Dissertationen: „Natural childbirth“

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Lin, Wennifer. „Birth art and the art of birthing creation and procreation on the 'Äina of Tütü Pele /“. Diss., Restricted to subscribing institutions, 2008. http://proquest.umi.com/pqdweb?did=1675789081&sid=1&Fmt=2&clientId=1564&RQT=309&VName=PQD.

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Rendina, Naomi R. „PHARMACEUTICALS AND THE NATURE OF AMERICAN CHILDBIRTH,1900-1970“. Case Western Reserve University School of Graduate Studies / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=case1591712326811695.

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Niven, Catherine A. „Factors affecting labour pain“. Thesis, University of Stirling, 1985. http://hdl.handle.net/1893/2572.

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The labour pain experienced by 101 women giving birth in a Scottish hospital was assessed by the McGill Pain Questionnaire and Visual Analogue Scales during active first stage labour and post-natally. Labour pain was found to be on average severe, but not intensely negatively affective. Its intensity varied considerably and was related to parity and the duration of the first stage of labour reflecting underlying differences in levels of noxious stimulation. Other obstetric and pharmacological factors which might affect noxious stimulation were not significantly related to pain scores. Induction was related to higher,and complications of pregnancy, to lower levels of pain attributable to psychological modulation. The desirability of pregnancy, positive and accurate expectations of birth, ante-natal training and the welcomed presence of the husband at the birth were associated with significantly lower levels of labour pain, particularly of non-sensory pain. A few subjects had very minimal previous experience of pain. These subjects had the lowest levels of pain in childbirth, perhaps because they were relatively insensitive to noxious stimulation. Subjects whose previous experience of pain had been extensive had significantly lower levels of labour pain than subjects whose previous pain experience had been more limited. Subjects who had extensive experience of pain used a larger number of strategies to cope with that pain than subjects whose experience had been more moderate. They used more strategies during labour, a greater proportion of which they had used previously. The use of a number of strategies in labour, either in combination or in sequence was related to lower levels of labour pain but not to painless childbirth. So too was the use of strategies which had been previously utilised. The relationship between previous pain experience and levels of labour pain was mediated by the differential use of coping strategies.

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Oliveira, Fernanda Mayra Mendonça de. „A natureza do parto e o parto natural“. Pós-Graduação em Psicologia Social, 2014. https://ri.ufs.br/handle/riufs/5959.

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This work has as its object the speeches about childbirth studied from the analysis of discourse. Using speeches about childbirth as relays for public policies and between technicians and users of the health system in Aracaju, social movements and the humanization of childbirth step to formulate the question: were the modes of naturalization in childbirth practices reflecting modeling conduct, production of stereotypies and determinism in the effects of this experience? The goal is to study how the disciplining and control bodies traverse the speeches on labor and the extent to which discourses about childbirth presented as progressive or liberating subdues can produce. To this end, the article shows a brief genealogy of the birth, the trajectory of their practices, biopolitical crossings and State policies, and discuss and give visibility to the affective, economic, aesthetic, ecological implications. The trajectory analysis ends up unfolding the relationship between the proposed humanized labor and the emergence of a pedagogy of childbirth and pregnancy anchored in the role of Doula. The research method is based on the concepts of institutional analysis implication and superimplication, regarded to research on the implications of the research are considered the essence of scientific work.
O presente trabalho tem como objeto os discursos sobre o parto estudado a partir da análise do discurso. Utilizando os discursos sobre o parto tal como se veicula pelas políticas públicas e entre técnicos e usuários do sistema de saúde em Aracaju, e pelos movimentos sociais de humanização do parto passo a formular a questão: estariam os modos de naturalização nas práticas de parto refletindo modelação de condutas, produção de estereotipias e determinismos nos efeitos dessa experiência? O objetivo é estudar de que forma a disciplinarização e/ou o controle dos corpos atravessam os discursos sobre o parto e em que medida os discursos sobre o parto apresentados como progressistas ou libertadores podem produzir assujeitamentos. Para tanto, o texto percorre uma breve genealogia do parto, a trajetória de suas práticas, atravessamentos biopolíticos e das políticas de Estado, além de discutir e dar visibilidade às implicações afetivas, econômicas, estéticas, ecológicas. A trajetória da análise acaba desdobrando as relações entre a proposta de parto humanizado e a emergência de uma pedagogia do parto e da gestação ancorada na função da Doula. O método da pesquisa se baseia nos conceitos da análise institucional de implicação e sobreimplicação que se refere à pesquisa em que as implicações do pesquisador são consideradas como o essencial do trabalho científico.

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Shorten, Allison. „Making choices for childbirth after caesarean section : a randomised controlled trial of a decision-aid“. Phd thesis, Faculty of Nursing and Midwifery, 2005. http://hdl.handle.net/2123/7741.

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Kelson, Lynette. „An exploration of the reasons why 10 women from central Victoria chose to birth at home“. Thesis, University of Ballarat, 2004. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/40029.

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Marques, Maria João Pimenta. „Parto normal/natural assistido: projeto para a assistência em meio intra-hospitalar no HESE-EPE“. Master's thesis, Universidade de Évora, 2014. http://hdl.handle.net/10174/13022.

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Os avanços tecnológicos em Obstetrícia tornaram corrente o parto em ambiente medicalizado colocando-se a parturiente no papel de colaboradora. Contudo a OMS recomenda o parto normal e sublinha a sua participação ativa. A meta deste trabalho é preparar a mudança de paradigma na assistência ao parto normal/natural. Realizou-se o diagnóstico de situação em amostra de Enfermeiras Especialistas de Saúde Materna e parturientes (21 e 125). Recolheram-se dados em instrumentos desenhados a partir das recomendações da OMS. Observaram-se práticas recomendadas e não recomendadas. Face ao diagnóstico de situação, elaborou-se documentação, nomeadamente manual de boas práticas, cartaz e guia informativos. Projetou-se o espaço-tipo físico e equipamentos a adquirir com a concordância da instituição. Para um novo modelo de cuidados acredita-se ser necessário fortalecer a autonomia dos saberes próprios das Enfermeiras Especialistas face ao previsto legal nas suas atividades diárias. De facto acompanham o processo de nascimento e são reconhecidas pelas organizações; ABSTRACT: Childbirth / Natural Assisted: Project for Assistance in a Hospital Environment of the HESE - EPE Technological advances in Obstetrics led to unusual medicalized environment in childbirth, in which the mother plays a collaborator role. However, the WHO recommends normal delivery and emphasizes their active participation. This work aims to prepare a shift of paradigm for care in normal/natural birth. A situation analysis was conducted using a sample of Maternal Health Specialists Nurses and mothers (21 and 125). Data was collected in questionnaires following WHO recommendations. Recommended and not recommended practices are being used. Given the situation analysis, documentation, including good practice guide, poster and informative guide were elaborated. A physical space prototype and equipment to be purchased were projected with the approval of the institution. Towards a new model of care is believed to be necessary to strengthen the autonomy of the Nurses' own knowledge given their daily activities under the law. In fact they follow the birth process and are recognized by organizations.

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Aleksa, Linda C. „Management of a social experiment across multiple settings and institutions regarding childbirth education programs and type of birth“. Diss., Virginia Polytechnic Institute and State University, 1986. http://hdl.handle.net/10919/53615.

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Experimentation in field settings addressing socially sensitive topics are generally avoided by researchers. This avoidance is based on the restrictive nature of the required controls and the perceived inability to implement the required designs. In this study, the researcher has documented the necessary steps to meet design requirements for the conduct of a quasi-experimental study in two field settings. This quasi-experimental study addresses a case dealing with the attitudes of parents regarding their childbirth experiences. Programs for childbirth education traditionally emphasize the "natural" method of birth. Socially, cesarean births are currently being performed in 20 percent of the cases. Nursing education literature Suggests that prepared childbirth education programs contribute to negative parental attitudes for those experiencing cesarean birth. In the case for this study, attitudes of parents experiencing both vaginal and cesarean births and receiving three different levels of childbirth education were investigated. Documentation of the required research controls for the case was achieved through the maintenance of a log of events. The three levels of childbirth education included two types of Lamaze training and the non-prepared. Two hundred and sixteen (216) parents in each of the settings were included in the study representing 54 vaginal and 54 cesarean births. The measurements included hospital records/and response to a modified Likert scale. Analysis of variance was used to test the research hypothesis. Documentation of all research requirements for the study was successfully completed and case results obtained. Parents experiencing cesarean birth had more negative attitudes than those experiencing vaginal birth. In one of the two field settings, childbirth education was validated as contributing to more negative attitudes for cesarean birth, but was not replicated in the second setting. A significant (P<.05) first order interaction between type of birth and receipt of childbirth education was found in both settings.
Ed. D.

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Weckend, Marina J. „Physiological plateaus during childbirth: A constructivist grounded theory and novel definition“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2023. https://ro.ecu.edu.au/theses/2692.

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Background: During childbirth, one of the most common diagnoses of pathology is ‘failure to progress,’ frequently resulting in labour augmentation and intervention cascades. However, ‘failure to progress’ is poorly defined and some evidence suggests that plateauing labour (slowing, stalling and pausing of labour processes) may represent a typical and physiological occurrence during normal childbirth. Therefore, this study aimed to explore what exactly midwives define as ‘physiological plateaus’ and which significance such plateaus may have for the labour trajectory and birth outcome. Methods: This study followed a constructivist grounded theory approach, assuming a position of ontological critical realism combined with epistemological constructivism. Twenty midwives across Australia participated in individual semi-structured interviews between September 2020 and February 2022. Midwives were eligible to participate if they had a midwifery qualification (any type, any country) and had experience with supporting women during normal childbirth (any birth setting). Interviews were transcribed and analysed using multiple, inductive and deductive, coding steps and constant comparative methods, resulting in a descriptive and explanatory grounded theory. This research was funded through an Australian Government Research Training Program Scholarship as part of MW’s PhD program. Ethical approval was obtained from Edith Cowan University’s Human Research Ethics Committee. Findings: This study found that physiological plateaus are common, can occur during the entire continuum of labour and birth, are typically followed by a self-resumption and acceleration of labour and result in good birth outcomes for mother and baby. The primary aetiology of physiological plateaus appears to be a self-regulation of the mother-baby-unit. Further, it was found that the conceptualisation of plateauing labour depends largely on health professionals’ philosophical assumptions around childbirth. Whereas the ‘Medical Dominant Paradigm’ frames plateaus as invariably pathological, the ‘Holistic Midwifery Paradigm’ acknowledges plateaus as a normal and valuable element of labour. Consequently, some midwives find themselves in a position of philosophical dissonance in their workplace, perceiving that physiological plateaus are misinterpreted as pathological and subsequently reverting to (overt and covert) juggling strategies aimed at protecting women from undue medical interventions. Conclusions: This study provides evidence that midwives’ unique holistic philosophy can have a direct positive impact on birth outcomes for mothers and babies, as it challenges narrow definitions of normality and adapts flexibly to women’s individual labour patterns, including patterns with physiological plateaus. The novel theory presented in this study emphasises the significance of physiological plateaus during labour and encourages a renegotiation of what can be considered healthy and normal during childbirth.

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Morison, Susanjane. „A phenomenological study of the homebirth experience : The couples perspective“. Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1996. https://ro.ecu.edu.au/theses/943.

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The purpose of this qualitative study was to describe the experience of parents who have had a homebirth in the past two years in Perth. Studies conducted to date have predominantly used quantitative research methods, investigating the safety of homebirth and comparing home to hospital birth without exploring a couples experiences. A phenomenological approach was used as it seeks to understand human experience in context. The research design consisted of a field study, in which ten parent couples were interviewed and three homebirth videos observed. Data analysis was conducted according to the procedure outlined by Colaizzi (cited in Knaack, 1984, p. 110) which is to describe, interpret and extrapolate common themes and meanings. Of the ten couples interviewed four couples spoke of their first child's homebirth and the remaining six couples had three or four children who had been born at home. Research participants were attended to during their homebirth by one of five registered midwives. The essence of these parents' experiences of homebirth was gained through identifying significant statements from transcripts and field notes then clustering these into themes. The four essential themes were Constructing the Environment, Assuming Control, Birthing, and Resolving Expectations. The research findings provide health professionals and consumers with an insight into homebirth which challenges them to alter their practices and assumptions regarding this birth environment.

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Raphael, Amanda-Jane. „Natural childbirth in twentieth century England : a history of alternative approaches to birth from the 1940s to the 1990s“. Thesis, Queen Mary, University of London, 2010. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1601.

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It is well-established that a medical model of childbirth shaped maternity policy during the second half of the twentieth century. However, alongside this narrative of medicalised childbirth, an idea emerged that was to challenge medical hegemony in maternity care provision. In 1933 British doctor Grantly Dick-Read published his first book, Natural Childbirth, detailing his theories on pain during childbirth and its remedy. Natural childbirth was a controversial idea and was not well-received by the medical profession. Nevertheless, some women were enthusiastic about the nonmedical approach suggested by Dick-Read and by the 1950s natural childbirth was recognised as a distinct method of coping with the rigours of labour and birth. The term later became synonymous with a range of alternative ideas about the management of childbirth. Such ideas were disseminated through literature advising women about childbirth, and through antenatal education, which aimed to inform, enlighten and empower childbearing women. Childbirth alternatives were consistently regarded with scepticism and the medical establishment remained critical of them. Midwifery was surprisingly ambivalent, given that it shared some of its core values with the principles of natural childbirth. Nevertheless, a vocal minority continued to enthuse about childbirth alternatives, and a handful of consumer organisations committed to promoting them emerged. By the 1970s and 1980s, a backlash against medicalised childbirth in contemporary Britain provided a platform for such organisations to push their agenda even further. Natural childbirth discourse provided the means to express dissatisfaction with the medical system of childbirth; it also helped to give form to disillusionment with contemporary maternity services by shaping expectations. By the late 1980s, policy makers attempted to address the groundswell of discontent amongst childbearing women by alluding to childbirth alternatives and offering a choice of services. Still, as their shared history suggests, the relationship between the medical and natural models of childbirth remained complex and littered with paradoxes.

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Calegari, Fernanda Luciana. „Condução do parto e nascimento: repercussões na primeira mamada do recém-nascido em alojamento conjunto“. Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-14012013-162659/.

