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1.
Midwifery ; 112: 103424, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35850078

RESUMO

OBJECTIVE: To evaluate women and partners' experience of birth in a "birth environment room" compared to a standard birth room. DESIGN: A single centre parallel randomised controlled trial. Women and partners were enrolled during a 3-year period (May 2015 to March 2018). SETTING: The Department of Obstetrics and Gynaecology at Herning Hospital, Denmark. PARTICIPANTS AND INTERVENTION: A total of 680 Danish speaking nulliparous women, more than 18 years old, with a singleton pregnancy in cephalic presentation, and a spontaneous onset of labour, and their partners were randomly assigned to give birth in a "birth environment room" (n = 340) or in a standard birth room (n = 340) on arrival at the birth unit. MEASUREMENTS AND FINDINGS: Outcomes were the overall birth experience and overall satisfaction with care, measured on a Likert scale, obtained in the postpartum questionnaire sent to the women 6 weeks after birth and to their partners 1/2 weeks after birth. Other outcomes were "staff support for partner", "undisturbed contact with new-born", "feeling of being listened to", "level of information", "attention to psychological needs", "suggestions for pain-relief", "participation in decision-making", "midwife present when wanted", "support from midwife", "birth wishes were met", "loss of internal control" (only women), "loss of external control", "support from partner" (partners: "being supportive for partner"), "importance of physical environment for birth" and "importance of physical environment for staff´s ability to involve the women" (only women). All outcomes were prespecified. We applied Mann Whitney U test for comparing the two groups. Data were collected from 326 women and 236 partners in the intervention group and from 315 women and 209 partners in the control group. The intention-to-treat analysis revealed no difference in the overall experience of birth for women or partners (p 0.81 and p 0.17, respectively). Partners in the intervention group reported more overall satisfaction with care compared to partners in the control group (p 0.048). In the intervention group, fewer women and partners responded they had not had the opportunity for undisturbed contact with their new-born in the first hours after birth (RR 0.19 (95% CI 0.04-0.87) and OR 0.00 CI (0.00-0.83), respectively). Otherwise, there were no differences between groups. The thematic analysis revealed that many women and partners felt they were not able to benefit from the features in "the birth environment room" in the most intense hours of birth. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: "The birth environment room" did not improve the overall experience of birth for women and partners. Partners in the intervention group were overall more satisfied with care. These findings are of importance in the developing of physical birth environments that support the mental/emotional process of labour.


Assuntos
Trabalho de Parto , Tocologia , Adolescente , Emoções , Feminino , Humanos , Trabalho de Parto/psicologia , Parto/psicologia , Período Pós-Parto , Gravidez
2.
BMJ Open ; 12(6): e062869, 2022 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-35760537

RESUMO

INTRODUCTION: Pregnant women experience early labour with different physical and emotional symptoms. Early admission to hospital has been found to be associated with increased intervention and caesarean section rates. However, primiparous women often contact the hospital before labour progresses because they encounter difficulties coping with symptoms of onset of labour on their own. An evidence-based instrument for assessing the individual needs to advise primiparous women during early labour is currently missing. The study aims to develop and validate a tool to inform the joint decision for or against hospital admission. METHODS AND ANALYSIS: A scale development and validation study will be conducted including following steps: (1) Generation of a pool with 99 items based on a scoping review and focus group discussions with primiparous women, (2) Assessment of content and face validity by an expert panel and item reduction to 32 items, (3) Multicentre data collection in six study sites in Switzerland, with application of the preliminary tool and the validation items with a target sample size of approximately n=400 women and (4), item reduction using exploratory factor analysis, factor loading and item-to-item correlation. Internal consistency of the tool will be assessed using Cronbach's alpha and convergent validity computing correlations of items of the tool with the German versions of the Childbirth Self-Efficacy Inventory and the Cambridge-Worry Scale. Analyses will be performed using Stata V.17. ETHICS AND DISSEMINATION: Ethical approval was obtained by the Ethics Committees Zurich and Northwestern and Central Switzerland (BASEC-Nr. 2021-00687). Results will be disseminated at the final study conference, at national and international congresses and by peer reviewed and not peer-reviewed articles in scientific and professional journals. Approved and anonymised data will be shared. The dissemination of the findings will have a contributable impact on clinical practice, scientific discussions and future research. TRIAL REGISTRATION NUMBER: DRKS00025572, SNCTP000004555.


