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Mirzania M, Shakibazadeh E, Hantoushzadeh S, Panahi Z, Bohren MA, Khajavi A. An investigation into the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companionship in Tehran: a qualitative inquiry on mitigating mistreatment of women during childbirth. BMC Public Health 2024; 24:1292. [PMID: 38741128 DOI: 10.1186/s12889-024-18751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A birth companion is a powerful mechanism for preventing mistreatment during childbirth and is a key component of respectful maternity care (RMC). Despite a growing body of evidence supporting the benefits of birth companions in enhancing the quality of care and birth experience, the successful implementation of this practice continues to be a challenge, particularly in developing countries. Our aim was to investigate the acceptability, adoption, appropriateness, feasibility, and fidelity of implementation strategies for birth companions to mitigate the mistreatment of women during childbirth in Tehran. METHODS This exploratory descriptive qualitative study was conducted between April and August 2023 at Valiasr Hospital in Tehran, Iran. Fifty-two face-to-face in-depth interviews were conducted with a purposive sample of women, birth companions, and maternity healthcare providers. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis, with a deductive approach based on the Implementation Outcomes Framework in the MAXQDA 18. RESULTS Participants found the implemented program to be acceptable and beneficial, however the implementation team noticed that some healthcare providers were initially reluctant to support it and perceived it as an additional burden. However, its adoption has increased over time. Healthcare providers felt that the program was appropriate and feasible, and it improved satisfaction with care and the birth experience. Participants, however, highlighted several issues that need to be addressed. These include the need for training birth companions prior to entering the maternity hospital, informing women about the role of birth companions, assigning a dedicated midwife to provide training, and addressing any physical infrastructure concerns. CONCLUSION Despite some issues raised by the participants, the acceptability, adoption, appropriateness, feasibility, and fidelity of the implementation strategies for birth companions to mitigate the mistreatment of women during childbirth were well received. Future research should explore the sustainability of this program. The findings of this study can be used to support the implementation of birth companions in countries with comparable circumstances.
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Affiliation(s)
- Marjan Mirzania
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Health Information Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Vali-E-Asr Reproductive Health research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Panahi
- Department of Obstetrics and Gynecology, Maternal-Fetal Neonatal Research Center, Tehran University of Medical Sciences, Valiasr Hospital, Tehran, Iran
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Abdoljavad Khajavi
- Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
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Alwahaibi N, Al-Julandani R, Al-Kalbani A. The role and effect of companions during childbirth in Oman. BMC Pregnancy Childbirth 2024; 24:47. [PMID: 38195477 PMCID: PMC10775649 DOI: 10.1186/s12884-024-06256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND There is increasing evidence that a companionship is an important tool for improving the quality of care provided to pregnant women during the labour and delivery process. The literature review shows very limited studies assessing the role of companions during childbirth from the companion's point of view. Many published papers studied the role and satisfaction of pregnant women but not their companions. Therefore, this study aimed to assess the role and effect of companions during childbirth in Oman. METHODS This cross-sectional observational study was conducted at Sultan Qaboos University Hospital, Oman, between June 2022 and April 2023. Companions were interviewed face-to-face at a time convenient to them. A telephone interview was conducted with those who left the hospital early. The questionnaire comprised sociodemographic data and other sections, including the nature of the help provided by the supportive companion, their effects on the women who gave birth, and the timing of their presence during companionship. RESULTS A total of 214 companions were included in this study with the mean age of 42.54 years. The most common relationship to the pregnant women was mothers (35.7%), followed by husbands (30.5%). The majority of companions provided support during admission (62.6%), in the immediate post-partum ward (56.5%) and during delivery (54.2%), while a minority helped from admission to discharge (22.4%). The most common type of support provided was encouraging words (89.7%) followed by transferring things (43.9%), massage (37.4%) and touch (33.6%). The majority of companions (96.7%) reported that their support helped very much, and the pregnant women felt better and calmer. CONCLUSIONS Labouring women felt better and calmer because of the presence of companions. Companions preferred to be present in the postpartum and during labour and delivery. The majority of companions support their labouring women by encouraging wards. Companions love and encourage others to support their labouring women during their critical times.
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Affiliation(s)
- Nasar Alwahaibi
- Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Muscat, 123, Oman.
| | - Rodina Al-Julandani
- Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Muscat, 123, Oman
| | - Alzarah Al-Kalbani
- Department of Biomedical Science, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 35, Muscat, 123, Oman
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Uhawenimana TC, Gray NM, Whitford H, McFadden A. Development and early validation of questionnaires to assess system level factors affecting male partners' attendance at childbirth in LMICs. BMC Pregnancy Childbirth 2023; 23:258. [PMID: 37069553 PMCID: PMC10108494 DOI: 10.1186/s12884-023-05580-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 04/07/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND There is evidence that a woman who receives continuous labour support from a chosen companion can have shorter labour duration, is more likely to give birth without medical interventions, and report a satisfying childbirth experience. These outcomes result from the beneficial effects of emotional and practical support from the woman's chosen companion, and care provided by health providers. When a woman's chosen companion is her male partner, in addition to the above benefits, his presence can promote his bonding with the baby, and shared parenthood. However, there may be healthcare system barriers, including organisational, management and individual (staff) factors, that inhibit or restrict women's choice of companion. There are currently no suitable survey tools that can be used to assess the system level factors affecting the implementation of male partners' attendance at childbirth in low- and middle- income countries (LMICs). METHODS We designed two questionnaires to help to address that gap: the Male Partners' Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs); and the Male Partners' Attendance at Childbirth-Questionnaire for Maternity Staff (MPAC-QMS). We carried out an extensive review to generate initial items of the two questionnaires. We assessed the content and face validity of the two questionnaires in a three-round modified Delphi study. RESULTS The Male Partners' Attendance at Childbirth-Questionnaire for Heads of Maternity Units (MPAC-QHMUs) focused on organisational and management factors. The Male Partners' Attendance at Childbirth-Questionnaire of Maternity Staff (MPAC-QMS) focused on individual staff factors. The final MPAC-QHMUs and MPAC-QMS included items which garnered over 80% content relevance according to the experts' rating. After all three consensus rounds of the Delphi study, 43 items were retained for the MPAC-QHMUs and 61 items were retained for the MPAC-QMS. CONCLUSIONS The MPAC-QHMUs and the MPAC-QMS may help understanding of barriers affecting male partners' attendance at childbirth in LMICs in order to devise implementation strategies to enable wider availability and to maximize women's choices during labour and childbirth. The MPAC-QHMUs and the MPAC-QMS as newly-developed questionnaires require further validation of their acceptability and feasibility in different cultural contexts, and languages.
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Affiliation(s)
- Thierry Claudien Uhawenimana
- College of Medicine and Health Sciences, School of Nursing and Midwifery, Department of Midwifery, University of Rwanda, Po. Box: 3286, Kigali, Rwanda.
| | - Nicola M Gray
- School of Health Sciences, University of Dundee, Dundee, DD1 4HJ, Scotland, UK
| | - Heather Whitford
- School of Health Sciences, University of Dundee, Dundee, DD1 4HJ, Scotland, UK
| | - Alison McFadden
- School of Health Sciences, University of Dundee, Dundee, DD1 4HJ, Scotland, UK
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Madeiro A, Rufino AC, Acaqui RF, Barbosa CM, Martins VMML, de Sousa AMC. Disrespect and abuse during childbirth in maternity hospitals in Piauí, Brazil: a cross-sectional study. Int J Gynaecol Obstet 2022; 159:961-967. [PMID: 35749275 DOI: 10.1002/ijgo.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/06/2022] [Accepted: 06/20/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the prevalence and associated factors of disrespect and abuse during childbirth in Piauí, Brazil. METHODS A cross-sectional study with 698 postpartum women in 21 maternity hospitals in 14 municipalities between August 2018 and September 2019. Face-to-face interviews were carried out at least 6 hours after birth, with an assessment of disrespect and abuse during childbirth (D&A). Robust Poisson regression was used, with calculation of the adjusted prevalence ratio (aPR) and 95% confidence intervals (95%CI). RESULTS There was evidence that 19.8% of women experienced at least one type of D&A, with verbal abuse (12.6%), non-compliance with professional standards (11.6%) and health service restrictions being more common (8.3%). There was an association of D&A with women aged 10-19 years (aPR=1.97; 95%CI 1.58-2.44), absence of companions (aPR=2.43; 95%CI 1.85-2.89), cesarean sections after labor (aPR=2.19; 95%CI 1.64-3.59), public hospitals (aPR=1.87; 95%CI1.42-2.85) and in the countryside (aPR=2.29; 95%CI 1.81-3.98). CONCLUSIONS There was a high prevalence of D&A in Piauí, associated with structural conditions of the services, care practices and characteristics of women.
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Affiliation(s)
- Alberto Madeiro
- Health Sciences Center, State University of Piauí, Teresina, Piauí, Brazil
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Figueiredo KNDRS, Campelo CL, Machado PMA, Silva NBPD, Queiroz RCDS, Silva AAMD, Santos AMD. [Supply of best childbirth practices in maternity units of Rede Cegonha according to Item Response Theory]. CIENCIA & SAUDE COLETIVA 2022; 27:2303-2315. [PMID: 35649018 DOI: 10.1590/1413-81232022276.15962021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022] Open
Abstract
This study aimed to develop an intelligible scale to measure the level of supply of best practices in labor, childbirth and delivery in maternity units in the Rede Cegonha (RC) based on the workers' perception. The scale consisted of seventeen items related to best practices, based on the instrument used in the "Evaluation of care during delivery and birth in maternity hospitals in the RC" research The three-parameter logistic model of Item Response Theory was used to create the scale and analyze the items. The scale consisted of three levels. In the first level, there are maternity hospitals that adequately offered strategies for welcoming and encouraging the pregnant woman to circulate during labor. The second level maternity wards also included the adequate offer of the right to a companion of choice, massage, ball and different birth positions. Finally, the third level maternity hospitals also offered an adequate delivery stool, as well as the items already mentioned. The findings of this study showed the contribution of each item in measuring the level of supply of best practices in care for labor, childbirth and delivery and the construction of an intelligible scale to assess RC maternity hospitals.
