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1.
Recurso educacional aberto em Espanhol | CVSP - Argentina | ID: oer-4080

RESUMO

La Diplomatura en Equidad de Género en Salud es una propuesta pedagógica que pretende generar un espacio de reflexión de las prácticas en salud desde una perspectiva feminista, transfeminista e interseccional. Está destinada a trabajadorxs de salud, docentes, activistas y referentes de la comunidad. La iniciativa -que surgió desde la Dirección de Equidad de Género en Salud y la Escuela de Gobierno en Salud Floreal Ferrara, ambos espacios del Ministerio de Salud bonaerense; y la Universidad Nacional de La Plata- promueve una activa participación de les estudiantes, en el marco de una pedagogía rondera y reflexiva.


Assuntos
Assistência Perinatal , Entorno do Parto , Gravidez
2.
Recurso educacional aberto em Espanhol | CVSP - Argentina | ID: oer-4082

RESUMO

La Diplomatura en Equidad de Género en Salud es una propuesta pedagógica que pretende generar un espacio de reflexión de las prácticas en salud desde una perspectiva feminista, transfeminista e interseccional. Está destinada a trabajadorxs de salud, docentes, activistas y referentes de la comunidad. La iniciativa -que surgió desde la Dirección de Equidad de Género en Salud y la Escuela de Gobierno en Salud Floreal Ferrara, ambos espacios del Ministerio de Salud bonaerense; y la Universidad Nacional de La Plata- promueve una activa participación de les estudiantes, en el marco de una pedagogía rondera y reflexiva


Assuntos
Poder Familiar , Entorno do Parto , Parto
3.
Birth ; 49(3): 403-419, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35441421

RESUMO

BACKGROUND: The United States has the highest perinatal morbidity and mortality (M&M) rates among all high-resource countries in the world. Birth settings (birth center, home, or hospital) influence clinical outcomes, experience of care, and health care costs. Increasing use of low-intervention birth settings can reduce perinatal M&M. This integrative review evaluated factors influencing birth setting decision making among women and birthing people in the United States. METHODS: A search strategy was implemented within the CINAHL, PubMed, PsycInfo, and Web of Science databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided the review, and the Johns Hopkins Nursing Evidence-Based Practice model was used to evaluate methodological quality and appraisal of the evidence. The Whittemore and Knafl integrative review framework informed the extraction and analysis of the data and generation of findings. RESULTS: We identified 23 articles that met inclusion criteria. Four analytical themes were generated that described factors that influence birth setting decision making in the United States: "Birth Setting Safety vs. Risk," "Influence of Media, Family, and Friends on Birth Setting Awareness," "Presence or Absence of Choice and Control," and "Access to Options." DISCUSSION: Supporting women and birthing people to make informed decisions by providing information about birth setting options and variations in models of care by birth setting is a critical patient-centered strategy to ensure equitable access to low-intervention birth settings. Policies that expand affordable health insurance to cover midwifery care in all birth settings are needed to enable people to make informed choices about birth location that align with their values, individual pregnancy characteristics, and preferences.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Tocologia , Morte Perinatal , Entorno do Parto , Tomada de Decisões , Feminino , Humanos , Recém-Nascido , Parto , Gravidez , Estados Unidos
4.
BMC Pregnancy Childbirth ; 22(1): 43, 2022 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-35038990