Assuntos
Cesárea , Trabalho de Parto , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto/psicologia , Parto , Gravidez , Psicometria , Reprodutibilidade dos Testes , Literatura de Revisão como Assunto
3.
J Affect Disord ; 312: 92-99, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35716784

RESUMO

INTRODUCTION: In recent years, clinical studies have shown that perinatal pain could increase the risk of postpartum depression, while such a conclusion appears controversial. Therefore, we conducted this systematic review and meta-analysis to explore the association between perinatal pain and postpartum depression, and to evaluate the effectiveness of epidural labor analgesia in reducing the risk of postpartum depression. METHODS: PubMed, Web of Science, Embase and Cochrane Library were searched from inception to Jan 30th, 2022. The effect size of the meta-analysis was calculated using odds ratio and 95 % confidence interval. Statistical analysis was performed using Stata 15.0 software. RESULTS: There were 19 studies included with a total of 96,378 patients. Among the included studies, 10 investigated the association between perinatal pain and the risk of postpartum depression, and 9 reported that between labor analgesia and the risk of postpartum depression. The results of meta-analysis showed that perinatal pain increased the risk of postpartum depression [OR = 1.43, 95% CI (1.23, 1.67), p<0.05], and epidural analgesia could reduce the risk of postpartum depression [OR = 0.42, 95% CI (0.33, 0.55), p < 0.05]. LIMITATIONS: Source of heterogeneity in the association between perinatal pain and PPD could not be identified due to the limitations of the original studies. There were mainly cohort studies included in the assessment for effectiveness of epidural analgesia in reducing the incidence of postpartum pain. Therefore, we look forward to more RCTs to confirm our results. CONCLUSION: Perinatal pain is one of the risk factors for postpartum depression, and epidural analgesia could reduce the risk of PPD. This result might provide guidance for clinical practice. However, psychological health counseling should be combined with epidural analgesia for perinatal pain to reduce the risk of PPD.


Assuntos
Analgesia Epidural , Depressão Pós-Parto , Dor do Parto , Trabalho de Parto , Analgesia Epidural/efeitos adversos , Analgesia Epidural/métodos , Analgesia Epidural/psicologia , Analgésicos , Depressão Pós-Parto/psicologia , Feminino , Humanos , Dor do Parto/tratamento farmacológico , Dor do Parto/epidemiologia , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Manejo da Dor/psicologia , Gravidez
4.
Int J Qual Stud Health Well-being ; 17(1): 2056958, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35403573

RESUMO

PURPOSE: There is a trend worldwide to induce pregnant women earlier. However, few studies have focused on women's experiences. The aim was to gain a deeper understanding of women's lived experiences of induction of labour in late- and post-term pregnancy. METHODS: Phenomenology with a reflective lifeworld approach was chosen as the method. Twelve women participating in a larger study in which women were randomized to either induction of labour in week 41 or to expectant management until week 42, were interviewed one to three months after giving birth. RESULTS: The essence is described as follows: labour becomes another journey than the intended one. The women adapted to this new journey by seeing the advantages and handing themselves over to the healthcare system, but at the same time something about giving birth could be lost. The result is further described by its four constituents: planning the unplannable, being a guest at the labour ward, someone else controlling the labour, and overshadowed by how it turned out. CONCLUSION: Induced labour presents a challenge to maternity personnel to support the birthing woman's normal progress, not to rush her through labour, and to involve her in the process.


Assuntos
Trabalho de Parto Induzido/psicologia , Trabalho de Parto/psicologia , Gestantes/psicologia , Feminino , Humanos , Trabalho de Parto Induzido/métodos , Parto/psicologia , Gravidez , Suécia
5.
HERD ; 15(3): 193-205, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35293256