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Apesar dos esforços a favor da humanização do nascimento, sabemos que ainda se fazem presentes na prática uma série de procedimentos intervencionistas no trabalho de parto e parto que interferem nesse processo. Assim, a depender de como se dá o processo de parturição, este acarretará nas condições maternas e neonatais para o início do aleitamento materno, e como consequência, no processo da amamentação, uma vez que a mulher deve ser o elemento chave para esta prática. A prontidão do recém-nascido (RN) para mamar, depende do seu estado de consciência, sendo que pode apresentar-se mais sonolento em situações que envolvem o uso de anestésicos ou outras intervenções em suas mães durante o trabalho de parto. O objetivo do presente estudo é identificar a relação entre a prontidão do RN para sugar a mama materna na primeira mamada no alojamento conjunto e a condução do trabalho de parto, parto e nascimento. Trata-se de um estudo observacional, transversal, descritivo exploratório, realizado com 43 binômios, com RN de idade gestacional entre 37 e 41 semanas e 6 dias, Apgar >= 7 no 5º minuto, filhos de mães primíparas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, com protocolo (Nº1219/2010). As informações do processo de nascimento foram coletadas dos prontuários, e a partir das entrevistas às puérperas. A avaliação da prontidão dos RN para sugarem, foi feita por meio de filmagens dos neonatos desde o início ao término da primeira mamada no alojamento conjunto, sendo avaliados os estados de sono e vigília e mamada, com base no Formulário de Observação da mamada da OMS (1997). De acordo com o formulário os itens foram categorizados como \"sinais positivos\" e \"sinais negativos\", relacionados às condições favoráveis e às dificuldades na mamada. A análise foi fundamentada na estatística descritiva e na realização de testes estatísticos para análise comparativa entre as variáveis. Quanto aos resultados, em sala de parto, 17 (39,5%) neonatos foram colocados em contato pele imediato e apenas 4 (9,3%) sugaram o seio materno. Das 43 parturientes, 39 (90,7%) receberem analgesia, porém apenas 14 (32,6%) receberam a segunda analgesia (repique). No momento em que as mesmas receberam a primeira analgesia, a dilatação cervical variou entre 2 e 9 cm, sendo que 13 (33,3%) estavam com 5 cm. No repique, a dilatação cervical variou entre 4 e 10 cm, sendo que 6 (42,9%) estavam com 8 cm. O período mínimo de duração do trabalho de parto, foi de 25 minutos, e o tempo máximo, 11 horas. A menor duração do período expulsivo foi de 1 minuto e o tempo máximo, 59 minutos. Quanto aos dados referentes ao puerpério imediato, 36 (83,7%) mães referiram que estavam com sono logo após o parto e apenas 9 (20,9%) delas relataram estar sentindo algum tipo de dor e quanto ao cansaço, a maioria 41 (95,3%) referiu estar cansada. O período sem ingerir líquido variou de 33 minutos a 22h e 35 min e o período em jejum alimentar variou entre 2h 50 min e 21h 05 min. Em relação ao estado de sono e vigília no período que antecedeu a mamada, 18 (41,9%) dos recém nascidos estiveram no estado alerta quieto. Durante a mamada em 21(48,8%) dos neonatos, o estado sono ativo foi predominante. Na avaliação da mamada, os índices positivos se fizeram presentes nos diferentes domínios avaliados: 86,1% na sucção, 85,6% na postura corporal, 82,3% nas respostas do RN, 100% na anatomia da mama, no 78,4% tempo gasto na sucção durante a mamada. Quanto às associações entre as variáveis do trabalho de parto, parto e nascimento e as da mamada, obteve-se dados significativos entre a duração do período expulsivo e grupo sono e sonolento de estado de sono e vigília, com p=0,03. Embora as mães tivessem recebido intervenções durante o trabalho de parto e parto que pudessem interferir na qualidade da primeira mamada em alojamento conjunto, a maioria dos neonatos apresentou-se em estado de alerta, isto foi o suficiente para que eles apresentassem boa prontidão para mamar neste momento. O alojamento conjunto precoce, se mostrou uma prática favorável para a obtenção de sinais positivos na avaliação da primeira mamada à admissão de ambos.
Despite efforts to promote the humanization of birth, we know that still present in practice a number of interventional procedures during labor and childbirth that interfere with this process. So, depending on how is the parturition process, this will result in maternal and neonatal conditions for the initiation of breastfeeding, and as consequence, in the process of breastfeeding, since the woman should be the key element to this practice. The readiness of the newborn (NB) to nurse, depends on your state of consciousness, and may present more drowsy in situations involving the use of anesthetics or other interventions in their mothers during labor. The aim of this study is to identify the relationship between NB readiness to suck the maternal breast in the first feeding on the rooming in and conduct of labor, and birth. This is an observational, cross-sectional, descriptive and exploratory, conducted with 43 binomials, with NB in the gestational age between 37 and 41 weeks and 6 days, Apgar score >= 7 in the fifth minute, the children of first-time mothers. The project was approved by the Research Ethics Committee of the Nursing School of Ribeirão Preto, University of São Paulo, with protocol (No. 1219/2010). Information from the birth process was collected from medical records and from interviews with puerperal. The assessment of the NB readiness to suck, was made by filming the neonates from the beginning to the end of the first feeding in rooming in, evaluated the states of sleep and wakefulness and feeding, based on Observation of breastfeeding from WHO (1997). According to the form of the items were categorized as \"positive signals\" and \"negative signals\", related to the favorable conditions and difficulties in feeding. The analysis was based on descriptive statistics and statistical tests for comparative analysis between the variables. As for the results in the delivery room, 17 (39.5%) neonates were placed in immediate contact skin and only 4 (9,3%) sucked the breast. Of the 43 pregnant women, 39 (90.7%) received analgesia, but only 14 (32.6%) received the second analgesia (reinjection). At the moment in which they receive a first analgesia, cervical dilation varied between 2 and 9 cm, while 13 (33.3%) had 5 cm. In reinjection, cervical dilation varied between 4 and 10 cm, and 6 (42.9%) had 8 cm. The minimum duration of labor was 25 minutes and the maximum period 11 hours. The lowest delivery duration was 1 minute and the maximum time, 59 minutes. As for the data relating to postpartum, 36 (83.7%) mothers reported that they were sleepy soon after birth and only 9 (20.9%) of them reported to be feeling some sort of pain and tiredness, the most 41 (95.3%) reported being tired. The period without ingesting fluid ranged from 33 minutes to 22h and 35 min and fasting period varied between 50 min and 21h 2h 05 min. Regarding the state of sleep and wakefulness in the run-feeding, 18 (41.9%) of the infants were in quiet alert state. While feeding in 21 (48.8%) of the neonates, the active sleep state was predominant. In the assessment of breastfeeding, positive indices were present in different areas evaluated: 86.1% in sucking, 85.6% in body posture, 82.3% of infants\' responses, 100% in the anatomy of the breast, 78, 4% time spent sucking during breastfeeding. Regarding the associations between the variables of labor, and birth and breastfeeding, significant data was obtained from the delivery duration and sleep group and sleepy state of sleep and wakefulness, with p = 0.03. Although mothers had received interventions during labor and delivery that could interfere with the quality of the first feeding in rooming in, most neonates presented on alert, that was enough for them to present good readiness to nurse this time. The early rooming in practice proved favorable for obtaining positive signals in the evaluation of the first feed intake both.

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Gouveia, Cristiane Moretti. „Intercorrencias fisicas e emocionais no puerperio e suas relações com intervenções na assistencia ao parto“. [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/313836.

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Orientador: Ana Maria Segall Correa
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-11T19:09:49Z (GMT). No. of bitstreams: 1 Gouveia_CristianeMoretti_M.pdf: 2691354 bytes, checksum: c5ebcf4d90fe493f5689917c710d408c (MD5) Previous issue date: 2008
Resumo: As intervenções durante o trabalho de parto e parto têm sido objeto de debates de órgãos nacionais e internacionais. No Brasil há mobilização, por meio dos gestores de suas políticas públicas, no sentido de diminuir o número de cesarianas, episiotomias e outras intervenções que se revelaram inadequadas quando utilizadas sem indicação clínica. O objetivo desta pesquisa é estudar a relação entre intervenções clínicas e cirúrgicas no trabalho de parto e parto e a saúde física e psicológica (transtornos mentais menores) das mulheres no puerpério imediato, mediato e tardio de um hospital público do interior do Estado de São Paulo. Trata-se de um estudo de caráter descritivo, com abordagem quantitativa, no qual foram entrevistadas 278 mulheres no puerpério imediato e mediato (em torno do 10o dia), com perguntas referentes ao seu estado físico e psicológico. No 40o dia pós parto foi possível entrevistar 130 mulheres com o objetivo de analisar possíveis intercorrências tardias. A análise estatística inicial foi exploratória, com descrição de freqüência dos eventos e testes bivariados para nível de significância de 95%. A análise da medida de efeito foi realizada através da prevalência para observar complicações no puerpério imediato e tardio de acordo com as categorias de cada variável. Os resultados mostraram índices de analgesia e parto fórcipe acima dos citados em literatura. O parto fórcipe se mostrou fator de risco para lacerações perineais mais severas e Rns com Apgar menor que 7 no 1º minuto.
Abstract: The interventions during labor and delivery have been subject of national and international agency debates. In Brazil, health policies has been implemented in order to reduce the rates of surgical delivery, episiotomies, and other birth procedures revealed as inadequate when used without clinical indication. The aim of this study is to identify the relationship between interventions during labor and delivery and, the physical and psychological women's condition in the puerperal period in a public hospital in the State of São Paulo. It's a quantitative descriptive study that depicts the assistance received in the labor and its association to the kind of delivery, the interventions performed, the occurrence of depression and complications to the mothers in their puerperium. A sample of 278 women have been interviewed about their physical and psychological state on the 10th day of their puerperium, and 130 out of these 278 on the 40th day. An analysis was undertaken for potential risky factors, with outcome variable being presence or absence of complications. Confidence intervals at 95% level were calculated for each variable. Prevalence was calculated to identify the relationship between delivery clinical and surgical procedures and woman's health during puerperium period. The results showed a prevalence of analgesia and instrumental delivery above the expected by the current literature. Forceps delivery was a risk factor for more severe perineal lacerations and for newborns with and Apgar index lower than 7 in the first minute of life.
Mestrado
Epidemiologia
Mestre em Saude da Criança e do Adolescente

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Ukioka-Minegishi, Yasuko. „Pain is evil; pain is natural; Reactions to pain in childbirth and the use of obstetic anaesthesia in Britain, 1847-1900“. Thesis, Royal Holloway, University of London, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.530793.

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Kaibe, Nonkululeko Veronica. „The knowledge of the registration of the role of the doula in the facilitation of natural child birth“. Thesis, Stellenbosch : University of Stellenbosch, 2011. http://hdl.handle.net/10019.1/6849.

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Thesis (MCur)--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: This research was an attempt to investigate the role of the doula during labour and the promotion of natural childbirth as well as the assessment of the effect of the presence of the doula during natural childbirth. There has been a shift from home-based deliveries to hospital-based deliveries, which does not sufficiently provide for optimal care and emotional support to the women during labour. The registered midwives in the maternity units in Port Elizabeth in the Eastern Cape region in both private and public hospitals displayed some reluctance in using the doulas during labour. The design for this study utilised a quantitative approach which is non-experimental, explorative, descriptive and contextual in nature. The data -collection method used was only the statistical data from the registered midwives’ questionnaire designed as per the format from the University of Stellenbosch. Research ethics implemented were confidentiality, informed consent, privacy, protection, information and debriefing. Validity and reliability had to be observed on this study as it was observed that the content of the study had to be closely related to what was measured, as well as consistency of the data –gathering instrument in obtaining the same results in similar situations The study took place at the Port Elizabeth Maternity Units in the Eastern Cape with registered midwives (40 in the Public Sector and 45 in the Private Sector),and 45 in the private sector of the maternity units of the selected hospitals. The results of this study and the interpretation thereof assisted the researcher to confirm that there was indeed a great need for the doulas during natural childbirth in the maternity units in the public sector, where there is a shortage of registered midwives and care workers to attend to the basic needs of the patients. The value of the contributions of the doula to support and provide comfort measures to women during labour should not be underestimated; and registered midwives should be informed about the important role of the doula and how the doula can complement the obstetrical care rendered by the midwife.
AFRIKAANSE OPSOMMING: Hierdie navorsingstudie is uitgevoer om die rol van die doula of kindergeboorte-begeleidster gedurende baring in die bevordering van natuurlike kindergeboorte asook die effek van die teenwoordigheid van laasgenoemde te ondersoek. Die klem het verskuif van tuisbevallings na hospitaal- bevallings. Hierdie tendens het veroorsaak dat daar nie genoeg voorsiening gemaak word vir versorging en emosionele ondesteuning nie. Die geregistreede vroedvroue in die verlossings-eenhede in Port Elizabeth in die Oos-Kaapse streek, in beide openbare en private hospitale toon ‘n mate van onwilligheid om doulas tydens baring te benut, Die studie ontwerp is non-eksperimenteel, eksploratief, beskrywend en kontekstueel van aard, met ‘n kwantitatiewe benadering. In kwantitatiewe studies help die ontwerp, die navorser deur middel van prosedures om akkurate en interpreteerbare data te ontwikkel. Die studie is onderneem by die Port Elizabeth se Verloskunde-eenhede in die Oos-Kaap. In hierdie hospitale is daar 40 geregistreerde vroedvroue in die Openbare- en 45 in die Privaatsektor. Die resultate van hierdie studie en die interpretasie daarvan het die navorser gehelp om te bevestig dat daar inderdaad ‘n groot behoefte bestaan vir die bydraes van kindergeboortbegeleidsterss en veral in die openbare sektor waar daar groot tekorte aan geregistreerde vroedvroue voorkom en nie genoeg personeel is om in die basiese behoeftes van die pasiënte te voorsien nie. Die waarde van die bydraes van doulas om ondersteuning en bemoedigingsmaatreëls vir die vrou tydens baring te voorsien moet nie onderskat word nie; en geregistreerde vroedvroue behoort bewus gemaak te word van die belangrike rol van die doula en hoe die doula die obstetriese sorglewering van die pasient kan komplementeer.

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Kringeland, Tone. „Perspective of risk in childbirth, women’s expressed wishes for mode of delivery and how they actually give birth“. Doctoral thesis, Nordic School of Public Health NHV, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3686.

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Aims: The main aim of this thesis was to study a perspective of women`s expressed wishes for mode of delivery and how they actually give birth. Additional aims were to examine the notion of risk applied to childbirth, to examine what characterizes women who want to give birth as naturally as possible without painkillers or intervention and the characteristics of women who would, if possible, choose to have a cesarean section. Material and methods: The notion of risk was examined in an essay. Self-rating instruments were completed by 55,858 MoBa participants during week 30 of their pregnancy and available from The Norwegian Mother and Child Cohort Study (MoBa) by April, 2007. Individually reported information on socioeconomic factors, lifestyle factors, feelings related to childbirth, factors concerning psychosocial health, physical, psychological and sexual harassment and information on satisfaction with antenatal care health services were collected from a MoBa questionnaire. Data on the mother’s age, parity, physical health before and during the pregnancy, previous cesarean sections and actual mode of delivery were collected through a linkage to the The Medical Birth Registry of Norway. Findings: General perspectives on risk differ depending on both the person and the profession. More and more childbearing women are in danger of being considered deficient and in the danger zone. Figures on risk are not objective values, and the association between risk and security is socially and culturally determined. Personal symbols can be basic assumptions about the life one leads, and the childbearing woman has preferences of her own. Interest in natural childbirth was expressed by 72 percent and a wish for caesarean section was expressed by ten percent of the women. Positive experience from previous childbirths, first birth or third or later birth, no dread of giving birth, and reporting positive intra-psychic phenomena are significantly associated with the wish for natural birth. Negative experiences from previous childbirths and fear of giving birth are two of the strongest factors associated with a wish for a caesarean section.Overall, 47 percent of the women who wanted ”as natural a birth as possible” had their preference fulfilled. The figures differed largely for primiparas and multiparas; the risk of acute caesarean sections was high among primiparas and the effects of the predictors of natural birth were stronger for primiparas than for multiparas. Conclusions:The factors that influence the chance of having a natural birth are different for primiparas and multiparas. The high rate of non-natural births among first time mothers who actually want to have a vaginal birth without interventions should call attention to the increasing incidence of cesarean section in Norway. The chance of actually having a natural birth for women with a preference for a natural birth is much larger for multiparas. Negative experiences from previous childbirths and cesarean section are, however, important factors associated with non-natural birth and should be taken into consideration in public health
Mål: Det overordna målet for denne avhandlingen var å studere perspektiv omkring hvordan kvinner uttrykker at de ønsker å føde og hvordan de faktisk føder. I tillegg var målet å undersøke risikobegrepet anvendt innen fødselsomsorg, undersøke hva som karakteriserer kvinner som ønsker å føde så naturlig som mulig uten smertestillende eller intervensjon og undersøke hva som karakteriserer kvinner som ville valgt å ta keisersnitt dersom det var mulig. Materiell og metode: Avhandlingen inkludere fire artikler. Risikobegrepet drøftes i første artikkel som er et essay. De 3 andre inkluderer data fra Den norske mor og barn-undersøkelsen. Data fra 55,858 MoBa informanter var ferdigregistrert april 2007 og omfatter individuell informasjon om sosioøkonomiske faktorer, livsstilsfaktorer, følelser/opplevelser relatert til fødsel, faktorer som omhandler psykososial helse, fysiske, psykiske og seksuelle overgrep og informasjon om tilfredshet med offentlig svangerskapsomsorg. Tidligere keisersnitt og hvordan kvinnene faktisk fødte i dette svangerskapet ble hentet fra en link til Medisinsk Fødselsregister. Funn: Generelt perspektiv på risiko er forskjellig, avhengig av både person og profesjon. Stadig flere gravid/fødekvinner står i fare for å bli betraktet som utsatte/mangelfulle og i faresonen. Kalkulasjoner av risiko er ikke objektive verdier og assosiasjonen mellom risiko og sikkerhet er sosialt og kulturelt bestemt. Subjektive symbol kan være grunnleggende antagelser/forståelser i forhold til det livet en lever og blivende mødre har sine egne preferanser. Syttito prosent av kvinnene uttrykte ønske om å føde så naturlig som mulig og ti prosent av kvinnene ønsket å ta keisersnitt. Positive erfaringer fra tidligere fødsler, det å være førstegangsfødende eller ha født mer en ett barn tidligere, ikke være redd for å føde, samt å rapportere positivt i forhold til intrapsykiske fenomen, er signifikant assosiert med ønske om å føde så naturlig som mulig. Negative erfaringer fra tidligere fødsler og redsel for å føde er de to faktorene som er sterkest assosiert med ønske om keisersnitt. Samlet sett fikk 47 prosent av de kvinnene som ønsket så naturlig fødsel som mulig, oppfylt ønskene sine. Resultatet var svært ulikt mellom førstegangsfødende og fleregangsfødende; risikoen for akutt keisersnitt var høg blant førstegangsfødende og effekten av prediktorene for naturlig fødsel var sterkere i forhold til førstegangsfødende enn for fleregangsfødende. Konklusjon: Faktorene som influerer sjansen til å føde så naturlig som mulig er ulike for førstegangsfødende og for fleregangsfødende. Den høge tallet på fødsler med intervensjon hos førstegangsfødende som egentlig ønsker å føde vaginalt uten intervensjon burde fått større oppmerksomhet. Dette bør også sees i sammenheng med en stadig økende innsidens for keisersnitt i Norge. Muligheten for å få en så naturlig fødsel som mulig er mye større for fleregangsfødende. Negative erfaringer fra tidligere fødsler og tidligere keisersnitt er, likevel, viktige faktorer assosiert med ikke-naturlig fødsel og bør reflekteres over/tas i betraktning i et folkehelseperspektiv.