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Affiliation(s)
- Kely Nayara Dos Reis Silva Figueiredo
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Coletiva, Universidade Federal do Maranhão (UFMA). R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
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Goiabeira YNLDA, Thomaz EBAF, Lamy ZC, Santos AMD, Leal MDC, Bittencourt SDDA, Gama SGND, Queiroz RCDS. Presence of a full-time companion in Brazilian maternities linked to the Rede Cegonha. CIENCIA & SAUDE COLETIVA 2022; 27:1581-1594. [PMID: 35475837 DOI: 10.1590/1413-81232022274.07462021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
The objective was to estimate the proportion of women with a full-time companion in Brazilian maternities linked to the Rede Cegonha (RC) and to compare them between the macro-regions in Brazil. A nationwide study, carried out from December/2016 to October/2017. 10,665 puerperal women from all regions of Brazil participated in the study, who gave birth at one of 606 maternity hospitals with a regional action plan approved by RC. Proportions and respective 95% confidence intervals were estimated, adjusted for the cluster effect, by comparing the macro-regions using Wald's chi-square test. The presence of a full-time companion occurred in 71.2% of maternities, being higher among women aged 20-35 years, brown-skinned, with higher education, married, and assisted in vaginal delivery. Almost 30% of puerperal women did not have a full-time companion. In the Southeast and Midwest regions, self-declared black women, with less schooling and unmarried women were less accompanied. The moment of delivery had less presence of the companion (29.2%). Despite the advances, this right is still not fully fulfilled, pointing to the occurrence of social inequities among Brazilian macro-regions.
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Affiliation(s)
| | | | - Zeni Carvalho Lamy
- Departamento de Saúde Pública, Universidade Federal do Maranhão. Rua Barão de Itapary, 155 Centro, 65020-070. São Luís MA Brasil.
| | - Alcione Miranda Dos Santos
- Departamento de Saúde Pública, Universidade Federal do Maranhão. Rua Barão de Itapary, 155 Centro, 65020-070. São Luís MA Brasil.
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Hunie Asratie M, Mohammed Assfaw H, Abuhay M. Labor Companionship in Labor and Delivery at Debremarkos Town Public Health Facilities: Magnitude and Associated Factors. Int J Womens Health 2021; 13:815-827. [PMID: 34526827 PMCID: PMC8437416 DOI: 10.2147/ijwh.s327753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Labor companionship is a human interactive process that provides social support during the childbirth process. Despite it being one component of respectful maternity care (RMC) that is used for quality assurance to achieve the sustainable goal of maternal and neonatal mortality reduction, there is limited evidence about the current status of birth companionship. The study was aimed to assess labor companion and its associated factors at Debremarkos town public health facilities. Methods An institution-based cross-sectional study design was conducted. The study was conducted at Debremarkos town from February 1/2021 to March 30/2021. From the 559 sample size, 548 women participated in the study. A systematic random sampling technique was used. A pre-tested interviewer-administered questioner was used, data were entered and analyzed with Epi-data version 4.60 and SPSS version 25.0. Bivariable regression was done and variables with p-value </= 0.20 were analyzed with multivariable logistic regression. Variables with p-value </= 0.05 were considered significantly associated with labor companionship. Hosmer–Lemeshow goodness of fit was checked and all multi-collinearity of variables with variance inflation factors (VIF) up to 10 was tolerated. Results A total of 548 participants were involved in the study with a 98.03% response rate. The magnitude of labor companionship was found to be 14.6% (11.7–17.5). Women who had complicated pregnancy (adjusted odds ratio [AOR]=5.53; 95% CI: 3.09–9.92), women's desire for a labor companion (AOR=3.63; 95% CI: 1.51–8.69), being primipara (AOR=3.49; 95% CI: 1.93–6.35), labor followed by female skilled birth attendant (AOR=0.37;95% CI: 0.17–0.82), and women’s perceived busyness of skilled birth attendant (AOR=0.13;95% CI: 0.07–0.23) were significantly associated with labor companionship. Conclusions Labor companionship was found to be low. Giving emphasis on the desire, primipara, complicated pregnancy, sex of skilled birth attendant and women perceived busy skilled birth attendant were suggested for the improvement of labor companionship.
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Affiliation(s)
- Melaku Hunie Asratie
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hussien Mohammed Assfaw
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Abuhay
- Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Singh S, Goel R, Gogoi A, Caleb-Varkey L, Manoranjini M, Ravi T, Rawat D. Presence of birth companion-a deterrent to disrespectful behaviours towards women during delivery: an exploratory mixed-method study in 18 public hospitals of India. Health Policy Plan 2021; 36:1552-1561. [PMID: 34427637 DOI: 10.1093/heapol/czab098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/13/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Birthing women require support, particularly emotional support, during the process of labour and delivery. Traditionally, across cultures, this support was made available by the continuous presence of a companion during labour, childbirth and the immediate post-partum period. However, this practice is not universal, especially in health facilities in low- and middle-income countries. This cross-sectional study was conducted in 18 tertiary health care facilities of India using a mixed-method approach. The quantitative data were collected to document the number of birthing women, birth companions and healthcare providers in the labour rooms, and the typology of disrespect and abuse (D&A) faced by women. This was followed by in-depth interviews with 55 providers to understand their perspective on the various dimensions of D&A and the challenges they face to provide respectful care. This article explores the status of birth companionship in India and its plausible associations with D&A faced by birthing women in public facilities. Our study reveals that birth companionship is still not a common practice in Indian public hospitals. Birth companions were present during less than half of the observational period, also less than half of the birthing women were accompanied by a birth companion. Lack of hospital policy, space constraints, overcrowding and privacy concerns for other patients were cited as reasons for not allowing birth companions in the labour rooms, whose supportive roles, both for women and providers, were otherwise widely acknowledged during the qualitative interviews. Also, the presence of birth companions was found to be critically negatively associated with occurrences of D&A of birthing women. We contend that owing to the high pressure on the public hospitals in India, birth companions can be a low-cost intervention model for promoting respectful maternity care. However, adequate infrastructure is a critical aspect to be taken care of.
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Affiliation(s)
- Shalini Singh
- Indian Council of Medical Research, New Delhi, India
| | - Richa Goel
- Indian Council of Medical Research, New Delhi, India
| | - Aparajita Gogoi
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Leila Caleb-Varkey
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Mercy Manoranjini
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
| | - Tina Ravi
- Centre for Catalyzing Change, National Secretariat for White Ribbon Alliance, New Delhi, India
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da Matta Machado Fernandes L, Lansky S, Reis Passos H, T. Bozlak C, A. Shaw B. Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study. PLoS One 2021; 16:e0248740. [PMID: 33861756 PMCID: PMC8051805 DOI: 10.1371/journal.pone.0248740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
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.
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Affiliation(s)
| | - Sônia Lansky
- Department of Health, Belo Horizonte, Minas Gerais, Brazil
| | | | - Christine T. Bozlak
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
| | - Benjamin A. Shaw
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
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Silva LRE, Vasconcelos CTM, Nicolau AIDO, Teles LMR, Ribeiro GL, Damasceno AKDC. The effect of educational technology use to guide parturient women's companions: a randomized controlled study. Rev Esc Enferm USP 2021; 55:e03666. [PMID: 33886898 DOI: 10.1590/s1980-220x2019022903666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/15/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the companion's role during the labor and delivery processes, comparing the influence of the use of an educational technology. METHOD A single-blind randomized controlled study, in which 73 participants were divided into two groups, 35 in the intervention group and 38 in the comparison group. To analyze the groups the chi-square and the Fisher's exact tests were used in categorical variables and the Student's t-test or the Mann-Whitney test in continuous variables. RESULTS When comparing the experience and the support provided, it was found that there was no difference between the groups in relation to the level of support (p=0.48) and satisfaction with the experience of monitoring the delivery process (p=0.19). However, there was a difference regarding insecurity in monitoring (p=0.00) and concern regarding the parturient health status (p=0.00). CONCLUSION The companions who received the intervention with educational technology were more likely to use physical, emotional and intermediation support actions. Registry of Brazilian Clinical Trials UTN: U1111-1231-8695.
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Affiliation(s)
- Laise Ramos E Silva
- Universidade Federal do Ceará, Complexo Hospitalar, Maternidade Escola Assis Chateaubriand, Fortaleza, CE, Brazil
| | | | | | - Liana Mara Rocha Teles
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brazil
| | - Gabriela Lima Ribeiro
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brazil
| | - Ana Kelve de Castro Damasceno
- Universidade Federal do Ceará, Faculdade de Farmácia, Odontologia e Enfermagem, Departamento de Enfermagem, Fortaleza, CE, Brazil
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Vidal ÁT, Barreto JOM, Rattner D. Barriers to implementing childbirth recommendations in Brazil: the women's perspective. Rev Panam Salud Publica 2021; 45:e17. [PMID: 33643400 PMCID: PMC7898362 DOI: 10.26633/rpsp.2021.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/24/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To identify barriers to the implementation of National Childbirth Guidelines in Brazil from the women's perspective. METHODS A descriptive exploratory study was performed using a qualitative approach and an interpretive perspective. The hermeneutic unit of analysis was established based on the contribution of users to a public online consultation about the National Childbirth Guidelines in Brazil, performed in 2016 by the National Committee for Health Technology Incorporation into the Unified Health System (CONITEC). Content analysis techniques were used to examine the answers provided to the following specific question: "Considering your local reality, what would hinder the implementation of this protocol or guideline?" RESULTS Of 396 contributions recorded by CONITEC, 55 were included in the content analysis. The mean age of women was 31 years, with most self-declared as white (69%) and living in the Southeast of Brazil (56.3%). Coding revealed seven barrier categories, which were grouped into three families - barriers related to 1) professional training and culture (which highlighted the centrality of physicians, not women, in childbirth), 2) social culture (general population not well informed), and 3) political and management issues (little interest on the part of managers, lower physician compensation for vaginal childbirth vs. cesarian section, and poor hospital infrastructure). CONCLUSIONS Aspects of professional training and culture, social culture, and political as well as management issues are critical points to be considered in future interventions aiming at overcoming or weakening the barriers to implementing childbirth recommendations in Brazil.
