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Węgrzynowska M, Nenko I, Raczkiewicz D, Baranowska B. Investment in the peace of mind? How private services change the landscape of maternity care in Poland. Soc Sci Med 2023; 337:116283. [PMID: 37857238 DOI: 10.1016/j.socscimed.2023.116283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
For over two decades midwifery research advocated for the continuity of care and the ability to establish a relationship between care providers and care users as an important features of quality maternity services. In many countries, while unavailable through public services, continuity of care became commercialized and can be access as a private service. In Poland, private prenatal consultations and dedicated midwifery care allow women to access continuity and establish personal relationships with care providers. In this study, we explore, how accessing these private services, impact the rates of medical interventions and type of care women receive during labour and birth. We analyse data collected through an online questionnaire from 4402 first-time mothers in healthy pregnancy who had given birth in Poland between 2020 and 2021. We show that while private consultation did not translate into any significant differences in care, women who accessed private dedicated midwifery services experienced more attentive and less medicalized care, namely were more likely to give birth in vertical position, move freely during labour and less likely to experience emergency caesarean section. However, private dedicated midwifery care did not shield them from negative experience. While private care offers benefits for women who can afford it, it also contributes to inequalities in access to quality care and puts women with less social and financial resources in a vulnerable position. Efforts should be made to develop a more universal and equitable model of care that allows for building personal relationships between maternity care providers and women.
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Affiliation(s)
- Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Ilona Nenko
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
| | - Dorota Raczkiewicz
- Department of Medical Statistics, Centre of Postgraduate Medical Education, Warsaw, Poland.
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland.
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Souza FC, Domingues RMSM, Torres JA, Gomes ML, Leal MDC. Evaluation of labor and childbirth care by nurse-midwives in Brazilian private hospitals: results of a quality improvement project. Reprod Health 2023; 20:17. [PMID: 36658552 PMCID: PMC9850504 DOI: 10.1186/s12978-022-01537-0] [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] [Accepted: 11/25/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In 2015, a quality improvement project-the "Adequate Childbirth Project" (Projeto Parto Adequado, or PPA)-was implemented in Brazilian private hospitals with the goal of reducing unnecessary cesarean sections. One of the strategies adopted by the PPA was the implementation of labor and childbirth care by nurse-midwives. The objective of this study is to evaluate the results of the PPA in the implementation and adequacy of labor and childbirth care by nurse-midwives in Brazilian private hospitals. METHODS Cross-sectional, hospital-based study, carried out in 2017, in 12 hospitals participating in the PPA. We assessed the proportion of women assisted by nurse-midwives during labor and childbirth care and the adequacy of 13 care practices following parameters of the World Health Organization. Women assisted in the PPA model of care and in the standard of care model were compared using the chi-square statistical test. RESULTS 4798 women were interviewed. Women in the PPA model of care had a higher proportion of labor (53% × 24.2%, p value < 0.001) and vaginal birth (32.7% × 11.3%, p value < 0.001), but no significant differences were observed in the proportion of women assisted by nurse-midwives during labor (54.8% × 50.1%, p value = 0.191) and vaginal birth (2.2% × 0.7%, p value = 0.142). The implementation of recommended practices was adequate, except the use of epidural analgesia for pain relief, which was intermediate. There was a greater use of recommended practices including "oral fluid and food", "maternal mobility and position", "monitoring of labor", "use of non-pharmacological methods for pain relief" and "epidural analgesia for pain relief" in women assisted by nurse-midwives in relation to those assisted only by doctors. Many non-recommended practices were frequently used during labor by nurse-midwives and doctors. CONCLUSIONS There was an increase in the proportion of women with labor and vaginal birth in the PPA model of care and an appropriate use of recommended practices in women assisted by nurse-midwives. However, there was no difference in the proportion of women assisted by nurse-midwives in the two models of care. The expansion of nursing participation and the reduction of overused practices remain challenges.
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Affiliation(s)
- Fabrine C Souza
- Programa de pós-graduação em epidemiologia em saúde pública, Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil.
| | - Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Maysa Luduvice Gomes
- Faculdade de Enfermagem, Departamento de Enfermagem Materno-Infantil, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Rozée V, Schantz C. [Gynecological and obstetric violence: the construction of a political and public health issue]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:629-634. [PMID: 35485119 DOI: 10.3917/spub.215.0629] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The concept of “gynecological and obstetric violence”, which emerged in the early 2000s in Latin America in activist and scientific circles, has been debated since the 2010s in French and European feminist and political circles. We show here how this concept is defined, what realities and practices it covers and by whom and in what context it is used in the public space in France and internationally, and in academic research. This concept allows for a new approach to medical care in gynecology and obstetrics that takes into account the experiences, both objective and subjective, of women and medical practices that are now technical, sometimes impersonal and disrespectful. Although there is a growing body of work in the social sciences that uses this conceptual approach, it focuses more on childbirth and less on strictly gynecological medical care.
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Mirouse L. Ignoring international alerts? The routinization of episiotomy in France in the 1980s and 1990s. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:42-52. [PMID: 34693044 PMCID: PMC8517717 DOI: 10.1016/j.rbms.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/20/2021] [Accepted: 07/12/2021] [Indexed: 06/13/2023]
Abstract
As scientific evidence from the UK and the USA in the 1980s was questioning the usefulness of episiotomy, the rate in France increased from 38% in 1981 to 58.4% in 1996. In 1996, the World Health Organization recommended limiting the episiotomy rate to 10%. This article aims to examine this paradox through an analysis of the French medical debate on episiotomy during the 1980s and 1990s. Drawing on an analytical corpus composed of 192 articles published in French professional journals of obstetrician-gynaecologists and midwives, it shows that the majority of these health professionals considered episiotomy to be a preventive intervention. The most influential professional organizations and experts manage to refute most of the international alerts on the limitations and side effects of episiotomy through the constant production of new justifications and competing knowledge for the procedure. In the 1980s, episiotomy was seen as a means to prevent tearing and thus avoid perineal dysfunction. Episiotomy and perineal re-education (which developed into a new health sector) were put forward as 'the' solution to the problem. From the mid-1990s onwards, the focus shifted from the mother to the baby as episiotomy was promoted as a way to reduce the risk of newborn mortality and morbidity. This article shows that the alerts and controversies on the assumed iatrogenic effects of biomedical technologies and practices were silenced through efficient and dynamic production of competing knowledge about their assumed benefits.