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Peppe, Mariana Vitor. „A assistência puerperal prestada pelas enfermeiras abstetras e/ou obstetrizes que realizam o parto domiciliar planejado no estado de São Paulo“. Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-29032018-151158/.

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O nascimento é um evento natural que através dos tempos sofreu diversas modificações, levando o parto, que até então era privado, íntimo e feminino, a ser vivido de maneira pública e institucional. Atualmente vivencia-se a desmedicalização do parto e um aumento na procura das gestantes pela opção de parir em casa. No domicílio toda ação é desenvolvida em função das necessidades da mulher, e este modelo, não se resume apenas no parto domiciliar planejado, mas também na assistência pré-natal e puerperal. O puerpério é um período de adaptação física e emocional, a assistência puerperal deve garantir um olhar voltado já às primeiras alterações após o parto, devendo ser iniciado e executado um plano de cuidado. Tem-se como objetivo geral compreender o cuidado prestado pela enfermeira obstetra e/ou obstetriz no período puerperal de um parto domiciliar planejado. Trata-se de uma pesquisa qualitativa, que contou com a participação de doze parteiras que assistem partos domiciliares em algumas regiões do estado de São Paulo. Os dados foram coletados por meio de uma entrevista semi-estruturada, com a seguinte questão norteadora: \"Me fale sobre a assistência que você presta no período puerperal de um parto domiciliar\". Os dados coletados foram transcritos na íntegra e, posteriormente, analisados, utilizando o método de Interpretação dos Sentidos. Da análise emergiram três categorias: \"Motivações e valores que levaram as parteiras de volta para o domicílio\", \"O parto em casa tem que ser planejado\" e \"O cuidado puerperal de um parto domiciliar planejado\", diversos cuidados foram descritos na assistência domiciliar prestada para a mulher e para o recém-nascido. A síntese apresentada infere que a assistência puerperal domiciliar prestada pelas parteiras é individualizada, entretanto, se faz necessário, uma melhora na qualidade da abordagem emocional e pessoal da puérpera. Os resultados evidenciaram que as parteiras enfatizam mais os cuidados biomédicos do que os emocionais e humanísticos, dessa maneira é fundamental apontar que essa assistência deve ser ampliada para uma abordagem integral e individualizada
Childbirth is a natural event that has suffered several changes over time, and what was once experienced in a private, intimate, and feminine world, became public and institutional. Currently, there has been a demedicalization of childbirth, and an increase in the search by pregnant women to give birth at home. In the household, every action is developed considering the woman\'s needs, and this model is not only applied to the planned home birth, but also to prenatal and postpartum care. Postpartum is a period of physical and emotional adaptation, and postpartum care must ensure attention is given to the first changes after birth, when a care plan must be started and executed. The main objective of this study was to understand the care provided by nurse midwives in the postpartum period following a planned home birth. A qualitative study was developed with twelve nurse midwives who assist planned home births in different regions in the state of São Paulo. Data were collected by means of a semi-structured interview with the following guiding question: \"Tell me about the care you provide in the postpartum period following a planned home birth\". The collected data were fully transcribed and later analyzed using the Interpretation of Meanings method. Analysis resulted in three categories: \"Motivations and values that led the nurse midwives back to the household setting\", \"Home childbirth must be planned\", and \"Postpartum care for a planned home birth\", and different care measures were described in the home care provided to women and newborns. The synthesis presented suggests that the postpartum home care provided by nurse midwives is individualized, however the quality of the postpartum women\'s personal and emotional approach must be improved. The results evidenced that the nurse midwives emphasize biomedical care rather than an emotional and humanizing assistance, thus it is fundamental to point out that this care must be broadened to a comprehensive and individualized approach

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Santos, Silvana dos. „A busca pelo parto natural e motivações para o preparo do assoalho pélvico com o epi-no“. Universidade Federal de São Carlos, 2015. https://repositorio.ufscar.br/handle/ufscar/3282.

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This work entitled "The search for natural childbirth and motivations to prepare the pelvic diaphragm with the epi-no" has as main objectives: to understand the elements involved in the choice of women for natural childbirth, identify motivations for the preparation of the pelvic diaphragm with the epi-no, seeking natural childbirth and identify the components that facilitate and those that hinder this choice. Was carried out with women who were part of the Epi-no Program, Health Laboratory initiative of Women of University of São Paulo, between 2013 and 2014. This is a qualitative research, for which we used as theoretical and methodological approach, Feminism Dialogic proposed by Lygia Puigvert (2001) and the Critical Communicative Methodology (MCC) proposed by Gomez et al (2006), both anchored in theoretical frameworks of Dialogic Learning, which in turn are based on concept of Communicative Action Habermas (1999) and dialogical of Paulo Freire (1994; 2005). The MCC seeks to identify the transformative dimensions, that is, those that promote or facilitate, in this case, a pleasurable experience of childbirth and cause difficulties dimensions, that is, those that represent a barrier to this experience, both relating to the categories of life and world system. Data collection began in November / 2013, and the analysis was organized as the basic level of analysis proposed by the MCC. Eight women were interviewed, seven of them completed the two phases of the communicative account, according to the methodology and there was canceling an interview, due to loss of material. The women were between 22 and 38 years with predominance of age above 30 years, all had a partner, five were primiparous (1st pregnancy) and two multiparous (2 or more pregnancies), with a history of cesarean section and abortion and all performed in childbirth hospital environment. The results showed that the discovery of pregnancy urged to talk with family, friends and health professionals about natural childbirth; aroused the personal search for information (books, magazines, internet, support groups natural childbirth); motivated to prepare the pelvic diaphragm with epi-no, among others. Childbirth, previously seen as traumatic and surrounded interventions (oxytocin, episiotomy, Kristeller) and suffering, in general gained a new meaning, exchanging a traumatic experience for a autonomous, self-control, fulfilling and unforgettable experience. The dimensions that transformed the labor context were linked to the experience of women and were related to world of life category. The analysis showed that they were more promising than category system, in other words , institutions, spaces, organization systems and guidelines governed by power or money. The processing dimensions were represented by groups who take the initiative to provide the dissemination of knowledge to women or who brought innovations (epi-no equipment, for example). In the case of cause difficulties dimensions, it was observed that the elements that related to the system and those related to the world of life is presented in similar numbers, showing that the woman is motivated to prepare the natural birth is difficult, both in his personal / family life, as in institutions. This work demonstrated that the changes initiated in the world of life category and that women rethought their way to see the birth, overcame their fears and naturelly tried to "convince" people around them. In the population studied was noted that the epi-no reduced lacerations, episiotomies warned, however in some cases did not prevent lacerations 1st degree. It is hoped that this work contribute to reflections on the delivery care model in order to rescue the female autonomy in childbirth and reduce myths and anxiety around the issue, reaffirming the importance, both from a personal point of view as a social and epidemiological , to follow the recommendations of the World Health Organization, as regards the issue of labor and birth.
O presente trabalho intitula-se A busca pelo parto natural e motivações para o preparo do assoalho pélvico com o epi-no e teve como principais objetivos: compreender os elementos envolvidos na escolha da mulher pelo parto natural, identificar motivações para o preparo do assoalho pélvico com o epi-no, visando o parto natural e identificar as dimensões que facilitam e aquelas que dificultam essa escolha. Foi realizado com gestantes que faziam parte do Programa de Epi-no, iniciativa do Laboratório de Saúde da Mulher de uma Universidade do interior de São Paulo, entre os anos 2013 e 2014. Trata-se de uma pesquisa qualitativa, para a qual se utilizou como referencial teórico-metodológico, o Feminismo Dialógico proposto por Lygia Puigvert (2001) e a Metodologia Comunicativa Crítica (MCC) proposta por Gomez et al (2006), ambos ancorados nos referenciais teóricos da Aprendizagem Dialógica, que por sua vez se baseiam no conceito da Ação Comunicativa de Habermas (1999) e na Dialogicidade de Paulo Freire (1994; 2005). A MCC busca identificar as dimensões facilitadoras, ou seja, aquelas que promovem, neste caso, uma vivência prazerosa do parto e as dimensões dificultadoras, ou seja, aquelas que representam uma barreira à esta vivência, relacionando ambas às categorias mundo da vida e sistema. A coleta de dados foi iniciada em novembro/ 2013 e a análise foi organizada conforme o nível básico de análise proposto pela MCC. Foram entrevistadas oito mulheres, sete delas concluíram as duas fases do relato comunicativo, de acordo com a metodologia e houve cancelamento de uma entrevista, devido à perda de material. As mulheres tinham entre 22 e 38 anos com predominância de idade acima dos 30 anos, todas tinham companheiro, cinco eram primíparas (1ª gestação) e duas multíparas (2 ou mais gestações), com histórico de cesárea e abortos e todas realizaram o parto no ambiente hospitalar. Os resultados mostraram que a descoberta da gravidez incitou, nessas mulheres, curiosidade em dialogar com familiares, amigos e profissionais da saúde sobre o parto natural; despertou a busca pessoal por informações (livros, revistas, internet, grupos de apoio ao parto natural); motivou para o preparo do assoalho pélvico com o epi-no, entre outros. O parto, visto anteriormente como traumático e cercado de intervenções (ocitocina, episiotomia, Kristeller) e sofrimento, em geral ganhou um novo significado e passou de uma experiência traumatizante para uma experiência autônoma, de autocontrole, realizadora e inesquecível. As dimensões que facilitam o contexto do parto estavam ligadas à vivência das mulheres e se relacionaram a categoria mundo da vida. A análise mostrou que foram mais promissoras do que aquelas que se apresentaram a categoria sistema, ou seja, as instituições, espaços, sistemas de organização e diretrizes reguladas pelo poder ou dinheiro. As dimensões facilitadoras foram representadas por grupos que tomam a iniciativa de proporcionar a difusão de conhecimento para as mulheres ou que trouxeram inovações (equipamento epi-no, por exemplo). No caso das dimensões dificultadoras, observou-se que, os elementos que se relacionaram ao sistema e os que se relacionaram ao mundo da vida se apresentaram em números equiparados, demonstrando que a mulher que se motiva para o preparo do parto natural encontra dificuldades, tanto em sua vida pessoal/familiar, quanto nas instituições. Este trabalho demonstrou que as mudanças iniciaram no mundo da vida e que as mulheres repensaram sua forma de ver o parto, superaram seus medos e tentaram contagiar as pessoas em seu entorno. Na população estudada notou-se que o epi-no reduziu as lacerações, preveniu episiotomias, porém em alguns casos não evitou lacerações de 1º grau. Espera-se com este trabalho contribuir para reflexões acerca do modelo de atenção ao parto, de forma a resgatar a autonomia feminina no parto e reduzir mitos e ansiedade em torno do tema, reafirmando a importância, tanto do ponto de vista pessoal como social e epidemiológico, de atender as recomendações da Organização Mundial da Saúde, no que se refere às questões do parto e nascimento.

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Jamas, Milena Temer. „Assistência ao parto em um centro de parto normal: narrativas das puérperas“. Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-20052010-115651/.

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A assistência ao parto em Centro de Parto Normal (CPN) mostra-se como uma tendência a ser incorporada por muitos serviços de assistência obstétrica no contexto brasileiro. Estudos com enfoque na experiência do cuidado, segundo a perspectiva da mulher, ainda são escassos. A presente pesquisa teve como objetivo descrever a experiência de mulheres que receberam assistência ao parto em um CPN. O estudo de abordagem qualitativa utilizou a análise da narrativa, como método de pesquisa. Este método é composto das fases de ler, analisar, transcrever, contar e ouvir a experiência; sua essência consiste no acesso à experiência primária, tal como representada pela pessoa que a vivencia. A análise dos depoimentos, foi desenvolvida de forma indutiva e interpretativa e resultou nas seguintes categorias descritivas da representação da experiência: a) O primeiro atendimento recebido no hospital; b) As experiências vividas no Centro de Parto Normal que foram relativas às orientações recebidas dos profissionais, as práticas de cuidado realizadas no trabalho de parto, os procedimentos executados pelos profissionais, a permanência do profissional no ambiente assistencial, o relacionamento interpessoal estabelecido pelos profissionais, a presença do acompanhante e as percepções em relação à sensação dolorosa; c) A estrutura física do hospital e d) Os conhecimentos e demandas por orientação expressos pelas mulheres. A categoria central A satisfação com a assistência recebida sintetiza a representação coletiva da experiência da assistência recebida no CPN. A experiência positiva relatada pelas mulheres confirma a premissa de que o local de assistência e as suas características influenciam a qualidade da assistência ao parto. Esta constatação fornece sustentação à política pública vigente no Brasil, que recomenda a implementação de CPNs em todo o território nacional. Cabe aos profissionais atuantes nesse contexto, o desenvolvimento da assistência ao parto, de acordo com as recomendações internacionais.
The healthcare rendered during childbirth in Birth Centers (BC) is seen as a trend to be incorporated by several services of obstetrical units in Brazil. Studies focusing on the experience of care according to the woman`s perspective are scarce. The objective of this research was to describe the experience of women who received healthcare during childbirth in a BC. This qualitative used descriptive analysis as a research method. The method consisted of steps to read, analyze, transcribe, relate and listen to experiences, its essence is the primary access to the experience, exactly as presented by the person who experienced it. Analysis of the interviews was developed in an inductive and interpretative manner and resulted in the following categories describing the representation about the experience: a) The first healthcare received in the hospital; b) Experiences in the Birth Center in accordance with guidelines received from the professionals, care practices performed during the childbirth, procedures executed by the professionals, permanence of the professional in the healthcare environment, interpersonal relationship established by the professionals, presence of a patient companion, and perceptions related to pain; c) The hospital physical structure; and d) The demands for knowledge and guidance expressed by women. The central category Satisfaction with the care received summarizes the collective representation of the healthcare received in the BC. The positive experience described by the women, confirms the premises that the healthcare unit and its characteristics do influence the quality of healthcare during childbirth. This finding provides support to current public policy in Brazil, which recommends the implementation of BC throughout the country. It is up to the professionals working in this context to develop childbirth care in accordance with international recommendations.

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Kerrigan, Angela Mary. „Care of obese women during labour : the development of a midwifery intervention to promote normal birth“. Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/27479.

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Normal birth, defined as birth without induction of labour, anaesthetic, instruments or caesarean section conveys significant maternal and neonatal benefits. Currently one-fifth of women in the United Kingdom are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes. There is a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support obese women to maximise their opportunity for normal birth. This thesis aims to provide evidence to address this gap and develop an evidence-based intervention to promote normal birth. Using a methodological approach aligned with pragmatism, this research was conducted in four parts and underpinned by the Medical Research Council framework for the development of complex interventions. Part one was a national survey involving 24 maternity units. Part two was a qualitative study of the experiences of 24 health professionals and part three involved 8 obese women. The final part was a multi-disciplinary workshop that used consensus decision-making to design the intervention. Collectively, the findings suggest that intrapartum care of obese women is medicalised. Health professionals face challenges when caring for obese women but many strive to optimise the potential for normal birth by challenging practice and utilising ‘interventions’ to promote normality. The findings also demonstrate that obese women have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for change. The intervention consists of three component parts; an educational aspect (e-learning package), a clinical aspect (intrapartum care pathway) and a leadership aspect (ward champions). Whilst acknowledging the importance of safety, increasing intervention during labour for obese women may further increase the risk of complications, with detrimental effects. Addressing intrapartum management of obese women through non-medicalised interventions is of paramount importance in order to promote normality, maximise the opportunity for normal birth and reduce the associated morbidities.

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Agostinho, Cláudia Catarina Granjo. „Competências clínicas e de investigação para um nascimento positivo“. Master's thesis, Universidade de Évora, 2020. http://hdl.handle.net/10174/27695.