RESUMO

AIM: To explore women's experiences of physical features in a birthing room designed to be adaptable to personal wishes and needs during labor and birth. BACKGROUND: Childbirth is a central life event influenced by numerous factors, including the healthcare environment; however, there is insufficient knowledge on how the physical design affects women during birth. METHODS: This study was part of a randomized controlled trial in the Room4Birth research project, including women randomized to receive care in a new birthing room designed with physical features changeable according to personal wishes. Data consisted of responses to two questions analyzed with descriptive statistics (n = 202) and semi-structured interviews analyzed for content (n = 19). RESULTS: A total of 93.6% (n = 189) assessed the physical features in the birthing room as meaningful to a very high or high extent. The overall impression of the room was positive and exceeded women's expectations. They felt welcomed and strengthened by the room, which shifted the focus to a more positive emotional state. The room differed from traditional hospital birthing rooms, contained familiar features that maintained integrity, and had space for companions. The variety of physical features was appreciated. Of nine listed physical features, the bathtub was ranked most important, followed by the projection of nature scenery, and dimmable lighting, but the room as a whole appeared most important. CONCLUSIONS: When planning and designing hospital-based birthing rooms, it is crucial to offer possibilities to adapt the room and physical features according to personal wishes.


Assuntos
Salas de Parto , Trabalho de Parto , Parto Obstétrico/psicologia , Feminino , Humanos , Recém-Nascido , Trabalho de Parto/psicologia , Parto/psicologia , Gravidez , Pesquisa Qualitativa , Suécia
6.
Acta Clin Croat ; 60(3): 399-405, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35282486

RESUMO

The experience of labor pain is a complex process that represents the interaction of the nociceptive stimulus within the physiologic process with a series of psychological factors. The aim of this study was to investigate the relation between the choice of epidural analgesia as a form of pain management and psychological state of woman in labor; moreover, whether the women in labor with a higher level of anxiety have a more intensive experience of pain during labor and therefore decide on epidural analgesia. Pain was evaluated by the visual analog scale, while the sensory and affective pain components were evaluated by the McGill Pain Questionnaire, and anxiety as a trait was measured with the State-Trait Anxiety Inventory-form X. Women in labor with a higher level of anxiety had a significantly increased affective component of pain, but did not significantly more frequently decide on labor with epidural analgesia. The women having chosen epidural analgesia experienced more intense pain during delivery before epidural analgesia, with the sensory component of pain being less pronounced in the women in labor without epidural analgesia, while there was no difference in the affective component of pain.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Dor do Parto , Trabalho de Parto , Analgesia Obstétrica/psicologia , Ansiedade/etiologia , Ansiedade/psicologia , Feminino , Humanos , Dor do Parto/tratamento farmacológico , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Gravidez
7.
Midwifery ; 108: 103286, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35231873

RESUMO

OBJECTIVE: to explore first-time Italian parents' expectations of labour and birth. DESIGN: qualitative Husserlian phenomenological approach, using face-to-face focus groups for parents during the late third trimester of pregnancy. Data analysis, using Colaizzi's phenomenological method, included the processes of reading and re-reading the text to extract relevant statements in order to identify themes and finally member checking was performed to validate participants' expressions SETTING: consultant-led maternity unit in Northern Italy, with approximately 2500 births per annum. PARTICIPANTS: purposive sample of eight first-time parents-to-be, with a straightforward singleton pregnancy, who participated in two focus groups during pregnancy, one for women and one for their partners, to explore their expectations of birth. FINDINGS: uncertainties, doubts and fears were reported by all women. Although they expected to have a normal birth, they remained open-minded due to the awareness of the unpredictable nature of childbirth. One of the strongest emotions expressed by women was that of fear, especially of labour. They found different strategies to cope with those fears and to anticipate their potential disappointment and frustration regarding a childbirth experience that potentially could differ from their expectations. Women wanted their partner with them to share the birth experience and they valued their presence as essential. The midwife was expected to be a supportive guide. Fathers-to-be, although happy about the idea to be present at birth, were also concerned about their reaction to an unknown experience, about the woman's labour pain and were worried about not being helpful to her. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: to our knowledge this is the first such study to be conducted in Italy. In order to support families as a whole, the importance of the father in a supportive role and as an essential parent himself should be addressed, considering his wishes. Midwives should strive to provide family centre-care, to be supportive and sensitive. Antenatal education classes should be conducted with both parents in order to understand their expectations, give information about duration and stages of labour and birth, prepare for parenthood, addressing fears and enhancing a positive experience of birth.