RESUMO

BACKGROUND: Available research on the contribution of traditional midwifery to safe motherhood focuses on retraining and redefining traditional midwives, assuming cultural prominence of Western ways. Our objective was to test if supporting traditional midwives on their own terms increases cultural safety (respect of Indigenous traditions) without worsening maternal health outcomes. METHODS: Pragmatic parallel-group cluster-randomised controlled non-inferiority trial in four municipalities in Guerrero State, southern Mexico, with Nahua, Na savi, Me'phaa and Nancue ñomndaa Indigenous groups. The study included all pregnant women in 80 communities and 30 traditional midwives in 40 intervention communities. Between July 2015 and April 2017, traditional midwives and their apprentices received a monthly stipend and support from a trained intercultural broker, and local official health personnel attended a workshop for improving attitudes towards traditional midwifery. Forty communities in two control municipalities continued with usual health services. Trained Indigenous female interviewers administered a baseline and follow-up household survey, interviewing all women who reported pregnancy or childbirth in all involved municipalities since January 2016. Primary outcomes included childbirth and neonatal complications, perinatal deaths, and postnatal complications, and secondary outcomes were traditional childbirth (at home, in vertical position, with traditional midwife and family), access and experience in Western healthcare, food intake, reduction of heavy work, and cost of health care. RESULTS: Among 872 completed pregnancies, women in intervention communities had lower rates of primary outcomes (perinatal deaths or childbirth or neonatal complications) (RD -0.06 95%CI - 0.09 to - 0.02) and reported more traditional childbirths (RD 0.10 95%CI 0.02 to 0.18). Among institutional childbirths, women from intervention communities reported more traditional management of placenta (RD 0.34 95%CI 0.21 to 0.48) but also more non-traditional cold-water baths (RD 0.10 95%CI 0.02 to 0.19). Among home-based childbirths, women from intervention communities had fewer postpartum complications (RD -0.12 95%CI - 0.27 to 0.01). CONCLUSIONS: Supporting traditional midwifery increased culturally safe childbirth without worsening health outcomes. The fixed population size restricted our confidence for inference of non-inferiority for mortality outcomes. Traditional midwifery could contribute to safer birth among Indigenous communities if, instead of attempting to replace traditional practices, health authorities promoted intercultural dialogue. TRIAL REGISTRATION: Retrospectively registered ISRCTN12397283 . Trial status: concluded.


In many Indigenous communities, traditional midwives support mothers during pregnancy, childbirth, and some days afterwards. Research involving traditional midwives has focused on training them in Western techniques and redefining their role to support Western care. In Guerrero state, Mexico, Indigenous mothers continue to trust traditional midwives. Almost half of these mothers still prefer traditional childbirths, at home, in the company of their families and following traditional practices. We worked with 30 traditional midwives to see if supporting their practice allowed traditional childbirth without worsening mothers' health. Each traditional midwife received an inexpensive stipend, a scholarship for an apprentice and support from an intercultural broker. The official health personnel participated in a workshop to improve their attitudes towards traditional midwives. We compared 40 communities in two municipalities that received support for traditional midwifery with 40 communities in two municipalities that continued to receive usual services. We interviewed 872 women with childbirth between 2016 and 2017. Mothers in intervention communities suffered fewer complications during childbirth and had fewer complications or deaths of their babies. They had more traditional childbirths and fewer perineal tears or infections across home-based childbirths. Among those who went to Western care, mothers in intervention communities had more traditional management of the placenta but more non-traditional cold-water baths. Supporting traditional midwifery increased traditional childbirth without worsening health outcomes. The small size of participating populations limited our confidence about the size of this difference. Health authorities could promote better health outcomes if they worked with traditional midwives instead of replacing them.


Assuntos
Entorno do Parto , Assistência à Saúde Culturalmente Competente , Povos Indígenas , Tocologia , Parto/etnologia , Complicações na Gravidez/epidemiologia , Adulto , Análise por Conglomerados , Feminino , Instalações de Saúde , Parto Domiciliar , Humanos , Saúde Materna/etnologia , México/etnologia , Segurança do Paciente , Gravidez , Inquéritos e Questionários
5.
Metas enferm ; 24(10): 65-71, DICIEMBRE 21/ENERO 22. tab
Artigo em Espanhol | IBECS | ID: ibc-206120

RESUMO

Objetivo: evaluar la efectividad de una intervención de educación maternal en medio acuático guiado por matronas en mujeres gestantes en seguimiento en Atención Primaria.Método: estudio cuasi-experimental, longitudinal y prospectivo. Participarán las mujeres gestantes pertenecientes a los centros de salud adscritos al programa de educación maternal que hayan realizado el seguimiento completo del embarazo en los centros de salud ubicados en el distrito de Usera (Madrid), y cuyo parto haya tenido lugar en el hospital de referencia. El programa de educación maternal consta de seis sesiones de 50 minutos de duración, que incluye ejercicios acuáticos dirigidos por las matronas del centro de salud. La variable principal será el porcentaje de partos eutócicos. Entre las variables secundarias se analizará el control del dolor y el traumatismo perineal. Se llevará a cabo análisis descriptivo. Para la comparación entre grupos se usarán los test estadísticos adecuados al tipo de variables.Conclusión: con la implementación del programa se pretende disminuir la tasa de cesáreas.(AU)