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Introdução. A aquisição do grau de mestre concorre para o exercício profissional autónomo, fundamentado na evidência científica, que aplicado de forma individualizada permite ganhos em saúde materna. Objetivo. Descrever a experiência dos vários contextos de aprendizagem através das oportunidades clínicas e de investigação para a aquisição de competências. Metodologia. Descrição dos campos de estágio, análise das experiências clínicas e de investigação empírica sobre as expectativas e experiências do casal, face ao momento de nascimento. A amostra da vertente de investigação apresenta-se através de estatísticas descritivas. Resultados. A aquisição de competências clínicas teve balanço positivo, com mais/melhor conhecimento e desenvolvimento de competências. Da investigação resultou, que a aplicação do Plano de Parto, definido pela mulher/casal constitui medida optimizadora da experiência de nascimento. Conclusões. Em simultâneo com aquisição de competências, contribuiu-se para desocultar o fenómeno e promover experiências positivas no casal; ABSTRACT: Clinical and research skills for a positive birth Background. The purpose in graduating in a nursing master contributes to empowered nursing practice, based in scientific evidence, which when applied in an individualized way allows gains in maternity care. Objective. To examine the experiences in the different learning environments experienced through clinic nursing practice and research opportunities to competences development. Methods. Describing the internship places and to analyze clinical experiences and empirical research about parents’ experiences and expectations on the childbirth. This investigation is an exploratory descriptive study, using a qualitative approach. Results. The clinical competences acquisition had a great positive balance, with greater expertise and competences development. This study evidenced that the birth plan, designed by the mother or both parents, is an optimizing measure of the birth experience. Conclusion. Simultaneously with clinical competences development, the birth plan contributes with beneficial effects in regard of fear and concerns about the childbirth and promotes positive experiences between the couple.

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Santos, Ana Raquel Gouvêa 1980. „Avaliação da dificuldade técnica e dor na inserção de sistema intrauterino liberador de levonorgestrel : Evaluation of pain and technical difficulties at insertion of the levonorgestrel-releasing intrauterine system“. [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309677.

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Orientador: Ilza Maria Urbano Monteiro
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A anticoncepção intrauterina é um método bastante eficiente, porém sub-utilizada. Uma das causas que diminuem seu uso são as dificuldades que o profissional enfrenta no momento da inserção bem como a dor que a paciente sente durante o procedimento. Recentemente o sistema intrauterino liberador de levonorgestrel (SIU-LNG) foi introduzido como uma nova opção de dispositivo intrauterino com características que ampliaram a indicação e uso do mesmo. A introdução do SIU-LNG retomou a discussão sobre seu uso em cada vez mais mulheres inclusive nas nunca engravidaram. Objetivo: Identificar e comparar as dificuldades técnicas na inserção do SIU-LNG e o grau de dor referida entre nuligestas e multíparas com e sem cesárea anterior. Métodos: Setenta e quatro mulheres que procuraram o serviço de planejamento familiar do CAISM/UNICAMP para primeira colocação de SIU - LNG como método anticoncepcional (MAC) foram incluídas no estudo, de Maio a Dezembro de 2011. As mulheres foram divididas em três grupos: 23 nuligestas, 28 multíparas com antecedente de cesárea e 23 sem antecedente de cesárea. Após serem submetidas à inserção do SIU-LNG foi pedido que classificassem a dor segundo a Escala Visual Analógica (EVA) de 0 (sem dor) a 10 (maior dor possível). No retorno, entre 45 e 60 dias após a inserção, foram questionadas novamente sobre a dor que sentiram no dia da inserção segundo o mesmo score. O profissional responsável pela inserção classificou a inserção em fácil, com dificuldade esperada, mais difícil que o esperado ou impossível de realizar inserção. O mesmo também classificou a causa da dificuldade encontrada em: estenose cervical, irregularidade da cavidade uterina, dor da paciente, reação vagal. Foi realizada uma análise de comparação de médias entre os três grupos sobre a dor e de características clínicas que poderiam estar associadas com a mesma. Grau de significância 5% com poder do teste de 80%. Resultados: Todas as mulheres referiram dor no momento da inserção. Não houve diferença nas médias de dor de acordo com paridade ou via de parto. Não houve diferença também quando classificamos a dor em leve, moderada ou severa. Apesar da dor, 93% das mulheres referiram que submeteriam-se novamente a inserção do SIU-LNG tanto no momento da inserção como um mês após. A média de dor referida após um mês foi semelhante entre os grupos e não foi significativamente menor do que imediatamente após a inserção. Nas nuligestas o tipo de dificuldade mais encontrada foi estenose cervical, nas multíparas com cesárea anterior foi irregularidade da cavidade uterina e nas multíparas sem cesárea anterior foi dor da paciente no momento da inserção. Não houve maior dificuldade de inserção em nenhum dos grupos. Não houve associação de algum dos tipos de dificuldade com maiores média de dor. Conclusões: Todas as mulheres independente da paridade ou via e parto referiram dor no momento da inserção do SIU-LNG. A dor não consistiu em um empecilho para a escolha do SIU-LNG. A principal causa de dificuldade variou de acordo com a paridade. A inserção do SIU-LNG é possível para todos os grupos de pacientes
Abstract: Background: Despite the high contraceptive effectiveness and non-contraceptive benefits there are still concerns of use of the levonorgestrel-releasing intrauterine system (LNG-IUS) in nulligravida women. Objective: Evaluate ease of insertion and cause of difficulty by health proffessionals and women pain at insertion of the LNG-IUS in nulligravida women compared to parous women with and without cesarean section (C-section). Methods: Three groups were constituted: one with 23 nulligravida women, one with 28 parous women with previous cesarean and one with 23 parous women without previous C-section who received an LNG-IUS. The pain at insertion was evaluated immediately after insertion on the Visual Analogic Scale (VAS). On the second visit after one month women were asked again about the pain at insertion according to the VAS. The ease of insertion was evaluated as easy or difficult and was classified by the health professional according to cause (cervical stenosis, uterine irregularity, pain) after insertion. Results: Almost all patients reported pain at insertion, independent of parity and delivery. Despite reporting pain about 93% of the women would submit themselves to LNG-IUS insertion once again if necessary. In the followup control there was no diference, as well in the pain scores among the groups. In nulligravida the type of difficulty most common was cervical stenosis, in parous women with C-section was uterine cavity irregularity in parous women without C-section was pain. There was no association between type of difficulty and high pain scores. Conclusions: All women reported pain at insertion. Pain at insertion is not a problem for the use of the method among patients. Type of difficulty at insertion is related to parity. There was no difference in difficulty for any group
Mestrado
Fisiopatologia Ginecológica
Mestre em Ciências da Saúde

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Grilo, Ana Rita Calvinho. „Parto hospitalar...outra perspetiva“. Master's thesis, Universidade de Évora, 2014. http://hdl.handle.net/10174/10967.

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Parto Hospitalar…Outra perspetiva Este trabalho é uma descrição e análise da intervenção desenvolvida no âmbito da unidade curricular – Relatório Final, do Mestrado em Enfermagem de Saúde Materna e Obstetrícia, requisito de avaliação para a obtenção do título de mestre na referida área. Os serviços de saúde deveriam garantir condições para a mulher vivenciar a experiência do parto com autonomia, de forma mais natural e num ambiente confortável, de confiança e intimidade. Baseado em evidências, elaborou-se o “Manual de Procedimentos do Parto Natural Assistido”, o qual deu resposta ao objectivo: proporcionar um guia de trabalho e consulta para o grupo profissional, dos critérios e procedimentos da vigilância do parto natural assistido. Foram realizados vários esforços no sentido de criar uma sala de partos com um ambiente com características mais familiares e menos hospitalares. Contudo, este objetivo não foi atingido, uma vez que não se reuniu apoio financeiro. *** ABSTRAT: Title: Hospital Birth ... Another perspective This paper is a description and analysis of the intervention developed within the course - Final Report, Masters in Maternity and Obstetrics, assessment requirement for obtaining a master's degree in this area. Health services should ensure autonomous conditions for women experiencing childbirth experience, within a more natural and comfortable environment of trust and intimacy. Based on scientific evidence, it was built into "Procedures manual on Assisted Natural Childbirth”, which responded to the objective: providing a working guide and consultation to the professional group, using the criteria and procedures for monitoring assisted natural childbirth. Several efforts were undertaken to create a delivery room with a more familiar environment and fewer hospital characteristics. However, this objective was not achieved, since it was not possible to facilitate this financially.

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Macedo, Priscila de Oliveira. „Significando a dor no parto: expressão feminina da vivência do parto vaginal“. Universidade do Estado do Rio de Janeiro, 2007. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=698.

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Estudo qualitativo. Teve como objetivos Identificar os significados atribuídos à dor por mulheres que vivenciaram o parto vaginal, Analisar a vivência da dor segundo a percepção de mulheres que pariram por via vaginal e Discutir as estratégias vivenciadas pelas mulheres para aliviar a dor durante o trabalho de parto e parto vaginal. Os dados foram coletados no Alojamento Conjunto da maternidade da Unidade Integrada de Saúde Herculano Pinheiro com puérperas que passaram algum tempo dos seus trabalhos de parto na instituição. O instrumento para coleta de dados foi a entrevista semi-estruturada. As entrevistas foram gravadas, transcritas e os dados tratados com a técnica de Análise temática de Conteúdo. Para análise dos dados foi utilizado um referencial teórico pertinente aos diversos modelos assistenciais ao parto no Brasil. Vimos que as mulheres significam a dor no parto como sofrimento e/ou prazer e esse sofrimento tem a dimensão redentora influenciada pela Igreja, a dimensão heróica influenciada pela cultura e a dimensão inútil influenciada pela medicalização que retira os significados da dor. Elas significam a dor também com o prazer quando a relaciona com o bebê e com a saúde. As depoentes viveram a dor no parto sentindo uma sensação intensa e até violenta ou fisiológica que tem características próprias e são pertinentes ao processo de parturição. Algumas mulheres não focaram sua atenção na dor. Ela valorizaram mais as respostas psicoemocionais. As depoentes sentiram mais dor quando estavam dentro do hospital sofrendo as intervenções do seu modelo assistencial. Perante a dor no parto elas estrategicamente seguem os conselhos medicalizadas e comportam-se de forma civilizada. Outras mulheres utilizam estratégias instintivas para lidar com a dor no parto. Todas as estratégias utilizadas parecem ter por finalidade a finalização do processo parturitivo.
Qualitative study. Its object was to identity the meanings attributed to the pain by women who experienced vaginal childbearing, analyze the experience of the pain according to the perception of women who gave birth through vaginal delivery and discuss the strategies experienced by women to alleviate the pain during labor and delivery. The data was collected at the Unidade Integrada de Saúde Herculano Pinheiro with women in their immediate puerperium who had their childbearing labor at that institution. The data was collected through a semi-structured interview. The interviews were recorded, transcribed and the data treated through the technique of Thematic Content Analysis. For the data analysis, a theoretical standpoint was adopted pertaining to the various models of childbearing assistance in Brazil. We discovered that women see the pain in labor as suffering and/or pleasure and that suffering carries the redeeming aspect as influenced by the Church, the heroic aspect as influenced by culture and the useless aspect as influenced by the medicalization which removes all the significance of pain. They also see the pain as pleasure when they associate it to the child and health. The interviewed women experienced the pain in labor as an intense sensation, sometimes even violent or physiological, which bears its own characteristic relating to the delivery process. Some women did not focus on the pain. They valued the psycho-emtional response more. The interviewed women felt more pain while inside the hospital enduring the interventions of their assistential model. When facing the pain in labor, those women strategically follow the medicalized advice and behave in a civilized manner. Other women employ instinctive strategies to deal with the pain in labor. All the strategies used seem to aim to complete the delivery process.

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Costa, Natália de Freitas. „Desfechos maternos perinatais da assistência da enfermagem obstétrica com a conduta hands off: um estudo de corte transversal“. Universidade Federal de Juiz de Fora (UFJF), 2018. https://repositorio.ufjf.br/jspui/handle/ufjf/7784.

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O processo de institucionalização do parto e nascimento trouxe importantes avanços e melhorias para a atenção à mulher e ao neonato, porém veio acompanhado de um conjunto de práticas obstétricas padronizadas e intervencionistas, utilizadas de forma rotineira caracterizando o modelo tecnicista. Durante a evolução e desenvolvimento da assistência obstétrica, o períneo feminino ganhou visibilidade, tornando-se com frequência, um local de intervenção cirúrgica. A partir da década de 1980, em resposta aos resultados desfavoráveis desse modelo, surgiu o movimento de humanização do parto, que além da assistência respeitosa e acolhedora, propôs uma atenção baseada em evidências científicas sendo destacado pela OMS e MS a enfermeira obstétrica como componente da humanização. Diante da função do corpo perineal, sua importância para as estruturas adjacentes e a consciência da morbidade após o trauma, a manutenção da integridade anatômica é fundamental para o funcionamento adequado e para a qualidade de vida da mulher e por isso diferentes técnicas e intervenções perineais estão sendo utilizadas e estudadas objetivando a manutenção da integridade local e minimizando lacerações de maior gravidade. O objetivo deste estudo foi analisar o desfecho materno perinatal da assistência às mulheres pelas enfermeiras obstétricas com a utilização da conduta hands off. Conduziu-se um estudo de corte transversal, incluindo 608 mulheres que tiveram seus partos assistidos por enfermeiras obstétricas com a utilização de hands off como conduta de proteção perineal. Foram avaliadas as características sociodemográficas e clínicas obstétricas. Os dados foram coletados a partir de prontuário eletrônico e livros de registros da equipe de enfermagem. A análise estatística foi realizada através do teste χ2 de Pearson e do modelo de regressão logística. Foi observado que houve uma prevalência de desfechos perineais de baixa gravidade, em 96,5% foram de acometimentos de baixa gravidade (1° grau ou períneo integro), mostrandose com aumento de chance de correção perineal em mulheres primíparas e quando peso foi maior ou igual a 3500g. Contudo, considerando os resultados desta investigação, acredita-se que a conduta expectante para proteção perineal, hands off, pode ser considerada dentro das boas práticas para assistência à mulher no processo de parturição, tendo em vista que esta conduta promove benefícios relacionados aos desfechos maternos perineais sem comprometer os resultados perinatais.
The process of institutionalization of childbirth and birth brought important advances and improvements for the care of women and the newborn, but it was accompanied by a set of standardized and interventionist obstetric practices routinely used to characterize the technical model. During the evolution and development of obstetric care, the female perineum gained visibility, often becoming a surgical site. From the 1980s onwards, in response to the unfavorable results of this model, the humanization movement of childbirth emerged, which, in addition to the respectful and welcoming assistance, proposed an attention based on scientific evidence, being highlighted by WHO and MS obstetric nurse as a component of Humanization. In view of the function of the perineal body, its importance for adjacent structures and the awareness of morbidity after trauma, the maintenance of anatomical integrity is fundamental for the proper functioning and quality of life of the woman and therefore different perineal techniques and interventions are being used and studied aiming the maintenance of the local integrity and minimizing lacerations of greater gravity. The objective of this study was to analyze the perinatal maternal outcome of care for women by obstetric nurses with the use of the hands off procedure. A cross-sectional study was conducted, including 608 women who had their deliveries attended by obstetric nurses with the use of hands off as perineal protection conduit. Sociodemographic and obstetric clinical characteristics were evaluated. The data were collected from electronic medical records and records books of the nursing team. Statistical analysis was performed using the Pearson χ2 test and the logistic regression model. It was observed that there was a prevalence of low-severity perineal outcomes in 96.5% of cases of low-severity (1st degree or integral perineum), showing an increased chance of perineal correction in primiparous women and when weight was greater than or equal to 3500g. However, considering the results of this investigation, it is believed that expectant management for perineal protection, hands off, can be considered within the good practices to assist women in the process of parturition, considering that this conduct promotes benefits related to maternal outcomes without compromising perinatal outcomes.

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Jamas, Milena Temer. „Adaptação cultural e validação para a língua portuguesa da \"Escala de Bienestar Materno en Situación de Parto (BMSP 2)“. Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-11092013-162127/.