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Affiliation(s)
- Lola Mirouse
- Centre for the Study of Social Movements (EHESS/CNRS UMR8044/Inserm U1276), Paris, France
- ANR Hypmedpro, School for Advanced Studies in the Social Sciences, Paris, France
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Maphanga CM, Naidoo TD. The perception and knowledge about episiotomy: A cross-sectional survey involving healthcare workers in a low- and middle-income country. Afr J Prim Health Care Fam Med 2021; 13:e1-e6. [PMID: 33970009 PMCID: PMC8111667 DOI: 10.4102/phcfm.v13i1.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Episiotomy was introduced into clinical practice without clear evidence of its benefits.The knowledge and understanding of episiotomy guidelines and practice by healthcare workers is substandard in our setting; hence, the injudicious use of this procedure have led to high rates. AIM To assess the knowledge, perception and practice of episiotomy by healthcare workers. SETTING Research was conducted in a Pietermaritzburg complex, South AfricaMethods: A questionnaire-based survey was conducted amongst healthcare workers regarding episiotomy practice. In addition to providing demographic data, the participants were requested to respond to 35 proposed statements regarding episiotomy practice. Data were analysed using SPSS (Statistical Package for the Social Sciences) software. RESULTS One hundred and forty-two midwives and 66 medical practitioners completed the questionnaires. There were variations in responses to several statements on episiotomy practice by medical practitioners and nurses based on their level of experience. This study found that the majority of HCWs did not have access to a protocol or policy on episiotomy practice in their units; furthermore, nor knowledge of the South African guidelines for maternity care on episiotomy practice. Significantly, more medical practitioners felt a need for more in-service training and an increase in the number of episiotomies performed under supervision. The commonly reported reason for performing an episiotomy by both medical practitioners and midwives was to reduce 3rd - 4th degree perineal tears. CONCLUSION Healthcare workers in our setting displayed poor knowledge about the practice of episiotomy and were not aware of existing national guidelines on episiotomy practice.
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Affiliation(s)
- Cyprian M Maphanga
- Department Obstetrics and Gynaecology, Greys Hospital, Pietermaritzburg, South Africa; and, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg.
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Schantz C, Pantelias AC, de Loenzien M, Ravit M, Rozenberg P, Louis-Sylvestre C, Goyet S. 'A caesarean section is like you've never delivered a baby': A mixed methods study of the experience of childbirth among French women. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2021; 12:69-78. [PMID: 33354630 PMCID: PMC7744624 DOI: 10.1016/j.rbms.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 05/28/2023]
Abstract
The experience of childbirth has been technologized worldwide, leading to major social changes. In France, childbirth occurs almost exclusively in hospitals. Few studies have been published on the opinions of French women regarding obstetric technology and, in particular, caesarean section. In 2017-2018, we used a mixed methods approach to determine French women's preferences regarding the mode of delivery, and captured their experiences and satisfaction in relation to childbirth in two maternity settings. Of 284 pregnant women, 277 (97.5%) expressed a preference for vaginal birth, while seven (2.5%) women expressed a preference for caesarean section. Vaginal birth was also preferred among 26 women who underwent an in-depth interview. Vaginal birth was perceived as more natural, less risky and less painful, and to favour mother-child bonding. This vision was shared by caregivers. The women who expressed a preference for vaginal birth tended to remain sexually active late in their pregnancy, to find sexual intercourse pleasurable, and to believe that vaginal birth would not enlarge their vagina. A large majority (94.5%) of women who gave birth vaginally were satisfied with their childbirth experience, compared with 24.3% of those who underwent caesarean section. The caring attitude of the caregivers contributed to increasing this satisfaction. The notion of women's 'empowerment' emerged spontaneously in women's discourse in this research: women who gave birth vaginally felt satisfied and empowered. The vision shared by caregivers and women that vaginal birth is a natural process contributes to the stability of caesarean section rates in France.
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Affiliation(s)
- Clémence Schantz
- Centre d’Etude des Mouvements Sociaux, CNRS/EHESS FRE2023 – INSERM U1276, Paris, France
- Centre Population et Développement, Institut de Recherche pour le Développement et Université de Paris, INSERM ERL 1244, Paris, France
| | - Anne-Charlotte Pantelias
- École de Sages-Femmes de Suresnes, Hôpital Foch, Université de Versailles Saint Quentin en Yvelines, UFR des Sciences de la Santé Simone Veil, Suresnes, France
| | - Myriam de Loenzien
- Centre Population et Développement, Institut de Recherche pour le Développement et Université de Paris, INSERM ERL 1244, Paris, France
| | - Marion Ravit
- Centre Population et Développement, Institut de Recherche pour le Développement et Université de Paris, INSERM ERL 1244, Paris, France
| | - Patrick Rozenberg
- Versailles St-Quentin University, Research Unit EA 7285, Montigny-le-Bretonneux, France
- Département d’Obstétrique et de Gynécologie, CHI Poissy-Saint Germain, Poissy, France
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Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Socio-historical evolution of the episiotomy practice: A literature review. Women Health 2019; 59:760-774. [PMID: 30615591 DOI: 10.1080/03630242.2018.1553814] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Episiotomy is an enlargement of the vaginal orifice made by a surgical incision of the perineum. This review aimed to provide a socio-historical retrospective on the practice or episiotomy. Using the criteria from the PRISMA guidelines, the authors conducted a literature review, browsing twenty databases and several papers available in the gray literature. Sixty-four articles, seven reports, and fifteen books were selected. Through this study, four eras with different approaches to episiotomy practice could be identified: 1792-1920, 1920-1980, 1980-1996, and 1996-2018. This review shows that institutionalization and medicalization of birth lead to a systematic practice of episiotomy in many westernized countries until 1996. Lay questioning and evidence-based medicine may have reversed this trend into a restrictive practice. After making an inventory of the factors associated with the evolution of change in the rate of episiotomies, the review finally revealed that evolution of the practice of episiotomy has also been influenced by ideological, political, and social factors.
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Affiliation(s)
- Christophe Clesse
- a Interpsy Laboratory (EA4432) , Université de Lorraine, Campus Lettres et Sciences Humaines , Nancy France.,b Jury-Lesmetz , Hospital Centre of Jury-les-Metz , France.,c Polyclinic Majorelle , Nancy , France
| | - Joëlle Lighezzolo-Alnot
- a Interpsy Laboratory (EA4432) , Université de Lorraine, Campus Lettres et Sciences Humaines , Nancy France
| | | | | | - Michèle Scheffler
- c Polyclinic Majorelle , Nancy , France.,d Cabinet de Gynécologie Médicale et Obstétrique , Nancy , France
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Löwy I. The birthing house as a place for birth: contextualizing the Rio de Janeiro birthing house. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2018; 25:1161-1169. [PMID: 30624484 DOI: 10.1590/s0104-59702018000500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 06/25/2018] [Indexed: 06/09/2023]
Abstract
Within the context of the creation of birthing houses around the world and different models of care for childbirth, the author proposes an analysis that contributes to the discussion about the place for birth, especially in urban Brazil.