Objective: to evaluate the effectiveness of a maternal education intervention in an aquatic environment and guided by midwives for pregnant women under follow-up by Primary Care.Method: a quasi-experimental, longitudinal and prospective study, which will include pregnant women from the Primary Care centres affiliated with the Maternal Education Program, who have received complete follow-up for their pregnancy in the health centres at the Usera district (Madrid), and with delivery taking place in their hospital of reference. The Maternal Education program consists of six 50-minute sessions, and includes aquatic exercises guided by the Primary Care centre midwives. The primary endpoint will be the proportion of normal deliveries. The secondary endpoints will include the analysis of pain management and perineal trauma. Descriptive analysis will be conducted. The statistical tests adequate for this type of endpoints will be used for comparison between arms.Conclusion: the implementation of the program intends to reduce the rate of Caesarean deliveries.(AU)


Assuntos
Humanos , Feminino , Parto Humanizado , Parto , Entorno do Parto , Parto Normal , Gestantes , Enfermeiras Obstétricas , Gravidez , Exercício Físico , Atenção Primária à Saúde , Enfermagem Materno-Infantil , Estudos Prospectivos
7.
Am J Gastroenterol ; 117(2): 280-287, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34908535

RESUMO

INTRODUCTION: Several US subgroups have increased risk of gastric cancer and gastric intestinal metaplasia (GIM) and may benefit from targeted screening. We evaluated demographic and clinical risk factors for GIM and examined the interaction between race/ethnicity and birthplace on GIM risk. METHODS: We identified patients who had undergone esophagogastroduodenoscopy with gastric biopsy from 3/2006-11/2016 using the pathology database at a safety net hospital in Houston, Texas. Cases had GIM on ≥1 gastric biopsy histopathology, whereas controls lacked GIM on any biopsy. We estimated odds ratios and 95% confidence intervals (CI) for associations with GIM risk using logistic regression and developed a risk prediction model of GIM risk. We additionally examined for associations using a composite variable combining race/ethnicity and birthplace. RESULTS: Among 267 cases with GIM and 1,842 controls, older age (vs <40 years: 40-60 years adjusted odds ratios (adjORs) 2.02; 95% CI 1.17-3.29; >60 years adjOR 4.58; 95% CI 2.61-8.03), Black race (vs non-Hispanic White: adjOR 2.17; 95% CI 1.31-3.62), Asian race (adjOR 2.83; 95% CI 1.27-6.29), and current smoking status (adjOR 2.04; 95% CI 1.39-3.00) were independently associated with increased GIM risk. Although non-US-born Hispanics had higher risk of GIM (vs non-Hispanic White: adjOR 2.10; 95% CI 1.28-3.45), we found no elevated risk for US-born Hispanics (adjOR 1.13; 95% CI 0.57-2.23). The risk prediction model had area under the receiver operating characteristic of 0.673 (95% CI 0.636-0.710) for discriminating GIM. DISCUSSION: We found that Hispanics born outside the United States were at increased risk of GIM, whereas Hispanics born in the United States were not, independent of Helicobacter pylori infection. Birthplace may be more informative than race/ethnicity when determining GIM risk among US populations.