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Introdução: A avaliação da assistência prestada é uma das condições básicas para promover a qualidade dos serviços de saúde. Obter dados a respeito do bem estar segundo a perspectiva da mulher permite corrigir inadequações e melhorar a qualidade da assistência ao parto. Objetivo da pesquisa: Esta pesquisa teve o objetivo de adaptar culturalmente e validar as propriedades psicométricas da Escala de Bienestar Materno em Situación de Parto (BMSP 2) para a língua portuguesa (Brasil).Metodologia: Trata-se de um estudo do tipo metodológico aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem da Universidade de São Paulo, sob o parecer nº 170.412. A adaptação cultural desta Escala, que foi produzida por enfermeiras obstétricas chilenas, foi feita conforme recomendações da literatura científica pertinente: tradução da BMSP2 para a língua portuguesa; retrotradução para língua de origem do instrumento; avaliação por um comitê de juízes; pré-teste da versão adaptada e aplicação da versão final em português. Os dados foram coletados no período de dezembro de 2012 a março de 2013 em um Hospital-Escola, situado na Zona Norte do Município de São Paulo. Participaram do estudo, 500 mulheres que receberam assistência ao parto normal na Instituição. A validade de face e conteúdo foi avaliada pelo comitê de juízes; para a validade de constructo foi realizada a análise fatorial; a validade de constructo convergente foi avaliada através do Teste de Correlação de Pearson entre a BMSP 2 e o domínio satisfação com a vida da Escala de Bem Estar Subjetivo; a validade de constructo divergente foi avaliada por meio de teste para comparação de grupos distintos. A confiabilidade foi avaliada pela consistência interna de seus itens (Alfa de Cronbach). O nível de significância adotado foi de 0,05. Resultados: A maioria das participantes do estudo vivia com o parceiro, possuía idade de 26,7 anos em média, era da cor branca, tinha entre nove e 11 anos de estudo e era do lar. Em relação às características obstétricas, 36,2% era multigesta, 28% estava na segunda gestação e 35,8% era primigesta, com idade gestacional entre 39 e 39 semanas e 6 dias (33,8%). Na avaliação das propriedades psicométricas, a análise fatorial apresentou um agrupamento diferente do encontrado pelos autores da versão original do instrumento, demonstrando a necessidade de desenvolver novos estudos objetivando propor nova distribuição fatorial para a versão brasileira desta escala. A validade de constructo convergente apresentou correlação positiva com o domínio satisfação com a vida da EBES. Na validade de constructo divergente foi obtida uma relação significante com algumas características sociodemográficas e clinico obstétricas. Com relação à confiabilidade, foi obtido um valor adequado para a consistência interna da versão adaptada da BMSP 2 (Alfa de Cronbach 0,93). Conclusão: A versão adaptada para o português da BMSP 2 mostrou-se válida e confiável na amostra estudada. Novos estudos necessitam ser realizados para testar essas propriedades em outros grupos de pacientes brasileiras.
Introduction: To evaluate the effects of health care on women`s wellness during childbirth is possible with the use of scales based on women`s perception of care. To establish the quality of these assessments is required by using a valid and cultural scale to make possible to achieve the desired improvements on outcomes of midwifery care. Objectives: The aims of this study were to translate the Chilean scale Mother`s Wellness during Childbirth to Brazilian Portuguese and to evaluate its reliability and validity. Method: This quantitative study followed five steps of cultural adaptation of the scales: translation of the scale to Brazilian Portuguese; back-translation to Spanish; assessment by a judge´s committee, scale pre-test and the application of the final version of the scale. The data were collected from December, 2012 to March, 2013 in a Brazilian University Hospital. A total of 500 women who had childbirth in this institution participated in this study. The face validity and content validity was assessed by an expert´s committee; the factor analysis was performed using the construct validity, the convergent validity was tested using the Pearson´s Correlation Test between Mother`s Wellness during Childbirth and Subjective Welfare Scale; and the divergent validity test was used to compare different groups. The reliability of the scale`s final version was assessed through internal consistency of its items using Cronbach\'s Alpha.The significance level was 0.05. Results: Women aged 26.7, were white, had a partner, had nine to 11 years of study and were housewives. Most women were multiparous, with gestational age between 39 weeks and 39 weeks and six days. The factorial analysis of scale showed a cluster difference in relation to the original scale indicating the need to explore better new distribution factors for the portuguese version of the scale. The convergent construct validity was positively correlated with life satisfaction domain of Subjective Welfare Scale and the divergent construct validity had a significant relationship with sociodemographic obstetric characteristics. The reliability of the Portuguese version of Mother`s Wellness during Childbirth was adequate for internal consistency observed with Cronbach\'s alpha value (0.93). Conclusion: Portuguese version of Mother`s Wellness during Childbirth is valid and reliable for this studied sample.

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Rodríguez, Garrido Pía. „Fortalecimiento de la mujer en la decisión de un parto en domicilio en Chile“. Doctoral thesis, Universitat de Barcelona, 2021. http://hdl.handle.net/10803/673410.

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INTRODUCCIÓN: El nacimiento humano es un fenómeno social y cultural que por siglos ha estado expuesto a transformaciones. La profesionalización de la partería, la incorporación de médicos hombres a la obstetricia y la aplicación de tecnologías, por mencionar algunas, han generado una serie de consecuencias en la socialización actual del nacimiento. Frente a esto, el aumento de la medicalización del parto ha develado importantes complicaciones en la salud mental, emocional, física y social de las mujeres. En su respuesta han emergido diversos colectivos interpelando el rol que juegan las instituciones sanitarias en la atención del nacimiento, visualizando el parto en domicilio acompañado por una profesional como alternativa posible frente a sus demandas. OBJETIVOS: Por lo expuesto, surge la necesidad de (1) Explorar las representaciones sociales y sanitarias del parto en domicilio, (2) Analizar el concepto de seguridad del parto en domicilio; y (3) Analizar los significados sociales que las mujeres le otorgan al parto en domicilio en el contexto chileno. METODOLOGÍA: Para responder a los objetivos de este estudio se estructuró la investigación en 3 fases con uso de la metodología idónea para abordar cada uno de ellos. Es así como para responder al primer objetivo general, se utilizó una revisión integradora de la literatura permitiendo explorar las representaciones sociales y sanitarias del parto en domicilio. A su vez, para responder al segundo objetivo general, se realizó un scoping review lo que permitió analizar el concepto de seguridad que rodea al parto en domicilio. Por último, para responder al tercer objetivo general, se utilizó un enfoque cualitativo, fenomenológico feminista y situado, a partir de entrevistar a 30 mujeres habitantes de las zonas norte, centro y sur de Chile, que habían dado a luz en sus domicilios. RESULTADOS: De este modo y en base al compendio desarrollado, se presentan los principales hallazgos de esta investigación a través de la publicación de tres artículos científicos. Por su parte y en respuesta al primer objetivo, emergieron cuatro dimensiones centrales de análisis: (1) Dimensión de empoderamiento en el nacimiento; (2) Dimensión comparativa de estudios sociosanitarios del nacimiento; (3) Dimensión institucional del parto; (4) Dimensión cultural del parto. Y nueve subdimensiones: (1.1) Empoderamiento de la mujer; (1.2) Soberanía del cuerpo; (1.3) Políticas contra-hegemónicas; (2.1) Domicilio versus hospital; (2.2) Costos versus efectividad; (2.3) Seguridad versus inseguridad; (3.1) Profesionales de la salud; (3.2)
INTRODUCTION: The human birth is a social and cultural phenomenon that for centuries has been exposed to transformations. The professionalization of midwifery, the incorporation of male doctors to obstetrics and the application of technologies, to name a few, have generated a series of consequences in the current socialization of birth. Faced with this, the increase in the medicalization of childbirth has revealed important complications in the mental, emotional, physical, and social health of women. In their response, various groups have emerged questioning the role played by health institutions in birth care, visualizing home delivery accompanied by a professional as a possible alternative to their demands. AIMS: (1) Explore the social and health representations of home delivery, (2) Analyze the concept of home delivery safety; and (3) Analyze the social meanings that women give to home birth in the Chilean context. METHOD: The research was structured in 3 phases. Thus, to respond to the first general aim, an integrative review of the literature was used to explore the social and health representations of home birth. In turn, to respond to the second general aim, a scoping review was carried out, which allowed analyzing the concept of safety surrounding home delivery. Finally, to respond to the third general aim, a qualitative, feminist and situated phenomenological approach was used, based on interviewing 30 women living in the northern, central, and southern areas of Chile, who had given birth at home. RESULTS: The main findings of this research are presented through the publication of three scientific articles. For its part, and in response to the first objective, four central dimensions of analysis emerged: (1) Dimension of empowerment at birth; (2) Comparative dimension of social and health studies of birth; (3) Institutional dimension of childbirth; (4) Cultural dimension of childbirth. In response to the second objective, three central categories of analysis emerged: (1) Risk of death; (2) Delivery setting; (3) Consensus model. Finally, in response to the third research objective, a central category of analysis emerged: (1) Home birth trajectories. Two subcategories: (1.1) Making the decision to deliver at home; (1.2) The moment of childbirth: (re)born. CONCLUSION: In relation to the social and health representations of home birth, it is evident that, from a health and institutional perspective, home birth is not widely accepted as a valid and safe alternative. However, social representations indicate a certain interest in returning to home birth as a response to the excessive medicalization and institutionalization of birth. In turn, the scientific literature that addresses the concept of home birth safety is permeated by notions of risk and mortality. Both are decisive when making the decision and decreeing an ideal place for the birth. However, scientific evidence determines compliance with safety standards to carry it out at home. In their response, the social meanings that Chilean women give to home birth reveal a series of positive and negative feelings in their trajectories, the latter a product of the sociocultural resistance that surrounds them. Even so, they mean home birth as a political act, positively valuing the presence of midwives and their partners.

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Muñoz, Sellés Ester. „Teràpies complementaries i alternatives en l’atenció al part: implantació i ús en els hospitals acreditats per a l’atenció natural al part normal i formació de les llevadores que hi donen assistència“. Doctoral thesis, Universitat de Barcelona, 2013. http://hdl.handle.net/10803/134964.

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L’augment de la demanda de teràpies complementàries i alternatives (TCA) per part de la població és una realitat. Cada dia és més freqüent el seu ús en l’àmbit de la obstetrícia. És important que les llevadores que treballen en l’assistència al part estiguin formades per a poder aconsellar, acompanyar i aplicar a les dones durant el seu procés de maternitat, respectant les seves preses de decisions. OBJECTIUS: Determinar el nivell de formació de les llevadores catalanes en referència al coneixement i ús de les teràpies complementaries i alternatives (TCA) aplicades durant l’atenció natural al part normal i descriure la percepció de les dones sobre l’aplicabilitat i ús de les TCA. METODOLOGIA: Àmbit d’estudi: els 28 hospitals Catalans acreditats per l’atenció al part normal l’any 201. Disseny: estudi observacional descriptiu amb ús de metodologia quantitativa i qualitativa. Subjectes: 455 llevadores i 12 dones (que van donar llum entre 2011-2013). Variables i dimensions: variables referents a la formació, experiència i percepció d’us de les TCA per part de les llevadores; les dones es van seleccionar d’acord a criteris teòrics assegurant la màxima variabilitat segons paritat, nivell d’estudis, àmbit de residència i tipus de part. Instruments de mesura: un qüestionari específic, previ pre-test cognitiu, amb un índex de concordances superior al 88% per a les variables referents a les llevadores; per a recollir la opinió de les dones es va utilitzar l’entrevista individual semiestructurada. Anàlisis de les variables: X2,T-student i Correlació de Pearson mitjançant el programa SPSS Statístics v20; i l’anàlisis temàtic de contingut amb suport del programa Atlas Ti. RESULTATS: El percentatge de llevadores formades, posterior a la formació bàsica de l’especialitat, és d’un 30,4% (72), amb una mitjana de formació en 5,97 teràpies (DE 3,56). Existeix una correlació negativa entre la formació en TCA i l’edat (r= - 0,284; p<0,001) i els anys treballats (r= - 0,136; p=0,036). Les llevadores opinen que l’aplicació de les TCA és útil per alleujar el dolor de part en la utilització de tècniques de relaxació 64,3% (90), hidroteràpia 84,8 % (67) i en aplicació de compreses en el perineu 75,9 % (63). En referència a les dones, elles afirmen conèixer algunes TCA. Es constata la diferencia entre expectatives i experiències de part en el cas de les primípares. Les dones confien en els professionals per obtenir informació veraç i de qualitat. S’ha observat que l’aplicació de les TCA depèn de la formació dels professionals i que són ells mateixos qui les ofereixen durant el part; la percepció de les dones vers l’ús de les TCA varia individualment. Les dones constaten diferenciació en el nivell de coneixement i formació en TCA per part de les llevadores que els han donat assistència. També s’observa diferència en quant als recursos disponibles en els hospitals per a la seva aplicació. CONCLUSIONS: Queda evidenciada la poca formació en TCA per part de les llevadores, les dones confien en l’expertesa dels professionals, però detecten variabilitat en la formació en TCA a l’hora de donar assistència. Seria recomanable una unificació de criteris en relació als recursos i teràpies que han d’oferir els diferents centres i hospitals, per tal d’aprofundir en el coneixement de la seguretat i efectivitat d’aquestes teràpies cal motivar als professionals perquè investiguin més al respecte, i perquè es formin per tal que les utilitzin amb criteris de seguretat i eficàcia.
BACKGROUND: The use of complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAT is important. The aims of this study are to know about the CAT use during labour. METHODS: A descriptive, cross-sectional, quantitative and qualitative methods were used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers, and the perception of women on the applicability and use of these therapies. RESULTS: Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). The availability of resources for providing CAT during normal birth care varied widely from center to center. Women claim to know some TCA. It shows the difference between expectations and experiences of childbirth in the case of first child. Women observe differences between the level of knowledge and training in TCA by midwives who have given assistance. CONCLUSIONS: Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety, and support the decisions of women. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

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Faria, Denise Gonzalez Stellutti de. „“EMBRIÃO” de centro de parto normal fundamentado na experiência de formação de enfermeiros obstetras“. Faculdade de Medicina de São José do Rio Preto, 2015. http://hdl.handle.net/tede/274.

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Introduction: The obstetric care model in Brazil has been the subject of much discussion and research. Attention has centered on the need to consider women’s autonomy during the delivery process and the inclusion of midwives and obstetric nurses in the conduct of low-risk labor and birth. In-hospital normal birth centers (IHNBC) constitute an appropriate model for the care of women in labor and for the incorporation of practices recommended by the World Health Organization (WHO). Objective: To present a proposal of implementation and development of an IHNBC. Methods: This study is divided into chapters and includes a comprehensive review of the literature on the following topics: the Brazilian obstetric care process and the identification of ways to decrease the extremely high rates of cesarean sections in the country; Obstetric Violence; Childbirth Humanization; training and performance of midwives and obstetric nurses; and Normal Birth Centers and Birth Houses. This review supported the creation and implementation of the proposed IHNBC. The hospital that served as a research field is located in the state of São Paulo and offers obstetric care to women who use the Unified Health System (SUS). It also serves as a traineeship field for undergraduate medical and nursing students, medical residents and obstetric nursing specialization students. Results: We present environmental, social and programmatic characteristics (protocols) of the proposed IHNBC, according to the recommendations of the WHO and Ministry of Health. Additionally, we discuss the strengths, difficulties, expectations and perspectives of the development process, in order to comply with the “Stork Network” prerogatives (rede Cegonha, in Portuguese). Conclusion: In the specific context of this research, we expect that the proposed IHNBC implemented in the analyzed obstetric unit continues to be valued by managers and receives greater medical involvement. Moreover, we hope that this proposal is effectively implemented in the assessment phase according to the standards of the Stork Network, with the effective participation of midwives and obstetric nurses, and that this resut in the humanization of obstetric care, the assignment of greater value and recognitition to obstetric nursing and increased normal delivery rates.
Introdução: O modelo de assistência obstétrica no Brasil tem sido tema de muitas discussões e pesquisas que considerem a autonomia da mulher no processo de parturição e a inserção de obstetrizes e enfermeiros obstetras na condução do trabalho de parto e parto de baixo risco. Os Centros de parto normal intra-hospitalares- CPNIH constituem modelo de assistência apropriada à parturiente e da incorporação das práticas recomendadas pela Organização Mundial da Saúde (OMS). Objetivo: apresentar a proposta de implantação e a trajetória de desenvolvimento de um CPNIH. Método: Faz-se ampla revisão da literatura, apresentada em Capítulos, sobre o processo de assistência obstétrica no Brasil que permita diminuir os índices extremos de cesarianas no país, sobre Violência Obstétrica, Humanização do Nascimento, formação e atuação de obstetrizes e enfermeiros obstetras e sobre Centros de Parto Normal e Casas de Parto, que subsidiaram a organização e implantação do CPN proposto. O hospital campo da pesquisa é localizado no interior do estado de São Paulo, atende em Obstetrícia mulheres usuárias do SUS e constitui-se em campo de estágio curricular de alunos de graduação em medicina e enfermagem e para residentes médicos e alunos de especialização em enfermagem obstétrica. Resultados: são apresentadas as características ambientais, sociais e programáticas (protocolos) do CPNIH proposto, segundo as recomendações da OMS e MS, as facilidades, dificuldades, expectativas e perspectivas no desenvolvimento, que possa culminar com atendimento às prerrogativas da rede Cegonha. Conclusão: No aspecto específico desta pesquisa, esperamos que o CPNIH proposto na unidade obstétrica estudada continue a ter a valorização dos gestores, maior participação médica, implantação efetivada na avaliação segundo as normas da Rede Cegonha, efetiva atuação de obstetrizes e enfermeiros obstetras, que se reflitam na humanização do atendimento obstétrico, na valorização da enfermagem obstétrica e aumento dos índices de partos normais.