Assuntos
Dor do Parto , Trabalho de Parto , Tocologia , Feminino , Humanos , Recém-Nascido , Dor do Parto/psicologia , Trabalho de Parto/psicologia , Motivação , Pais , Parto/psicologia , Gravidez , Pesquisa Qualitativa
8.
BMC Pregnancy Childbirth ; 22(1): 134, 2022 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-35180852

RESUMO

BACKGROUND: The Mothers Autonomy in Decision Making Scale (MADM) assesses women's autonomy and role in decision making. The Mothers on Respect Index (MORi) asseses women's experiences of respect when interacting with their healthcare providers. The Childbirth Experience Questionnaire 2.0 assesses the overall experience of childbirth (CEQ2.0). There are no validated Dutch measures of the quality of women's experiences in the intrapartum period. Therefore, the aim of this study was to evaluate the psychometric properties of these measures in their Dutch translations. METHODS: The available Dutch versions of the MADM and MORi were adapted to assess experiences in the intrapartum period. The CEQ2.0 was translated by using forward-backward procedures. The three measures were included in an online survey including items on individual characteristics (i.e. maternal, birth, birth interventions). Reliability was assessed by calculating Cronbach's alphas. Mann-Whitney, Kruskal Wallis or Student T-tests were applied where appropriate, to assess discrimination between women who differed on individual characteristics (known group validity). We hypothesized that women who experienced pregnancy complications and birth interventions would have statistically lower scores on the MADM, MORi and CEQ2.0, compared with women who had healthy pregnancies and physiological births. Convergent validity was assessed using Spearman Rank correlations between the MADM, MORi and/or CEQ2.0. We hypothesized moderate to strong correlations between these measures. Women's uptake of and feedback on the measures were tracked to assess acceptability and clarity. RESULTS: In total 621 women were included in the cross sectional study. The calculated Cronbach's alphas for the MADM, MORi and CEQ, were ≥ 0.77. Knowngroup validity was confirmed through significant differences on all relevant individual characteristics, except for vaginal laceration repair. Spearman Rank correlations ranged from 0.46-0.80. In total 98% of the included women out of the eligible population completed the MADM and MORi for each healthcare professional they encountered during childbirth. The proportions of MADM and MORi-items which were difficult to complete ranged from 0.0-10.8%, 0.6-2.7%, respectively. CONCLUSIONS: The results of our study showed that the Dutch version of the MADM, MORi and CEQ2.0 in Dutch are valid instruments that can be used to assess women's experiences in the intrapartum period.


Assuntos
Trabalho de Parto/psicologia , Parto/psicologia , Assistência Perinatal , Período Periparto/psicologia , Psicometria , Inquéritos e Questionários , Adulto , Estudos Transversais , Tomada de Decisões , Feminino , Humanos , Países Baixos , Autonomia Pessoal , Gravidez , Reprodutibilidade dos Testes , Respeito , Traduções
9.
BMC Pregnancy Childbirth ; 22(1): 156, 2022 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-35216563

RESUMO

BACKGROUND: Legal and social changes mean that information sharing and consent in antenatal and intrapartum settings is contentious, poorly understood and uncertain for healthcare professionals. This study aimed to investigate healthcare professionals' views and experiences of the consent process in antenatal and intrapartum care. METHODS: Qualitative research performed in a large urban teaching hospital in London. Fifteen healthcare professionals (obstetricians and midwives) participated in semi-structured in-depth interviews. Data were collectively analysed to identify themes in the experiences of the consent process. RESULTS: Three themes were identified: (1) Shared decision-making and shared responsibility -engaging women in dialogue is often difficult and, even when achieved, women are not always able or do not wish to share responsibility for decisions (2) Second-guessing women - assessing what is important to a woman is inherently difficult so healthcare professionals sometimes feel forced to anticipate a woman's views (3) Challenging professional contexts - healthcare professionals are disquieted by consent practice in the Labour ward setting which is often at odds with legal and professional guidance. CONCLUSIONS: Results suggest that there is a mismatch between what is required of healthcare professionals to effect an antenatal or intrapartum consent process concordant with current legal and professional guidance and what can be achieved in practice. If consent, as currently articulated, is to remain the barometer for current practice, healthcare professionals need more support in ways of enabling women to make decisions which healthcare professionals feel confident are autonomous whatever the circumstances of the consultation.