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Affiliation(s)
- Ávila Teixeira Vidal
- Universidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
| | - Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz)Brasília (DF)BrazilFundação Oswaldo Cruz (Fiocruz), Brasília (DF), Brazil.
| | - Daphne Rattner
- Universidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Saúde ColetivaBrasília (DF)BrazilUniversidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brazil.
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Tomasi YT, Saraiva SDS, Boing AC, Delziovo CR, Wagner KJP, Boing AF. From prenatal care to childbirth: a cross-sectional study on the influence of a companion on good obstetric practices in the Brazilian National Health System in Santa Catarina State, 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2020383. [PMID: 33503213 DOI: 10.1590/s1679-49742021000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze association between presence of a companion during prenatal consultations and childbirth and quality of care received by puerperal women using the Brazilian National Health System (SUS). METHODS This was a cross-sectional study with puerperal women who underwent prenatal care and delivery on the SUS in Santa Catarina State, Brazil, in 2019, and who were interviewed within 48 hours postpartum. Prevalence ratios were estimated using Poisson regression. RESULTS 3,580 puerperal women were interviewed. In prenatal care, presence of a companion was positively associated with receiving guidance from health professionals (PR=1.27 - 95%CI 1.08;1.50) and building a birth plan (PR=1.51 - 95%CI 1.15;1.97). At delivery, presence of a companion was associated with greater receipt of analgesics (PR=2.89 - 95%CI 1.40;5.97), non-pharmacological pain relief management (PR=1.96 - 95%CI 1.44;2.65), choice of position for delivery (PR=1.63 - 95%CI 1.24;2.16) and less likelihood of being strapped down (PR=0.47 - 95%CI 0.35;0.63). CONCLUSION Presence of a companion during prenatal care and delivery was associated with better quality of care.
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Affiliation(s)
- Yaná Tamara Tomasi
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brasil
| | | | - Alexandra Crispim Boing
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brasil
| | - Carmem Regina Delziovo
- Secretaria de Estado da Saúde de Santa Catarina, Superintendência de Planejamento em Saúde, Florianópolis, SC, Brasil
| | | | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, SC, Brasil
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Vidal ÁT, Barreto JOM, Rattner D. [Barriers to implementing childbirth recommendations in Brazil: the women's perspectiveObstáculos para la aplicación de las recomendaciones de asistencia al parto normal en Brasil: perspectiva de las mujeres]. Rev Panam Salud Publica 2020; 44:e164. [PMID: 33337448 PMCID: PMC7737643 DOI: 10.26633/rpsp.2020.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/24/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To identify barriers to the implementation of National Childbirth Guidelines in Brazil from the women's perspective. METHOD A descriptive exploratory study was performed using a qualitative approach and an interpretive perspective. The hermeneutic unit of analysis was established based on the contribution of users to a public online consultation about the National Childbirth Guidelines in Brazil, performed in 2016 by the National Committee for Health Technology Incorporation into the Unified Health System (CONITEC). Content analysis techniques were used to examine the answers provided to the following specific question: "Considering your local reality, what would hinder the implementation of this protocol or guideline?" RESULTS Of 396 contributions recorded by CONITEC, 55 were included in the content analysis. The mean age of women was 31 years, with most self-declared as white (69%) and living in the Southeast of Brazil (56.3%). Coding revealed seven barrier categories, which were grouped into three families - barriers related to 1) professional training and culture (which highlighted the centrality of physicians, not women, in childbirth), 2) social culture (general population not well informed), and 3) political and management issues (little interest on the part of managers, lower physician compensation for vaginal childbirth vs. Caesarian section, and poor hospital infrastructure). CONCLUSIONS Aspects of professional training and culture, social culture, and political as well as management issues are critical points to be considered in future interventions aiming at overcoming or weakening the barriers to implementing childbirth recommendations in Brazil.
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Affiliation(s)
- Ávila Teixeira Vidal
- Universidade de Brasília (UnB)Faculdade de Ciências da SaúdeDepartamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
| | - Jorge Otávio Maia Barreto
- Fundação Oswaldo Cruz (Fiocruz)Brasília (DF)BrasilFundação Oswaldo Cruz (Fiocruz), Brasília (DF), Brasil.
| | - Daphne Rattner
- Universidade de Brasília (UnB)Faculdade de Ciências da SaúdeDepartamento de Saúde ColetivaBrasília (DF)BrasilUniversidade de Brasília (UnB), Faculdade de Ciências da Saúde, Departamento de Saúde Coletiva, Brasília (DF), Brasil.
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Resende MTDS, Lopes DS, Bonfim EG. Profile on childbirth care at a public maternity hospital. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to describe the profile on childbirth care at a reference maternity hospital in the State of Piauí based on the 2018 World Health Organization Recommendations. Methods: retrospective cross-sectional quantitative study, descriptive documentary, population census, containing vaginal deliveries performed in 2017. The data was entered in Microsoft Excel for simple statistical analysis. Results: the percentages registered at the Centro Obstétrico Superior (Superior Obstetric Center) and Centro de Parto Normal (Normal Delivery Center) were, respectively, 85.5% and 98% with the presence of a companion, 34.2% and 94% used the partogram, 63.8% and 98% took non-pharmacological methods for pain relief, 74.8% and 98.7% received fluids during labor. Amniotomy at 15.2% and 17.2%, oxytocin was administered at 26.5% and 14.6% in the 1st and 2nd periods, non-lithotomic position at 39.7% and 93.4%, episiotomy 9.9% and 6.6%. After birth, 85.5% and 96% of newborns had skin-to-skin contact and, in 65.5% and 94% there were maternal breastfeeding promotion. Conclusions: this study comprehended the indicators on childbirth care service, which are, in general, better than the national and the northeast region ones. The importance of registering indicators to evaluate care is emphasized.
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Violência institucional referida pelo acompanhante da parturiente em maternidades públicas. ACTA PAUL ENFERM 2020. [DOI: 10.37689/actaape/2020ao02202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Viellas EF, Franco Netto TDL, Gama SGND, Baldisserotto ML, Prado Neto PFD, Rodrigues MR, Martinelli KG, Domingues RMSM. Childbirth care for adolescents and advanced maternal age in maternities linked to Rede Cegonha. CIENCIA & SAUDE COLETIVA 2020; 26:847-858. [PMID: 33729341 DOI: 10.1590/1413-81232021263.12492020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 11/22/2022] Open
Abstract
Based on the Rede Cegonha guidelines that propose the strengthening of women's sexual and reproductive rights, we sought to present a brief overview of issues related to reproductive planning and to analyze obstetric practices in childbirth care for adolescents and women of advanced age in maternity hospitals linked to Rede Cegonha. Data were extracted from an assessment conducted in 2017, based on information from the interview with puerperal women and from the hospital record. For age extremes, the high proportion of unplanned pregnancies and low use of contraception means problems in accessing family planning programs. Adolescents are more exposed to the presence of a companion and less to the use of analgesia in labor. Advanced maternal age were more likely to use analgesia in labor and to give birth in the lithotomy position, being less exposed to amniotomy. Although Rede Cegonha is an excellent strategy for improving assistance to childbirth, attention is still needed to the use of potentially unnecessary or not recommended interventions, with greater incentive to good obstetric practices.
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Affiliation(s)
- Elaine Fernandes Viellas
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | | | - Márcia Leonardi Baldisserotto
- Escola Nacional de Saúde Pública, Fiocruz. R. Leopoldo Bulhões 1480, Manguinhos. 21041-210 Rio de Janeiro RJ Brasil.
| | | | - Mariana Ramos Rodrigues
- Secretaria de Estado da Saúde do Distrito Federal, Governo do Distrito Federal. Brasília DF Brasil
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17
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Bittencourt SDDA, Vilela MEDA, Marques MCDO, Santos AMD, Silva CKRTD, Domingues RMSM, Reis AC, Santos GLD. Labor and childbirth care in maternities participating in the "Rede Cegonha/Brazil": an evaluation of the degree of implementation of the activities. CIENCIA & SAUDE COLETIVA 2020; 26:801-821. [PMID: 33729338 DOI: 10.1590/1413-81232021263.08102020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.
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Affiliation(s)
| | | | | | | | | | - Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Ana Cristina Reis
- Escola Politécnica Joaquim Venâncio, Fiocruz. Rio de Janeiro RJ Brasil
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Pujól von Seehausen M, Pérez-Escamilla R, Couto de Oliveira MI, do Carmo Leal M, Siqueira Boccolini C. Social support modifies the association between pre-pregnancy body mass index and breastfeeding initiation in Brazil. PLoS One 2020; 15:e0233452. [PMID: 32438388 PMCID: PMC7242016 DOI: 10.1371/journal.pone.0233452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many biological, social and cultural barriers for suboptimal breastfeeding practices have been identified in literature. Among these, excessive pre-pregnancy weight has been identified as a risk factor for not initiating breastfeeding early. Social support, coming from social networks (e.g. a partner, family or friends) or health care providers, has been positively associated with breastfeeding. This study aimed to examine the association between pre-pregnancy excessive weight and breastfeeding within the first hour after birth and if social support modifies this association. DESIGN National population-based study conducted with 21,086 postpartum women from February 1, 2011 to October 31, 2012 in 266 hospitals from all five regions of Brazil. Social support was defined as having a companion at the hospital. Main effects and interactions were tested with multivariable regression analyses. RESULTS Multivariate regression analyses indicated that class I and class II obese women had lower odds of breastfeeding within the first hour when a companion was not present (AOR = 0.59, 95% CI 0.42-0.82 and AOR = 0.59, 95% CI 0.36-0.97, respectively), but there was no association when the companion was present. Among overweight and obese women, the predicted probability of breastfeeding within the first hour was lower for those without a companion. This association was not found among those with normal pre-pregnancy BMI. CONCLUSIONS Social support modifies the relationship between pre-gestational BMI and breastfeeding initiation among women who are overweight or obese, specifically it reduces the risk of delayed breastfeeding initiation.