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Lemes, Luana Beatriz. „Avaliação de um programa pré-natal de educação em saúde (PRENACEL) na redução das lesões do períneo: um ensaio aleatorizado por conglomerados“. Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/17/17139/tde-28082018-161950/.

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Introdução: Informação qualificada no período pré-natal pode contribuir para o conhecimento das mulheres sobre práticas realizadas no parto, o que pode colaborar para melhores resultados maternos e perinatais, incluindo a integridade perineal. Objetivo: Avaliar se o programa de educação em saúde e apoio às mulheres (PRENACEL) contribui para a redução das lesões no períneo durante o parto de mulheres atendidas na rede pública de saúde de Ribeirão Preto, sudeste brasileiro. Métodos: Análise secundária do estudo PRENACEL, um ensaio aleatorizado por conglomerados implementado na cidade Ribeirão Preto. Participaram do estudo todas as mulheres com 18 anos ou mais que iniciaram acompanhamento pré-natal de risco habitual antes da 20ª semana gestacional, em uma das 20 unidades de saúde selecionadas. Para avaliar o desfecho perineal foram incluídas as mulheres que pariram por via vaginal em uma das quatro maternidades que oferecem atendimento público. A intervenção PRENACEL correspondeu ao oferecimento, via telefonia celular, de um pacote de mensagens curtas de texto (SMS) contendo informações essenciais ao acompanhamento do pré- natal e parto de baixo risco. Este programa de educação em saúde foi oferecido como um complemento ao cuidado pré-natal ofertado pelo Sistema Único de Saúde. A aleatorização dos conglomerados foi realizada em duas etapas através de sorteios aleatórios simples. A primeira etapa correspondeu à formação de dois grupos que, na segunda etapa, foram alocados em grupos intervenção ou controle. No grupo intervenção foi utilizada inscrição passiva para incluir as mulheres no programa. As participantes do grupo controle foram incluídas no momento da coleta de dados nas maternidades. Não foi adotada estratégia de mascaramento. O risco relativo e seu intervalo de confiança foram calculados, considerando um nível de significância de 5% para os testes. Resultados: Dez unidades de saúde participaram do grupo intervenção e dez do grupo controle. Para avaliar o desfecho principal foram consideradas 704 mulheres. A integridade perineal foi relatada por aproximadamente 30% das mulheres e a episiotomia foi um procedimento utilizado em aproximadamente 15% dos partos. Não foi encontrada diferença significativa relacionada ao desfecho perineal entre as participantes dos grupos. Conclusão: O uso de SMS, como uma proposta de educação em saúde oferecida no pré-natal, não foi associada à redução de traumas perineais durante o parto, apesar dos seus benefícios comprovados na atenção pré-natal. O estudo PRENACEL está catalogado no Registro Brasileiro de Ensaios Clínicos (ReBEC, RBR-54zf73).
Introduction: Qualified information in the antenatal period can contribute to women\'s knowledge about practices performed during childbirth, which may to improve maternal and perinatal outcomes, including perineal integrity. Objective: To evaluate whether the health education and support programme for women (PRENACEL) contributes to the reduction of perineal trauma of women attended in the public health system of Ribeirão Preto, Southeastern Brazil. Methods: Secondary analysis of the PRENACEL study, a cluster randomized trial implemented in the city of Ribeirão Preto. All women aged 18 years or more who started antenatal care at usual risk before the 20th gestational week, in one of the 20 selected health units participated in the study. To evaluate the perineal outcome, women who had a vaginal birth in one of the four participating maternity hospitals were included. The PRENACEL intervention corresponded to the offer, by mobile phones, of a package of short text messages (SMS) containing essential information about low-risk pregnancy and childbirth and related care. This health education programme was a complement to standard antenatal care offered in public health system (Sistema Único de Saúde). Cluster randomization was performed in two steps through simple random sweepstake. The first stage corresponded to the formation of two groups that, in the second stage, were allocated in intervention or control group. In the intervention group, passive enrollment was used to include women in the programme. Participants in the control group were included at the moment of data collection in the maternity hospitals. No masking strategy was adopted. The relative risk and the confidence interval were calculated, considering a level of significance of 5% for the tests. Results: Ten health units participated in the intervention group and ten in the control group. To evaluate the main outcome, 704 women were considered. Perineal integrity was reported by approximately 30% of women and episiotomy was a procedure used in approximately 15% of deliveries. No significant difference was found related to the perineal outcome between the participants of the groups. Conclusion: The use of SMS, as a proposed health education offered in antenatal care, was not associated with the reduction of perineal traumas during childbirth, despite its benefits in antenatal care. The PRENACEL study is included in the Brazilian Registry of Clinical Trials (ReBEC, RBR-54zf73).

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Weiss, Kátia Maria. „Via de nascimento e resultado da triagem auditiva neonatal“. reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/108494.

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Estudo quantitativo prospectivo transversal analítico realizado entre janeiro e abril de 2014 em um hospital universitário de Porto Alegre, com o objetivo de verificar a influência da via de nascimento no resultado da triagem auditiva neonatal. A população foi composta por 543 neonatos cujos critérios de inclusão foram: terem nascido de via vaginal ou via cesárea, permanecerem internados em alojamento conjunto, com idade gestacional igual ou superior a 37 semanas, sem indicadores de risco para a deficiência auditiva, com peso ao nascimento igual ou superior a 2500 gramas e estarem com 24 horas ou mais de vida no momento da avaliação. Foram realizadas duas tentativas para obter respostas na triagem auditiva neonatal utilizando o procedimento de emissões otoacústicas evocadas transientes. Entre as duas tentativas foi utilizada a manobra facilitadora quando a resposta não era observada na primeira tentativa. Dos 543 neonatos, 70,3% (n = 382) nasceram de por vaginal e 29,7% (n = 161) de por cesárea. Os resultados mostraram que quando comparadas as características dos neonatos conforme a via de nascimento, o grupo de neonatos nascidos por via cesárea apresentou maior prevalência de sexo masculino (p=0,020), recém-nascidos com menor Apgar no primeiro e no quinto minuto (p=0,011 e p=0,005, respectivamente). Entretanto os neonatos que necessitaram de uma segunda tentativa para se observar presença de respostas das emissões otoacústicas, o grupo de cesárea teve mais necessidade de manobra em ambas as orelhas e no grupo de via vaginal foi necessário mais manobra mais a orelha esquerda (p=0,027). Quando ajustado por possíveis fatores de confusão (sexo, peso, número de horas de vida, via de nascimento, idade materna, número de consultas pré-natal e idade gestacional), a via cesárea permanece um fator significativamente associado à necessidade de manobra facilitadora em ambas as orelhas. Recém-nascidos de cesárea têm 2,83 vezes mais a prevalência de manobra em ambas as orelhas, quando comparados aos RN de via vaginal (RP=2,83; IC 95%: 1,20 – 6,68; p=0,017). Conclui-se que, quando ajustado por possíveis fatores de confusão, a via de nascimento pode influenciar nas respostas da triagem auditiva. Assim, esse é um tema que necessita de mais estudos que levem à compreensão dos fatores presentes durante o nascimento que possam interferir nos resultados da triagem auditiva neonatal. Acredita-se que estudos semelhantes com metodologia diferente possam elucidar e corroborar com estes achados.
A cross-sectional prospective quantitative study carried out between January and April 2014 in a university hospital in Porto Alegre, in order to check the influence of the route of birth results in neonatal hearing screening. The population consisted of 543 neonates whose inclusion criteria were: being born vaginally or via cesarean section, remain hospitalized in rooming with gestational age less than 37 weeks without risk indicators for hearing loss, with weight birth equal to or greater than 2500 grams and be 24 hours or more of life at the time of evaluation. Two attempts were made to obtain responses in neonatal hearing screening using the procedure of transient evoked otoacoustic emissions. Between the two attempts at facilitating maneuver when the response was not observed in the first trial was used. Of the 543 neonates, 70.3% (n = 382) were born vaginally and 29.7% (n = 161) by cesarean section. The results showed that compared the characteristics of newborns as a means of birth, the group of neonates born by cesarean section showed a higher prevalence of male gender (p = 0.020), infants with lower Apgar scores at one and five minutes (p = 0.011 and p = 0.005, respectively). However neonates who required a second attempt to observe the presence of OAE responses, the cesarean group had more need to maneuver in both ears and the group of vaginally more maneuver was necessary over the left ear (p = 0.027 ). When we adjusted for potential confounders (sex, weight, number of hours of life, route of birth, maternal age, number of prenatal visits and gestational age), cesarean section remains a factor significantly associated with the need for facilitating maneuver both ears. Newborn cesarean have 2.83 times the prevalence of maneuver in both ears, when compared with infants of vaginally (PR = 2.83, 95% CI: 1.20 to 6.68, p = 0.017) . We conclude that, when adjusted for possible confounding factors, the route of birth may influence the responses of auditory screening. So, this is a topic that needs further study leading to the understanding of factors present at birth that may affect the outcome of neonatal hearing screening. It is believed that similar studies with different methodology elucidate and corroborate these findings.
Un estudio cuantitativo prospectivo transversal realizado entre enero y abril de 2014 en un hospital universitario de Porto Alegre, con el fin de comprobar la influencia de la ruta de los resultados de nacimiento en tamizaje auditivo neonatal. La población estuvo constituida por 543 neonatos cuyos criterios de inclusión fueron: haber nacido por vía vaginal o por cesárea, permanece hospitalizado en alojamiento conjunto con la edad gestacional menor de 37 semanas sin indicadores de riesgo para la pérdida de audición, con el peso nacimiento igual o mayor que 2500 gramos y ser de 24 horas o más de vida en el momento de la evaluación. Se hicieron dos intentos para obtener respuestas en el cribado auditivo neonatal utilizando el procedimiento de evocadas transitorias emisiones otoacústicas. Entre los dos intentos de facilitar la maniobra cuando no se observó la respuesta en el primer ensayo se utilizó. De los 543 recién nacidos, el 70,3% (n = 382) nacieron por vía vaginal y el 29,7% (n = 161) por cesárea. Los resultados mostraron que, en comparación de las características de los recién nacidos como un medio de nacimiento, el grupo de neonatos nacidos por cesárea mostraron una mayor prevalencia de sexo masculino (p = 0,020), los niños con menores puntuaciones de Apgar al minuto y cinco minutos (p = 0,011 y p = 0,005, respectivamente). Sin embargo los recién nacidos que requirieron un segundo intento de observar la presencia de respuestas OAE, el grupo de cesárea tenían más necesidad de maniobrar en ambas orejas y el grupo de la vagina más maniobra fue necesaria sobre la oreja izquierda (p = 0,027 ). Cuando ajustamos por posibles factores de confusión (sexo, peso, número de horas de duración, ruta de nacimiento, edad materna, número de visitas prenatales y la edad gestacional), la cesárea sigue siendo un factor asociado significativamente con la necesidad de facilitar la maniobra ambos oídos. Cesárea recién nacido tiene 2,83 veces la prevalencia de maniobra en ambos oídos, en comparación con los bebés de la vagina (RP = 2,83, IC del 95%: 1,20 a 6,68, p = 0,017) . Llegamos a la conclusión de que, al ajustar por posibles factores de confusión, la vía de nacimiento puede influir en las respuestas de screening auditivo. Por lo tanto, este es un tema que requiere mayor estudio que lleva a la comprensión de los factores presentes en el nacimiento que pueden afectar el resultado del cribado auditivo neonatal. Se cree que los estudios similares con diferente metodología de dilucidar y corroborar estos hallazgos.

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Bio, Eliane Rodrigues. „Intervenção fisioterapêutica na assistência ao trabalho de parto“. Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5139/tde-12022008-141747/.

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A assistência ao trabalho de parto envolve constante atualização sobre as intervenções obstétricas benéficas e necessárias para o nascimento seguro. Neste sentido, há uma redescoberta das posturas verticais e da liberdade de movimento da parturiente como prática eficiente para facilitar o trabalho de parto. Paralelamente, há uma tendência mundial à valorização do parto vaginal, a despeito das altas taxas de cesárea em nosso meio. Nesse contexto, se insere a proposta de intervenção fisioterapêutica na assistência ao trabalho de parto, com o objetivo de avaliar a influência da mobilidade da parturiente sobre a progressão da fase ativa, sobre a evolução da dilatação cervical e para facilitar o parto vaginal. Foi realizado um ensaio clínico controlado prospectivo, com análise comparativa entre um grupo de estudo e um grupo controle, no Centro Obstétrico do Hospital Universitário da Universidade de São Paulo. Os critérios de inclusão foram: primigestas em trabalho de parto espontâneo com pelo menos duas contrações a cada dez minutos e cérvico-dilatação de 3 a 4 cm; idade gestacional entre 37 e 42 semanas; feto único em apresentação cefálica fletida e concordância em assinar o termo de consentimento livre e esclarecido. Foram excluídas parturientes com patologias clínicas. As parturientes foram acompanhadas pela mesma fisioterapeuta durante toda a fase ativa e orientadas a manterem-se em posições verticais e em movimento coordenado, principalmente a mobilidade pélvica.O grupo controle teve acompanhamento obstétrico sem a presença do fisioterapeuta e foi selecionado retrospectivamente, a partir dos registros de prontuário, com os mesmos critérios de inclusão e exclusão. A amostra estudada foi de 132 parturientes: 70 no grupo de estudo e 62 no grupo controle. No grupo de estudo, 62 parturientes (89%) evoluíram para parto vaginal e oito (11%) para cesárea. Entre as parturientes que evoluíram para parto vaginal, 50 o fizeram sem uso de ocitócico e a média de duração da fase ativa foi de 5h16min, enquanto que no grupo controle foi de 8h28min (p<0,001);nenhuma parturiente fez uso de analgésicos durante a fase ativa, ao passo que no grupo controle 62% das parturientes necessitaram de fármacos (p<0,001); quanto a anestesia para o parto, nas parturientes do grupo de estudo 12% não fizeram uso de anestesia, 76% usaram anestesia entre 9 e 10 cm de dilatação; no controle, todas as parturientes usaram algum tipo de anestesia e 40% delas o fizeram entre 7 e 8cm de dilatação (p<0,001). As 12 parturientes que evoluíram para parto vaginal com uso de ocitocina durante a fase ativa, devido a hipoatividade uterina, tiveram, em média, 7h de fase ativa e o controle, 11h (p=0,059); o grupo de estudo iniciou mais tardiamente o uso de ocitocina e durante menos tempo(p<0,05); nenhuma parturiente fez uso de analgésicos, enquanto que no controle 83% usaram fármacos para analgesia (p<0,001). Concluiu-se que a ação na estrutura osteomuscular facilitou a progressão da fase ativa, a mobilidade pélvica promoveu a evolução da dilatação e o uso consciente do corpo favoreceu o parto vaginal.
Obstetrics intervention during labor involves a continuous up date on childbirth safety. Thus, vertical positions and free movements of woman, have been rediscovered as an efficient practice, to make easy the evolution of labor. Parallelly, there is a worldwide opinion supporting natural childbirth, despite the high scores of cesarean section in our country. This is the argument of physiotherapy intervention during labor for evaluate the influence of the maternal mobility on the progression of the active phase of labor, on the evolution of cervical dilatation and to facilitate the vaginal delivery. A prospective clinical trial was conducted through comparative analysis among a treatment group and a control group, in the Obstetric Center of the Hospital Universitário da Universidade de São Paulo. The inclusion criteria were: primigravidae with spontaneous labor with two uterine contractions every ten minutes and 3 or 4 cm of cervical dilatation; with 37 to 42 weeks of pregnancy; with a single fetus on cephalic presentation, besides the agreement to sign the free and informed consent term. Patients with clinical affections were excluded. Patients were assisted by the same physiotherapist during the whole active phase and encouraged to stay in vertical positions and to move in coordenation and specially pelvic mobility. Control group had an obstetric support without the presence of the physiotherapist and it was selected retrospectively, according to the same inclusion and exclusion criteria. 132 primigravidae were accompained: 70 in the treatment group and 62 in the control group. In the treatment group, 62 (89%) evolved to vaginal delivery and eight (11%) evolved to cesarean section. Among the patients who evolved to vaginal delivery, 50 didn\'t use ocitocina and the mean of active phase was 5h16min, and in the control group the mean was 8h28min (p<0,001); none of the patients used analgesics during the active phase, but in the control group 62% of the patients needed farmacos (p<0,001); as far as anesthesia for delivery is concearned, in the treatment group 12% didn\'t use any, 76% used anesthesia between 9 and10cm of dilatation; in the control group, all the patients used some kind of anesthesia and 40% of them did it between 7 and 8cm of dilatation (p<0,001). The 12 patients who evolved to vaginal delivery with ocitocina during the active phase, due to an uterine hipoactivity, had a mean of 7h duration active phase and the control group, 11h (p=0,059); the treatment group started later with the ocitocina and for a short period of time (p<0,05); none of the patients used analgesics whereas in the control group 83% used farmacos for analgesia (p<0,001). It follows that the intervention in the osteo and muscular structure facilited the progression of active phase, the pelvic mobility promoted the evolution of dilatation and the conscious use of the body improved the vaginal delivery.