Assuntos
Entorno do Parto/estatística & dados numéricos , Etnicidade , Vigilância da População , Lesões Pré-Cancerosas , Grupos Raciais , Neoplasias Gástricas/etnologia , Estômago/patologia , Adulto , Biópsia , Estudos Transversais , Humanos , Incidência , Metaplasia/etnologia , Metaplasia/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Estômago/microbiologia , Neoplasias Gástricas/diagnóstico , Texas/epidemiologia
8.
J Obstet Gynecol Neonatal Nurs ; 51(2): 141-152, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34914926

RESUMO

OBJECTIVE: To use a scoping review to explore the existing literature on best practice guidelines for safe, dignified, and compassionate care in the labor and birth setting for pregnant women who use methamphetamines. DATA SOURCES: We conducted a systematic search for articles and best practice guidelines from health-related databases (MEDLINE; CINAHL; and the Web of Science, including the Core Collection and Social Science Citation Index, PsycInfo, Women's Studies International, and Sociological Abstracts) and gray literature. Search terms included substance use disorder, methamphetamine, childbirth, and labor and delivery. STUDY SELECTION: We included English-language, peer-reviewed reports of primary research, systematic reviews, and practice guidelines from credible databases and organizations published between 1991 and 2020. We screened 1,297 resources and agreed to review 156 articles and 16 gray literature resources in the full-text analysis. Nine of the 156 articles and 16 gray literature resources met the inclusion criteria. DATA EXTRACTION: We used the Joanna Briggs Institute review guidelines (2015) criteria for extraction of the following data: author(s); year of publication; type of study; objectives; country of origin; study population and sample size (if applicable); inclusion of best practice guidelines for the labor and birth setting; care approaches specific to safety, dignity, compassion; and the targeted substance(s) discussed (e.g., methamphetamine, opioids, etc.). We further documented the phenomena of interest to determine if articles or best practice guidelines included safe, dignified, and compassionate care approaches specific to pregnant women who use methamphetamine. DATA SYNTHESIS: We summarized the best practice guidelines, which included universal screening, assessment, and management of analgesia during labor, as well as broad guidance regarding the inclusion of a multidisciplinary health care team. Safe, dignified, and compassionate care approaches were focused on communication, shared decision making, and the provision of nonjudgmental care. Although evidence about substance use during the childbearing years is increasing, stronger evidence for clinical care approaches in the labor and birth setting is needed, inclusive of all stakeholder perspectives. CONCLUSION: The articles and best practice guidelines reviewed provided broad clinical recommendations that were applicable to pregnant women who use methamphetamine. However, we did not find a complete comprehensive best practice guideline for labor and birth that was specific, was solution focused, and delineated a safe, dignified, and compassionate care approach.


Assuntos
Trabalho de Parto , Metanfetamina , Entorno do Parto , Feminino , Humanos , Metanfetamina/efeitos adversos , Parto , Guias de Prática Clínica como Assunto , Gravidez , Gestantes
9.
Ciênc. rural (Online) ; 52(2): e20210081, 2022. tab, graf, ilus
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1339657

RESUMO

Gilts represent a group risk for Mycoplasma hyopneumoniae vertical transmission in swine herds. Therefore, parity segregation can be an alternative to control M. hyopneumoniae infections. The study evaluated the effect of parity segregation on M. hyopneumoniae infection dynamics and occurrence and severity of lung lesions at slaughter. For that, three multiple site herds were included in the study. Herd A consisted of the farm where gilts would have their first farrowing (parity order (PO) 1). After the first farrowing PO 1 sows were transferred to herd B (PO2-6). Herd C was a conventional herd with gilt replacement (PO1-6). Piglets born in each herd were raised in separated nursery and finishing units. Sows (n = 33 (A), 37 (B), 34 (C)) in all herds were sampled prior to farrowing and piglets (n = 54 (A), 71 (B), 66 (C)) were sampled longitudinally at 21, 63, 100, 140 days of age and at slaughter for M. hyopneumoniae detection by PCR and lung lesions scoring. M. hyopneumoniae prevalence in sows did not differ among herds. Prevalence of positive piglets was higher at weaning in the PO1 herd (A) (P < 0.05). However, prevalence of positive pigs from 100 days of age to slaughter age was higher in the PO2-6 herd (B) (P < 0.05). Lung lesion occurrence and severity were higher in herd B. The authors suggested that the lack of a proper gilt acclimation might have influenced the results, leading to sows being detected positive at farrowing, regardless of the parity.


