Violation of the rights of the companion during hospitalization for childbirth in public maternity hospitals

OBJECTIVE

To estimate the prevalence of violation of the rights of the companion during the hospitalization of the woman for childbirth.

METHOD

Cross-sectional study conducted in public maternity hospitals in Florianopolis between 2015 and 2016, with data from individual interview with 1.145 companions. Prevalence ratio and Pearson's chi-square test were applied in the analysis.

RESULTS

Women (92.8%), who received prenatal care (93.1%) and were unaware of the companions' law (92.7%) suffered more violation of rights. Not having received written guidance (93.6%), not identifying the health professional (65.0%) and not being encouraged to participate in care (55.9%) were violated rights. Welcoming and communicating with the team were the care aspects that most violated the rights of the companion.

CONCLUSION

The high prevalence of violation of rights demonstrates the disrespect and the need to value companions of choice.

Violação de direitos do acompanhante durante a internação para o parto em maternidades públicas

RESUMO Objetivo Estimar a prevalência de violação de direitos do acompanhante durante a internação da mulher para o parto. Método Estudo transversal, conduzido em maternidades públicas de Florianópolis, entre 2015 e 2016, com dados de entrevista individual com 1.145 acompanhantes. Na análise, aplicou-se cálculo de razão de prevalência e teste qui-quadrado de Pearson. Resultados Mulheres (92,8%), que acompanharam o pré-natal (93,1%) e desconheciam a lei do acompanhante (92,7%) sofreram mais violação de direitos. Não ter recebido orientação escrita (93,6%), não ter identificado o profissional assistente (65,0%) e não ter sido estimulado a participar do cuidado (55,9%) foram direitos violados. O acolhimento e a comunicação com a equipe foram os aspectos assistenciais que mais infringiram direitos do acompanhante. Conclusão A elevada prevalência de violação de direitos demonstra o desrespeito e a necessidade de valorização do acompanhante de parto.

Information that (de)motivate women's decision making on Planned Home Birth

OBJECTIVE

To understand how information about Planned Home Birth motivates or discourages women's decisions on this location of birth.

METHOD

Descriptive exploratory study, qualitative approach. Data collection carried out from February to April 2019, through semi-structured interviews with 14 women and documentary sources. The data were analyzed using Bardin's content analysis process, with the help of ATLAS.ti 8.0.

RESULTS

The motivations for choosing Planned Home Birth are: respect for the autonomy and natural process of childbirth and delivery, support from a partner and trust in professionals. Aspects that discourage this choice are fear of complications, the need for a hospital medical structure, opinions that value risk.

CONCLUSION

Women's choices are based not only on information, but also on how that information is processed. This study demonstrated that the perception pertaining to the safety of Planned Home Birth is essential for making this decision.

FACTORS ASSOCIATED WITH SUPPORT PROVIDED TO WOMEN DURING CHILDBIRTH BY COMPANIONS IN PUBLIC MATERNITY HOSPITALS

ABSTRACT Objective: to identify the factors associated with providing emotional, physical, informational and intermediation support for companions during childbirth. Method: this is a cross-sectional study, whose sample consisted of 861 companions from public maternity hospitals in Florianópolis, SC. Data collection was carried out from March/2015 to May/2016, using a questionnaire as a data collection instrument. The data were analyzed by Binary Logistic Regression, using the Hierarchical Model of Multivariate Analysis. Results: the factors associated with emotional support were: having between 8 and 11 years of study (OR: 2.70 - CI: 1.19-6.13), participation in prenatal care (OR: 3.40 - CI: 1.63 -7.10), adequate environment (OR: 3.02 - CI: 1.35-6.75) and concern about pain (OR: 2.95 - CI: 1.33-6.50); in relation to physical support: having 12 or more years of study (OR: 1.68 - CI: 1.10-2.56); in relation to informational support: companion being a woman’s mother (OR: 2.96 - CI: 1.71 to 5.12) and having knowledge about the Companion Law (OR: 1.47 - CI: 1.04 - 2.08); in relation to intermediation support: maternity hospital characteristics. Having received guidance from health professionals and participating in prenatal care were also associated with informational and intermediation support. Providing support in all four dimensions in labor was associated with all outcomes. Conclusion: the companion’s participation in prenatal and labor, maternity hospital characteristics and professionals’ attitude were the factors associated with support in childbirth.