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Duarte, Thaiana Bezerra. „CINESIOTERAPIA PERINEAL EM MULHERES COM DÉFICIT MUSCULAR NO ASSOALHO PÉLVICO E COM UMA ÚNICA VIA DE PARTO: ensaio clínico“. Universidade Federal do Maranhão, 2012. http://tedebc.ufma.br:8080/jspui/handle/tede/1172.

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Made available in DSpace on 2016-08-19T18:16:06Z (GMT). No. of bitstreams: 1 Dissertacao Thaiana.pdf: 528185 bytes, checksum: 3b0b8bd2ffffcc21653f51c9c42e1317 (MD5) Previous issue date: 2012-06-18
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BACKGROUND: Pregnancy and delivery route influence the strength of pelvic floor muscles, which are considered risk factors for the onset of urinary incontinence and genital dystopias. OBJECTIVES: To evaluate the effects of kinesiotherapy in the pelvic floor muscles in women with a single delivery. METHODS: Participants were 503 women who responded to the protocol record, 297 (59.0%) aged between 35 and 45 years underwent functional evaluation of the pelvic floor by bidigital touch and perineometer. There were 165 (32.8%) women with deficiency on muscles strength participating in the trial, which were allocated into two groups according to the delivery route (A - vaginal delivery and B - abdominal delivery). They were randomized into groups A1 (n = 44) and B1 (n = 42), and were submitted to kinesiotherapy and groups A2 (n = 39) and B2 (n = 40) without kinesiotherapy. The protocol had perineal contraction exercises in the supine, sitting and standing posture and was performed twice a week for a total of 15 sessions. Statistical analysis used the chi-square test, Mann-Whitney test, Z test, Kruskall Wallis test, and ANOVA one criterion, the Spearman Correlation Coefficient, the Pearson Correlation Coefficient and PHI, with significance level 0.05. RESULTS: As the result of the kinesiotherapeutic protocol by comparing the force of contraction of the pelvic floor before and after application of kinesiotherapy compared to those without kinesiotherapy, there was significant increase in strength on women with both routes of delivery, by the both methods of evaluation (p < 0.0001). Among the variables possibly associated with the DFMAP, only parity was statistically significant (p ˂ 0.0001). CONCLUSIONS: The protocol proposed proved to be effective in the increase of pelvic floor muscle s strength at the assessment by both methods of evaluation. The delivery route was not responsible for weakening perineal but parity, demonstrating that the perineal muscles strength is inversely proportional to the number of births, suggesting that kinesiotherapy during pregnancy may be an alternative to prevent the weakening of pelvic floor.
INTRODUÇÃO: A gravidez e a via de parto alteram a força muscular do assoalho pélvico, considerados fatores de risco para o surgimento de incontinências urinárias e distopias genitais. OBJETIVO: avaliar os efeitos da cinesioterapia na musculatura do assoalho pélvico em mulheres com via de parto única e verificar a existência de associação entre as variáveis estudadas e o déficit de força muscular do assoalho pélvico (DFMAP). METODOLOGIA: Obteve-se um total de 165 mulheres com idade entre 35 e 45 anos, apresentando déficit de força muscular que participaram do ensaio clínico, as quais foram alocadas em dois grupos de acordo com a via de parto (A parto vaginal e B parto cesárea). Em seguida, foram divididas aleatoriamente em Grupos A1 (n = 44) e B1 (n = 42), para realização do protocolo cinesioterapêutico e em Grupos A2 (n = 39) e B2 (n = 40), grupos controle. O protocolo continha exercícios de contração perineal em decúbito dorsal, postura sentada e bípede e foi realizado duas vezes por semana em um total de 15 atendimentos. Para análise estatística utilizaram-se os testes qui-quadrado, Mann-Whitney, teste Z, teste Kruskall Wallis, ANOVA um critério, Coeficiente de Correlação de Spearman, de Correlação de Pearson e de Correlação PHI, com nível de significância 0,05. RESULTADOS: Verificou-se aumento significativo de força nas mulheres com ambas as vias de parto, pelos dois métodos de avaliação (p < 0,0001) após a realização da cinesioterapia. Dentre as variáveis possivelmente associadas ao DFMAP, somente a paridade mostrou-se estatisticamente significante (p ˂ 0,0001). CONCLUSÃO: O protocolo cinesioterapêutico proposto mostrou-se eficaz no fortalecimento muscular do assoalho pélvico quer seja pela avaliação pelo toque bidigital, quer seja pelo perineômetro. Continua controverso na literatura o efeito protetor da cesareana em relação aos danos ao assoalho pélvico, já que neste estudo a via de parto não foi responsável pelo enfraquecimento perineal e sim a paridade, sugerindo que a cinesioterapia durante o período gestacional pode ser uma alternativa para a prevenção do enfraquecimento do assoalho pélvico.

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Rodrigues, Aurea Maria Pires. „Apoio institucional : dispositivo na produção de usuária cuidadora“. Pós-Graduação em Psicologia Social, 2014. https://ri.ufs.br/handle/riufs/5964.

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The present work has as a studying theme the Institutional Support, that is understood as a gadget and/or strategy, in the Public Health Management and Attention field, which aims to expand the analysis and intervention capacity of the collectivity, tensing, changing and producing practices, by fostering leadership and co-responsibility, as well as the articulation and network production. The objective is to analyze the Institutional Support, in the part that blurs the established, enabling the institutional movements in the production of users caregivers. Users that are part of a process of health care, set amongst some of the clinical and political fabric of networks, which emphasis is on the subjects´ existential territories. The theoretical/methodological field is based on the thought of authors such as Foucault, Deleuze, Guattari, Simondon, Canguilhem and authors in the Public Health field, especially with regard to the relationship of co-engendering between health production and subject production. The research was performed at Nossa Senhora de Lourdes Maternity, that is a reference in high-risk delivery, network equipment of the Urgency, Emergency and Hospital of the State of Sergipe, between September/2012 and April/2013. The methodology is guided in cartography, as a research-intervention method and monitoring of subjectivity production processes, as well as some concepts-tools of institutional analysis. A field diary was used to record the experiences and, from these recordings, instituted practices and instituting movements, effects of the Institutional Support operation mode, were analyzed and discussed. The Institutional Support, in turn, besides being the object came to be device/tool in the production of the research itself. In the monitoring process we could see and make be viewed that, while certain practices were repetitive daily - producing passive bodies against the power/knowledge from the doctor/hospital-centered - collective analysis, of this making clinic mode, operated as germs new ways of doing clinical and produce bodies, pointing to the possibility of producing users of their care - caregivers users.
O presente trabalho tem como temática de estudo o Apoio Institucional, entendido como dispositivo e/ou estratégia, no campo da gestão e da atenção em saúde coletiva, que visa ampliar a capacidade de análise e de intervenção dos coletivos, tensionando, modificando e produzindo práticas, a partir do fomento ao protagonismo e à coresponsabilidade, bem como da articulação e produção de redes. O objetivo é analisar o Apoio Institucional, naquilo que borra o instituído, possibilitando movimentos instituintes na produção de usuárias cuidadoras. Usuárias que integram um processo de cuidado em saúde, situado entre uma certa política da clínica e de tessitura de redes, cuja ênfase recai nos territórios existenciais dos sujeitos. O campo teórico/metodológico fundamenta-se no pensamento de autores como Foucault, Deleuze, Guattari, Simondon, Canguilhem e autores do campo da Saúde Coletiva, especialmente no que diz respeito à relação de coengendramento entre produção de saúde e produção de sujeito. A pesquisa foi realizada na Maternidade Nossa Senhora de Lourdes, referência em parto de alto risco, equipamento da rede de Urgência, Emergência e Hospitalar do Estado de Sergipe, entre setembro de 2012 e abril de 2013. A metodologia pauta-se na cartografia, como método de pesquisa-intervenção e de acompanhamento de processos de produção de subjetividade, como também em alguns conceitos-ferramentas da análise institucional. Foi utilizado um diário de campo para registro das vivências e, a partir desses registros, práticas instituídas, bem como movimentos instituintes, efeitos de um modo de operar o Apoio Institucional, foram analisadas e problematizadas. O Apoio Institucional, por sua vez, além de objeto, passou a ser dispositivo/ferramenta na produção da própria pesquisa. No acompanhamento do processo, pudemos ver e fazer ver que, ao mesmo tempo em que certas práticas repetiam-se no fazer cotidiano, produzindo corpos passivos frente ao poder/saber médico/hospitalocêntrico, análises coletivas, desse modo de fazer clínica, operaram como germes de novos modos de fazer clínica e de produzir corpos, apontando a possibilidade de usuárias produtoras de seu cuidado usuárias cuidadoras.

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Silva, Flora Maria Barbosa da. „Transferências maternas de uma casa de parto para o hospital: estudo caso-controle“. Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/7/7141/tde-24012012-111043/.

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Centros de parto normal (CPN) têm como finalidade a assistência à mulher no parto normal sem complicações. Podem ter localização intra-hospitalar, peri-hospitalar ou extra-hospitalar (autônomo). Os objetivos foram: identificar os fatores de risco para transferência materna de um CPN para o hospital; elaborar um modelo de risco para transferência intraparto baseado nos fatores identificados e analisar os desfechos maternos e neonatais das transferências. Estudo do tipo caso-controle, com coleta de dados retrospectiva, em um centro de parto extra-hospitalar (Casa do Parto de Sapopemba - CPS) e no Hospital Estadual de Vila Alpina (HEVA), na cidade de São Paulo. Os casos foram todas as mulheres transferidas da CPS para o HEVA, de março de 2002 a dezembro de 2009. Os controles foram mulheres não transferidas que deram à luz na CPS no mesmo período, selecionadas aleatoriamente, sendo quatro controles para cada caso. Os fatores de risco para transferências maternas intraparto foram analisados primeiro pelo teste Qui-Quadrado. Na análise múltipla, incluíram-se as variáveis com p<0,20. Elaborou-se a seguir o modelo de regressão logística múltiplo pelo processo stepwise forward selection; variáveis com p<0,05 foram fatores independentes associados às transferências maternas. Transferências maternas pós-parto tiveram análise descritiva, em razão do reduzido número (13). Variáveis identificadas como fatores de risco independentes para transferência intraparto: nuliparidade (OR 5,6; IC 95% 2,9-10,9), idade materna 35 anos (OR 5,0; IC 95% 2,0-12,7), não ter companheiro (OR 2,7; IC 95% 1,4-5,1), ser admitida na CPS com cervicodilatação 3 cm (OR 2,0; IC 95% 1,1-3,4), realizar 5-12 consultas na CPS (OR 3,3; IC 95% 1,6-6,7) e peso do RN de 4.000-4.600 g (OR 3,5; IC 95% 1,1-11,2). Adequação entre altura uterina e idade gestacional baixa (OR 0,3; IC 95% 0,2-0,6) foi fator de proteção para a transferência. Apresentou-se modelo de risco para transferência intraparto, com probabilidade de transferência estimada de acordo com as variáveis identificadas como fatores de risco. Nos desfechos das transferências maternas: taxa de transferência intraparto: 4,1%; pós-parto: 0,5%; não houve óbitos entre as mulheres que deram à luz na CPS ou no HEVA e entre os RN da CPS; houve óbito de dois RN do HEVA (taxa de mortalidade perinatal: 0,73/1.000 nascidos vivos). Causas de transferência intraparto: maternas (57,6% falha no progresso do trabalho de parto); fetais (28% líquido amniótico meconial e traçado cardiotocográfico alterado); outras (14,4%); via de parto das mulheres transferidas: 49,5% parto normal; 44,1% cesariana; 4,5% fórceps e 1,8% vácuo extrator. Entre os RN de mães transferidas: 25,2% e 4,5% tiveram Apgar <7 nos 1º e 5º minutos, respectivamente; unidade de internação: 10,8% na UTI neonatal, 9,0% unidade de cuidados intermediários, 0,9% setor de observação e 79,3% alojamento conjunto. Causas de transferência no pós-parto: retenção placentária (38,5%); outros problemas (30,8%); sangramento vaginal aumentado (15,4%) e febre materna (15,4%); 46,1% necessitaram de curetagem e 38,4% de transfusão sanguínea. Concluiu-se que identificar os fatores de risco para transferência materna contribui para refinar os critérios de admissão de mulheres atendidas em CPN, ao auxiliar na identificação de casos que podem resultar em complicações.
Birth centers (BC) aim to provide care to women in normal birth without complications. They may have in-hospital, alongside or freestanding (autonomous) locations. The objectives were to identify risk factors for maternal transfer from a BC to the hospital, to develop a risk model for intrapartum transfers using the identified factors and to analyze the maternal and neonatal outcomes of transfers. It was a case-control study, with retrospective data collection in a freestanding birth center (Sapopemba Birth Center - SBP) and the State Hospital Vila Alpina (HEVA), in São Paulo. The cases were all women transferred from SBP to HEVA, from March 2002 to December 2009. The controls were not transferred women who gave birth in CPS in the same period, randomly selected, four controls for each case. Risk factors for maternal intrapartum transfers were primarily analized by the Chi-square test. In the multivariate analysis, the variables with p <0.20 were included. The multiple logistic regression model was build by stepwise forward selection process; variables with p <0.05 were factors independently associated with maternal transfers. Postpartum maternal transfers had descriptive analysis, due to the small number (13). Variables identified as independent risk factors for intrapartum transfer: nulliparity (OR 5.6, 95% CI 2.9 to 10.9), maternal age 35 years (OR 5.0, 95% CI 2.0 to 12. 7), no partner (OR 2.7, 95% CI 1.4 to 5.1), admission to the CPS with cervical dilation 3 cm (OR 2.0, 95% CI 1.1-3.4), number of appointments on SBC 5-12 CPS (OR 3.3, 95% CI 1.6 to 6.7) and newborn weight 4000-4600 g (OR 3.5, 95% CI 1.1 to 11.2). The low result for fitting uterine height and gestational age (OR 0.3, 95% CI 0.2-0.6) was a protective factor for transfer. A model of risk for intrapartum transfer was presented, to estimate the probability of transfer according to the variables identified as risk factors. The outcomes of maternal transfers were: intrapartum transfer rate: 4.1%; postpartum transfer rate: 0.5%; there were no deaths among women who gave birth in SBC or HEVA or between the newborns who were born on SBC; there were two deaths of newborns born in HEVA (perinatal mortality rate: 0.73 / 1,000 live births). Causes of intrapartum transfer: maternal (57.6% failure to progress in labor), fetal (28% meconium stained amniotic fluid and cardiotocographic trace changes), others (14.4%); mode of delivery of the transferred women: 49, 5% normal delivery, cesarean section 44.1%, 4.5% forceps and 1.8% vacuum extractor. Among infants of mothers transferred: 25.2% and 4.5% had Apgar score <7 at 1st and 5th minutes, respectively; unit admission of newborns: 10.8% in the neonatal intensive care unity, 9.0% intermediate care unit, 0, 9% observation rooms and 79.3% rooming-in unity. Causes of postpartum transfer: retained placenta (38.5%), other problems (30.8%), increased vaginal bleeding (15.4%) and maternal fever (15.4%); 46.1% required curettage and 38.4% blood transfusion. It was concluded that identifying risk factors for maternal transfer contributes to refine the criteria for admission of women attending BC, as it can be useful in identifying cases that may lead to complications.

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Roux, Samantha Lynne. „An exploratory study of mothers perceptions and experiences of an unplanned Caesarean section / Samantha Lynne Roux“. Thesis, North-West University, 2010. http://hdl.handle.net/10394/4943.

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Objective The present study aimed to explore women's perceptions and experiences of childbirth by unplanned Caesarean section. Background New motherhood is characterised as a profound change, and research suggests that the psychological effects of childbirth can be significant and far–reaching for some women. The processes occurring during a traumatic birth experience could affect a woman's emotional and psychological state, and she may experience considerable adjustment difficulties in adapting to unfulfilled expectations of delivering her baby naturally. Methods In–depth interviews explored 10 women's lived experiences of childbirth, after which thematic content analysis was used to synthesise data. The elements of phenomenological theory served as a broad framework for the structuring, organizing and categorizing of data, with interpretation aimed at gaining a greater understanding of women's internalised childbirth accounts. Findings Women described their contact with medical personnel, as well as the physical, environmental, and emotional aspects of their unplanned Caesarean sections, as distressing and traumatic. A sense of loss of control was the most significant contributor to women's negative childbirth experiences. Feelings of failure and disappointment were primarily related to unmet expectations and a lack of preparedness. Negative experiences were mediated by attentive caregiving, inclusion in decision–making, and support from loved ones.
Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2011.