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Affiliation(s)
- Ilana Löwy
- Centre de Recherche Médecine, Sciences, Santé, Santé Mentale, Societé (CERMES). Paris - France
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Sen G, Reddy B, Iyer A. Beyond measurement: the drivers of disrespect and abuse in obstetric care. REPRODUCTIVE HEALTH MATTERS 2018; 26:6-18. [DOI: 10.1080/09688080.2018.1508173] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Gita Sen
- Distinguished Professor & Director, Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Bhavya Reddy
- Research Associate, Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Aditi Iyer
- Senior Research Scientist & Adjunct Associate Professor, Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India
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Madhiwalla N, Ghoshal R, Mavani P, Roy N. Identifying disrespect and abuse in organisational culture: a study of two hospitals in Mumbai, India. REPRODUCTIVE HEALTH MATTERS 2018; 26:36-47. [PMID: 30102132 PMCID: PMC6178091 DOI: 10.1080/09688080.2018.1502021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This paper draws on findings from a qualitative study of two government hospitals in Mumbai, India, which aimed to provide a better understanding of the institutional drivers of disrespect and abuse (D&A) in childbirth. The paper describes the structural context, in which government hospital providers can exercise considerable power over patients, yet may be themselves vulnerable to violence and external influence. Decisions that affect care are made by a bureaucracy, which does not perceive problems with the same intensity as providers who are directly attending to patients. Within this context, while contrasting organisational cultures had evolved at the two hospitals, both were characterised by social/professional inequality and hierarchical functioning, and marginalising women. This context generates invisible pressures on subordinate staff, and creates interpersonal conflicts and ambiguity in the division of roles and responsibilities that manifest in individual actions of D&A. Services are organised around the internal logic of the institution, rather than being centred on women. This results in conditions that violate women's privacy, and disregards their choice and consent. The structural environment of resource constraints, poor management and bureaucratic decision-making leads to precarious situations, endangering women’s safety. With the institution's functioning based on hierarchies and authority, rather than adherence to universal standards or established protocols, irrational, harmful practices endorsed by senior staff are institutionalised and reproduced. A deeper focus on organisational culture, embedded in the discourse of D&A, would help to evolve effective strategies to address D&A as systemic problems.
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Affiliation(s)
- Neha Madhiwalla
- a Co-ordinator, Centre for Studies in Ethics and Rights , Anusandhan Trust , Mumbai , India
| | - Rakhi Ghoshal
- b Senior Programme Officer, Centre for Studies in Ethics and Rights , Anusandhan Trust , Mumbai , India
| | - Padmaja Mavani
- c Associate Professor, Department of Obstetrics and Gynaecology , Seth G.S. Medical College and K.E.M. Hospital , Mumbai , India
| | - Nobhojit Roy
- d Head, WHO Collaborating Centre for Research on Surgical Care Delivery in LMICS, Surgical Unit , BARC Hospital , Mumbai , India
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Stan S, Toma VV. Accumulation by Dispossession and Public–Private Biomedical Pluralism in Romanian Health Care. Med Anthropol 2018; 38:85-99. [DOI: 10.1080/01459740.2018.1492572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Sabina Stan
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Valentin-Veron Toma
- Department of Cultural Anthropology, Francisc I. Rainer Institute of Anthropology, Bucharest, Romania
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Bouchard A, Cohen de Lara A. [Birth and separation, questioning caesarean deliveries on maternal request]. SOINS. PÉDIATRIE, PUÉRICULTURE 2018; 39:34-36. [PMID: 29335150 DOI: 10.1016/j.spp.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Clinical practice and literature highlight the emergence and the growth in the number of caesareans carried out on the request of the mother without medical indication. For some women, a vaginal delivery is an anachronism, while for others it is a necessary passage towards motherhood. A reflection was carried out to illustrate the singularity behind these requests and attempt to overcome the 'for' and 'against' divide.
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Affiliation(s)
- Alexandra Bouchard
- Maternité de l'Institut hospitalier franco-britannique, 3 rue Barbès, 92300, Levallois-Perret, France; Université Paris 13-Sorbonne Paris Cité, UTRPP EA 4403, 99 avenue Jean-Baptiste Clément, 93430, Villetaneuse, France.
| | - Aline Cohen de Lara
- Université Paris 13-Sorbonne Paris Cité, UTRPP EA 4403, 99 avenue Jean-Baptiste Clément, 93430, Villetaneuse, France
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Giordano JC, Nascimento SL, Godoy-Miranda AC, Surita FG. The misleading choice for safer births in Brazilian's most developed region: a cross-sectional study. J Matern Fetal Neonatal Med 2017; 32:718-723. [PMID: 28988503 DOI: 10.1080/14767058.2017.1390558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the Cesarean Section (CS) rate in Brazilian women according to category of health insurance and individual characteristics associated with the mode of delivery. MATERIALS AND METHODS A cross-sectional study was performed in three maternity services (one public tertiary referral center, one maternity service for both public and private care, and one private maternity service) in Campinas city, Brazil. Eligibility criteria were: inpatient during the immediate postpartum period, hospital birth, single pregnancy, and live newborn. Sociodemographic and anthropometric data, reproductive history, pregnancy planning, and prenatal care information was obtained from participants. Comorbidities, type of birth, and newborn data were collected from medical records. The mode of delivery was categorized as either CS or vaginal delivery. RESULTS A total of 1276 women were included in this study. The overall CS rate was 57.5%. CS rates were 41.6, 54.8, and 90.1% for public, mixed (public and private), and private maternity services, respectively. Mean age was higher in women who had a CS (28.0 ± 6.0 years versus 25.9 ± 6.5 years, p < .0001) as was the mean Body Mass Index (25.2 ± 5.3 kg/m2 versus 23.8 ± 4.5 kg/m2, p < .0001). CS was related to higher education, employment, white skin color, planned pregnancy, antenatal care in a private service, and primiparity. CONCLUSIONS The overall CS rate was high (greater than 50%); in the private service, almost all participants had a CS delivery (90.1%). Better socioeconomic conditions and primiparity were associated with higher CS rates in Brazil. Political pressure for the management of unnecessary CSs is vital in Brazil. Together with the provision of real incentives for normal deliveries in public and, most importantly, private services.