Modelos de assistência obstétrica na Região Sul do Brasil e fatores associados

Os objetivos do estudo foram identificar modelos de assistência obstétrica em gestantes de risco habitual na Região Sul do Brasil, estimar os fatores associados a esses modelos e os desfechos maternos e neonatais. Realizou-se estudo seccional a partir da pesquisa Nascer no Brasil, de base hospitalar, que envolveu puérperas e recém-nascidos. Foram identificadas 2.668 gestantes de risco habitual. Procedeu-se a uma análise exploratória, com a utilização da proporção de práticas por hospital, entre elas o desencadeamento do trabalho de parto, a presença de acompanhante, a cesárea e o contato pele a pele, para a obtenção de modelos de assistência obstétrica denominados Boas Práticas, Intervencionista I e Intervencionista II. Em seguida, realizou-se uma análise inferencial das características associadas. Os resultados mostraram que o acesso ao financiamento público ou privado, os fatores culturais e a atuação dos profissionais de saúde apresentaram associações com os modelos de assistência. A assistência pública apresentou diferentes contextos: um primeiro, alicerçado em políticas públicas e na prática baseada em evidência; um segundo, baseado na intencionalidade pelo parto vaginal, sem considerar os princípios de humanização. Já a assistência privada é padronizada e centrada no profissional médico, com maiores níveis de intervenção. Conclui-se que há predomínio dos modelos de assistência obstétrica intervencionistas na Região Sul do Brasil, uma assistência na contramão das melhores evidências, e que as mulheres assistidas em hospitais públicos possuem mais chance de serem beneficiadas com as boas práticas.

Support actions undertaken for the woman by companions in public maternity hospitals

OBJECTIVE

to identify the support actions undertaken for the woman during labor, birth, cesarean section and the postpartum period.

METHOD

a transversal study, undertaken in three public maternity hospitals, with a sample of 1,147 companions. The data were collected through interviews and were analyzed using descriptive statistics. The support actions were classified in four dimensions: emotional, physical, informational and relating to intermediation.

RESULTS

the majority of interviewees were the partner/father of the baby (76.7%). In labor, birth and the postpartum period, the actions of emotional support - such as calming, encouraging and praising, were performed by more than 80.0% of the companions; informational support, by approximately 70.0%; and intermediation by fewer than 65.0% of them. In childbirth, the emphasis on physical support was observed in assisting with walking (84.4%), and in changing position (90.4%).

CONCLUSION

the companions participate actively in the birth process, performing actions of support in the four dimensions. Emotional support is the most frequent, followed by physical and informational support, mainly during labor and birth. The results contribute to valuing the companion from the woman's social network in the birth scenario and to the recognition of his/her role as a provider of support.

Efficacy of an educational manual for childbirth companions: pilot study of a randomized clinical trial

Objective:

to evaluate the effectiveness of an educational manual in the instrumentalization of companions to provide support to the parturients and check its influence on the satisfaction of companions and women during vaginal delivery.

Method:

pilot study of a randomized controlled clinical trial with 65 companions and puerperal women (intervention = 21 and control = 44). The previous knowledge of the companions was evaluated at baseline. The Evaluation Form for Companions in the Delivery Room was used to measure the actions provided and the satisfaction with the experience, and the Questionnaire for Evaluation of the Experience and Satisfaction of Puerperal Women with Labor and Delivery was used to evaluate the satisfaction of women with childbirth. The Student’s t-test or Wilcoxon, chi-square or Fisher’s exact test, risk ratios and 95% confidence intervals were used.

Results:

the companions in the intervention group performed a greater number of support actions (7.2 vs 4.6, p: 0.001) and had higher satisfaction scores (72.4 vs 64.2; p = 0.00). Puerperal women in the intervention group had higher satisfaction with childbirth (119.6 vs 107.9; p: 0.000).

Conclusion:

the manual was effective for the instrumentalization of companions, contributed to support actions to the parturients and had repercussions on the satisfaction of companions and women with the birthing process. RBR-776d9s

Institutional violence during the parturition process in Brazil: integrative review

ABSTRACT Objective: To identify the types of institutional violence of childbirth reported by the woman, the birth companion and health professionals. Method: Integrative review that analyzed 33 articles in the LILACS, BDENF, INDEXPSI, regional SciELO, Scopus, Web Of Science and PubMed databases. Results: Women were the main violence rapporteur, with predominance of the psychological type. Precarious infrastructure and the imposition of professional decisions were identified by the companion as violence. For health professionals, performing procedures without consent does not characterize violence, but guarantees childbirth security. Final considerations: The most common types of violence in Brazilian maternity hospitals are psychological, physical and structural. Most of the time, violence is reported by women, although professionals also perceive and admit its perpetuation.

SEPARAÇÃO DA MULHER E SEU ACOMPANHANTE NO NASCIMENTO POR CESÁREA: UMA VIOLAÇÃO DE DIREITO

Resumo: Objetivou-se desvelar a experiência da mulher e seu acompanhante que tiveram o direito de compartilhar o nascimento de seu filho violado. Trata-se de uma pesquisa qualitativa, exploratório-descritiva. Foram entrevistadas 13 puérperas e seus companheiros, de janeiro a julho de 2016. A análise se deu através da análise de conteúdo com o auxílio do software Atlas.ti 7.0. São apresentados em três categorias:  Experiência da mulher em não ter acompanhante na sala cirúrgica; Experiência do acompanhante em aguardar o nascimento sozinho; e o Poder dos profissionais de saúde sobre a cena do nascimento. O estudo evidenciou que os sentimentos negativos estiveram presentes na sala cirúrgica, a mulher sentiu-se desamparada sem a presença de seu acompanhante. O companheiro sentiu-se decepcionado por não vivenciarem o nascimento do filho. O principal fator para essa separação foi a atitude dos profissionais de saúde que ainda impedem a presença do acompanhante na sala cirúrgica.