Assuntos
Pessoal de Saúde/psicologia , Consentimento Livre e Esclarecido/psicologia , Trabalho de Parto/psicologia , Cuidado Pré-Natal/psicologia , Adulto , Tomada de Decisão Compartilhada , Feminino , Pessoal de Saúde/legislação & jurisprudência , Hospitais de Ensino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Londres , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Gravidez , Cuidado Pré-Natal/legislação & jurisprudência , Pesquisa Qualitativa , Saúde da Mulher
10.
BMC Pregnancy Childbirth ; 22(1): 49, 2022 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-35045813

RESUMO

OBJECTIVE: Childbirth pain and anxiety are often unnatural, as opposed to being one of the most practical ways to use non-pharmacological methods. The aim of this study was to compare the effectiveness of virtual reality and chewing mint gum on childbirth pain and anxiety. METHODS: This is a single-blind, three-group clinical trial study on 93 mothers referred to Allameh Bohlool Gonabadi and Sajjadieh Torbate Jam Hospitals for natural childbirth in 2018-2019. Subjects were randomly divided into three groups of chewing gum, virtual reality, and control using six blocks. Chewing gum interventions in one group and virtual reality in the other group were performed twice in 4-5 cm and 7-8 cm dilatations for 20 min. In the control group, no intervention except routine care was performed. The research tools included Visual Analogue Scale of Pain and Spielberger's Anxiety Inventory. Data were analyzed using SPSS) version 22(, ANOVA, Kruskal-Wallis, Chi-square and Tukey tests. Significance level was considered 0.05 in this study. RESULTS: The main result was differences in pain and anxiety before and after the intervention. There was no significant difference between pre-intervention pain and anxiety scores in the three groups, but there was a significant difference between pain and anxiety scores immediately and 30 min after the intervention. CONCLUSION: The results of this study showed that virtual reality and chewing mint gum intervention reduce pain and anxiety in the first stage of childbirth. TRIAL REGISTRATION: IRCT20181214041963N1 .


Assuntos
Ansiedade/terapia , Goma de Mascar , Dor do Parto/terapia , Trabalho de Parto/psicologia , Mentha , Realidade Virtual , Adulto , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Gravidez , Método Simples-Cego , Inquéritos e Questionários , Escala Visual Analógica
11.
BMC Pregnancy Childbirth ; 22(1): 63, 2022 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-35073861

RESUMO

BACKGROUND: The World Health Organization recommends that women are supported continuously throughout labor by a companion of their choice. And, that companions have clearly designated roles and responsibilities to ensure that their presence is beneficial to both the woman and her health care providers. Presently, there is lack of strong evidence regarding specific support actions in relation to women's needs of care. Thus, we aimed to explore birth companion support actions for women during childbirth. METHODS: This was an exploratory descriptive qualitative study conducted between August 2019 and December 2019; at a referral hospital in the Eastern part of Uganda. Ten women were purposively selected: those who were admitted in early labor, expecting a normal delivery, and had fulltime birth companion. Nonparticipant direct observation and in-depth interviews were used to collect data. Latent content analysis was used. RESULTS: Three themes were identified: "Support actions aiding a good childbirth experience", "Support actions hindering coping with labor", and "Women's needs and expectations of care". Support actions aiding a good experience described were; emotional presence, motivation, providing nourishments, messenger activities, body massage for pain relief, assisting in ambulation and coaching. Companion fearful behaviors and disrespectful care in form of unacknowledged needs and hostility from birth companions were reported to hinder coping. The women desired thoughtful communication, trust, for birth companions to anticipate their needs and recognize non perceptive phases of labor to allow them focus on themselves. CONCLUSION: Birth companions from this study largely supported women emotionally, and attended to their physical needs. The greater part of support actions provided were esteemed by the women. Presence of birth companion will be of benefit when individual needs of women are put into consideration. Also, more guidance for birth companions is necessary to boost their role and mitigate shortcomings of their presence during childbirth.


