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de Oliveira Paes LB, Fabbro MRC, de Oliveira Toso BRG, de Castro Bussadori JC, Ruiz MT, Salim NR, Wernet M, Silveira AO, de Abreu D Agostini FCP. Factors intervening in the childbirth experience: a mixed-methods study. BMC Pregnancy Childbirth 2024; 24:14. [PMID: 38166863 PMCID: PMC10759435 DOI: 10.1186/s12884-023-06175-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To analyze the childbirth experience focusing on the intervening factors and on the delivery method. METHOD A sequential and explanatory mixed-methods study guided by the World Health Organization document for positive childbirth experiences. The participants were puerperal women in a maternity teaching hospital from inland São Paulo (Brazil). The first quantitative stage involved descriptive analysis with Poisson regression of 265 answers to the "Termômetro da Iniciativa Hospital Amigo da Mulher e da Criança" ("Women- and Baby-Friendly Hospital Initiative Thermometer") questionnaire. The second stage, qualitative, thematically analyzed the interviews conducted with 44 puerperal women who took part in the first stage. Data integration was by connection. THE RESULTS AND DISCUSSION The analysis by connection showed that among the factors that restricted the positive experience, C-section was predominant (61.9%), understood as an option due to fear of pain, the treatment modality and previous traumas. Restrictions referring to the presence of a companion (99.6%), not having privacy (83%), disrespectful situations (69.5%), too many touches (56.9%) and the absence of skin-to-skin contact (55%), among others, potentiated fear, loneliness, concern, shame, the perception of disrespect and insecurity with the assistance provided. The promoting factors were as follows: choosing the companion (95.4%) for collaborating in the safety perception, not having infections (83.9%), having continuous team monitoring (82.2%) and pain relief methods (78.9%), which were valued by the women. CONCLUSION The intervening factors that promoted positive experiences were related to clinical and protocol-related issues and to service availability. The restrictive factors were associated with excess interventions, deprivation of rights and of choice, absence of privacy and restriction referring to the presence of a companion. Women with a normal postpartum period felt more insecure and disrespected when compared to those subjected to C-sections, whose choices were considered, although they had lower prevalence of skin-to-skin contact. There is an urgent need to apprehend women's experiences and turn them into actions that guarantee their lives in a safe and respectful way.
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Affiliation(s)
| | | | | | | | | | - Natália Rejane Salim
- Federal University of Sao Carlos, São Carlos, SP, 13565-905, Rod. Washington Luís, s/n, Brazil
| | - Monika Wernet
- Federal University of Sao Carlos, São Carlos, SP, 13565-905, Rod. Washington Luís, s/n, Brazil
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Marmitt LP, Cordeiro MF, Cesar JA. Trend and Inequality in Episiotomy in Southern Brazil, 2007-2016: Evidence of Reduced Abusive Practice. Matern Child Health J 2021; 26:1231-1238. [PMID: 34839433 DOI: 10.1007/s10995-021-03291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. METHODS We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48 h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. RESULTS This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4-73.5) in 2007 to 40.1% (95%CI: 37.3-42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. CONCLUSIONS FOR PRACTICE Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status.
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Affiliation(s)
- Luana P Marmitt
- Universidade Federal do Rio Grande (FURG), Rua General Osorio, Rio Grande, RS, 96201-900, Brazil.
- Universidade do Oeste de Santa Catarina (Unoesc), Rua Getúlio Vargas, 2125-Bairro Flor da Serra, Joaçaba, SC, 89600-000, Brazil.
| | - Marcos F Cordeiro
- Universidade do Oeste de Santa Catarina (Unoesc), Rua Getúlio Vargas, 2125-Bairro Flor da Serra, Joaçaba, SC, 89600-000, Brazil
| | - Juraci A Cesar
- Universidade Federal do Rio Grande (FURG), Rua General Osorio, Rio Grande, RS, 96201-900, Brazil
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Farrington E, Connolly M, Phung L, Wilson AN, Comrie-Thomson L, Bohren MA, Homer CSE, Vogel JP. The prevalence of uterine fundal pressure during the second stage of labour for women giving birth in health facilities: a systematic review and meta-analysis. Reprod Health 2021; 18:98. [PMID: 34006288 PMCID: PMC8132352 DOI: 10.1186/s12978-021-01148-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine fundal pressure involves a birth attendant pushing on the woman's uterine fundus to assist vaginal birth. It is used in some clinical settings, though guidelines recommend against it. This systematic review aimed to determine the prevalence of uterine fundal pressure during the second stage of labour for women giving birth vaginally at health facilities. METHODS The population of interest were women who experienced labour in a health facility and in whom vaginal birth was anticipated. The primary outcome was the use of fundal pressure during second stage of labour. MEDLINE, EMBASE, CINAHL and Global Index Medicus databases were searched for eligible studies published from 1 January 2000 onwards. Meta-analysis was conducted to determine a pooled prevalence, with subgroup analyses to explore heterogeneity. RESULTS Eighty data sets from 76 studies (n = 898,544 women) were included, reporting data from 22 countries. The prevalence of fundal pressure ranged from 0.6% to 69.2% between studies, with a pooled prevalence of 23.2% (95% CI 19.4-27.0, I2 = 99.97%). There were significant differences in prevalence between country income level (p < 0.001, prevalence highest in lower-middle income countries) and method of measuring use of fundal pressure (p = 0.001, prevalence highest in studies that measured fundal pressure based on women's self-report). CONCLUSIONS The use of uterine fundal pressure on women during vaginal birth in health facilities is widespread. Efforts to prevent this potentially unnecessary and harmful practice are needed.
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Affiliation(s)
- Elise Farrington
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Mairead Connolly
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Laura Phung
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Alyce N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Liz Comrie-Thomson
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, School of Population and Global Health, Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Joshua P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, VIC, 2010, Australia
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Marrero L, Brüggemann OM, Costa R, Junges CF, Scheneck CA. Violência institucional referida pelo acompanhante da parturiente em maternidades públicas. ACTA PAUL ENFERM 2020; 33:eAPE20190220. [DOI: 10.37689/actaape/2020ao02202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ritter SK, Gonçalves ADC, Gouveia HG. Práticas assistenciais em partos de risco habitual assistidos por enfermeiras obstétricas. ACTA PAUL ENFERM 2020; 33:eAPE20180284.. [DOI: 10.37689/acta-ape/2020ao0284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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