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Morisaki N, Zhang X, Ganchimeg T, Vogel JP, Souza JPD, Cecatti JG, Torloni MR, Ota E, Mori R, Mittal S, Tough S, Dolan S, Kramer MS. Provider-initiated delivery, late preterm birth and perinatal mortality: a secondary analysis of the WHO multicountry survey on maternal and newborn health. BMJ Glob Health 2017; 2:e000204. [PMID: 28589019 PMCID: PMC5444091 DOI: 10.1136/bmjgh-2016-000204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction In high-income countries, a reduced clinical threshold for obstetric interventions such as labour induction (LI) and prelabour caesarean delivery (PLCD) has played a substantial role in increasing rates of late preterm births. However, the association between provider-initiated delivery and perinatal outcomes have not been studied in a multicountry setting including low-income and middle-income countries. Methods 286 hospitals in 29 countries participated in the WHO Multi-Country Survey on Maternal and Newborn Health and yielded 2 52 198 singleton births of at least 34 weeks in 2010–2011. We used an ecological analysis based on generalised estimating equations under multilevel logistic regression to estimate associations between hospital rates of PLCD and LI with rates of late preterm birth (34–36 weeks), stillbirth and intrahospital early neonatal death, in relation to country development based on the Human Development Index (HDI). Results Rates of LI were higher in hospitals from very high-HDI (median 10.9%) and high-HDI (11.2%) countries compared with medium-HDI (4.0%) or low-HDI (3.8%) countries. Rates of PLCD were by far the lowest in low-HDI countries compared with countries in the other three categories (5.1% vs 12.0%–17.9%). Higher rates of PLCD were associated with lower perinatal death rates (OR 0.87 (0.79, 0.95) per 5% increase in PLCD) and non-significantly with late preterm birth (1.04 (0.98, 1.10)) regardless of country development. LI rates were positively associated with late preterm birth (1.04 (1.01, 1.06)) regardless of country development and with perinatal death (1.06 (0.98, 1.15)) only in middle-HDI and low- HDI countries. Conclusion PLCD was associated with reduced perinatal mortality and non-significantly with increased late preterm birth. LI was associated with increases in both late preterm birth and, in less-developed countries, perinatal mortality. Efforts to provide sufficient, but avoid excessive, access to provider-initiated delivery should be tailored to the local context.
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Affiliation(s)
- Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Research, Setagaya-ku, Tokyo, Japan
| | - Xun Zhang
- Department of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Togoobaatar Ganchimeg
- Department of Global Health Nursing, Faculty of Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Joshua P Vogel
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Joo Paulo Dias Souza
- Department of Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Jose G Cecatti
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Maria Regina Torloni
- Evidence Based Healthcare post-graduate program, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St Luke's International University, Chuo-ku, Tokyo, Japan.,Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Suneeta Mittal
- Department of Obstetrics and Gynecology, Fortis Memorial Research Institute Gurgaon, Gurgaon, Haryana, India
| | - Suzanne Tough
- Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Siobhan Dolan
- Department of Obstetrics and Gynecology and Womens Health, Albert Einstein College of Medicine / Montefiore Medical Center, New York, NY, USA
| | - Michael S Kramer
- Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
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Schantz C, Sim KL, Petit V, Rany H, Goyet S. Factors associated with caesarean sections in Phnom Penh, Cambodia. REPRODUCTIVE HEALTH MATTERS 2016; 24:111-121. [DOI: 10.1016/j.rhm.2016.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/09/2016] [Accepted: 11/09/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Clémence Schantz
- Centre Population et Développement (Ceped), UMR 196: IRD (Institut de Recherche pour le Développement), ParisFrance
| | | | | | - Heng Rany
- Calmette Maternity Hospital, Phnom Penh, Cambodia
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Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, Diaz V, Geller S, Hanson C, Langer A, Manuelli V, Millar K, Morhason-Bello I, Castro CP, Pileggi VN, Robinson N, Skaer M, Souza JP, Vogel JP, Althabe F. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016; 388:2176-2192. [PMID: 27642019 DOI: 10.1016/s0140-6736(16)31472-6] [Citation(s) in RCA: 638] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
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Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniela Colaci
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniel Comandé
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Stacie Geller
- Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Langer
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Victoria Manuelli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Kathryn Millar
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Imran Morhason-Bello
- University of Ibadan, Ibadan, Nigeria; London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia Pileggi Castro
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vicky Nogueira Pileggi
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - João Paulo Souza
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Schantz C. ‘Cousue pour être belle’ : quand l’institution médicale construit le corps féminin au Cambodge. ACTA ACUST UNITED AC 2016. [DOI: 10.3917/cdge.061.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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18
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Edmonds A, Sanabria E. [Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil]. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2016; 23:193-210. [PMID: 27008081 DOI: 10.1590/s0104-59702016000100012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.
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Affiliation(s)
| | - Emilia Sanabria
- Laboratoire Triangle & INSERM 15 Parvis René Descartes, Ecole normale supérieure de Lyon, Lyon, França,
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Schantz C, Sim KL, Ly EM, Barennes H, Sudaroth S, Goyet S. Reasons for routine episiotomy: A mixed-methods study in a large maternity hospital in Phnom Penh, Cambodia. REPRODUCTIVE HEALTH MATTERS 2015; 23:68-77. [PMID: 26278834 DOI: 10.1016/j.rhm.2015.06.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/11/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022] Open
Abstract
First documented in 1741, the practice of episiotomy substantially increased worldwide during the 20th century. However, research shows that episiotomy is not effective in reducing severe perineal trauma and may be harmful. Using a mixed-methods approach, we conducted a study in 2013-14 on why obstetricians and midwives in a large maternity hospital in Phnom Penh, Cambodia, still do routine episiotomies. The study included the extent of the practice, based on medical records; a retrospective analysis of the delivery notes of a random sample of 365 patients; and 22 in-depth interviews with obstetricians, midwives and recently delivered women. Of the 365 women, 345 (94.5%, 95% CI: 91.7-96.6) had had an episiotomy. Univariate analysis showed that nulliparous women underwent episiotomy more frequently than multiparous women (OR 7.1, 95% CI 2.0-24.7). The reasons given for this practice by midwives and obstetricians were: fear of perineal tears, the strong belief that Asian women have a shorter and harder perineum than others, lack of time in overcrowded delivery rooms, and the belief that Cambodian women would be able to have a tighter and prettier vagina through this practice. A restrictive episiotomy policy and information for pregnant women about birthing practices through antenatal classes should be implemented as soon as possible.
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Affiliation(s)
- Clémence Schantz
- Centre Population & Développement (CEPED)-UMR 196: IRD (Institut de Recherche pour le Développement) and Université Paris Descartes, Paris, France.
| | | | - Ek Meng Ly
- Calmette Maternity Hospital, Phnom Penh, Cambodia
| | - Hubert Barennes
- ANRS (Agence Nationale de Recherche sur le VIH et les Hépatites), and Epidemiology Unit, Pasteur Institute, Phnom Penh, Cambodia; Isped (Institut de Santé Publique d'Epidémiologie et de Développement), Centre INSERM (Institut National de la Santé et de la Recherche Médicale) U897-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France
| | - So Sudaroth
- Calmette Maternity Hospital, Phnom Penh, Cambodia
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20
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Edmonds A, Sanabria E. Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil. Anthropol Med 2014; 21:202-16. [PMID: 25175295 PMCID: PMC4200605 DOI: 10.1080/13648470.2014.918933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.