[Possibilities of inclusion of the partner in deliveries in public institutions]

Qualitative research, with an exploratory and descriptive approach, was conducted between September 2011 and February 2012, aimed at revealing the possibility of inclusion of the partner in deliveries in institutions that currently restrict their presence. Twelve nurses responsible for obstetric centers and five technical directors of health institutions of Santa Catarina, who did not allow or infrequently allowed the presence of the partner during delivery, were interviewed. Data were analyzed using Bardin Content Analysis, with the support of ATLAS.ti software. The possibilities of including the partner are permitted in three categories: I - Labor pain process; II - Receptiveness of professionals to the partner; and III - Empowerment of patients. Although some institutions limit the presence of the partner, they describe aspects that favor their inclusion. From the results presented, it is suggested that these enabling elements could be bolstered with management strategies, ongoing learning and intersectoral actions.

Nascer no Brasil: the presence of a companion favors the use of best practices in delivery care in the South region of Brazil

OBJECTIVE To analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil. METHODS This is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%. RESULTS Most women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49). CONCLUSIONS In the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

ADAPTAÇÃO TRANSCULTURAL DE INSTRUMENTOS DE PESQUISA CONDUZIDA PELA ENFERMAGEM DO BRASIL: UMA REVISÃO INTEGRATIVA

RESUMO Objetivo: identificar e analisar as abordagens teóricas e propostas processuais utilizadas na adaptação transcultural de instrumentos de pesquisa para a língua portuguesa, pela enfermagem brasileira. Método: revisão integrativa de artigos que descreviam o processo de adaptação transcultural de instrumentos utilizados na prática clínica hospitalar, publicados entre 2005-2016. A busca foi realizada na MEDLINE®, CINAHL®, Scopus®, Web of science®, LILACS®, BDENF e SciELO®. Foram analisados 22 artigos, identificando-se as etapas do processo de adaptação, a abordagem metodológica, o instrumento e especialidade clínica. Resultados: todos os estudos utilizaram a abordagem universalista e em 20 deles Beaton foi o referencial metodológico adotado. Dentre os pontos fortes, destacam-se a adoção de referenciais metodológicos, cumprimento e detalhamento dos procedimentos adotados no processo, validação de conteúdo e avaliação psicométrica. Entretanto, a fragilidade predominante foi a ausência de informações importantes do processo de adaptação. Conclusão: evidencia-se uma supervalorização da avaliação psicométrica, em detrimento do cumprimento rigoroso do processo adaptação. Os achados possibilitam a elaboração de recomendações para estudos de adaptação transcultural, que podem subsidiar futuras pesquisas deste método.

Acolhimento com classificação de risco em unidade de pronto atendimento: estudo avaliativo

RESUMO Objetivo Descrever a avaliação da estrutura, processo e resultado do Acolhimento com Classificação de Risco, na perspectiva dos médicos e enfermeiros de uma Unidade de Pronto Atendimento. Método Estudo avaliativo, descritivo, quantitativo, desenvolvido em Santa Catarina. Dados coletados com instrumento validado e adaptado, constituído por 21 itens distribuídos nas dimensões Estrutura (instalações), Processo (atividades e relações no atendimento) e Resultado (efeitos do atendimento). Na análise, aplicaram-se a estatística descritiva, o cálculo do Ranking Médio e o da Pontuação Média. Resultados A amostra foi de 37 participantes. Dos 21 itens avaliados, 11 (52,4%) tiveram Ranking Médio entre 3 e 4, e nenhum atingiu o máximo (5 pontos). A “Priorização dos casos graves” e o “Atendimento primário por gravidade do caso” obtiveram maior Ranking Médio (4,5), enquanto a “Discussão sobre fluxograma” revelou menor Ranking (2,1). As dimensões Estrutura, Processo e Resultado atingiram, respectivamente, as pontuações médias 23,9, 21,9 e 25,5, indicando avaliação Precária (17,5 a 26,1 pontos). Conclusão Há precarização do Acolhimento com Classificação de Risco, em especial no que se refere ao processo, que obteve menor nível de satisfação dos participantes.

Special attention to women experiencing high-risk pregnancy: Delivery, care assistance and neonatal outcomes in two Brazilian maternity wards

BACKGROUND

To compare two care models of high-risk pregnant women--a House for Pregnant Women, staffed by nurse-midwives, versus a traditional care model in a hospital maternity ward.

DESIGN

This was across-sectional study conducted in two reference maternity hospitals for high-risk pregnancies, in Belo Horizonte, Minas Gerais, Brazil. The sample consisted of 312 high-risk pregnant women consecutively admitted from January 1st to December 31^st, 2010, either to the House for Pregnant Women (n=247), or the hospital maternity ward (n=65). Gestational ages varied from 22 weeks to 36 weeks and six days. We measured individual, demographic, obstetric, labour and delivery variables, and newborn characteristics. For data analysis, we used descriptive, bivariate and multivariate statistics using Poisson regression, with a 5% significance level.