As leitoas consistem em um grupo de risco na transmissão vertical de Mycoplasma hyopneumoniae dentro do sistema de produção de suínos. Dessa forma, a segregação de partos poderia ser utilizada como alternativa para controlar as infecções por M. hyopneumoniae. O objetivo deste estudo foi avaliar o efeito da segregação de partos sobre a dinâmica de infecção de M. hyopneumoniae e a ocorrência e severidade das lesões pulmonares ao abate. Para isso três sistemas de produção de suínos com três sítios cada foram incluídos no estudo. A granja A consistia da unidade onde as leitoas tem o primeiro parto, ou seja, alojava somente de fêmeas de ordem de parto 1 (Granja OP1). Após o primeiro parto as fêmeas OP1 foram transferidas para a granja B (Granja OP2-6), ou seja, consistia de fêmeas de ordem de parto 2 a 6, e a granja C consistiu em uma granja convencional com reposição de leitoas (Granja OP1-6), com fêmeas de ordem de parto 1 a 6. Os leitões nascidos de cada granja foram transferidos e criados em creches e terminações segregadas. As matrizes (n = 33 (A), 37 (B), 34 (C)) de todas as granjas do estudo foram amostradas previamente ao parto e os leitões (n = 54 (A), 71 (B), 66 (C)) foram amostrados longitudinalmente aos 21, 63, 100 e 140 dias de idade e ao abate. Em todos os momentos de coleta, as amostras foram avaliadas por PCR para detecção de M. hyopneumoniae. As lesões pulmonares foram avaliadas e escores de lesão foram atribuídos ao abate. A prevalência de matrizes positivas para M. hyopneumoniae não diferiu entre as granjas (P > 0,05). A prevalência ao desmame foi maior na granja A (OP1) (P < 0,05). No entanto, dos 100 dias de idade até o abate a prevalência de leitões positivos para M. hyopneumoniae foi maior na granja B (OP2-6) (P < 0,05). A ocorrência e severidade de lesões pulmonares foram maiores na granja B. Os autores sugerem que a falta de uma aclimatação adequada das leitoas pode ter influenciado nos resultados, levando à detecção de matrizes positivas ao parto, independente da ordem de parto.


Assuntos
Animais , Feminino , Gravidez , Suínos/lesões , Suínos/microbiologia , Mycoplasma hyopneumoniae/isolamento & purificação , Pneumonia Suína Micoplasmática/prevenção & controle , Reação em Cadeia da Polimerase/veterinária , Transmissão Vertical de Doenças Infecciosas/veterinária , Entorno do Parto
10.
BMC Pregnancy Childbirth ; 21(1): 836, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930167

RESUMO

BACKGROUND AND OBJECTIVES: The aim of the study was to use the United States Optimality Index (OI-US) to assess the feasibility of its application in making decisions for more optimal methods of delivery and for more optimal postpartum and neonatal outcomes. Numerous worldwide associations support the option of women giving birth at maternity outpatient clinics and also at home. What ought to be met is the assessments of requirements and what could be characterized as the birth potential constitute the basis for making the right decision regarding childbirth. MATERIALS AND METHODS: The study is based on a prospective follow-up of pregnant women and new mothers (100 participants) who were monitored and gave birth at the hospital maternity ward (HMW) and pregnant women and new mothers (100 participants) who were monitored and gave birth at the outhospital maternity clinics (OMC). Selected patients were classified according to the criteria of low and medium-risk and each of the parameters of the OI and the total OI were compared. RESULTS: The results of this study confirm the benefits of intrapartum and neonatal outcome, when delivery was carried out in an outpatient setting. The median OI of intrapartum components was significantly higher in the outpatient setting compared to the hospital maternity ward (97 range from 24 to 100 vs 91 range from 3 to 100). The median OI of neonatal components was significantly higher in the outpatient compared to the inpatient delivery. (99 range from 97 to 100 vs 96 range from 74 to 100). Certain components from the intrapartum and neonatal period highly contribute to the significantly better total OI in the outpatient conditions in relation to hospital conditions. CONCLUSION: Outpatient care and delivery provide multiple benefits for both the mother and the newborn.