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Affiliation(s)
- Mariana Pujól von Seehausen
- Programa de Pós-Graduação em Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Maria Inês Couto de Oliveira
- Departamento de Epidemiologia e Bioestatística, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cristiano Siqueira Boccolini
- Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
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Fernandes LMM, Lansky S, Oliveira BJ, Friche AAL, Bozlak CT, Shaw BA. Changes in perceived knowledge about childbirth among pregnant women participating in the Senses of Birth intervention in Brazil: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:265. [PMID: 32370737 PMCID: PMC7201865 DOI: 10.1186/s12884-020-02874-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/12/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Senses of Birth (SoB) is a health education intervention in Brazil that aims to reduce unnecessary cesareans in the country by providing information on reproductive rights, benefits and risks of childbirth, and use of intrapartum evidence-based practices (EBP) which are recommended by the World Health Organization (WHO) to improve childbirth outcomes and satisfaction. This study evaluates the impact of the SoB on pregnant women's perceived knowledge about normal birth (NB), cesarean, and use of EBP. METHODS 1287 pregnant women answered a structured survey immediately after their visit to the intervention, between March 2015 and March 2016. To estimate the potential impact of the intervention on women's perceived knowledge, and possible associations between sociodemographic characteristics and perceived knowledge, statistical analyses were performed, including paired T-tests, ANOVA, and logistic and linear regressions. RESULTS The mean score (MS) of perceived knowledge after the intervention was higher than the MS before experiencing the intervention for all three knowledge domains: Normal Birth (MS Before = 3.71 x MS After = 4.49), Cesarean (MS Before = 3.54 x MS After = 4.26) and EBPs (MS Before = 3.14 x MS After = 4.14). The results suggest that perceived knowledge increased more for low-income women (B = 0.206; p < 0.001 for EBP), women without private health insurance (OR 2.47, 95% CI: 1.49-4.09 for NB), with private prenatal care (OR 2.42, 95% CI: 1.59-3.66 for NB), experiencing their first pregnancy (OR 1.92, 95% CI: 1.31-2.82 for EBP; OR 1.37, 95% CI: 1.03-1.84 for NB; OR 1.37, 95% CI: 1.03-1.84 for cesarean), and in their first or second trimester (OR 1.64, 95% CI: 1.13-2.39 for EBP; OR 1.48, 95% CI: 1.11-1.97 for NB; OR 1.85, 95% CI: 1.40-2.41 for cesarean). CONCLUSION The study showed that participation in the SoB was associated with an increase in perceived knowledge among Brazilian pregnant women. The intervention gains relevance considering the lack of evidence of the impact of non-clinical interventions to reduce unnecessary cesareans in middle and low-income countries.
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Affiliation(s)
- Luísa M M Fernandes
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA.
| | - Sônia Lansky
- Department of Health, City Hall, Belo Horizonte, Minas Gerais, Brazil
| | - Bernardo J Oliveira
- School of Education, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Amélia A L Friche
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Christine T Bozlak
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA
| | - Benjamin A Shaw
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, One University Place, Rensselaer, NY, 12144, USA
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20
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Bonifácio LP, Franzon ACA, Zaratini FS, Vicentine FB, Barbosa-Júnior F, Braga GC, Sanchez JAC, Oliveira-Ciabati L, Andrade MS, Fernandes M, Fabio SV, Duarte G, Pileggi VN, Souza JP, Vieira EM. PRENACEL partner - use of short message service (SMS) to encourage male involvement in prenatal care: a cluster randomized trial. Reprod Health 2020; 17:45. [PMID: 32252789 PMCID: PMC7132868 DOI: 10.1186/s12978-020-0859-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background The partner has an important role when he participates of the prenatal care as showed in the positive results relate to the mother and the child health. For this reason it is an important strategy to bring future fathers closer to health services and to improve their link with paternity. Aim To evaluate whether the implementation of SMS technology, through the PRENACEL program for the partner as a health education program, is a useful supplement to the standard prenatal monitoring. Methods A parallel cluster randomized trial was carried out, with the clusters representing primary care health units. The 20 health units with the largest number of pregnant women in 2013 were selected for the study. There was a balance of the health units according to the size of the affiliated population and the vulnerability situation and these were allocated in intervention and control health units by the randomization. The partners of the pregnant women who started prenatal care prior to the 20th week of gestation were the study population of the intervention group. The participants received periodic short text messages via mobile phone with information about the pregnancy and birth. In the control group units the partners, together with the women, received the standard prenatal care. Results One hundred eighty-six partners were interviewed, 62 from the PRENACEL group, 73 from the intervention group that did not opt for PRENACEL and 51 from the control group. A profile with a mean age of 30 years was found and the majority of respondents (51.3%) declared themselves as brown race/color. The interviewees presented a mean of 9.3 years of study. The majority of the men (95.2%) cohabited with their partner and 63.7% were classified as socioeconomic class C. The adherence to the PRENACEL program was 53.4%. In relation to the individual results, there was a greater participation of the PRENACEL partners in the prenatal consultations, as well as a greater presence of them accompanying the woman at the moment of the childbirth when compared to the other groups. Conclusion The study showed that a health education strategy using communication technology seems to be a useful prenatal care supplement; the intervention had a good acceptability and has a promising role in men’s involvement in prenatal, labour and postpartum care of their partners. Trial registration Clinical trial registry: RBR-54zf73, U1111–1163-7761.
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Affiliation(s)
- Lívia Pimenta Bonifácio
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
| | - Ana Carolina Arruda Franzon
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fabiani Spessoto Zaratini
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Bergamini Vicentine
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Francisco Barbosa-Júnior
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Giordana Campos Braga
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.,Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Jazmin Andrea Cifuentes Sanchez
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Lívia Oliveira-Ciabati
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Magna Santos Andrade
- Department of Education, College of Nursing, State University of Bahia (UNEB), Senhor do Bonfim, Bahia, Brazil
| | - Mariana Fernandes
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Suzi Volpato Fabio
- Women Health Programme, Ribeirao Preto Health Department, Ribeirao Preto, São Paulo, Brazil
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Vicky Nogueira Pileggi
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Elisabeth Meloni Vieira
- Department of Social Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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De Mucio B, Binfa L, Ortiz J, Portela A. Status of national policy on companion of choice at birth in Latin America and the Caribbean: Gaps and challenges. Rev Panam Salud Publica 2020; 44:e19. [PMID: 32117467 PMCID: PMC7039278 DOI: 10.26633/rpsp.2020.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization (WHO) recommends a companion of choice during labor and birth, to improve maternal and perinatal outcomes and women’s satisfaction with health services. To better understand the status of companion of choice in Latin America and the Caribbean (LAC), an online survey was conducted with members of a midwifery virtual community of practice and with key informants, aiming to identify: 1) existing regulatory instruments related to companion of choice in the countries where the members are practicing; and, 2) key characteristics of implementation of companion of choice, where regulation exists. Responses (n = 112) were received from representatives of 20 of the 43 countries of LAC. Respondents reported existence of a national policy or legislation in seven countries, ministerial norms or institutional protocols in five countries, and no existing policy/protocol in eight countries. Respondents from the same country often provided contradictory responses. Responses differed from information provided by ministries of health in a WHO-led global policy survey in 11 instances. These variations may reflect that midwives were not always aware of the national policy/guideline in their country. We propose that a more robust effort should be undertaken to understand the status of companion of choice for labor and birth in LAC countries, at national, regional, and local level, in public and private facilities. It is important to know if policies exist, at what level of the system, and if key stakeholders, maternity-care health providers, and women are aware of their existence. Efforts should also be made to understand barriers to implementing companion of choice.
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Affiliation(s)
- Bremen De Mucio
- Latin American Center for Perinatology, Women and Reproductive Health Pan American Health Organization/World Health Organization Montevideo Uruguay Latin American Center for Perinatology, Women and Reproductive Health, Pan American Health Organization/World Health Organization, Montevideo, Uruguay
| | - Lorena Binfa
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina Universidad de Chile Santiago Chile Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jovita Ortiz
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina Universidad de Chile Santiago Chile Departamento de Promoción de la Salud de la Mujer y el Recién Nacido, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing World Health Organization Geneva Switzerland Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Aquino EML, Reichenheim M, Menezes GMS, Araújo TVBD, Alves MTSSBE, Alves SV, Almeida MDCC. Quality assessment of abortion care from the users' perspective: dimensional structure of the QualiAborto-Pt questionnaire. CAD SAUDE PUBLICA 2020; 36Suppl 1:e00197718. [PMID: 32049125 DOI: 10.1590/0102-311x00197718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/19/2019] [Indexed: 11/22/2022] Open
Abstract
Abortion complications are a major public health problem, and studies to assess the quality of abortion care require adequate measurement tools. This study is a continuation of such an instrument's refinement, the QualiAborto-Pt questionnaire. Using data from a survey of 2,336 women hospitalized for abortion complications in 19 hospitals in three state capitals in Northeast Brazil (Salvador - Bahia, Recife - Pernambuco, and São Luís - Maranhão), we implemented a series of exploratory and confirmatory factor analyses based on a 55-item prototype. The analyses indicate a structure with 17 items in five dimensions: reception, orientation, inputs/physical environment, technical quality, and continuity of care. All the items in the final model displayed acceptable reliability, absence of content redundancy, and factor specificity, as well as theoretical consistency with the respective dimensions. The solution also shows discriminant factor validity. Despite some persistent issues for further analysis and clarification, this version merits recommendation for use in Brazil.