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21
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Alves MTSSDBE, Araújo TVBD, Alves SV, Marinho LFB, Schiavo E, Menezes G, Coimbra LC, Rios CTF, Rodrigues AC, Romeu UM, Aquino EML, Lim LP. Atenção ao aborto no Sistema Único de Saúde no Nordeste Brasileiro: a estrutura dos serviços. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2014. [DOI: 10.1590/s1519-38292014000300004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objetivos: avaliar a estrutura de maternidades que prestam atenção a mulheres em situação de abortamento no Sistema Único de Saúde, em Salvador, Recife e São Luís. Métodos: foram selecionadas três maternidades em cada capital. Os dados foram obtidos por entrevista com gerente do serviço ou equipe de direção e observação direta. Utilizou-se instrumento com 120 questões pontuadas abrangendo seis componentes - planta física, recursos materiais, recursos humanos, materiais de consumo, educação em saúde e ferramentas de gestão que incorporam quatro dimensões de avaliação - insumo/ambiente físico; qualidade técnica e gerencial do cuidado; acolhimento/orientação e continuidade da atenção. Os resultados foram categorizados pelo percentual obtido em relação ao máximo esperado: suficiente (B a 80%); intermediário (de 50% a 79%); insuficiente (< 50%). Resultados: os componentes melhor pontuados foram planta física, recursos materiais e material de consumo. Educação em saúde e ferramentas de gestão tiveram pior pontuação. Nenhuma unidade atingiu nível considerado suficiente. Sete foram classificadas no nível intermediário e duas insuficiente. Conclusões: as unidades estudadas não apresentam estrutura adequada para o modelo de atenção ao abortamento preconizado. Há necessidade de intervenções para qualificar a estrutura dos serviços para a atenção ao aborto e promover a huma-nização do cuidado.
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22
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do Carmo Leal M, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, Bastos MH, da Gama SGN. Expanding the discussion. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S27-31. [PMID: 25167188 DOI: 10.1590/0102-311xco07s114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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23
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Diniz CSG, d'Orsi E, Domingues RMSM, Torres JA, Dias MAB, Schneck CA, Lansky S, Teixeira NZF, Rance S, Sandall J. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-14. [DOI: 10.1590/0102-311x00127013] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 03/20/2014] [Indexed: 11/22/2022] Open
Abstract
As evidências sobre os benefícios do apoio contínuo durante o parto levou à recomendação de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele é garantido por lei desde 2005, mas os dados sobre a sua implementação são escassos. Nosso objetivo foi estimar a frequência e fatores sociodemográficos, obstétricos e institucionais associados à presença de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita análise estatística descritiva para a caracterização dos acompanhantes (em diferentes momentos do tempo da internação), fatores maternos e institucionais; as associações foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres não tiveram acompanhante algum, 18,8% tinham companhia contínua, 56,7% tiveram acompanhamento parcial. Preditores independentes de não ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor público, multiparidade e parto vaginal. A implementação do acompanhante foi associada com ambiência adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.
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Affiliation(s)
| | | | | | | | | | | | - Sônia Lansky
- Secretaria Municipal de Saúde de Belo Horizonte, Brasil
| | | | - Susanna Rance
- Plymouth University Peninsula Schools of Medicine and Dentistry, U.K
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24
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Aquino EML. Para reinventar o parto e o nascimento no Brasil: de volta ao futuro. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-3. [DOI: 10.1590/0102-311xpe01s114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/28/2014] [Indexed: 11/22/2022] Open
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25
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Chadwick RJ, Foster D. Negotiating risky bodies: childbirth and constructions of risk. HEALTH RISK & SOCIETY 2013. [DOI: 10.1080/13698575.2013.863852] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Smith-Oka V. Managing Labor and Delivery among Impoverished Populations in Mexico: Cervical Examinations as Bureaucratic Practice. AMERICAN ANTHROPOLOGIST 2013. [DOI: 10.1111/aman.12046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Vania Smith-Oka
- Department of Anthropology; University of Notre Dame; Notre Dame IN 46556
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Edmonds A. Can medicine be aesthetic? Disentangling beauty and health in elective surgeries. Med Anthropol Q 2013; 27:233-52. [PMID: 23784970 DOI: 10.1111/maq.12025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article analyzes tensions between aesthetics and health in medicine. The blurring of distinctions between reconstructive and cosmetic procedures, and the linking of plastic surgery with other medical treatments, have added to the legitimacy of an emerging "aesthetic medicine." As cosmetic surgeries become linked to other medical procedures with perceived greater medical necessity, health and aesthetics become entangled. One consequence is that medical needs are magnified while perceptions of the risks of surgery are minimized. Drawing on ethnographic work on plastic surgery, as well as other studies of obstetrics and cosmetic surgery, I illustrate this entanglement of health and aesthetics within the field of women's reproductive health care in Brazil. I argue that while it would be difficult to wholly disentangle aesthetics and health, analysis of how risk-benefit calculations are made in clinical practice offers a useful critical strategy for illuminating ethical problems posed by aesthetic medicine.
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Affiliation(s)
- Alexander Edmonds
- Department of Anthropology and Sociology, University of Amsterdam, the Netherlands
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O'Dougherty M. Plot and irony in childbirth narratives of middle-class Brazilian women. Med Anthropol Q 2013; 27:43-62. [PMID: 23674322 DOI: 10.1111/maq.12015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Brazil's rate of cesarean deliveries is among the highest in the world and constitutes the majority of childbirths in private hospitals. This study examines ways middle-class Brazilian women are exercising agency in this context. It draws from sociolinguistics to examine narrative structure and dramatic properties of 120 childbirth narratives of 68 low- to high-income women. Surgical delivery constituted 62% of the total. I focus on 20 young middle-class women, of whom 17 had C-sections. Doctors determined mode of childbirth pre-emptively or appeared to accommodate women's wishes, while framing the scenario as necessitating surgical delivery. The women strove to imbue C-section deliveries with value and meaning through staging, filming, familial presence, attempting induced labor, or humanized childbirth. Their stories indicate that class privilege does not lead to choice over childbirth mode. The women nonetheless struggle over the significance of their agency in childbirth.
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Abstract
This article explores how race, sexual attractiveness and ‘female nature’ are biologised in plastic surgery. I situate this analysis in relation to recent debates over the limits of social constructionism and calls for more engagement with biology in feminist theory and science studies. I analyse not only how the biological is represented by biomedicine, but also how it is experienced by patients and, most problematically, how it is entangled with social constructions of beauty, race and female reproduction. Drawing on ethnographic fieldwork conducted in Brazil, I focus on plastic surgery, but also analyse how this specialty is linked to Ob-Gyn and endocrinology. I argue that medical procedures instantiate a biologised model of beauty I call ‘bare sex’ ( Edmonds, 2010 ) that is defined in terms of racial traits, anatomy, reproductive processes, hormones and ‘secondary sexual traits’. While this is a historically specific model, it is also one that is inscribed on patients, altering anatomy and physiological processes. It thus has the potential to create a biological self-awareness that cannot fully be accounted for by a social constructionist analysis.