FINDINGS

At the conventional hospital maternity ward, more women had six or more antenatal exams, greater frequencies of diagnosis related to blood pressure, and a greater number of women underwent either a C-section or a vaginal delivery with an episiotomy and analgesia. At the House for Pregnant Women, the majority of the hospitalizations were related to preterm labour and premature rupture of membranes. There were no statistical differences in the newborn characteristics.

KEY CONCLUSIONS

The House for Pregnant Women care model, utilizing midwives was less interventionist, yet with results as favorable as in a conventional maternity hospital setting.

Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

Objective

analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil.

Methods

a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests.

Results

differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001), have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001) and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001) than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years.

Conclusion

this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

MATERNAL RESULTS FROM PLANNED HOME BIRTHS ASSISTED BY NURSES FROM THE HANAMI TEAM IN THE SOUTH OF BRAZIL, 2002-2012

ABSTRACT Objective: described the maternal results of the care with planned home births provided by the Hanami Team in 2002-2012. Method: this transversal study It includes home and hospital births (212). Descriptive analysis was undertaken, with CI 95%, using the SAS/9.1.3 software. Results: the rate of amniotomy was 9.9% (CI 95% 5.9-13.9), of episiotomy was 0.5% (CI 95% 0.5-1.5), the amniotic fluid remained clear in 95.2% (CI 95% 92.4-98), there was no change in fetal heartbeat in 94.3% (CI 95% 92-96.6). The vaginal tears perineal trauma were exclusively of first degree (64.7%; CI 95% 57.8-71.6) and second degree (7.0%; CI 95% 3.4-10.8), it being the case that almost half did not need suturing (46.8%; CI 95% 41.1-52.6). The rate of transfer to hospital was 7.4%, all these cases occurring during labor (CI 95% 3.8 - 11.0). The rate of cesareans in the sample was 9.9%. Conclusions: the women assisted at home undergo few interventions. Rates of complications and transfers to hospital for obstetric reasons were low.

Labor and birth care by nurse with midwifery skills in Brazil

BACKGROUND

The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections.

METHODS

Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births.

RESULTS

16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower.

CONCLUSIONS

The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.

[In vaginal and cesarean deliveries, a companion is not allowed in the room: discourses of nurses and technical directors]

OBJECTIVE

To understand the reasons why health institutions from the state of Santa Catarina, Brazil prevent the presence of a companion in vaginal and caesarean delivery, from the perspective of nurses and technical directors.

METHOD

Exploratory-descriptive, qualitative research. A total of 12 nurses and five technical directors were interviewed from September/2011 to February/2012. The reports were analyzed according to the Collective Subject Discourse.

RESULTS

In the central ideas of restrictions to the companion we may cite: the operating room is not the place for a companion; in the delivery room companions are not allowed to come in; the companion does not have emotional and psychological preparation; lack of participation in prenatal care hinders the entrance of the companion; if the companion does not ask, he does not come in, but if he requires, he may come in.

FINAL CONSIDERATIONS

The companion impediment is guided by pre-conceived ideas that can negatively interfere in the organization of the birth process.

WATER BIRTH IN A MATERNITY hospital OF THE SUPPLEMENTARY HEALTH SECTOR IN SANTA CATARINA, BRAZIL: A CROSS-SECTIONAL STUDY

ABSTRACT The aim of this cross-sectional study was to identify the prevalence of water births in a maternity hospital of Santa Catarina, Brazil, and to investigate the association between sociodemographic and obstetric variables and water birth. The sample consisted of 973 women who had normal births between June 2007 and May 2013. Data was analyzed through descriptive and bivariate statistics, and estimated prevalence and tested associations through the use of the chi-square test; the unadjusted and adjusted odds ratio were calculated. The prevalence of water births was 13.7%. Of the 153 women who had water birth, most were aged between 20 to 34 years old (122), had a companion (112), a college degree (136), were primiparous (101), had a pregnancy without complications (129) and were admitted in active labor (94). There was no association between sociodemographic characteristics and obstetric outcomes in the bivariate and multivariate analyses and in the adjusted model. Only women with private sources for payment had the opportunity to give birth in water.

Satisfaction of companions with the experience of supporting the parturient at a university hospital

A cross-sectional study that aimed to assess the satisfaction of companions with the experience of supporting the parturient, and to identify the related factors. Data were collected at a university hospital in Southern Brazil, by means of semi-structured interviews with 314 caregivers, between October of 2009 and January of 2010. The satisfaction scores were determined by the Cronbach's alpha coefficient. The Kruskal-Wallis and the Mann-Whitney tests estimated the related factors. The mean satisfaction of the companions was high in three domains: 1) How the woman and the newborn were cared for (92,6; SD=11.5), 2) Welcoming in each place (89,9; SD=12.9), and 3) Explanation about what was happening (88,9; SD=14.1). The educational level was statistically related to the satisfaction in domain 3, not being present in the delivery room was statistically related to domain 1, and not receiving instructions from the physician regarding his role was statistically related to domain 2. The companions manifested high satisfaction with the experience of providing support to the women.