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Affiliation(s)
- Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | - Michael Reichenheim
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Greice M S Menezes
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Abstract
Resumo Este estudo propõe uma revisão crítica da legislação voltada para a assistência obstétrica, nomeadamente no que concerne ao processo da parturição. A história recente mostra numerosas iniciativas governamentais através de legislação e de políticas públicas que garantem direitos às mulheres. Buscou-se identificar possíveis convergências e descompassos nas relações entre a legislação e as políticas, especialmente no que tange ao asseguramento de direitos. Procedeu-se à análise documental do material selecionado seguindo os parâmetros recomendados na literatura. A presença do acompanhante foi o tema focalizado na análise. O período histórico coberto pelo estudo teve como marcador temporal a promulgação da Lei nº 11.108/2005. Os resultados apresentados revelaram um conjunto considerável de diplomas sancionados e incorporados pelos órgãos governamentais da administração federal. Todavia, o crescente fortalecimento dos direitos focalizados não se fez repercutir no cotidiano dos serviços que deveriam implementá-los. Apesar dos avanços, o problema da proteção e usufruto dos direitos ainda persiste. É possível cogitar que o fortalecimento político do campo contra-hegemônico representa perspectiva promissora para a superação das dificuldades ao legítimo exercício da cidadania.
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Dev A, Kivland C, Faustin M, Turnier O, Bell T, Leger MD. Perceptions of isolation during facility births in Haiti - a qualitative study. Reprod Health 2019; 16:185. [PMID: 31881973 PMCID: PMC6935234 DOI: 10.1186/s12978-019-0843-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Haiti's maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision. METHODS We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any. RESULTS All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women's negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term "isolation," which encompasses feelings of being isolated in the hospital during delivery. CONCLUSION Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position.
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Affiliation(s)
- Alka Dev
- Geisel School of Medicine at Dartmouth College, Hanover, United States.
- Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, 330W Borwell, Lebanon, NH, 03756, United States.
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Lopes GDC, Gonçalves ADC, Gouveia HG, Armellini CJ. Attention to childbirth and delivery in a university hospital: comparison of practices developed after Network Stork. Rev Lat Am Enfermagem 2019; 27:e3139. [PMID: 31038633 PMCID: PMC6528631 DOI: 10.1590/1518-8345.2643-3139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 01/06/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE to compare, after four years of the implementation of the Stork Network, the obstetric practices developed in a university hospital according to the classification of the World Health Organization. METHOD cross-sectional study carried out in the year of adherence to the Stork Network (377 women) and replicated four years later (586 women). Data were obtained through medical records and a structured questionnaire. The Chi-square test was used in the analysis. RESULTS four years after the implementation of the Stork Network, in Category A practices (demonstrably useful practices/good practices), there was increased frequency of companions, non-pharmacological methods, skin-to-skin contact and breastfeeding stimulation, and decreased freedom of position/movement. In Category B (harmful practices), there was reduction of trichotomy and increased venoclysis. In Category C (practices with no sufficient evidence), there was increase of Kristeller's maneuver. In Category D (improperly used practices), the percentage of digital examinations above the recommended level increased, as well as of analgesics and analgesia, and there was decrease of episiotomy. CONCLUSION these findings indicate the maintenance of a technocratic and interventionist assistance and address the need for changes in the obstetric care model. A globally consolidated path is the incorporation of midwife nurses into childbirth for the appropriate use of technologies and the reduction of unnecessary interventions.
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Affiliation(s)
- Giovanna De Carli Lopes
- Universidade Federal do Rio Grande do Sul , Escola de Enfermagem ,
Porto Alegre , RS , Brasil
| | | | - Helga Geremias Gouveia
- Universidade Federal do Rio Grande do Sul , Escola de Enfermagem ,
Porto Alegre , RS , Brasil
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Bezerra FD, Menezes MADS, Mendes RB, Santos JMDJ, Leite DCF, Kassar SB, Gurgel RQ. PERINATAL CARE IN A NORTHEASTERN BRAZILIAN STATE: STRUCTURE, WORK PROCESSES, AND EVALUATION OF THE COMPONENTS OF ESSENTIAL NEWBORN CARE. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2019; 37:140-148. [PMID: 30810691 PMCID: PMC6651313 DOI: 10.1590/1984-0462/;2019;37;2;00003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 01/28/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. METHODS A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants' records, were also analyzed. RESULTS Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. CONCLUSIONS The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.
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Lansky S, Oliveira BJ, Peixoto ER, Souza KV, Fernandes LM, Friche AA. The Senses of Birth intervention to decrease cesarean and prematurity rates in Brazil. Int J Gynaecol Obstet 2019; 145:91-100. [PMID: 30671949 PMCID: PMC7473078 DOI: 10.1002/ijgo.12765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 10/05/2018] [Accepted: 01/21/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To increase knowledge and promote cultural change toward valuing normal birth, and to lower rates of cesarean and unnecessary interventions during childbirth in Brazil via the Senses of Birth (SoB) exhibition. METHODS The SoB intervention targeted 22 621 participants in three Brazilian cities in 2015. The effects of the exhibition in knowledge, perceptions, and preferences regarding childbirth were analyzed in a multi-method study. Pre- and post-exhibition survey responses of 17 501 (77.0%) visitors, 1947 (8.6%) non-pregnant women, and all pregnant women (n=1287) were collected at the exhibition. A follow-up survey was completed by 555 (43.0%) postpartum women who had participated at SoB while pregnant. Univariate analyses were used to compare before and after changes. RESULTS There was a significant increase in knowledge about normal birth, varying from 10.0% to 25.0% among general visitors (P<0.001) and 27.3% to 42.0% among pregnant women (P<0.001). Perceptions and preferences for normal birth also changed, reaching 83.0% of general visitors and 87.4% of pregnant women. CONCLUSION SoB was found to effectively improve knowledge about and preference for normal birth. Scaling-up the intervention might contribute to cultural change toward valuing normal birth, and might decrease the rate of unnecessary cesarean and premature birth in Brazil.
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Affiliation(s)
- Sônia Lansky
- Department of Health, Belo Horizonte City Hall, Belo Horizonte, Brazil
| | - Bernardo J. Oliveira
- School of Education, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane R.M. Peixoto
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kleyde V. Souza
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luísa M.M. Fernandes
- School of Public Health, State University of New York at Albany, Albany, NY, USA
| | - Amélia A.L. Friche
- School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Santana ATD, Felzemburgh RDM, Couto TM, Pereira LP. Performance of resident nurses in obstetrics on childbirth care. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000100008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to describe good practices on childbirth care and obstetric interventions performed by resident nurses in obstetrics during the obstetric childbirth risk at a public maternity hospital in Salvador. Methods: a descriptive cross-sectional study with a quantitative approach, based on the of 102 parturients, between February and April 2016. The data collection was performed through the collection of information on clinical files for analysis by using descriptive statistics with absolute and relative frequencies for the evaluated categorical variables. Results: it was observed that 100.0% of the women used some kind of non-pharmacological method for pain relief, although the method of choice was to take a hot bath; 99.0% of the women drank liquids; 94.0% had the presence of a companion of free choice; 99.0% walked during labor; 100.0% had the freedom to choose a position during childbirth. It is noteworthy that no woman in this study was submitted to episiotomy, and more than 70.0% were not submitted to any obstetric intervention. Conclusions: the Programa de Residência em Enfermagem (Residency Nursing Program) an important point in the childbirth humanization process is directly associated to the increase in the normal childbirth rates, the highest use on good practices in childbirth care, and the reduction on obstetric interventions.
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Leal MDC, Bittencourt SDA, Esteves-Pereira AP, Ayres BVDS, Silva LBRADA, Thomaz EBAF, Lamy ZC, Nakamura-Pereira M, Torres JA, Gama SGND, Domingues RMSM, Vilela MEDA. Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. CAD SAUDE PUBLICA 2019; 35:e00223018. [DOI: 10.1590/0102-311x00223018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/06/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo: Este artigo tem como objetivo descrever os primeiros resultados de dois estudos avaliativos, um sobre a Rede Cegonha e outro sobre o projeto Parto Adequado, denominados, respectivamente, de avaliação da Rede Cegonha e Nascer Saudável, e identificar possíveis melhorias em comparação ao estudo Nascer no Brasil. Ambos os estudos têm desenho seccional, realizados em 2017. O estudo avaliação da Rede Cegonha incluiu todas as 606 maternidades públicas e mistas envolvidas na Rede Cegonha e um total de 10.675 puérperas. O estudo Nascer Saudável incluiu uma amostra de conveniência de 12 hospitais da rede privada e um total de 4.798 mulheres. Os indicadores de atenção ao parto e nascimento avaliados foram: presença de acompanhante, atendimento por enfermeira obstétrica, preenchimento de partograma, uso de métodos não farmacológicos, deambulação, alimentação, uso de cateter venoso periférico, analgesia, posição da mulher para o parto, episiotomia e manobra de Kristeler. Esses indicadores foram comparados aos encontrados no Nascer no Brasil, estudo de base nacional realizado em 2011-2012, antes do início dos dois programas de intervenção. Para as comparações utilizamos o teste do qui-quadrado para amostras independentes e nível de 95% de confiança. Houve um aumento significativo do número de mulheres com acesso à tecnologia apropriada ao parto entre os anos de 2011 e 2017 e redução de práticas consideradas prejudiciais. No setor privado, observou-se também redução nas taxas de cesariana e aumento da idade gestacional ao nascer. Os resultados deste estudo mostram que políticas públicas bem conduzidas podem mudar o cenário da atenção ao parto e nascimento, promovendo a redução de desfechos maternos e neonatais negativos.