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Malacrida C, Boulton T. The best laid plans? Women's choices, expectations and experiences in childbirth. Health (London) 2013; 18:41-59. [PMID: 23426792 DOI: 10.1177/1363459313476964] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past decades have seen a drastic increase in the medicalization of childbirth, evidenced by increasing Caesarean section rates in many Western countries. In a rare moment of congruence, alternative health-care providers, feminist advocates for women's health and, most recently, mainstream medical service providers have all expressed serious concerns about the rise in Caesarean section rates and women's roles in medicalization. These concerns stem from divergent philosophical positions as well as differing assumptions about the causes for increasing medicalization. Drawing on this debate, and using a feminist and governmentality framing of the problem, we interviewed 22 women who have recently had children about their birthing choices, their expectations and their birth experiences. The women's narratives revealed a disjuncture between their expectations of choosing, planning and achieving as natural a birth as possible, and their lived experiences of births that did not typically go to plan. They also reveal the disciplining qualities of both natural and medical discourses about birth and choice. Furthermore, their narratives counter assumptions that women, as ideal patient consumers, are driving medicalization.
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Diniz SG, d'Oliveira AFPL, Lansky S. Equity and women's health services for contraception, abortion and childbirth in Brazil. REPRODUCTIVE HEALTH MATTERS 2012; 20:94-101. [DOI: 10.1016/s0968-8080(12)40657-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Pacagnella RC, Cecatti JG, Osis MJ, Souza JP. The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework. REPRODUCTIVE HEALTH MATTERS 2012; 20:155-63. [PMID: 22789093 DOI: 10.1016/s0968-8080(12)39601-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Maternal mortality has gained importance in research and policy since the mid-1980s. Thaddeus and Maine recognized early on that timely and adequate treatment for obstetric complications were a major factor in reducing maternal deaths. Their work offered a new approach to examining maternal mortality, using a three-phase framework to understand the gaps in access to adequate management of obstetric emergencies: phase I--delay in deciding to seek care by the woman and/or her family; phase II--delay in reaching an adequate health care facility; and phase III--delay in receiving adequate care at that facility. Recently, efforts have been made to strengthen health systems' ability to identify complications that lead to maternal deaths more rapidly. This article shows that the combination of the "three delays" framework with the maternal "near-miss" approach, and using a range of information-gathering methods, may offer an additional means of recognizing a critical event around childbirth. This approach can be a powerful tool for policymakers and health managers to guarantee the principles of human rights within the context of maternal health care, by highlighting the weaknesses of systems and obstetric services.
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Abstract
In the last days of 2011, President of Brazil Dilma Rousseff issued a provisional measure (or draft law) entitled "National Surveillance and Monitoring Registration System for the Prevention of Maternal Mortality" (MP 557), as part of a new maternal health programme. It was supposed to address the pressing issue of maternal morbidity and mortality in Brazil, but instead it caused an explosive controversy because it used terms such as nascituro (unborn child) and proposed the compulsory registration of every pregnancy. After intense protests by feminist and human rights groups that this law was unconstitutional, violated women's right to privacy and threatened our already limited reproductive rights, the measure was revised in January 2012, omitting "the unborn child" but not the mandatory registration of pregnancy. Unfortunately, neither version of the draft law addresses the two main problems with maternal health in Brazil: the over-medicalisation of childbirth and its adverse effects, and the need for safe, legal abortion. The content of this measure itself reflects the conflictive nature of public policies on reproductive health in Brazil and how they are shaped by close links between different levels of government and political parties, and religious and professional sectors.
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Affiliation(s)
- Simone Diniz
- Department of Maternal and Infant Health, Faculty of Public Health, University of São Paulo, Brazil.
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da Silva FMB, de Oliveira SMJV, Bick D, Osava RH, Nobre MRC, Schneck CA. Factors associated with maternal intrapartum transfers from a freestanding birth centre in São Paulo, Brazil: a case control study. Midwifery 2012; 28:646-52. [PMID: 22944103 DOI: 10.1016/j.midw.2012.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES to identify factors associated with maternal intrapartum transfer from a freestanding birth centre to hospital. DESIGN case-control study with retrospective data collection. PARTICIPANTS AND SETTINGS cases included all 111 women transferred from a freestanding birth centre in Sao Paulo to the referral hospital, from March 2002 to December 2009. The controls were 456 women who gave birth in the birth centre during the same period who were not transferred, randomly selected with four controls for each case. METHODS data were obtained from maternal records. Factors associated with maternal intrapartum transfers were initially analysed using a χ(2) test of association. Variables with p<0.20 were then included in multivariate analyses. A multiple logistic regression model was built using stepwise forward selection; variables which reached statistical significance at p<0.05 were considered to be independently associated with maternal transfer. FINDINGS during the study data collection period, 111 (4%) of 2,736 women admitted to the centre were transferred intrapartum. Variables identified as independently associated factors for intrapartum transfer included nulliparity (OR 5.1, 95% CI 2.7-9.8), maternal age ≥35 years (OR 5.4, 95% CI 2.1-13.4), not having a partner (OR 2.8, 95% CI 1.5-5.3), cervical dilation ≤3 cm on admission to the birth centre (OR 1.9, 95% CI 1.1-3.2) and between 5 and 12 antenatal appointments at the birth centre (OR 3.8, 95% CI 1.9-7.5). In contrast, a low correlation between fundal height and pregnancy gestation (OR 0.3, 95% CI 0.2-0.6) appeared to be protective against transfer. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE identifying factors associated with maternal intrapartum transfer could support decision making by women considering options for place of birth, and support the content of appropriate information about criteria for admission to a birth centre. Findings add to the evidence base to support identification of women in early labour who may experience later complications and could support timely implementation of appropriate interventions associated with reducing transfer rates.
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Affiliation(s)
- Flora Maria Barbosa da Silva
- School of Arts, Sciences and Humanities, University of São Paulo, Av. Arlindo Béttio, 1000 - Ermelino Matarazzo, CEP 03828-000 São Paulo, Brazil.
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Watanabe T, Knobel R, Suchard G, Franco MJ, d’Orsi E, Consonni EB, Consonni M. Medical students' personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study. BMC MEDICAL EDUCATION 2012; 12:57. [PMID: 22818043 PMCID: PMC3552939 DOI: 10.1186/1472-6920-12-57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 07/06/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the way of childbirth preferred by medical students. METHODS A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice. RESULTS A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student's own or a partner's pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03-8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS. CONCLUSIONS A higher number of sixth year students preferred a CS for their own pregnancy (or their partner's) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students' preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.