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Freeze, Rixa Ann Spencer Lawrence Susan C. Raeburn John. „Born free unassisted childbirth In North America /“. 2008. http://ir.uiowa.edu/etd/202.

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Parsons, Myra, University of Western Sydney, College of Health and Science und School of Nursing. „Natural eating behaviour and its effect in labour outcomes“. 2005. http://handle.uws.edu.au:8081/1959.7/20637.

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The appropriate oral intake for labouring women has long been a controversial issue among midwives and anaesthetists. Anaesthetists argue that any type of food and, to some extent, fluid consumption during labour, will increase a woman’s risk of gastric content aspiration if general anaesthesia is required. Many midwives believe that aspiration, being such a rare event with contemporary medical practice, is unlikely in the hands of a skilled obstetric anaesthetist. These midwives believe that labouring without any form of sustenance other than water or clear fluids may be detrimental for the woman, her baby and the progress of labour. To date, research has been unable to provide reliable information to support either side of this debate. This thesis presents a series of studies (three surveys and a comparative trial) designed to enhance the body of knowledge available for decisions about labouring women’s oral requirements. The surveys were conducted to describe the policies of hospitals in New South Wales, Australia, and the views and practices of anaesthetists and midwives regarding the oral intake of labouring women. The main findings of this thesis come from a comparative study conducted to explore the effect of eating or not eating food on labour and birth outcomes of 217 nulliparous women with low risk pregnancies, (Eating group = 123; Non-eating group = 94). The study employed a naturalistic approach to its design in order to capture the actual eating behaviour of labouring women rather than the manipulated approach used in a randomised control trial. The findings from this series of studies suggest women should be informed of the lack of evidence to support any dietary regime for labour, along with the possible risks and benefits, and allowed to make their own decisions about their oral intake needs for labour. Although this thesis has augmented knowledge, it has been unable to demonstrate that eating food during labour improves labour and birth outcomes. However, it did not find this practice to be harmful for mothers or babies. The lack of reliable research evidence on which to base practice decreases the ability of midwives to be assured of the ‘best practice’ for labouring women’s oral intake. Further research is essential to ascertain ‘best practice’ for this aspect of care.
Doctor of Philosophy (PhD)

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Williams, Sara Jane. „Caught in the middle maternity nurses and the natural childbirth movement /“. 1987. http://catalog.hathitrust.org/api/volumes/oclc/16206554.html.

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Thesis (M.S.)--University of Wisconsin--Madison, 1987.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 120-129).

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Coffey, Kimberly Ann. „Pushing for natural childbirth : a rhetorical analysis of the alternative birth movement“. Thesis, 2012. http://hdl.handle.net/1957/29773.

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The purpose of this study is to examine how rhetoric functions in the Alternative Birth Movement (ABM). In particular, communication published by movement leaders will be examined to discover how rhetoric propels the movement from one stage to the next as well as how rhetoric facilitates the goals of the movement. When the ABM began in the early 1970s, it faced strong opposition from medical organizations, such as the American College of Obstetricians and Gynecologists. Through the use of powerful rhetoric, however, the movement was able to withstand pressure from the opposition, attract members, and move toward achieving its goals. To understand the functions of rhetoric throughout the alternative birth movement, this study combines Leland Griffin's method of examining movements in phases with Charles Stewart's functional perspective. The study will address the following research questions: 1. How does rhetoric progress the movement from one stage to another? 2. How does rhetoric facilitate the goals of the movement?
Graduation date: 2012

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Parsons, Myra. „Natural eating behaviour and its effect in labour outcomes“. Thesis, 2005. http://handle.uws.edu.au:8081/1959.7/20637.

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The appropriate oral intake for labouring women has long been a controversial issue among midwives and anaesthetists. Anaesthetists argue that any type of food and, to some extent, fluid consumption during labour, will increase a woman’s risk of gastric content aspiration if general anaesthesia is required. Many midwives believe that aspiration, being such a rare event with contemporary medical practice, is unlikely in the hands of a skilled obstetric anaesthetist. These midwives believe that labouring without any form of sustenance other than water or clear fluids may be detrimental for the woman, her baby and the progress of labour. To date, research has been unable to provide reliable information to support either side of this debate. This thesis presents a series of studies (three surveys and a comparative trial) designed to enhance the body of knowledge available for decisions about labouring women’s oral requirements. The surveys were conducted to describe the policies of hospitals in New South Wales, Australia, and the views and practices of anaesthetists and midwives regarding the oral intake of labouring women. The main findings of this thesis come from a comparative study conducted to explore the effect of eating or not eating food on labour and birth outcomes of 217 nulliparous women with low risk pregnancies, (Eating group = 123; Non-eating group = 94). The study employed a naturalistic approach to its design in order to capture the actual eating behaviour of labouring women rather than the manipulated approach used in a randomised control trial. The findings from this series of studies suggest women should be informed of the lack of evidence to support any dietary regime for labour, along with the possible risks and benefits, and allowed to make their own decisions about their oral intake needs for labour. Although this thesis has augmented knowledge, it has been unable to demonstrate that eating food during labour improves labour and birth outcomes. However, it did not find this practice to be harmful for mothers or babies. The lack of reliable research evidence on which to base practice decreases the ability of midwives to be assured of the ‘best practice’ for labouring women’s oral intake. Further research is essential to ascertain ‘best practice’ for this aspect of care.

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Solomon, Anthea. „The childbirth experience of parents who received antenatal education“. Thesis, 2012. http://hdl.handle.net/10210/6810.

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M.Cur.
This dissertation studies the labour experiences of parents who received childbirth preparation. At the moment, the extended family is no longer prevalent, and the teachings mothers passed to daughters has decreased dramatically. As more medical interventions alter the labour process, couples need to be more aware of what to expect. The trend for first time parents is to attend some kind of formal antenatal preparation. How relevant is this preparation? A qualitative study design was utilised to allow for exploration and description of the experience of labour. An audio recording was done as well as the subjects filling in a questionnaire. A pilot study with one couple was completed initially. Mothers in the Northern Suburbs of Johannesburg were studied. They had given birth in private clinics in the area. The interviews were unstructured and conducted in English. The data once collected, was transcribed and analysed using cross case data analysis and classification according to common themes. Nursing for the Whole Person Theory was used as the paradigm and guide for analysis. The results are compared with the relevant literature which is presented in The results are displayed in various forms in the study and show a positive experience in women and men who attended antenatal preparation. Recommendations are made for the medical profession and presented in with the conclusions.

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Possamai-Inesedy, Alphia, University of Western Sydney, College of Social and Health Sciences und School of Applied Social and Human Sciences. „Risk within the confines of safety : an analysis of current pregnancy and birthing practices of Australian women“. 2005. http://handle.uws.edu.au:8081/1959.7/17344.

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The following thesis seeks to inquire whether the recent phenomenon of women seeking out and indeed actively engaging with a medicalised birth stems from a shift in not only perceptions of risk, but also how a shift in responsibility, choice and control has impacted on the birthing women of Australian society. The thesis examines sociology of risk employing the work of both Beck and Giddens, although an emphasis will be placed on the work of Ulrich Beck. The three major themes that underpin the work of Beck, namely his risk society thesis, reflexive modernization and individualization are employed to explore some of the issues that concern the relationship between risk and society, the ramifications of this form of society on its inhabitants and specifically in relation to its impact on those experiencing pregnancy and childbirth. The Risk Society as an explanatory framework was empirically tested by conducting 45 interviews with women who had recently given birth from three separate birthing environments: private birth mothers, birth centre and home birth mothers. The argument is put forward that whilst previous research into the area of childbirth is clearly important in shedding a critical light upon childbirth practices, it does nevertheless neglect some important current social changes. In this respect, the application of Beck and Giddens work to the area of sociology of reproduction captures more adequately the ideological shift which this thesis examines. It is argued, through the scrutinizing gaze of the public, that the pregnant woman is the least able to escape the consequences of risk society where changed notions of health and responsibility have created a cultural acceptance of medical intervention of childbirth.
Doctor of Philosophy (PhD)

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44

Yazbek, Mariatha. „The measurement of pain during the first stage of labour“. Thesis, 2012. http://hdl.handle.net/10210/8243.

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D.Cur.
Midwives are responsible to assess pain before treating it; then they should reassess the pain to evaluate the effectiveness of the interventions and plan future therapy. Accurate and objective measures of labour pain continue to be scarce and the discrepancy in labour pain perceptions between parturients and health-care providers remains challenging. Various pain measurement tools are currently in use measuring chronic and acute pain, but many problems were encountered applying these methods to the woman in labour. The charts were detailed and required too much time to complete. The aim of the study was to develop a multidimensional labour pain assessment instrument to assist clinicians and midwives with labour pain control. Objectives for developing a valid and reliable instrument to accurately measure labour pain included refinement of the labour pain assessment instrument developed from literature, testing of the refined instrument on patients during labour, compilation of a final instrument and development of guidelines on how to implement the labour pain assessment instrument in nursing practice. A descriptive and exploratory approach was used to describe, evaluate, observe, explore and assemble new knowledge on assessment and measurement of pain during the first stage of labour. Development of the instrument was addressed in the literature chapter. The research was conducted in three phases, combining qualitative and quantitative research.During phase one, the instrument was refined in two stages. Focus group interviews were conducted with members regarded as knowledgeable in the field of normal labour who evaluated the face and content validity of the instrument. The most senior people teaching Midwifery at all South African universities evaluated the face and content validity of the instrument with an open-ended questionnaire thereafter, using the Delphi technique. The analysis of the first Delphi round was compared to the focus group analysis. The instrument was altered and submitted to the Delphi experts in a second open-ended questionnaire to confirm the alterations.

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Nikodem, Vernicé Cheryl. „The effects of water on birth : a randomised controlled trial“. Thesis, 2012. http://hdl.handle.net/10210/6225.

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D.Cur.
The primary objective of the study was to ascertain the effects of the use of water during birth on maternal outcomes. The main maternal outcomes evaluated were maternal experience of the second stage of labour, and trauma to the birth canal. The second objective was to set guidelines for midwives whether or not to conduct deliveries under water.

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Jackson, Melanie. „Birthing outside the system : wanting the best and safest : a grounded theory study about what motivates women to choose a high-risk homebirth or freebirth“. Thesis, 2014. http://handle.uws.edu.au:8081/1959.7/uws:29953.

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Childbirth in Australia occurs largely in a medicalised context, with 96.9% of births occurring in hospital, 2.2% in birth centres and 0.4% at home as planned homebirths (Li, Zeki, Hilder, & Sullivan, 2013). Only a small percentage of women choose to birth outside the system – that is, have no midwife present (freebirth), or elect to have a homebirth with medical risk factors. In Australia, women with risk factors have little choice but to birth in hospital under obstetric care as they are often excluded from midwifery care programs, birth centres and publicly funded homebirth. In Australia, the choice to birth at home is often met with hostility from medical practitioners, while attracting disapproval from the majority of society. It is within this context that the women in this study have made their choice to birth outside the system. The research question for this study is: what motivates women to birth outside the system – that is, to have a homebirth with risk factors present, or a freebirth where the birth at home is intentionally unattended by health professionals.

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47

Possamai-Inesedy, Alphia. „Risk within the confines of safety : an analysis of current pregnancy and birthing practices of Australian women“. Thesis, 2005. http://handle.uws.edu.au:8081/1959.7/17344.

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The following thesis seeks to inquire whether the recent phenomenon of women seeking out and indeed actively engaging with a medicalised birth stems from a shift in not only perceptions of risk, but also how a shift in responsibility, choice and control has impacted on the birthing women of Australian society. The thesis examines sociology of risk employing the work of both Beck and Giddens, although an emphasis will be placed on the work of Ulrich Beck. The three major themes that underpin the work of Beck, namely his risk society thesis, reflexive modernization and individualization are employed to explore some of the issues that concern the relationship between risk and society, the ramifications of this form of society on its inhabitants and specifically in relation to its impact on those experiencing pregnancy and childbirth. The Risk Society as an explanatory framework was empirically tested by conducting 45 interviews with women who had recently given birth from three separate birthing environments: private birth mothers, birth centre and home birth mothers. The argument is put forward that whilst previous research into the area of childbirth is clearly important in shedding a critical light upon childbirth practices, it does nevertheless neglect some important current social changes. In this respect, the application of Beck and Giddens work to the area of sociology of reproduction captures more adequately the ideological shift which this thesis examines. It is argued, through the scrutinizing gaze of the public, that the pregnant woman is the least able to escape the consequences of risk society where changed notions of health and responsibility have created a cultural acceptance of medical intervention of childbirth.

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Mack, Ashley N. „Disciplining mommy : rhetorics of reproduction in contemporary maternity culture“. 2013. http://hdl.handle.net/2152/21299.

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In this dissertation, I argue that the maternal body is a chief site of discursive political and cultural struggle over gender, family, and work in a neoliberal America. I consider contemporary discourses of maternity, an aggregate I call maternity culture, as cultural products and rhetorical expressions of the antagonistic arrangements in contemporary capitalism since the neoliberal turn. The complexities of maternity culture discourses can therefore be better understood when they are historicized alongside changing economic and political realities. Using materialist feminism as my primary methodology, I contend that maternity culture discourses express the ethics of neoliberalism including the privatization of social/political responsibility and self-actualization through entrepreneurialism and labor, while simultaneously justifying the intensification of maternal labor and the continued surveillance of women's bodies. I argue that maternity culture discourses are, therefore, rhetorics of reproduction and reproducing rhetorics. That is to say, they are a part of a larger set of discourses about the reproductive function that are themselves caught in the logics of capital that may result in the reproduction of unequal arrangements in material and symbolic life. In order to illuminate how maternity culture operates in neoliberal public life as a reproducing rhetoric, I provide a historical analysis of rhetorics of women's health, and analyze two case studies involving discourses surrounding breastfeeding and natural childbirth, major sites of struggle within maternity culture.
text

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49

Mmakwena, Tsweleng Louisa. „The mother's experience of pain management during labour“. Thesis, 2008. http://hdl.handle.net/10210/1725.

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M.Cur.
The objective of this study explores and describes the experiences of first-time mothers regarding pain management during the first stage of labour. A qualitative approach involving phenomenology was used. Midwives were also interviewed to determine their assessment and management strategies in this regard in order to get a broader perspective on the focus of interest. The data collected from the mothers revealed three themes and they are: the care rendered, needs/wishes and beliefs/feelings of the mothers regarding the care given. These themes were further subdivided into small headings/categories as specified in the data and elaborated on. Eight categories of care strategies emerged from the data gathered from the midwives. Information from both the mothers and midwives were then extensively discussed and compared to the existing literature. Conclusions were drawn and recommendations formulated, in the form of guidelines, to assist midwives and other health-care professionals to improve their caring modalities in the management of patients with pain during the first stage of labour.

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Tseng, Chia-Lin, und 曾家琳. „The Formation and Transformation of the Medical Discourses about Episiotomy—The Medical Knowledge and Paradigm Shift of Natural Childbirth“. Thesis, 2005. http://ndltd.ncl.edu.tw/handle/41311643784183857706.

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碩士
國立臺灣大學
衛生政策與管理研究所
93
OBJECTIVES. This research is tried to analyze the medical discourses of formation and transformation about episiotomy in the obstetrics practice inside and outside Taiwan. And episiotomy is regarded as an important indicator of the paradigm of natural childbirth and it can be compared in the different social contexts. MATERIAL AND METHODS. Archives Analysis and field study were used to examine the medical discourses about episiotomy. Different electronic databases such as Medline, PsyLIT, SSI , ProQuest were searched by the keyword “ episiotomy”. Different editions of Williams Obstetrics, and the influential announcement or practical guidelines among the important organizations were also inspected. In the context inside Taiwan, lecture notes, textbooks, communications in the obstetrics community, newspapers and public journals were analyzed. Besides, Field studies in Germany and one Taipei regional hospital were described. RESULTS. The medical discourses about episiotomy were constructed under different points of view. The formation about the benefits of episiotomy was established in 1930s. Then the pathological assumptions put the natural childbirth into more medical intervention and episiotomy was gradually accepted in different societies. But it was transformed in 1990s. The reasons come from the results of the women’s health, natural childbirth movement, professional competitions, and the evidence based researches. Compared the overseas conditions, it seems that most Taiwanese obstetricians are not affected by the latest transformation due to obstetrics dominance, mostly institutionalized childbirth, and the newly childbirth movement involvement. The “High Tech” values among physicians make them ignore the importance of restricted use of episiotomy , which is a ”Low Tech” but “High Art” procedure. CONCLUSIONS. From the history of the formation and transformation about episiotomy, we know that the medical Paradigm of childbirth can be challenged. The obstetrical practice in Taiwan needs further scientific, psychosocial assessments and aggressive attentions towards women’s health.

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