Assuntos
Cuidadores , Amigos , Parto/psicologia , Qualidade da Assistência à Saúde , Adolescente , Adulto , Parto Obstétrico/psicologia , Feminino , Humanos , Trabalho de Parto/psicologia , Gravidez , Pesquisa Qualitativa , Uganda , Adulto Jovem
12.
Acta Obstet Gynecol Scand ; 101(2): 193-199, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34859422

RESUMO

INTRODUCTION: Childbirth experience is an increasingly recognized and important measure of quality of obstetric care. Previous research has shown that it can be affected by intrapartum care and how labor is followed. A partograph is recommended to follow labor progression by recording cervical dilation over time. There are currently different guidelines in use worldwide to follow labor progression. The two main ones are the partograph recommended by the World Health Organization (WHO) based on the work of Friedman and Philpott and a guideline based on Zhang's research. In our study we assessed the effect of adhering to Zhang's guideline or the WHO partograph on childbirth experience. Zhang's guideline describes expected normal labor progression based on data from contemporary obstetric populations, resulting in an exponential progression curve, compared with the linear WHO partograph. The choice of labor curve affects the intrapartum follow-up of women and this could potentially affect childbirth experience. MATERIAL AND METHODS: The Labor Progression Study (LaPS) study was a prospective, cluster randomized controlled trial conducted at 14 birth centers in Norway. Birth centers were randomized to either follow Zhang's guideline or the WHO partograph. Nulliparous women in active labor, with one fetus in cephalic presentation at term and spontaneous labor onset were included. At 4 weeks postpartum, included women received an online login to complete the Childbirth Experience Questionnaire (CEQ). Total score on the CEQ, the four domain scores on the CEQ, and scores on the individual items on the CEQ were compared between the two groups. RESULTS: There were 1855 women in the Zhang group and 1749 women in the WHO partograph group. There was no difference in the total or domain CEQ scores between the two groups. We found statistically significant differences for two individual items; women in the Zhang group scored lower on positive memories and feeling of control. CONCLUSIONS: Based on our findings on childbirth experience there is no reason to prefer Zhang's guideline over the WHO partograph.


Assuntos
Trabalho de Parto/psicologia , Avaliação de Resultados em Cuidados de Saúde , Parto/psicologia , Guias de Prática Clínica como Assunto , Cuidado Pré-Natal/normas , Psicometria , Adulto , Feminino , Humanos , Noruega , Gravidez , Inquéritos e Questionários
13.
PLoS One ; 16(11): e0259770, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34767612

RESUMO

In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients' perceptions of care and providers' experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives' experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby's condition. For the midwives' perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers' clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.


Assuntos
Trabalho de Parto/psicologia , Mães/psicologia , Satisfação do Paciente , Triagem/métodos , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Gravidez , Uganda , Adulto Jovem
14.
Sci Rep ; 11(1): 17005, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417541

RESUMO

Perceived stress is a dimension of the maternal stress response, however little data is available on perceived stress levels and its associated psychological risk factors during labor. In this secondary data analysis from a prospective study evaluating epidural regimens, we investigated the potential associations between depressive symptomatology, anxiety, and pain catastrophizing with perceived stress during labor. Healthy nulliparous adult women with term singleton pregnancies requesting for epidural analgesia in early labor were included. Assessments were administered after epidural analgesia and adequate pain relief were achieved. Perceived stress (Perceived Stress Scale, PSS, high PSS ≥ 16), depressive symptomatology (Edinburgh Postnatal Depression Scale, EPDS, high EPDS ≥ 10), and pain catastrophizing (Pain Catastrophizing Scale, PCS, high total PCS ≥ 25) were assessed as categorical variables. Additionally, anxiety (State-trait Anxiety Inventory, STAI), PCS total and its subscales (rumination, magnification and helplessness) were analyzed as continuous variables. Univariate and multivariable logistic regression models were used to identify factors associated with high PSS. Of 801 women included, 411 (51.9%) had high PSS. High EPDS (OR 2.16, 95%CI 1.36-3.44), increasing trait anxiety (OR 1.17, 95%CI 1.14-1.20), and increasing pain magnification (OR 1.12, 95%CI 1.05-1.19) were independently associated with high PSS. Depressive symptomatology, trait anxiety, and pain magnification were associated with perceived stress during labor, providing impetus for future research aimed at detecting and alleviating stress and its psychological or pain association factors.