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Affiliation(s)
- Tatiane Watanabe
- Medical student, University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Roxana Knobel
- Department of Gynecology and Obstetrics, University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Guilherme Suchard
- Medical student, University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Mario Julio Franco
- Department of Gynecology and Obstetrics, University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Eleonora d’Orsi
- Departament of Public Health, University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Elenice Bertanha Consonni
- Department of Neurology, Psychology and Psychiatry, Botucatu School of Medicine, Universidade Estadual Paulista (Unesp), Botucatu, Brazil
| | - Marcos Consonni
- Department of Gynecology and Obstetrics, Botucatu School of Medicine, Universidade Estadual Paulista (Unesp), Botucatu, Brazil
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da Silva FMB, de Oliveira SMJV, Bick D, Osava RH, Tuesta EF, Riesco MLG. Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre. J Clin Nurs 2012; 21:2209-18. [PMID: 22646921 DOI: 10.1111/j.1365-2702.2012.04133.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIM AND OBJECTIVES To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. BACKGROUND Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. DESIGN Cross-sectional study. METHODS Data were retrospectively collected from one independent birth centre in Brazil, during 2006-2009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). RESULTS There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. CONCLUSIONS Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. RELEVANCE TO CLINICAL PRACTICE The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.
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Affiliation(s)
- Flora M B da Silva
- National Council for Scientific and Technological Development (CNPq) Scholarship, University of São Paulo, São Paulo, SP, Brazil.
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Chadwick RJ, Foster D. Technologies of gender and childbirth choices: Home birth, elective caesarean and white femininities in South Africa. FEMINISM & PSYCHOLOGY 2012. [DOI: 10.1177/0959353512443112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the 1970s, feminist research has provided a powerful critique of biomedical models of childbirth. While this critique has been extremely important, it has to some extent led to the neglect of other forms of power. For example, there has been little research which has explored childbirth as a way of ‘doing gender’ in which normative or resistant forms of gender and femininity are (re)performed. Drawing on the Foucauldian notion of ‘technologies of power’, we argue that gender is a form of disciplinary power which shapes the choices that women make in relation to childbirth. Drawing on pre-birth interviews with 21 white, middle-class pregnant South African women who were planning on either a home birth (n = 12) or an elective caesarean section (n = 9), we show how three central technologies of white femininity shaped and regulated women’s childbirth choices. These included: a patriarchal optics of childbirth, the ‘natural childbirth’ ideal and the ‘good mother’ imperative. The article concludes that women’s childbirth choices are heavily shaped by gendered technologies of power and that the decision to have a home birth or an elective caesarean section intersects with scripts of ‘doing white femininity’ in South Africa.
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Mattar LD, Diniz CSG. Hierarquias reprodutivas: maternidade e desigualdades no exercício de direitos humanos pelas mulheres. ACTA ACUST UNITED AC 2012. [DOI: 10.1590/s1414-32832012005000001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A partir da concepção contemporânea de direitos humanos, o texto discute os direitos reprodutivos e o exercício da maternidade. Após histórico e definição dos direitos reprodutivos e dos direitos sexuais, o artigo trata da maternidade voluntária, segura, socialmente amparada e prazerosa, para propor uma reflexão sobre 'hierarquias reprodutivas'. Defende-se que diferentes aspectos das mães - tal como raça, classe social, idade e parceria sexual - determinam a legitimidade e aceitação social destas maternidades, e, portanto, suas vivências. Quanto maior o número de aspectos 'negativos' presentes na mulher (ou casal) ao exercitar a maternidade e/ou a reprodução e cuidado com os filhos, mais próxima da base da pirâmide hierárquica estará e, ainda, maior dificuldade encontrará no exercício de seus direitos humanos. O texto conclui que são necessárias políticas públicas de suporte social à maternidade para as mulheres que assim escolham, indistintamente, visando promover o exercício de seus direitos humanos.
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Victora CG, Barreto ML, do Carmo Leal M, Monteiro CA, Schmidt MI, Paim J, Bastos FI, Almeida C, Bahia L, Travassos C, Reichenheim M, Barros FC. Health conditions and health-policy innovations in Brazil: the way forward. Lancet 2011; 377:2042-53. [PMID: 21561659 DOI: 10.1016/s0140-6736(11)60055-x] [Citation(s) in RCA: 290] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brazil is a large complex country that is undergoing rapid economic, social, and environmental change. In this Series of six articles, we have reported important improvements in health status and life expectancy, which can be ascribed largely to progress in social determinants of health and to implementation of a comprehensive national health system with strong social participation. Many challenges remain, however. Socioeconomic and regional disparities are still unacceptably large, reflecting the fact that much progress is still needed to improve basic living conditions for a large proportion of the population. New health problems arise as a result of urbanisation and social and environmental change, and some old health issues remain unabated. Administration of a complex, decentralised public-health system, in which a large share of services is contracted out to the private sector, together with many private insurance providers, inevitably causes conflict and contradiction. The challenge is ultimately political, and we conclude with a call for action that requires continuous engagement by Brazilian society as a whole in securing the right to health for all Brazilian people.
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Affiliation(s)
- Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Brazil.
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Victora CG, Aquino EML, do Carmo Leal M, Monteiro CA, Barros FC, Szwarcwald CL. Maternal and child health in Brazil: progress and challenges. Lancet 2011; 377:1863-76. [PMID: 21561656 DOI: 10.1016/s0140-6736(11)60138-4] [Citation(s) in RCA: 524] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil's progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women's health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries.
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Affiliation(s)
- Cesar G Victora
- Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
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Exercise of essential competencies for midwifery care by nurses in São Paulo, Brazil. Midwifery 2009; 27:23-9. [PMID: 19892446 DOI: 10.1016/j.midw.2009.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 04/08/2009] [Accepted: 04/16/2009] [Indexed: 11/23/2022]
Abstract
UNLABELLED GENERAL OBJECTIVE: to analyse the exercise of essential competencies for midwifery care by nurses and/or midwives in the public health system of São Paulo (eastern zone), Brazil. SPECIFIC OBJECTIVES to develop a profile of the public health institutions and of the nurses and/or midwives who care for women before, during and following childbirth; to identify the activities performed in providing such care, as well as their frequency; and to specify the possible obstacles or difficulties encountered by them when exercising their competencies. DESIGN a descriptive and exploratory research design, using a quantitative approach. SETTING the study was conducted in all public health services of São Paulo (eastern zone), Brazil, namely 59 basic health-care units and six hospitals, during the period of October 2006-December 2007. PARTICIPANTS the study population consisted of 272 nurses and/or midwives who provide care for pregnant women and newborns at the primary health-care units and maternity hospitals of the public health system. Participants comprised 100% of hospital nurse coordinators (n=6), 61% of hospital maternity nursing and/or midwifery staff (n=62) and 64% (n=204) of nursing and/or midwifery staff working at primary health-care units. METHODS AND FINDINGS the data collection was based on a single form given to the coordinators and two questionnaires, one handed out to antenatal and postnatal nursing and/or midwifery staff and another handed out to labour and birth nursing and/or midwifery staff. The results showed that nurses and/or midwives providing care for women during pregnancy, labour, birth and the postnatal period did not put the essential competencies for midwifery care into practice, because they encountered institutional barriers and personal resistance, and lacked protocols based on best practice and on the exercise of essential competencies needed for effective midwifery care. KEY CONCLUSIONS the model of care in the public health services of São Paulo (eastern zone) is based much more on hierarchical positions than on professional competencies or on the recommendations of the scientific community. As a result, health authorities need to review their midwifery policies to improve maternal-infant care by nurses and/or midwives in order to ensure the implementation of best midwifery practice. PRACTICAL IMPLICATIONS the results of this study support actions to improve the quality of care delivered to women and their families, while integrating nursing and midwifery care in São Paulo, Brazil.