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Menezes MAS, Gurgel R, Bittencourt SDA, Pacheco VE, Cipolotti R, Leal MDC. Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study. BMJ Open 2018; 8:e021431. [PMID: 30598483 PMCID: PMC6318520 DOI: 10.1136/bmjopen-2017-021431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 10/10/2018] [Accepted: 11/02/2018] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To assess the use of the WHO's Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure. DESIGN A cross-sectional observational health facility assessment. SETTING This is a secondary analysis of the 'Birth in Brazil' study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care). PARTICIPANTS Data on 23 894 postnatal women and their newborn babies were analysed. MAIN OUTCOME MEASURES The facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers' sociodemographic characteristics. RESULTS The utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (ORadj 1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (ORadj 1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (ORadj 1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (ORadj 3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (ORadj 2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (ORadj 4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (ORadj 3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (ORadj 2.55; 95% CI 2.21 to 2.96). CONCLUSIONS The coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.
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Affiliation(s)
| | - Ricardo Gurgel
- Postgraduate Programme in Health Science, Sergipe Federal University, Aracaju, Brazil
| | - Sonia Duarte Azevedo Bittencourt
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Vanessa Eufrazino Pacheco
- Postgraduate Programme in Epidemiology and Public Health, National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Rosana Cipolotti
- Postgraduate Programme in Health Science, Sergipe Federal University, Aracaju, Brazil
| | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
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Da Cruz Lima E, Marques dos Santos L, Cerqueira dos Santos S, Moreira Christoffel M, Pereira da Costa Kerber N. Vivências de familiares durante o trabalho de parto pré-termo. REVISTA CUIDARTE 2018. [DOI: 10.15649/cuidarte.v10i1.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fernandes RC, Manera F, Boing L, Höfelmann DA. Socioeconomic, demographic, and obstetric inequalities in food insecurity in pregnant women. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to estimate the prevalence of Food Insecurity (FI) in pregnant women and to identify its association with demographic, socioeconomic, obstetric, and anthropometric variables in female users of Family Health Units (FHUs) in the city of Colombo, state of Paraná, South Region of Brazil. Methods: a cross-sectional study of a representative sample of pregnant women from 17 FHUs in Colombo. We used the short version of the Brazilian Household Food Insecurity Measurement Scale (EBIA). In addition, we used Poisson Regression Models with robust, crude, and adjusted variance to investigate the association between FI and exposure variables. Results: 316 pregnant women participated in the study. The prevalence of FI was 45.1% (CI95% = 39.6-50.6). Adjusted analysis showed higher prevalence of FI in pregnant women with 30 years of age or older (PR = 1.66; IC95% = 1.02-2.69), with black skin or indigenous background (PR= 1.39; CI95%= 1.08-1.79), with 7 years of education or less (PR = 1.58; CI95% = 1.14-2.19), and with lower income (PR = 2.07; CI95% = 1.36-3.14). Conclusions: There was a high prevalence of FI among pregnant women, particularly among those of older age and with worse socioeconomic conditions, a group that should be considered a priority for actions aimed at promoting food security.
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de Almeida KJQ, de Roure FN, Bittencourt RJ, dos Santos RMDB, Bittencourt FV, Gottems LBD, Amorim FF. Active health Ombudsman service: evaluation of the quality of delivery and birth care. Rev Saude Publica 2018; 52:76. [PMID: 30066816 PMCID: PMC6063641 DOI: 10.11606/s1518-8787.2018052017291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/03/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To evaluate the active health Ombudsman service as an instrument to evaluate the quality of delivery and birth care in the Cegonha Network of the Federal District of Brazil. METHODS This is a cross-sectional study of the telephone survey type carried out with 1,007 mothers with deliveries between October 15, 2013 and November 19, 2013 in the twelve public maternity hospitals that make up the Cegonha Network of the Federal District of Brazil. The instrument has 25 multiple choice or Likert scale questions, including sociodemographic data and acceptability evaluation in five domains: accessibility, relationship between the patient and health professionals, conditions of the structure of the service, information to the patient, and equity and opinion of the patient. We have studied qualitative or categorical variables according to the frequency and distribution of proportions. We have used the score transformed into a scale from zero to 100 for the analysis of the Likert-type scale questions. Results have been expressed as mean and standard deviation. RESULTS Access to prenatal appointments was evaluated as good or excellent by 86.1% of the participants and laboratory tests was evaluated as good or excellent by 85.2% of them. The access to imaging tests was evaluations as good or excellent by 45.7% of the women; 79.5% of the interviewees had their delivery in the maternity hospital where they sought initial care and 18.3% received a home visit by a community health agent after discharge. Most women reported that newborns were placed skin-to-skin immediately after birth, 48.9% had a companion at the time of the delivery, 76.3% were advised about the first appointment of the newborn, and 94.8% were advised on breastfeeding in the maternity hospital. Regarding the evaluation of health professionals, 85.9% of the women considered reception and cordiality as good or excellent at the prenatal care and 94.8% considered it as good or excellent at the maternity hospital. CONCLUSIONS The active health Ombudsman service has contributed to evaluate the quality of public management by allowing the incorporation of the perspective of users of the health service in the evaluation of the acceptability of the Cegonha Network in the Federal District of Brazil.
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Affiliation(s)
| | - Francis Nakle de Roure
- Secretaria de Estado de Saúde do Distrito Federal. Ouvidoria em Saúde. Brasília, DF, Brasil
| | - Roberto José Bittencourt
- Escola Superior de Ciências da Saúde. Coordenação de Pós-Graduação e Extensão Brasília, DF, Brasil
| | | | - Fernanda Viana Bittencourt
- Fundação de Ensino e Pesquisa em Ciências da Saúde. Coordenação de Projetos Estratégicos. Brasília, DF, Brasil
| | | | - Fábio Ferreira Amorim
- Escola Superior de Ciências da Saúde. Coordenação de Pós-Graduação e Extensão Brasília, DF, Brasil
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Junges CF, Brüggemann OM, Knobel R, Costa R. Support actions undertaken for the woman by companions in public maternity hospitals. Rev Lat Am Enfermagem 2018; 26:e2994. [PMID: 29947720 PMCID: PMC6051743 DOI: 10.1590/1518-8345.2251.2994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/26/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify the support actions undertaken for the woman during labor, birth, cesarean section and the postpartum period. METHOD a transversal study, undertaken in three public maternity hospitals, with a sample of 1,147 companions. The data were collected through interviews and were analyzed using descriptive statistics. The support actions were classified in four dimensions: emotional, physical, informational and relating to intermediation. RESULTS the majority of interviewees were the partner/father of the baby (76.7%). In labor, birth and the postpartum period, the actions of emotional support - such as calming, encouraging and praising, were performed by more than 80.0% of the companions; informational support, by approximately 70.0%; and intermediation by fewer than 65.0% of them. In childbirth, the emphasis on physical support was observed in assisting with walking (84.4%), and in changing position (90.4%). CONCLUSION the companions participate actively in the birth process, performing actions of support in the four dimensions. Emotional support is the most frequent, followed by physical and informational support, mainly during labor and birth. The results contribute to valuing the companion from the woman's social network in the birth scenario and to the recognition of his/her role as a provider of support.
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Affiliation(s)
- Carolina Frescura Junges
- PhD, RN, Hospital Universitário Polydoro Ernani de São Thiago,
Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Odaléa Maria Brüggemann
- PhD, Associate Professor, Departamento de Enfermagem, Universidade
Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roxana Knobel
- PhD, Adjunct Professor, Departamento de Ginecologia e Obstetrícia,
Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Roberta Costa
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade
Federal de Santa Catarina, Florianópolis, SC, Brazil
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Holanda SM, Castro RCMB, Aquin PDS, Pinheiro AKB, Lopes LG, Martins ES. INFLUÊNCIA DA PARTICIPAÇÃO DO COMPANHEIRO NO PRÉ-NATAL: SATISFAÇÃO DE PRIMÍPARAS QUANTO AO APOIO NO PARTO. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0104-070720180003800016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo: correlacionar a satisfação de primíparas quanto ao apoio e à utilidade do companheiro durante o processo de parto com a sua presença e capacitação no pré-natal. Métodos: estudo correlacional realizado com 155 primíparas no alojamento conjunto de uma maternidade terciária. Utilizou-se a subescala 6, referente ao apoio do companheiro, do Questionário de Experiência e Satisfação com o Parto. Para testar a associação entre as variáveis foi utilizado o teste do qui-quadrado, considerando-se o nível de significância de 5%. Resultados: a variável presença do companheiro no pré-natal esteve estatisticamente associada à satisfação da puérpera com o apoio (p=0,0004) e com a utilidade do apoio (p=0,007) durante o trabalho de parto, enquanto a variável capacitação do companheiro no pré-natal esteve estatisticamente associada à satisfação com o apoio (p=<0,00001) e à utilidade do apoio (p=<0,001; p=<0,00001 e p=0,006) prestado pelo companheiro durante todas as fases avaliadas (trabalho de parto, parto e pós-parto imediato). Conclusão: as associações significativas encontradas demonstram a importância de estimular a participação do parceiro no processo parturitivo e a sua capacitação.
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Teles LMR, Américo CF, Oriá MOB, Vasconcelos CTM, Brüggemann OM, Damasceno AKDC. Efficacy of an educational manual for childbirth companions: pilot study of a randomized clinical trial. Rev Lat Am Enfermagem 2018; 26:e2996. [PMID: 29742273 PMCID: PMC5942876 DOI: 10.1590/1518-8345.2277.2996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/29/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: to evaluate the effectiveness of an educational manual in the
instrumentalization of companions to provide support to the parturients and
check its influence on the satisfaction of companions and women during
vaginal delivery. Method: pilot study of a randomized controlled clinical trial with 65 companions and
puerperal women (intervention = 21 and control = 44). The previous knowledge
of the companions was evaluated at baseline. The Evaluation Form for
Companions in the Delivery Room was used to measure the actions provided and
the satisfaction with the experience, and the Questionnaire for Evaluation
of the Experience and Satisfaction of Puerperal Women with Labor and
Delivery was used to evaluate the satisfaction of women with childbirth. The
Student’s t-test or Wilcoxon, chi-square or Fisher’s exact test, risk ratios
and 95% confidence intervals were used. Results: the companions in the intervention group performed a greater number of
support actions (7.2 vs 4.6, p: 0.001) and had higher satisfaction scores
(72.4 vs 64.2; p = 0.00). Puerperal women in the intervention group had
higher satisfaction with childbirth (119.6 vs 107.9; p: 0.000). Conclusion: the manual was effective for the instrumentalization of companions,
contributed to support actions to the parturients and had repercussions on
the satisfaction of companions and women with the birthing process.