Assuntos
Ansiedade/psicologia , Catastrofização/psicologia , Depressão/psicologia , Trabalho de Parto/psicologia , Dor/psicologia , Estresse Psicológico/complicações , Adulto , Feminino , Humanos , Análise Multivariada , Gravidez
15.
Acta Med Port ; 34(4): 272-277, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-34214419

RESUMO

INTRODUCTION: In the current century, increasing importance has been given to the opinions, expectations and experiences of women using healthcare services. The fulfillment of expectations is determined by satisfaction. This study aims to analyze both expectations and satisfaction during childbirth regarding labor epidural analgesia among parturients, with a focus on myths. MATERIAL AND METHODS: A prospective observational study was conducted in parturients at the Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital in Lisbon, Portugal, applying a questionnaire to 317 random women. SPSS v22.0 was used for data analysis. RESULTS: Three hundred questionnaires were returned, from women with a mean age of 31. Among the respondents, 46.3% had a college degree and 64% were employed, 46% were primiparas and only 14% had a previous anesthesiology appointment for childbirth purposes. The overall degree of satisfaction surrounding the birth experience was good/excellent for 87% of women. Labor epidural analgesia was performed on 96% of all patients, with an excellent/good outcome for 82.1% and a higher than expected results for 40.7% of them. Regarding the myths, 52.5% believed that epidural analgesia imposes a dose limit and 58.9% that it often causes permanent back pain. The level of education was significantly associated with some myths (p < 0.05), since women with a higher level of education do not believe most of them. DISCUSSION: This study supports the need for an evaluation of the current information that women have about labor epidural analgesia/childbirth. Women's individual needs can be met by multidisciplinary teams including Anesthesiology specialists. CONCLUSION: Maternal satisfaction with childbirth and analgesia is a complex and dynamic process that includes and is not limited to the relief of pain.


Introdução: As opiniões, expectativas e experiências das mulheres que utilizam os serviços de saúde têm vindo a alcançar crescente importância. O cumprimento das expectativas é determinado pela satisfação. Este estudo tem como objetivo analisar as expectativas e satisfação das mulheres durante o trabalho de parto em relação à analgesia epidural, com foco principal nos mitos. Material e Métodos: Foi realizado um estudo observacional e prospetivo em grávidas do Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital, em Lisboa, Portugal, através da aplicação aleatória de um questionário a 317 mulheres. Foi utilizado o programa SPSS v.22 para análise estatística. Resultados: Foram obtidos 300 questionários, provenientes de mulheres com idade média de 31 anos. Entre as grávidas que responderam ao questionário, 46,3% possuíam diploma universitário e 64% estavam empregadas. Apenas 14% tiveram consulta prévia de Anestesiologia. O grau de satisfação em torno da experiência do parto foi bom/excelente para 87% das mulheres. A analgesia epidural foi realizada em 96% das grávidas, tendo 82,1% considerado a analgesia excelente e 40,7% avaliado como superior ao esperado. Em relação aos mitos, 52,5% acreditam que a técnica epidural apresenta uma dose limite e 58,9% consideram que a técnica acarreta dor permanente nas costas. O nível de escolaridade mostrou-se significativamente associado a alguns mitos (p < 0,05), uma vez que as mulheres com maior grau de escolaridade não acreditam na maioria destes. Discussão: Este estudo demonstra a necessidade da avaliação da informação que as mulheres possuem sobre a analgesia do trabalho de parto. As necessidades individuais devem ser geridas por equipas multidisciplinares que incluamanestesiologistas. Conclusão: A satisfação materna com o parto e respetiva analgesia é um processo complexo e dinâmico, que inclui e não se limita ao alívio da dor.


Assuntos
Analgesia Epidural/efeitos adversos , Dor do Parto/psicologia , Trabalho de Parto , Parto/psicologia , Satisfação do Paciente , Adulto , Analgesia Obstétrica , Estudos Transversais , Feminino , Humanos , Trabalho de Parto/psicologia , Pessoa de Meia-Idade , Motivação , Satisfação Pessoal , Portugal , Gravidez , Estudos Prospectivos , Centros de Atenção Terciária
16.
BMC Pregnancy Childbirth ; 21(1): 481, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215199