Social inequalities and women's satisfaction with childbirth care in Brazil: a national hospital-based survey

The objective is to identify factors associated with women's satisfaction towards the care provided by the health professionals during hospital assisted delivery and identify how those factors influence their general levels of satisfaction. The cohort hospital based study was carried out in connection with the Birth in Brazil research. 15,688 women were included, interviewed at home, through the phone, from March 2011 to February 2012. All the variables that compose the professional/pregnant woman relationship (waiting time, respect, privacy, clarity of explanations, possibility of asking questions and participating in the decisions) and schooling remained independently associated with general satisfaction towards delivery care, in the adjusted model. The white women assisted in the southeastern and southern regions of the country, by the private sector and with a companion present gave a better evaluation of the care provided. Women value the way in which they are assisted by the health professionals, and there are inequalities in the way they are treated based on skin color, geographic region and financial situation.

Maternal mortality due to hemorrhage in Brazil

OBJECTIVE

to analyze the rates of maternal mortality due to hemorrhage identified in Brazil from 1997 to 2009.

METHODS

the time series and population data from the Brazilian Health Ministry, Mortality Information System and Live Birth Information System were examined. From the Mortality Information System, we initially selected all reported deaths of women between 10 and 49 years old, which occurred from January 1, 1997 to December 31, 2009 in Brazil, recorded as a "maternal death".

RESULTS

during the research period, 22,281 maternal deaths were identified, among which 3,179 were due to hemorrhage, accounting for 14.26% of the total deaths. The highest rates of maternal mortality were found in the North and Northeast areas of Brazil.

CONCLUSIONS

the Brazilian scenario shows regional inequalities regarding maternal mortality. It presents hemorrhaging as a symptom and not as a cause of death.

Reasons which lead the health services not to allow the presence of the birth companion: nurses' discourses

This qualitative research aimed to investigate the reasons the health services of Santa Catarina, Brazil, do not allow the presence of the birth partner of choice of women in the birthing process. The data were collected from September 2011 to January 2012 through semi-structured interviews with 12 nurses responsible for obstetric centers which did not permit, or permitted sometimes, the presence of the birth companion. The interviews were analyzed using the Discourse of the Collective Subject, in which three themes emerged: professionals' resistance to the presence of the companion; lack of physical infrastructure and human and material resources; and the institution's resistance to implementing the Companion's Law. The discourses show that impeding the presence of the companion is mainly related to the decision of the professionals and the inadequacy of the organizational structure. This requires changes in the attitude of the staff, institutional support, and management strategies to increase the support for the presence of the woman's companion of choice.

Conhecimento sobre a Lei 11.108/2005 e a experiência dos acompanhantes junto à mulher no centro obstétrico

Pesquisa exploratório-descritiva, com abordagem qualitativa, realizada em uma maternidade pública de Santa Catarina, que objetivou conhecer quais informações os acompanhantes possuem acerca da Lei 11.108/2005, as suas percepções sobre a experiência no centro obstétrico e as ações de apoio junto à mulher. Os dados foram coletados por meio de entrevistas semiestruturadas, de novembro/2010 a maio/2011, com 16 acompanhantes que permaneceram com parturiente durante todos os períodos clínicos do parto. A análise dos dados, utilizando o Discurso do Sujeito Coletivo, indicou pouco conhecimento sobre a Lei, os acompanhantes consideraram a experiência positiva, avaliaram como satisfatório o atendimento prestado à mulher e desenvolveram ações de apoio físico e emocional. Apesar das adversidades do centro obstétrico e das situações de estresse inerentes ao processo de parturição, constatou-se ser possível que o acompanhante tenha uma experiência positiva e atue como provedor de apoio à mulher.

[Female urinary incontinence: a systematic review of qualitative studies]

Urinary incontinence has broad repercussions on female daily life. The objective of this study was to conduct a systematic review seeking to analyze results of qualitative research concerning female urinary incontinence published prior to 2009. After an electronic search, 53 research reports were identified with 30 fulfilling the exclusion and inclusion criteria. After classification according to the Critical Appraisal Skills Program, 13 constituted the analytical body for review. The data were synthesized according to the meta-ethnographical approach through reciprocal translation. Two categories emerged: life experiences among incontinent women; and proposals for care models for incontinent women. The restructuring of one's personal life metacategory points to individual adjustments necessary for dealing with the problem. In essence, the results reveal the option of the majority of women facing the loss of urine "silently" and point to the need for professionals to understand family perceptions in order to better comprehend the personal, family, and social implications involved in female urinary incontinence.

[Planned home births assisted by nurse midwives: maternal and neonatal transfers]

The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.