RBR-776d9s
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Andina-Diaz E, Ovalle-Perandones MA, Ramos-Vidal I, Camacho-Morell F, Siles-Gonzalez J, Marques-Sanchez P. Social Network Analysis Applied to a Historical Ethnographic Study Surrounding Home Birth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E837. [PMID: 29695089 PMCID: PMC5981876 DOI: 10.3390/ijerph15050837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022]
Abstract
Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health.
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Affiliation(s)
- Elena Andina-Diaz
- Health Research Group, Welfare and Social and Health Sustainability (SALBIS), Faculty of Health Science, University of León, Vegazana Campus, s/n, 24071 León, Spain.
| | - Mª Antonia Ovalle-Perandones
- Library and Information Science Department, Faculty of Humanities, Communication and Documentation, Carlos III University, 28903 Getafe, Madrid, Spain.
| | - Ignacio Ramos-Vidal
- Social Psychology Department, University of Seville, 41004 Seville, Spain.
- School of Social and Human Sciences, Pontifical Bolivarian University, Medellín, Colombia.
| | - Francisca Camacho-Morell
- Delivery Room, La Ribera University Hospital, 46600 Alcira, Valencia, Spain.
- Faculty of Nursing and Podiatry University of Valencia, 46010 Valencia, Spain.
| | - Jose Siles-Gonzalez
- Faculty of Health Sciences, University of Alicante, 03690 San Vicente del Raspeig, Alicante, Spain.
| | - Pilar Marques-Sanchez
- Health Research Group, Welfare and Social and Health Sustainability (SALBIS), Faculty of Health Science, University of León, Ponferrada Campus, s/n, 24401 Ponferrada, León, Spain.
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Brüggemann OM, Ebsen ES, Ebele RR, Batista BD. [Possibilities of inclusion of the partner in deliveries in public institutions]. CIENCIA & SAUDE COLETIVA 2018; 21:2555-64. [PMID: 27557028 DOI: 10.1590/1413-81232015218.16612015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/05/2015] [Indexed: 11/21/2022] Open
Abstract
Qualitative research, with an exploratory and descriptive approach, was conducted between September 2011 and February 2012, aimed at revealing the possibility of inclusion of the partner in deliveries in institutions that currently restrict their presence. Twelve nurses responsible for obstetric centers and five technical directors of health institutions of Santa Catarina, who did not allow or infrequently allowed the presence of the partner during delivery, were interviewed. Data were analyzed using Bardin Content Analysis, with the support of ATLAS.ti software. The possibilities of including the partner are permitted in three categories: I - Labor pain process; II - Receptiveness of professionals to the partner; and III - Empowerment of patients. Although some institutions limit the presence of the partner, they describe aspects that favor their inclusion. From the results presented, it is suggested that these enabling elements could be bolstered with management strategies, ongoing learning and intersectoral actions.
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Affiliation(s)
- Odaléa Maria Brüggemann
- Departamento e Programa de Pós-Graduação em Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Erika Simas Ebsen
- Departamento e Programa de Pós-Graduação em Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Romana Raquel Ebele
- Departamento e Programa de Pós-Graduação em Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
| | - Bruna Daniela Batista
- Departamento e Programa de Pós-Graduação em Enfermagem, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina. Campus Universitário, Trindade. 88040-900 Florianópolis SC Brasil.
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Monguilhott JJDC, Brüggemann OM, Freitas PF, d'Orsi E. Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil. Rev Saude Publica 2018; 52:1. [PMID: 29364356 PMCID: PMC5772405 DOI: 10.11606/s1518-8787.2018052006258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 10/19/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.
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Affiliation(s)
| | | | - Paulo Fontoura Freitas
- Núcleo de Orientação em Epidemiologia, Universidade do Sul de Santa Catarina, Palhoça, SC, Brasil
| | - Eleonora d'Orsi
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
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Fathi Najafi T, Latifnejad Roudsari R, Ebrahimipour H. The best encouraging persons in labor: A content analysis of Iranian mothers' experiences of labor support. PLoS One 2017; 12:e0179702. [PMID: 28683112 PMCID: PMC5499987 DOI: 10.1371/journal.pone.0179702] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 06/03/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIMS The process of giving birth is very stressing for the mother. Meanwhile, maternity ward staff's lack of awareness of mothers' fears make mothers feel lonely and helpless. This study aimed to explore women's perceptions of labor support during vaginal delivery. MATERIALS AND METHODS This exploratory qualitative study used qualitative content analysis to explore Iranian mothers' experiences of labor support. Data were collected using observations and semi-structured interviews with 25 individuals. The participants were recruited through a purposive sampling method. RESULTS Three categories, including "involvement of the spouse in the labor process", "asking for a companion during labor", and "mother's self-care to cope with labor pain", emerged during data analysis. These categories were merged to form the main theme of "trying to comply with the labor process". CONCLUSION Women believed that the presence of a companion, e.g. their husband, a family member, or a doula, during labor helped them better deal with the labor process, particularly when they felt lonely. Health care providers are expected to consider the needs of mothers and try to provide holistic support for mothers during labor pain. IMPLICATIONS FOR PRACTICE It seems that some mothers adopted particular coping strategies without receiving any relevant training. It is noteworthy that although mothers may make every effort to minimize their pain, health professionals should also practice medical approaches to help them through the process of labor.
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Affiliation(s)
- Tahereh Fathi Najafi
- PhD Student, Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Robab Latifnejad Roudsari
- Associated Professor, Evidence-Based Care Research Centre, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hossein Ebrahimipour
- Associate Professor in Health Services Management, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Leal MDC, Gama SGND, Pereira APE, Pacheco VE, Carmo CND, Santos RV. A cor da dor: iniquidades raciais na atenção pré-natal e ao parto no Brasil. CAD SAUDE PUBLICA 2017; 33Suppl 1:e00078816. [DOI: 10.1590/0102-311x00078816] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 01/09/2017] [Indexed: 11/22/2022] Open
Abstract
Poucas pesquisas com foco nas influências da raça/cor no tocante à experiência de gestação e parto foram conduzidas no Brasil, sendo inédita a análise de abrangência nacional. Este estudo teve como objetivo avaliar as iniquidades na atenção pré-natal e parto de acordo com a raça/cor utilizando o método de pareamento baseado nos escores de propensão. Os dados são oriundos da pesquisa Nascer no Brasil: Pesquisa Nacional sobre Parto e Nascimento, um estudo de base populacional de abrangência nacional com entrevista e avaliação de prontuários de 23.894 mulheres em 2011/2012. Regressões logísticas simples foram utilizadas para estimar as razões de chance (OR) e respectivos intervalos de 95% de confiança (IC95%) da raça/cor associada aos desfechos analisados. Em comparação às brancas, puérperas de cor preta possuíram maior risco de terem um pré-natal inadequado (OR = 1,6; IC95%: 1,4-1,9), falta de vinculação à maternidade (OR = 1,2; IC95%: 1,1-1,4), ausência de acompanhante (OR = 1,7; IC95%: 1,4-2,0), peregrinação para o parto (OR = 1,3; IC95%: 1,2-1,5) e menos anestesia local para episiotomia (OR = 1,5 (IC95%: 1,1-2,1). Puérperas de cor parda também tiveram maior risco de terem um pré-natal inadequado (OR = 1,2; IC95%: 1,1-1,4) e ausência de acompanhante (OR = 1,4; IC95%: 1,3-1,6) quando comparadas às brancas. Foram identificadas disparidades raciais no processo de atenção à gestação e ao parto evidenciando um gradiente de pior para melhor cuidado entre mulheres pretas, pardas e brancas.
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Brüggemann OM, Ebele RR, Ebsen ES, Batista BD. [In vaginal and cesarean deliveries, a companion is not allowed in the room: discourses of nurses and technical directors]. ACTA ACUST UNITED AC 2016; 36 Spec No:152-8. [PMID: 27057714 DOI: 10.1590/1983-1447.2015.esp.53019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To understand the reasons why health institutions from the state of Santa Catarina, Brazil prevent the presence of a companion in vaginal and caesarean delivery, from the perspective of nurses and technical directors. METHOD Exploratory-descriptive, qualitative research. A total of 12 nurses and five technical directors were interviewed from September/2011 to February/2012. The reports were analyzed according to the Collective Subject Discourse. RESULTS In the central ideas of restrictions to the companion we may cite: the operating room is not the place for a companion; in the delivery room companions are not allowed to come in; the companion does not have emotional and psychological preparation; lack of participation in prenatal care hinders the entrance of the companion; if the companion does not ask, he does not come in, but if he requires, he may come in. FINAL CONSIDERATIONS The companion impediment is guided by pre-conceived ideas that can negatively interfere in the organization of the birth process.
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Affiliation(s)
- Odaléa Maria Brüggemann
- Departamento de Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brasil
| | - Romana Raquel Ebele
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brasil
| | - Erika Simas Ebsen
- Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brasil
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Oliveira FAMD, Leal GCG, Wolff LDG, Gonçalves LS. [The use of Bologna Score to assess normal labor care in maternities]. ACTA ACUST UNITED AC 2016; 36 Spec No:177-84. [PMID: 27057717 DOI: 10.1590/1983-1447.2015.esp.56940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 11/25/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess care during labor and delivery in habitual risk maternity units in a capital in southern Brazil. METHOD It is an evaluation research, retrospective, quantitative, developed in three hospitals. The variables relating to the Bologna Score (presence of a companion, use of partograph, absence of stimulation to labor, delivery in non-supine position; skin-to-skin mother with newborn) were collected in 406 records, tabulated in spreadsheets and submitted to simple frequency analysis. Collection lasted from June to September 2014. RESULTS The assigned scores range from 0 to 5, according to the performance or not of practical activities. The following scores were obtained: 0 (7%); 1 (44,1%); 2 (40,4%); 3 (12,1%), 4 (2,5%), e 5 (0,2%). CONCLUSION In the usual risk maternities evaluated, the labor and birth care provided do not match the standards recommended by the World Health Organisation.