Assuntos
Instituições de Assistência Ambulatorial , Entorno do Parto/estatística & dados numéricos , Maternidades , Adulto , Parto Obstétrico/estatística & dados numéricos , Feminino , Indicadores Básicos de Saúde , Humanos , Montenegro/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente , Gravidez , Estudos Prospectivos
11.
PLoS One ; 16(10): e0259417, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34714872

RESUMO

BACKGROUND: One of the factors contributing to a high maternal mortality rate is the utilization of non-healthcare facilities as a birthplace for women. This study analyzed determinants affecting birthplace in middle-to lower-class women in Indonesia. METHODS: This study analyzed the 2017 Indonesian Demographic and Health Survey (IDHS) data. The total national sample size was 49,627 eligible women. Our sample included 11,104 women, aged 15-49, who had delivered babies and were of low-to-middle economic status. The type of survey dataset was individual record dataset. Data were analyzed with chi-square and multivariate logistic regression tests using Stata 16 software. RESULTS: About 64.99% middle to lower class women in Indonesia delivered in healthcare facilities. Women aged 45-49 (OR = 2.103; 95% CI = 1.13-3.93), who graduated from higher schools (OR = 2.885; 95% CI = 1.76-4.73), whose husbands had higher education (OR = 2.826; 95% CI = 1.69-4.74) and were employed (OR = 2.523; 95% CI = 1.23-5.17), who considered access to healthcare facilities was not a problem (OR = 1.528; 95% CI = 1.28-1.82), who had a single child (OR = 2.349; 95% CI = 1.97-2.80), and who lived in urban areas (OR = 2.930; 95% CI = 2.40-3.57) were determinants that significantly correlated with women giving birth in healthcare facilities. CONCLUSION: This study provides insights for policymakers and healthcare centers in the community to strengthen access to healthcare services and devise health promotion strategies for pregnant mothers. Policy interventions designed for middle- to lower-class women should be implemented to support vulnerable groups.


Assuntos
Atitude , Entorno do Parto/estatística & dados numéricos , Adolescente , Adulto , Status Econômico/estatística & dados numéricos , Escolaridade , Características da Família , Feminino , Maternidades/estatística & dados numéricos , Humanos , Indonésia , Pessoa de Meia-Idade
13.
BMC Cardiovasc Disord ; 21(1): 515, 2021 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-34689737

RESUMO

BACKGROUND: Pacific people experience a disproportionate burden of cardiovascular disease (CVD), whether they remain in their country of origin or migrate to higher-income countries, such as Australia, Aotearoa New Zealand or the United States of America. We sought to determine whether the CVD health needs of Pacific people vary according to their ethnicity or place of birth. METHODS: We conducted a systematic review of medical research databases and grey literature to identify relevant data published up to 2020. Texts were included if they contained original data stratified by Pacific-specific ethnicity or place of birth on the burden or management of CVD, and were assessed as having good quality using a National Heart, Lung, and Blood Institute quality assessment tool. The protocol for this review was registered with the Open Science Forum ( https://doi.org/10.17605/OSF.IO/X7NR6 ). RESULTS: Of 3679 texts identified, 310 full texts were reviewed and the quality of 23 of these assessed, using the pre-defined search strategy. Six items (four reports, one article, one webpage) of good quality met the review eligibility criteria. All included texts provided data on epidemiology but only one reported on the management of CVD. Four texts were of Pacific populations in Pacific Island countries and two were of Pacific diaspora in other countries. Data from the Global Burden of Disease study, which provided estimates for the greatest number of Pacific countries, showed substantial differences in mortality rates between Pacific countries for every CVD type. For example, the mortality rate per 100,000 for ischemic heart disease (IHD) ranged from 103.41 in the Cook Islands to 430.35 in the Solomon Islands. A New Zealand-based report showed differences in CVD rates by Pacific ethnicity (e.g. the age-standardised prevalence of IHD per 1,000 population in Auckland ranged from 107.8 (Niuean) to 138 among Cook Islands Maori (p < 0.001)). CONCLUSIONS: This review of published studies reveals that the epidemiology of CVD among Pacific people varies by specific ethnic groups, place of birth, and country of residence. There is a critical need for high-quality contemporary ethnic-specific Pacific data to respond to the diverse CVD health needs in these underrepresented groups.


