & controle , Tecnologia Educacional/instrumentação , Tecnologia Educacional/estatística & dados numéricos , Equipe de Assistência ao Paciente , Protocolos Clínicos , Sepse/diagnóstico , Sepse/terapia , Tocologia/normas
Implement Sci ; 14(1): 64, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215450


BACKGROUND: In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest several barriers exist to performing HePPBes. The aim of the study was to investigate the barriers and facilitators midwives perceive to undertaking HePPBes. METHODS: The research compromised of two studies. Study 1: midwives based in a community setting (N = 11) took part in semi-structured interviews underpinned by the theoretical domains framework (TDF). Interviews were analysed using a direct content analysis approach to identify important barriers or facilitators to undertaking HePPBes. Study 2: midwives (N = 505) completed an online questionnaire assessing views on their HePPBes including free text responses (n = 61) which were coded into TDF domains. Study 2 confirmed and supplemented the barriers and facilitators identified in study 1. RESULTS: Midwives' perceived a multitude of barriers and facilitators to carrying out HePPBes. Key barriers were requirements to perform an increasing amount of HePPBes on top of existing clinical work load, midwives' cognitive resources, the quality of relationships with pregnant women, a lack of continuity of care and difficulty accessing appropriate training. Key facilitators included midwives' motivation to support pregnant women to address their health. Study 1 highlighted strategies that midwives use to overcome the barriers they face in carrying out their HePPBes. CONCLUSIONS: Despite high levels of motivation to carry out their health promotion practice, midwives perceive numerous barriers to carrying out these tasks in a timely and effective manner. Interventions that support midwives by addressing key barriers and facilitators to help pregnant women address their health behaviours are urgently needed.

Consumo de Bebidas Alcoólicas , Exercício , Promoção da Saúde/organização & administração , Tocologia , Cuidado Pré-Natal/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Escócia , Inquéritos e Questionários
Lancet ; 393(10187): 2192-2193, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31162071
Artigo em Inglês | MEDLINE | ID: mdl-31203587


Background: Despite the maternal and infant health benefits of antenatal vaccines and availability of government-funded vaccination programs, Australia does not have a national system for routinely monitoring antenatal vaccination coverage. We evaluated the potential use of Western Australia's mandatory Midwives Notification System (MNS) as a tool for routinely monitoring antenatal vaccination coverage. Methods: Two hundred and sixty-eight women who gave birth to a live infant between August and October 2016 participated in a telephone survey of vaccines received in their most recent pregnancy. For women who reported receiving influenza and/or pertussis vaccine and whose vaccination status was documented by their vaccine provider, MNS vaccination data were compared with the vaccine provider's record as the 'gold standard.' For women who reported receiving no vaccines, MNS vaccination data were compared with self-reported information. Results: Influenza and pertussis vaccination status was complete (i.e. documented as either vaccinated or not vaccinated) for 66% and 63% of women, respectively. Sensitivity of MNS influenza vaccination data was 65.7% (95% CI 56.0-74.2%) and specificity was 53.0% (95% CI 42.4-63.4%). Sensitivity of MNS pertussis vaccination data was 62.5% (95% CI 53.3-70.9%) and specificity was 40.4% (95% CI 27.6-54.7%). There was no difference between vaccinated and unvaccinated women in the proportion of MNS records with missing or unknown vaccination information. When considering only MNS records with complete vaccination information, the sensitivity of the MNS influenza vaccination field was 91.8% (95% CI 83.0-96.9%) and the sensitivity of the MNS pertussis vaccination field was 88.0% (95% CI 76.7-95.5%). Conclusion: Due to the high proportion of records with missing or unknown vaccination status, we observed low sensitivity and specificity of antenatal vaccination data in the MNS. However, given we did not observe differential ascertainment by vaccination status, MNS records with complete information may be reliable data source for routinely monitoring antenatal vaccine coverage.

Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Vacina contra Coqueluche/imunologia , Complicações Infecciosas na Gravidez/prevenção & controle , Vacinação , Coqueluche/prevenção & controle , Adolescente , Adulto , Austrália/epidemiologia , Notificação de Doenças , Feminino , Humanos , Influenza Humana/epidemiologia , Influenza Humana/virologia , Programas Obrigatórios , Tocologia , Gravidez , Cuidado Pré-Natal , Inquéritos e Questionários , Cobertura Vacinal , Coqueluche/epidemiologia , Coqueluche/microbiologia , Adulto Jovem
Nurse Educ Today ; 79: 188-193, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31153089


BACKGROUND: There is a lack of research on resilience in midwifery, yet this may be a factor that can help prevent burnout and intention to leave the profession. OBJECTIVES: To explore the relationship between perceived stress, resilience and burnout and the intention to leave midwifery within Midwifery students. DESIGN: A Quantitative study with a cross-sectional survey design. SETTING: A London University in the UK. PARTICIPANTS: 150 BSc student midwives, aged between 18 and 44, studying at University participated in this study. This included 72 students in year one, 26 in year two and 52 in year three. METHODS: Participants completed the Perceived Stress Scale, the Oldenburg Burnout Inventory and the Resilience Scale-14 to examine their self-reported stress levels, burnout (emotional exhaustion and disengagement) and level of resilience. Intentions to quit the profession were also measured. RESULTS: All variables were significantly correlated but in multiple regression analyses only stress predicted disengagement, and stress and year of study predicted emotional exhaustion. High stress and reduced resilience predicted intentions to quit midwifery. Resilience did not act as a moderator. Thus the findings suggest that resilience did not protect students from high levels of stress leading to burnout or wanting to quit, although resilience did help to reduce intentions to quit. CONCLUSION: Student stress levels are not moderated by resilience and resilience played no role in reducing burnout. However, resilience may help students to persevere in the profession rather than leaving their studies. In order to minimise burnout and stress we need to consider alternative ways of enhancing the current workforce to reduce the decline in midwives entering the profession.