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Batista LE, Rattner D, Kalckmann S, Oliveira MCGD. Humanização na atenção à saúde e as desigualdades raciais: uma proposta de intervenção. SAUDE E SOCIEDADE 2016. [DOI: 10.1590/s0104-12902016146290] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo O artigo relata a proposta de ação/intervenção "Humanização do parto e nascimento: questões étnico/racial e de gênero", desenvolvida no Hospital Geral de São Mateus Dr. Manoel Bifulco em São Paulo (SP), que objetivou sensibilizar a equipe do hospital para a mortalidade materna de mulheres negras. Foram utilizados como fontes documentais relatórios de gestão, convênio estabelecido, relatórios de ordenamento de despesas e o livro Nascer com equidade. São descritas as sete etapas desenvolvidas: sensibilização e negociação na Secretaria de Estado da Saúde de São Paulo (SES-SP); negociação com o Ministério da Saúde; sensibilização e pactuação com o serviço de saúde; diagnóstico da situação; sensibilização dos profissionais para as questões de gênero e raça/cor, com a introdução do quesito "cor" nos sistemas de informação; formação dos profissionais do hospital; e formação do movimento social. O projeto teve como resultados a inclusão do quesito "cor" na Autorização de Internação Hospitalar; a sensibilização da equipe para as especificidades da saúde da mulher negra; e a mudança de percepção da equipe em relação à presença do pai na hora do nascimento, gerando a campanha "Pai não é visita". O projeto foi efetivo na abordagem de temas complexos.
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Theme Filha MM, Ayers S, da Gama SGN, Leal MDC. Factors associated with postpartum depressive symptomatology in Brazil: The Birth in Brazil National Research Study, 2011/2012. J Affect Disord 2016; 194:159-67. [PMID: 26826865 DOI: 10.1016/j.jad.2016.01.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/28/2015] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression is one of the most common postpartum mental disorders. Many sociodemographic and individuals risk factors are associated with maternal depression but the impact of high levels of birth intervention is unclear. The Brazilian context is characterized by excessive intervention and frequent non-compliance with recommended obstetric protocols. This study therefore examined the impact of sociodemographic, individual, and obstetric risk factors in postpartum depression. METHODS The Birth in Brazil research study is a national study of 23,894 postpartum women. Information about depression was obtained by telephone interview at 6-18 months after birth and was measured using the Edinburgh Postnatal Depression Scale. RESULTS The prevalence of probable cases of depression was 26.3%. A multiple logistic regression model identified significant sociodemographic and individual risk factors as: brown skin color (OR=1.15 CI 1.01-1.31), lower economic class (OR=1.70 CI 1.41-2.06), alcohol use (OR=1.41 CI 1.09-1.84) and a history of mental disorders (OR=3.13 CI 1.80-5.44). Significant obstetric factors were unplanned pregnancy (OR=1.22 CI 1.05-1.43 for wanted later and OR=1.38 CI 1.20-1.60 for never wanted), multiparity (OR=1.97 CI 1.58-2.47 for 3 or more children), and poor care during birth (OR=2.02 CI 1.28-3.20) or of the newborn (OR=2.16 CI 1.51-3.10). Obstetric interventions and complications were not associated with maternal depression. LIMITATIONS Depression was measured only once so we are not able to examine the course over time. The associational and reverse causality cannot be ruled out for some variables. CONCLUSIONS The prevalence of postpartum depression is high in Brazilian women six months after birth. Poor care of women and babies during birth is more important in postpartum depression than physical obstetric or neonatal intervention and complications.
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Affiliation(s)
- Mariza Miranda Theme Filha
- Department of Epidemiology and Quantitative Methods on Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City University, London, UK.
| | | | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods on Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Brüggemann OM, Koettker JG, Velho MB, Monguilhott JJDC, Monticelli M. Satisfaction of companions with the experience of supporting the parturient at a university hospital. ACTA ACUST UNITED AC 2015. [DOI: 10.1590/0104-07072015004220014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A cross-sectional study that aimed to assess the satisfaction of companions with the experience of supporting the parturient, and to identify the related factors. Data were collected at a university hospital in Southern Brazil, by means of semi-structured interviews with 314 caregivers, between October of 2009 and January of 2010. The satisfaction scores were determined by the Cronbach's alpha coefficient. The Kruskal-Wallis and the Mann-Whitney tests estimated the related factors. The mean satisfaction of the companions was high in three domains: 1) How the woman and the newborn were cared for (92,6; SD=11.5), 2) Welcoming in each place (89,9; SD=12.9), and 3) Explanation about what was happening (88,9; SD=14.1). The educational level was statistically related to the satisfaction in domain 3, not being present in the delivery room was statistically related to domain 1, and not receiving instructions from the physician regarding his role was statistically related to domain 2. The companions manifested high satisfaction with the experience of providing support to the women.
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Tesser CD, Knobel R, Andrezzo HFDA, Diniz SG. Violência obstétrica e prevenção quaternária: o que é e o que fazer. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2015. [DOI: 10.5712/rbmfc10(35)1013] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
O objetivo deste artigo é justificar a necessidade de prevenção quaternária frente à 'violência obstétrica' (VO), terminologia que agrupa todas as formas de violência e danos originados no cuidado obstétrico profissional, bem como discutir estratégias e ações de prevenção quaternária a serem realizadas pelos médicos de família e comunidade (MFC), pelas equipes de atenção primária à saúde (APS) e suas entidades associativas. A prevalência de violência obstétrica no Brasil é alta: ¼ das mulheres relata terem sofrido maus-tratos durante o atendimento ao parto, além de excesso de intervenções desnecessárias (como venóclise, ocitocina de rotina e episiotomia) e privação de uma assistência baseada em boas práticas, tais como parto em posição vertical, possibilidade de se alimentar e de se movimentar durante o trabalho de parto e presença de um acompanhante. Destaca-se o excesso crônico de cesarianas (55,6% do total de nascimentos) no Brasil, mais prevalente no setor privado (85%) do que no público (40%). Ações de prevenção quaternária dirigidas à VO são propostas e discutidas, como: (1) a elaboração (individual e coletiva) de planos de parto orientados pelas equipes de APS no pré-natal (para os quais se oferece um roteiro); (2) a introdução de outros profissionais qualificados no cuidado ao parto de risco habitual (incluindo MFC capacitados); e (3) a participação dos MFC e profissionais da APS e suas associações no movimento social e político pela “humanização” do parto, com apoio às mudanças nas maternidades já em funcionamento e às novas iniciativas de serviços de cuidado ao parto.
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Gonçalves ADC, Rocha CMD, Gouveia HG, Armellini CJ, Moretto VL, Moraes BA. O acompanhante no centro obstétrico de um hospital universitário do sul do Brasil. Rev Gaucha Enferm 2015; 36 Spec No:159-67. [DOI: 10.1590/1983-1447.2015.esp.57289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/20/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivos Verificar a prevalência de acompanhante, o tipo de vínculo com a mulher e as justificativas para sua ausência no Centro Obstétrico de um hospital universitário de Porto Alegre (RS). Métodos Estudo quantitativo, transversal, realizado com 385 mulheres no período de agosto a novembro de 2012. Procedeu-se à análise descritiva. Resultados Constataram-se 97,1% de acompanhantes no trabalho de parto; 90,6% no parto; 28,6% na recuperação pós-parto; e 87,1% na realização dos primeiros cuidados com o recém-nascido. O companheiro da mulher foi o acompanhante predominante em todos os momentos. O motivo mais citado para a sua ausência na recuperação pós-parto foi “não permitido” (57,8%). Conclusões A Instituição cumpre as determinações legais referentes à presença de acompanhante, no entanto, ainda há necessidade de sensibilização dos profissionais de saúde quanto à importância do acompanhante no pós-parto imediato, assim como de adequações do espaço físico do local, favorecendo a presença desse suporte à mulher.
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Leal MDC, Pereira APE, Domingues RMSM, Filha MMT, Dias MAB, Nakamura-Pereira M, Bastos MH, Gama SGND. Intervenções obstétricas durante o trabalho de parto e parto em mulheres brasileiras de risco habitual. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-16. [DOI: 10.1590/0102-311x00151513] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/01/2013] [Indexed: 11/21/2022] Open
Abstract
Este artigo avaliou o uso das boas práticas (alimentação, deambulação, uso de métodos não farmacológicos para alívio da dor e de partograma) e de intervenções obstétricas na assistência ao trabalho de parto e parto de mulheres de risco obstétrico habitual. Foram utilizados dados da pesquisa Nascer no Brasil, estudo de base hospitalar realizada em 2011/2012, com entrevistas de 23.894 mulheres. As boas práticas durante o trabalho de parto ocorreram em menos de 50% das mulheres, sendo menos frequentes nas regiões Norte, Nordeste e Centro-oeste. O uso de ocitocina e amniotomia foi de 40%, sendo maior no setor público e nas mulheres com menor escolaridade. A manobra de Kristeller, episiotomia e litotomia foram utilizada, em 37%, 56% e 92% das mulheres, respectivamente. A cesariana foi menos frequente nas usuárias do setor público, não brancas, com menor escolaridade e multíparas. Para melhorar a saúde de mães e crianças e promover a qualidade de vida, o Sistema Único de Saúde (SUS) e, sobretudo o setor privado, necessitam mudar o modelo de atenção obstétrica promovendo um cuidado baseado em evidências científicas.
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