RESUMO

BACKGROUND: The Lederman Prenatal Self-Evaluation Questionnaire (PSEQ) is used to assess psychosocial adaptation to pregnancy, labor, childbirth, and maternity. The PSEQ is a tool used in various countries and has been translated into Portuguese; however, it needs to be validated in Brazil. This study aimed to analyze the validity and reliability of the PSEQ in Brazilian pregnant women. METHOD: This methodological validity study investigated internal consistency and reliability using Cronbach's alpha and intraclass correlation coefficients. Construct validity was assessed using Pearson's correlation between domains and confirmatory factor analysis. To assess concurrent validity, Pearson's correlation between the different domains of the PSEQ and Prenatal Psychosocial Profile-Portuguese Version (PPP-VP) was determined. The level of significance was set at 5%. RESULTS: This study included 399 pregnant women in the northeastern region of Brazil. The internal consistency and reliability of the total PSEQ score were high (Cronbach's alpha = 0.89; intraclass correlation coefficient = 0.95). Validity analysis showed positive and significant correlations between all PSEQ domains, ranging from 0.14 to 0.56. Confirmatory factor analysis demonstrated the following values of goodness of fit: RMSEA = 0.05, SRMR = 0.08, CFI = 0.61, χ2/df = 1.77. The discriminant and concurrent validities of the PSEQ were confirmed. CONCLUSIONS: The Portuguese version of the PSEQ has adequate psychometric properties and is a valid and reliable tool to evaluate psychosocial adaptation to pregnancy in Brazilian pregnant women.


Assuntos
Adaptação Psicológica , Gravidez/psicologia , Psicometria/instrumentação , Inquéritos e Questionários , Adolescente , Adulto , Brasil , Análise Fatorial , Feminino , Humanos , Trabalho de Parto/psicologia , Parto/psicologia , Reprodutibilidade dos Testes , Adulto Jovem
17.
PLoS One ; 16(5): e0251072, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33951101

RESUMO

BACKGROUND: Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women's preferences for mode of birth and factors underlying preferences for CS. METHODS: Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. RESULTS: We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women's partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). CONCLUSIONS: A wide variety of factors underlie women's preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.


Assuntos
Cesárea/psicologia , Preferência do Paciente/psicologia , Gestantes/psicologia , China , Gerenciamento de Dados/métodos , Família/psicologia , Feminino , Humanos , Trabalho de Parto/psicologia , Parto/psicologia , Período Pós-Parto/psicologia , Gravidez , Pesquisa Qualitativa , Taiwan
18.
Online braz. j. nurs. (Online) ; 20: e20216483, 05 maio 2021.
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1223160

RESUMO

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


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


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


Assuntos
Humanos , Feminino , Gravidez , Trabalho de Parto/psicologia , Parto/psicologia , Gestantes/psicologia , Emoções , Interacionismo Simbólico , Saúde da Mulher , Pesquisa Qualitativa , Período Pós-Parto
19.
Holist Nurs Pract ; 35(3): 140-149, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33853098

RESUMO

This study conducted on 66 mothers aimed to investigate the effect of foot massages postpartum using an introductory information form, the Postpartum Comfort Scale, the visual analog scale, and a drug follow-up card. It was concluded that foot massages positively improved comfort, reduced pain levels, and reduced unnecessary medications.


Assuntos
Trabalho de Parto/psicologia , Massagem/normas , Manejo da Dor/normas , Período Pós-Parto , Adulto , Feminino , Humanos , Massagem/métodos , Massagem/psicologia , Mães/psicologia , Manejo da Dor/métodos , Manejo da Dor/psicologia , Medição da Dor/métodos , Medição da Dor/estatística & dados numéricos , Gravidez
20.
PLoS One ; 16(4): e0248740, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33861756

RESUMO

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women's experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women's needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.


Assuntos
Prática Clínica Baseada em Evidências/tendências , Parto/psicologia , Cuidado Pré-Natal/métodos , Adulto , Brasil/etnologia , Parto Obstétrico/tendências , Intervenção Médica Precoce/métodos , Intervenção Médica Precoce/tendências , Feminino , Educação em Saúde/tendências , Humanos , Trabalho de Parto/psicologia , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Tocologia/tendências , Gravidez , Gestantes/psicologia , Cuidado Pré-Natal/tendências , Relações Profissional-Paciente , Inquéritos e Questionários
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