Assuntos
Doenças Cardiovasculares/etnologia , Entorno do Parto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Humanos
14.
BMC Pregnancy Childbirth ; 21(1): 664, 2021 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-34592953

RESUMO

BACKGROUND: The outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted ('freebirth') due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth. METHODS: We conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020. RESULTS: The response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners' attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41). CONCLUSION: Danish pregnant womens' concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.


Assuntos
Ansiedade/psicologia , Entorno do Parto , COVID-19/psicologia , Serviços de Saúde Materna , Parto/psicologia , Gestantes/psicologia , Adulto , COVID-19/transmissão , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Tocologia , Gravidez , SARS-CoV-2 , Cônjuges , Inquéritos e Questionários
15.
Femina ; 49(9): 556-571, 20211030. tab
Artigo em Português | LILACS | ID: biblio-1342326

RESUMO

Objetivo: Determinar a correlação entre vias de parto, locais de parto e prognóstico neonatal por meio do índice de Apgar e a capacidade de diagnosticar malforma- ções. Métodos: A pesquisa foi realizada no Sistema de Informação de Nascidos Vivos para variáveis de parto e malformações. Também correlacionamos o Apgar com ou sem malformação fetal e local do parto. Resultados: Houve uma quantidade considerável de dados de Apgar indefinidos, especialmente em partos domiciliares. Os partos domiciliares com malformações fetais com Apgar 0-2 e 3-5 no primeiro minuto também apresentaram piores taxas de recuperação no quinto minuto em comparação a cesárea e parto vaginal intra-hospitalar. O registro do diagnóstico das malformações fetais ocorre em ambiente hospitalar e é mais frequente do que no domiciliar. Recém-nascidos com malformações fetais apresentaram maiores taxas de Apgar ao nascer em ambiente hospitalar. As anomalias associadas aos piores prognósticos foram neurológicas e cardiológicas, enquanto as menos associadas foram as de pés e quadris. Conclusão: Esta pesquisa sugere que a cesárea e o parto hospitalar estão correlacionados a um melhor prognóstico do recém-nascido com malformação, bem como a capacidade de diagnosticar doenças congênitas que potencialmente requerem intervenção médica imediata.(AU)


Objective: To determine the correlation between delivery routes, delivery sites and neonatal prognosis through Apgar score and the ability to diagnose malformations. Methods: Research was carried out in the Live Birth Information System for delivery variables and malformations. We also correlated Apgar with or without fetal malformation and delivery site. Results: There was a considerable amount of undefined Apgar data, especially in home births. Home births with fetal malformations with Apgar 0-2 and 3-5 in the first minute also showed worse recovery rates in the fifth minute compared to cesarean section and intra-hospital vaginal delivery. Registration of the diagnosis of fetal malformations occurs in a hospital environment and is more frequent than at home. Newborns with fetal malformations had higher Apgar rates when born in a hospital environment. The abnormalities associated with the worst prognoses were neurological and cardiological, while the least associated were those of the feet and hips. Conclusion: This research suggests that caesarean section and hospital births are correlated with a better prognosis of the newborn with malformation, as well as ability to diagnose congenital diseases that potentially require immediate medical intervention.(AU)


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Índice de Apgar , Anormalidades Congênitas/diagnóstico , Anormalidades Congênitas/epidemiologia , Parto , Prognóstico , Cesárea , Entorno do Parto , Parto Domiciliar , Parto Normal
16.
BMC Health Serv Res ; 21(1): 816, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34391422

RESUMO

BACKGROUND: In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. OBJECTIVES: The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. METHODS: This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. FINDINGS: 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. CONCLUSION: The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Austrália/epidemiologia , Entorno do Parto , Feminino , Humanos , Recém-Nascido , Parto , Gravidez
17.
BMC Pregnancy Childbirth ; 21(1): 477, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215218