[The production of knowledge regarding gestational hypertension in the stricto sensu graduate nursing studies in Brazil]

This documental study analyzed the Brazilian production of stricto sensu nursing graduate programs related to gestational hypertension. The data source used was the Brazilian Nursing Association Theses and Dissertations Database. The survey located 14 studies produced between 1979-2008, produced mainly in the Southeast region between 1996 and2008. The analytical process revealed a concern with the subjectivity of pregnant women and with aspects regarding nursing care. Furthermore, it showed that most studies used a qualitative methodology supported by nursing theories. The experience lived by pregnant women with hypertension is marked by negative feelings and socioeconomic problems, and is also affected by how the family is organized. The culture of pregnant women with hypertension is disregarded and they receive care in a context in which the disease is the priority. In conclusion, despite some scientific advancements, this topic has not raised the interest it deserves among nurses attending graduate study programs.

[Outcomes of planned home birth assisted by nurses, from 2005 to 2009, in Florianópolis, Brazil]

A cross-sectional study was performed to analyze obstetric and neonatal results of planned home births assisted by obstetric nurses in the city of Florianópolis, Southern Brazil. Data collected from the medical records of 100 parturient women cared for between 2005 and 2009 indicated 11 hospital transfers, nine of which underwent a Cesarean section. The majority of women who had a home birth showed normal fetal heart beat (94.0%) and progress on the partogram (61.0%), vertical water delivery was the position most frequently chosen (71.9%), newborns had an Apgar score ≥ 7 at five minutes (98.9%), episiotomy was performed in 1.0%, and 49.4% did not need perineal suturing. Outcomes indicated that planned home birth is safe.

Vivência do parto normal ou cesáreo: revisão integrativa sobre a percepção de mulheres

Foi realizada uma revisão integrativa com o objetivo de identificar a contribuição das pesquisas desenvolvidas, em âmbito nacional e internacional, sobre a percepção do parto normal e cesáreo pelas mulheres que os vivenciaram. A busca dos artigos ocorreu nas bases de dados MEDLINE, LILACS, BDENF, CINAHL e INDEXPSI, no período de 2000 a 2009, sendo selecionados e analisados 17 estudos. Os estudos apresentam percepções positivas e negativas das mulheres sobre os dois tipos de parto, tais como o protagonismo da mulher e a melhor recuperação no parto normal, a ausência de dor na cesárea, a insatisfação com a assistência recebida; assim como recomendações para a prática obstétrica e sugestão de novas pesquisas. Os resultados apontam aspectos assistenciais que podem contribuir para a satisfação das mulheres e a necessidade de outras investigações para compreender melhor a multidimensionalidade do processo de parto, seja normal ou cesáreo.

A responsabilidade profissional na assistência ao parto: discursos de enfermeiras obstétricas

Trata-se de um estudo qualitativo, de natureza exploratória, que objetivou identificar o conhecimento das enfermeiras obstétricas em relação à responsabilidade profissional na assistência ao parto. Foram entrevistadas 11 enfermeiras que atuavam na assistência ao parto em hospitais e/ou domicílio no estado de Santa Catarina, entre março e agosto de 2009. Após análise pelo Discurso do Sujeito Coletivo, emergiram Ideias Centrais que contemplam os temas sobre as relações das enfermeiras obstétricas com os médicos e a instituição; a responsabilização profissional e as repercussões morais e legais do erro. Verificou-se que as enfermeiras conhecem pouco a respeito das repercussões legais do erro. Ao assumir a assistência ao parto, devem dedicar total atenção aos limites da competência e à prevenção de erros previsíveis, tendo em mente que assumirão também a responsabilização por suas falhas. A atualização sobre responsabilidade legal é tão importante quanto a científica e pode contribuir para a autoconfiança profissional.

Filosofia assistencial de uma maternidade-escola: fatores associados à satisfação das mulheres usuárias

Estudo transversal que avaliou a filosofia de uma maternidade, a partir da satisfação das mulheres com o atendimento recebido na admissão obstétrica, no trabalho de parto/parto e no puerpério. Os dados foram coletados com 310 mulheres e analisados pelo teste qui-quadrado, exato de Fisher, Odds Ratio (IC 95%) e regressão logística. A satisfação na admissão esteve estatisticamente associada ao fato dos profissionais e acadêmicos se apresentarem, darem as orientações solicitadas e fornecerem apoio emocional; no trabalho de parto/parto esteve associada com privacidade, apoio emocional e recebimento de informações; e no puerpério, com apoio emocional e recebimento de informações. Chance de insatisfação ocorreu quando a mulher não recebeu apoio emocional na admissão (5,70; IC 95%: 1,88; 17,31) e não obteve informações no trabalho de parto/parto (6,53; IC 95%: 1,97; 21,64). A concretização de uma filosofia assistencial que atenda as necessidades das usuárias contribui para a satisfação com o atendimento, desde a internação até a alta.