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Gayeski ME, Brüggemann OM. Puerperal women's perceptions on vertical and horizontal deliveries. Rev Lat Am Enfermagem 2009; 17:153-9. [DOI: 10.1590/s0104-11692009000200003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Accepted: 12/23/2008] [Indexed: 11/22/2022] Open
Abstract
This qualitative study aims to better understand the perceptions of puerperal women regarding their experiences in vertical and horizontal deliveries and identify positive and negative aspects of each position. Semi-structured interviews were carried out with ten puerperal women hospitalized in the rooming-in unit of a teaching hospital. After thematic analysis - Collective Subject Discourse - positive aspects of the vertical position emerged, namely: greater comfort, freedom of movement, reduction of the expulsive effort, favors women's participation. Negative aspects were listed as discomfort and lack of obstetric intervention. Positive aspects of the horizontal position were reported as quickness, feelings of security and of being helped. Negative aspects were related to discomfort and difficulty in exerting strength. Positive aspects of the vertical position and negative aspects of the horizontal position stood out more intensely and frequently, and are in accordance with scientific evidence.
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Alves SV. Maternal mortality in Pernambuco, Brazil: what has changed in ten years? REPRODUCTIVE HEALTH MATTERS 2008; 15:134-44. [PMID: 17938078 DOI: 10.1016/s0968-8080(07)30326-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study examines changes in levels and patterns of maternal mortality in Pernambuco, Brazil, in 1994 and 2003. The research was carried out in five sub-regions of Pernambuco using the Reproductive Age Mortality Survey (RAMOS) method and based on death certificates of women of reproductive age registered in the local System of Information on Mortality. In-depth interviews with family members were also conducted for the abortion-related deaths. Of the 1,258 female deaths investigated, 54 maternal deaths were identified, corresponding to a maternal mortality ratio of 77 per 100,000 live births. The estimated level of under-reporting (46%) corresponds to an upward adjustment factor of 1.9. The illegal status of abortion in Brazil remains an important contributory factor for the abortion-related deaths. Approximately 94% of the maternal deaths were judged to be avoidable with improvements in health care. Maternal mortality declined by 30% over the ten-year period but the level of misclassification of maternal deaths remains. Improvements in maternity care for women and reporting of maternal deaths are still urgently needed.
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Affiliation(s)
- Sandra Valongueiro Alves
- Maternal Mortality Committee of State of Pernambuco, and Department of Social Medicine, Federal University, Recife, Pernambuco, Brazil.
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Affiliation(s)
- Simone Grilo Diniz
- Faculdade de Saúde Pública, Universidade de São Paulo, 01246 São Paulo, Brasil.
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Berer M. Maternal Mortality and Morbidity: Is Pregnancy Getting Safer for Women? REPRODUCTIVE HEALTH MATTERS 2007; 15:6-16. [DOI: 10.1016/s0968-8080(07)30338-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Lerchl A. Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany. Naturwissenschaften 2007; 95:165-70. [PMID: 17891530 DOI: 10.1007/s00114-007-0306-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 08/28/2007] [Accepted: 08/31/2007] [Indexed: 11/28/2022]
Abstract
A previous study has shown a marked and continuing decline in weekend births in Germany between 1988 and 2003 (Lerchl, Naturwissenschaften 92:592-594, 2005). The present study was performed to investigate the possible influence of caesarean sections (CS) on weekend birth number and on the involvement of midwives in births for all 16 German states for the year 2003. In total, data from 706,721 births were sorted according to weekday of births and state, respectively, and the weekend births avoidance rates were calculated. Weekend births were consistently less frequent than births during the week, with an average of -15.3% for all states and due to fewer births on Saturdays (-13.6%) and Sundays (-16.7%). Between the states, weekend births avoidance rates ranged from -11.6% (Bremen) to -24.2% (Saarland). The proportion of CS was 25.5% for all states, ranging from 19.2% (Sachsen and Sachsen-Anhalt) to 30.5% (Saarland). CS and weekend births avoidance rates were significantly correlated, consistent with the hypothesis that primary (planned) CS are regularly scheduled on weekdays. The number of births per midwife (BPM) was calculated according to the number of active members in the states' professional midwives' organizations. The mean number of BPM was 59.5, ranging from 45.2 (Bremen) to 82.4 (Sachsen-Anhalt). CS and BPM were significantly correlated, consistent with the hypothesis that higher CS ratios are associated with lower midwife involvement in births. It is concluded that the decline in weekend births and lower involvement of midwives are caused, at least in part, by an increased number of caesarean sections.
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Affiliation(s)
- Alexander Lerchl
- School of Engineering and Science, Jacobs University Bremen, Campus Ring 6, D-28759 Bremen, Germany.
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Bastos MH, Diniz SG, Riesco ML, de Oliveira SJ. Promoting evidence-based maternity care in middle-income countries: challenges and opportunities. Midwifery 2007; 23:111-2. [PMID: 17482321 DOI: 10.1016/j.midw.2007.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Maria Helena Bastos
- Centre for Research for Midwifery and Childbirth, Thames Valley University, London, UK
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Diniz CSG. Humanização da assistência ao parto no Brasil: os muitos sentidos de um movimento. CIENCIA & SAUDE COLETIVA 2005. [DOI: 10.1590/s1413-81232005000300019] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este texto recupera as origens do termo humanização do parto, o reconhecimento da sua assistência ao parto como evento desumanizante, a crítica técnica à assistência, o surgimento de um movimento nacional e internacional de humanização do parto, as políticas de humanização do parto desenvolvidas no Brasil, e as relações entre a crítica à assistência e a criação do movimento pela medicina baseada em evidências (MBE). Com base em um estudo de duas maternidades "humanizadas" do SUS, discute os diferentes (às vezes contraditórios) sentidos do termo, e seu alcance em questionar a cultura técnico-assistencial, a anatomia, a fisiologia femininas, e as relações de gênero. Entre os diferentes sentidos estão: o uso da MBE, o respeito aos direitos (reprodutivos e sexuais, ao acesso universal e ao consumo de tecnologia), o tratamento acolhedor e respeitoso, o manejo da dor do parto e a prevenção da dor iatrogênica, novas atribuições profissionais e disputas corporativas; a relação custo-benefício etc. Longe de querer achar a "humanização certa", busca-se compreender nos diferentes sentidos um diálogo, tenso e produtivo, entre atores sociais em disputa.
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