RESUMO

BACKGROUND: During public health emergencies, including the COVID-19 pandemic, access to adequate healthcare is crucial for providing for the health and wellbeing of families. Pregnant and postpartum people are a particularly vulnerable subgroup to consider when studying healthcare access. Not only are perinatal people likely at higher risk for illness, mortality, and morbidity from COVID-19 infection, they are also at higher risk for negative outcomes due to delayed or inadequate access to routine care. METHODS: We surveyed 820 pregnant people in California over two waves of the COVID-19 pandemic: (1) a 'non-surge' wave (June 2020, n = 433), and (2) during a 'surge' in cases (December 2020, n = 387) to describe current access to perinatal healthcare, as well as concerns and decision-making regarding childbirth, over time. We also examined whether existing structural vulnerabilities - including acute financial insecurity and racial/ethnic minoritization - are associated with access, concerns, and decision-making over these two waves. RESULTS: Pregnant Californians generally enjoyed more access to, and fewer concerns about, perinatal healthcare during the winter of 2020-2021, despite surging COVID-19 cases and hospitalizations, as compared to those surveyed during the COVID-19 'lull' in the summer of 2020. However, across 'surge' and 'non-surge' pandemic circumstances, marginalized pregnant people continued to fare worse - especially those facing acute financial difficulty, and racially minoritized individuals identifying as Black or Indigenous. CONCLUSIONS: It is important for clinicians, researchers, and policymakers to understand whether and how shifting community transmission and infection rates may impact access to perinatal healthcare. Targeting minoritized and financially insecure communities for increased upstream perinatal healthcare supports are promising avenues to blunt the negative impacts of the COVID-19 pandemic on pregnant people in California.


Assuntos
COVID-19 , Tomada de Decisões , Status Econômico , Acesso aos Serviços de Saúde , Assistência Perinatal , Adolescente , Adulto , Entorno do Parto , COVID-19/epidemiologia , California/epidemiologia , Feminino , Humanos , Grupos Minoritários , Parto , Gravidez , Cuidado Pré-Natal , SARS-CoV-2 , Inquéritos e Questionários , Adulto Jovem
19.
Am Fam Physician ; 103(11): 672-679, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34060788

RESUMO

Since the 1970s, most births in the United States have been planned to occur in a hospital. However, a small percentage of Americans choose to give birth outside of a hospital. The number of out-of-hospital births has increased, with one in every 61 U.S. births (1.64%) occurring out of the hospital in 2018. Out-of-hospital (or community) birth can be planned or unplanned. Of those that are planned, most occur at home and are assisted by midwives. Patients who choose a planned community birth do so for multiple reasons. International observational studies that demonstrate comparable outcomes between planned out-of-hospital and planned hospital birth may not be generalizable to the United States. Most U.S. studies have found statistically significant increases in perinatal mortality and neonatal morbidity for home birth compared with hospital birth. Conversely, planned community birth is associated with decreased odds of obstetric interventions, including cesarean delivery. Perinatal outcomes for community birth may be improved with appropriate selection of low-risk, vertex, singleton, term pregnancies in patients who have not had a previous cesarean delivery. A qualified, licensed maternal and newborn health professional who is integrated into a maternity health care system should attend all planned community births. Family physicians are uniquely poised to provide counseling to patients and their families about the risks and benefits associated with community birth, and they may be the first physicians to evaluate and treat newborns delivered outside of a hospital.


Assuntos
Entorno do Parto , Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Entorno do Parto/tendências , Centros de Assistência à Gravidez e ao Parto/normas , Centros de Assistência à Gravidez e ao Parto/tendências , Feminino , Parto Domiciliar/efeitos adversos , Parto Domiciliar/métodos , Parto Domiciliar/tendências , Humanos , Recém-Nascido , Tocologia/normas , Tocologia/tendências , Participação do Paciente , Segurança do Paciente , Seleção de Pacientes , Assistência Perinatal/métodos , Assistência Perinatal/normas , Guias de Prática Clínica como Assunto , Gravidez , Medição de Risco , Estados Unidos
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