O saber/fazer das parteiras na Maternidade Carmela Dutra de Florianópolis - SC (1967/1994)

Trata-se de uma pesquisa qualitativa com abordagem sócio-histórica que objetivou historicizar os saberes e fazeres das parteiras na Maternidade Carmela Dutra de Florianópolis-SC, no período de 1967 a 1994. Os dados foram coletados por meio de entrevistas semiestruturadas com quatro parteiras e categorizados com base na análise de conteúdo. Os resultados evidenciaram que as parteiras adquiriram seu saber no cotidiano da prática e em curso regular realizado em outra maternidade da capital. Estes saberes oportunizaram realizar cuidados junto às mulheres durante o trabalho de parto, parto, no pós-parto e aos recém-nascidos. Esse cuidado era congruente com o modelo biomédico da época, e com as condutas e rotinas instituídas na maternidade estudada. Estas parteiras tiveram um papel fundamental no contexto da saúde catarinense.

Percepção dos profissionais de saúde sobre a filosofia assistencial de uma maternidade pública da região sul do Brasil

Pesquisa descritivo-exploratória com objetivo de avaliar a implementação da filosofia assistencial de uma maternidade de ensino, sob a ótica dos profissionais. Participaram 113 profissionais que atuavam no segundo semestre de 2007. Os dados coletados por meio de questionário foram analisados por estatística descritiva. Do total de respondentes, 51,4% consideram que os 12 princípios são operacionalizados plenamente e 46,8%, parcialmente. Para um elevado percentual (> ou = 70,0%), aqueles relacionados aos direitos dos usuários são mais operacionalizados, seguidos dos que contemplam os aspectos gerais da assistência (> ou = 50,0%). Os que tratam da integração entre os profissionais e os serviços encontram-se entre os menos operacionalizados em alguns setores (> ou = 50,0%). Faz-se necessário conhecer os fatores que interferem negativamente na efetivação de todos os princípios filosóficos, integralmente

Métodos não farmacológicos para alívio da dor no trabalho de parto: uma revisão sistemática

Revisão sistemática que objetivou avaliar os resultados maternos e neonatais decorrentes da utilização de métodos não farmacológicos para alívio da dor no trabalho de parto, classificados como tecnologia leve-dura. Foi realizada uma pesquisa nas bases de dados CINAHL, MEDLINE, LILACS, SciELO, SCOPUS e Isi Web of Science. Incluiu-se 12 ensaios clínicos randomizados elegíveis, publicados entre 1980 e 2009, que avaliaram o banho de imersão, a massagem e a aromaterapia. Os resultados mostraram que o banho de imersão deve ser iniciado após 3 cm de dilatação, para não prolongar o trabalho de parto e prejudicar os resultados neonatais. A massagem é eficaz no alívio da ansiedade, dor e estresse, sendo mais efetiva para reduzir a dor, quando utilizada no começo da fase latente. A aromaterapia diminui a ansiedade e o medo. É necessário estabelecer parâmetros de aplicação de cada método para que os resultados maternos e neonatais sejam positivos e contribuam para a satisfação da mulher.

[Legal responsibilities of the nurse in obstetrical nursing]

The objective of this literature review is to identify how aspects related to legal responsibilities of the obstetrics nurse and the obstetrics nursing assistant have been approached in Brazilian publications. After researching the following databases for the period of 1980 to 2009; BDENF, CINAHL, LILACS, and SciELO, seven articles which dealt with judicial aspects were selected for this study. It was clear that none of these focused upon legal responsibilities for obstetrical nurses. Error prevention was highlighted among the majority of these publications, as well as civil and ethical responsibilities. However, the majority point out administrative sanctions and penal responsibilities. These aspects need to be researched in greater depth and reported upon, for they may contribute to more qualified formal education for nurses concerning the legal implications of their practice.

A filosofia assistencial da maternidade de um hospital universitário na visão dos acadêmicos: the academic view

Estudo transversal exploratório, que teve por objetivo avaliar a filosofia assistencial da maternidade de um hospital universitário, sob a ótica dos acadêmicos. A amostra foi composta por 47 alunos de enfermagem e 47 alunos de medicina. Os dados foram coletados em 2008, por meio de questionário. A análise englobou estatística descritiva e teste qui-quadrado. Os resultados evidenciaram que os princípios relacionados com a filosofia geral da assistência e com os direitos dos usuários são implementados em quase todos os setores, enquanto os relacionados com a integração entre os profissionais e entre os setores são os que apresentam maiores fragilidades. De forma geral os acadêmicos conhecem a filosofia e consideram que a mesma é implementada na maioria dos setores, com destaque para o centro obstétrico, o alojamento conjunto e a central de incentivo ao aleitamento materno. Contudo, também ressaltam que a operacionalização da filosofia, em sua totalidade, ainda permanece um desafio a ser superado.