Esgotamento Psicológico , Tocologia/educação , Resiliência Psicológica , Estresse Psicológico/psicologia , Estudantes de Enfermagem/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Londres , Reorganização de Recursos Humanos , Inquéritos e Questionários , Adulto Jovem
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 335-341, Apr.-June 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1013140


Abstract Objectives: ididentify the scores on the pregnant women's knowledge on the signs of alert and labor and correlate the scores with the maternal age, number of children and the guidance they received during pregnancy. Methods: this is a descriptive, cross-sectional study with a quantitative approach on pregnant women's previous knowledge of the signs of alert and labor performed with 100 pregnant women on their 30th week of gestation at the Hospital de Clínicas da UFTM (Clinical Hospital). The data collection was carried out from April to June 2016, using a semi-structured instrument tested as a pilot study. Results: only 21% of the pregnant women reported taking part in the pregnant women's group; 61% of them referred to not receiving any information on the signs of alert and labor. A statistically significant association was verified between the number of correct answers and the guidance they received during prenatal consultations. However, there was no correlation between the correct scores on maternal age and the number of children. Conclusions: the pregnant women who did not receive any kind of guidance, they had lower scores on the correct answers, which shows the importance of guiding them about Health Education during their prenatal consultations.

Resumo Objetivos: identificar escores de conhecimento de gestantes sobre os sinais de alerta e de trabalho de parto e correlacionar escores de acerto com a idade materna, o número de filhos e o recebimento de orientações durante a gestação. Métodos: trata-se de um estudo de abordagem quantitativa, transversal, sobre o conhecimento prévio acerca dos sinais de alerta e de trabalho de parto realizado com 100 gestantes, a partir da 30ª semana gestacional, no Hospital de Clínicas da UFTM. A coleta de dados foi realizada no período de abril a junho de 2016 por meio de instrumento semiestruturado, testado mediante estudo piloto. Resultados: apenas 21% das gestantes relataram a participação em grupo de gestantes e 61% referiram não ter recebido nenhum tipo de informação sobre os sinais de alerta e de trabalho de parto. Verificou-se uma associação estatisticamente significante entre o número de acertos e as orientações recebidas durante o pré-natal. Entretanto, não houve correlação entre escores de acerto e a idade materna e o número de filhos. Conclusões: gestantes que não receberam orientações tiveram escores de acertos mais baixos o que demonstra a importância da Educação em Saúde durante o pré-natal.

Humanos , Feminino , Gravidez , Cuidado Pré-Natal , Trabalho de Parto , Serviços de Saúde Materno-Infantil , Tocologia/educação , Gravidez , Educação em Saúde , Idade Materna , Dor do Parto
Rev. Bras. Saúde Mater. Infant. (Online) ; 19(2): 471-479, Apr.-June 2019.
Artigo em Inglês | LILACS | ID: biblio-1013142


Abstract Objectives: to understand the cultural context presented in hospitals and its relation to the obstetric nurse's autonomous practice on low-risk childbirth care. Methods: ethnographic research performed in three public maternities in Rio Grande do Norte, Brazil. Three managers and twenty-three obstetric nurses participated in this research. Results: distinctive on cultural, organizational and structural aspects of the hospital institution interfering directly with the obstetric nurse's autonomous practice. Among these aspects, professional appreciation on low-risk childbirth care contributes for the nurse's autonomy Conclusions: it was noticed that obstetric nurses undergo different contexts of action, which directly interfere with their autonomy on low-risk childbirth care and their decisionmaking abilities. It is necessary, then, to eradicate the relation of dominance and submission that it is still imposed by medical hegemony.

Resumo Objetivos: compreender o contexto cultural da instituição hospitalar e sua relação com a prática autônoma do enfermeiro obstetra na assistência ao parto de risco habitual. Métodos: pesquisa etnográfica desenvolvida em três maternidades públicas do Estado do Rio Grande do Norte, Brasil, com três gestores e 23 enfermeiros obstetras. Resultados: diferentes aspectos de ordem cultural, organizacional e estrutural da instituição hospitalar interferem diretamente na prática autônoma do enfermeiro obstetra. Dentre estes aspectos, a valorização profissional na assistência ao parto de risco habitual contribui para a autonomia do profissional em questão. Conclusões: constatou-se que o enfermeiro obstetra vivencia distintos contextos de atuação, os quais interferem diretamente na sua autonomia na assistência ao parto de risco habitual e no seu poder de decisão. Faz-se necessário, então, desvencilhar-se das relações de domínio e submissão, ainda impostas pela hegemonia médica.

Humanos , Prática Profissional , Cultura Organizacional , Autonomia Profissional , Tocologia , Enfermeiras Obstétricas , Brasil , Enfermagem Holística , Parto Humanizado , Tomada de Decisões , Humanização da Assistência