Violence against Amazon women

This quantitative and exploratory study analyzed violence against Amazon women presented in print media according to type and severity, and whether aggressors fell under the Maria da Penha law. A total of 181 issues of a regional newspaper were consulted. Based on content analysis, 164 items addressing violence against women were selected and 46 were included in the corpus of analysis. Results were gathered in three thematic groups: women killed with cruelty, sexual violence against women regardless of age, and violence against women and the limitations of the Maria da Penha law. Violence against these women varied in terms of form and severity, including up to homicide. Women are submitted to sexual violence from childhood through adulthood. The enforcement of this law shows the community it has a means to cope with this social phenomenon.

Parto vertical em hospital universitário: série histórica, 1996 a 2005

OBJETIVOS: descrever a evolução do número de partos horizontais e verticais na maternidade do Hospital da Universidade Federal de Santa Catarina, Brasil, e avaliar a associação dos mesmos com a taxa de cesárea, de internações dos recém-nascidos em unidade de tratamento intensivo e semi-intensivo e as transfusões sanguíneas maternas. MÉTODOS: estudo descritivo -série histórica. Foram incluídos todos os partos, as internações dos recémnascidos na Unidade de Terapia Intensiva e as transfusões sanguíneas maternas ocorridas de 1996 até 2005. Para testar as tendências, utilizou-se o método de Prais-Winsten para regressão linear generalizada. RESULTADOS: em 1996 a porcentagem de partos verticais era 5,4% e em 2005 foi 52,3%. A variação média anual dos partos verticais foi de +20,8% (p=0,007) e dos partos horizontais de -15,2% (p<0,001). Os partos cesáreos apresentaram tendência de estabilidade. Houve diminuição no número de recém-nascidos internados na unidade de terapia intensiva neonatal de 6,1% ao ano (p=0,001) e de transfusões sanguíneas ou hemoderivados (5,2% -p<0,01). CONCLUSÕES: o aumento de partos verticais em relação aos demais está em consonância com as evidências científicas e recomendações da Organização Mundial da Saúde. Essa prática foi incorporada gradativamente pelos profissionais da equipe de saúde.

Saúde da mulher e do recém-nascido: produção de conhecimento na graduação em enfermagem

Pesquisa exploratório-descritiva documental, que objetivou identificar a produção do conhecimento dos acadêmicos do Curso de Graduação em Enfermagem da Universidade Federal de Santa Catarina na área da saúde da mulher e do recém-nascido, nos trabalhos de conclusão de curso referentes ao período de março de 1982 a dezembro de 2007. Os dados foram coletados por meio de formulário, e realizou-se análise estatística descritiva (frequência e porcentagem). Do total de 538 trabalhos, foram analisados 127, por terem sido desenvolvidos na área. A maioria deles foi com mulheres (58,3%), predominando os temas relacionados com a saúde da mulher e do binômio (puerpério, 33,8%). Quanto aos cenários de cuidado, destacou-se a unidade local de saúde (37,0%) e o domicílio (25,2%). A teoria de Dorothea Orem foi a mais utilizada (25,2%). Há grande interesse dos acadêmicos pela área que se concentra em cenário de cuidado não hospitalar. Destaca-se a utilização de teorias de enfermagem como referencial teórico.

Puerperal women's perceptions on vertical and horizontal deliveries

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.

[Using quantitative and qualitative approaches in knowledge production]

The debate over the differences between quantitative and qualitative methods is frequent, holding favorable and opposite positions concerning their integration. Outlining a research that contemplates both approaches generates doubts and restlessness about how to use them without damaging the methods' rigor, specificity, as well as the methodological and reflective sophistication of each. The purpose isto report and discuss using the quantitative (randomized controlled clinical trial) and the qualitative approach to analyze and understand the practice of including a companion chosen by the woman during her labor and childbirth, performing the role of support provider. Using both methods allowed for approximating the multiple facets involved in this practice and evaluating both the explicative dimension and the comprehension, since it could be performed with complementary views.

Especialização em enfermagem obstétrica: percepções de egressas quanto ao exercício profissional e satisfação na especialidade

Pesquisa exploratório-descritiva com o objetivo de conhecer as percepções de egressas da especialização em enfermagem obstétrica quanto ao exercício profissional e a satisfação na especialidade. Participaram 54 egressas dos cursos de Especialização em Enfermagem Obstétrica da Universidade Federal de Santa Catarina. Os dados foram coletados de abril a dezembro/2006, através de questionário. Realizou-se análise estatística descritiva dos dados obtidos das perguntas fechadas e leitura flutuante, ordenação e interpretação das perguntas abertas. Para 58,3% das egressas a atuação inicial na especialidade foi dificultada pela não aceitação dos outros profissionais; 56,3% não vivenciaram discriminação profissional e 37,5% foram discriminadas pelos médicos; 68,5% destacaram que a hegemonia médica dificultou o exercício profissional. A maioria, 87,4%, está satisfeita com a especialidade, 70,8%, otimistas quanto ao futuro da mesma e 98,1% cursariam novamente a especialização. As dificuldades para atuação, ligadas à autonomia profissional, não geraram, entretanto, insatisfação e pessimismo, demonstrando capacidade de superação para o exercício da especialidade.