RESUMEN
RESUMO Objetivo: compreender os significados e experiências de mulheres que vivenciaram o parto domiciliar planejado assistido por enfermeira obstétrica e a motivação (das mulheres) para essa escolha. Metodologia: estudo qualitativo, exploratório e descritivo, com 16 mulheres, realizado por meio de entrevista semiestruturada e analisado pelos pressupostos da análise temática de conteúdo. Resultados: as mulheres vivenciaram o parto com tranquilidade, autonomia e respeito, escolheram as posições e as pessoas de sua preferência. O parto teve significado de vitória e de libertação, cuja experiência foi descrita como inesquecível, fantástica, intensa e protagonizada pela mulher. O descontentamento com o modelo de assistência vigente, a participação em grupo de gestantes, o acesso a informações e a vivência de violência obstétrica anterior motivaram as mulheres a optarem pelo parto domiciliar. Considerações finais: as experiências das mulheres convergem para o exercício da autonomia e respeito à individualidade. Evidencia-se o protagonismo das mulheres que vivenciaram um parto natural e livre de intervenções. A assistência obstétrica foi centrada nas necessidades da parturiente, proporcionou confiança, segurança, tranquilidade e respeito às suas escolhas. Aponta-se a necessidade de ampliar a assistência ao parto por enfermeiras obstétricas às mulheres que desejam o parto domiciliar planejado. Políticas públicas de assistência ao parto podem viabilizar isso.
RESUMEN Objetivo: comprender los significados y las experiencias de las mujeres que vivieron el parto domiciliario planificado asistido por enfermera obstétrica y la motivación (de las mujeres) para esta elección. Metodología: estudio cualitativo, exploratorio y descriptivo, con 16 mujeres, realizado a través de entrevista semiestructurada y analizado por los supuestos del análisis de contenido temático. Resultados: las mujeres experimentaron el parto con tranquilidad, autonomía y respeto, eligieron las posiciones y las personas de su preferencia. El parto tuvo un significado de victoria y liberación, cuya experiencia se describió como inolvidable, fantástica, intensa y protagonizada por la mujer. La insatisfacción con el modelo de atención actual, la participación en grupo de mujeres embarazadas, el acceso a informaciones y la experiencia de violencia obstétrica anterior motivaron a las mujeres a optar por el parto domiciliario. Consideraciones finales: las experiencias de las mujeres convergen para el ejercicio de la autonomía y respeto a la individualidad. Se evidencia el protagonismo de las mujeres que experimentaron un parto natural y libre de intervenciones. La atención obstétrica se centró en las necesidades de la parturienta, proporcionó confianza, seguridad, tranquilidad y respeto con sus elecciones. Se señala la necesidad de ampliar la atención al parto por enfermeras obstétricas a las mujeres que desean el parto domiciliario planificado. Las políticas públicas de atención al parto pueden hacer esto posible.
ABSTRACT Objective: to understand the meanings and experiences of women who dealt with planned home birth assisted by a nurse midwife and the motivation (of these women) for this choice. Methodology: qualitative, exploratory and descriptive study, with 16 women, performed by means of semi-structured interviews and analyzed by the assumptions of thematic content analysis. Results: the women experienced childbirth with tranquility, autonomy and respect, and they chose the positions and people of their preference. Childbirth had a meaning of victory and liberation, whose experience was described as unforgettable, fantastic, intense and carried out by the woman. The dissatisfaction with the current model of care, the participation in a group for pregnant women, the access to information and the experience of previous obstetric violence motivated women to choose home birth. Final considerations: the women's experiences converge towards the exercise of autonomy and respect for individuality. The leading role of women who experienced a natural birth and free of interventions, should be highlighted. Obstetric care was focused on the parturient woman's needs, provided confidence, security, tranquility and respect for her choices. There is a need to expand childbirth care provided by nurse midwives to women who wish to have a planned home birth. Public policies for childbirth care can make this possible.
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Parto Domiciliario/enfermería , Enfermeras Obstetrices/normas , Mujeres/psicología , Parto Humanizado , Parto/fisiología , Mujeres Embarazadas/psicología , Fenómenos Fisiológicos Reproductivos , Doulas/psicología , Acontecimientos que Cambian la Vida , Motivación/fisiología , Parto Normal/enfermeríaRESUMEN
OBJECTIVE: to know the conceptions of nurse midwives about the care guided in the best practices to the women in the delivery process. METHOD: descriptive research with a qualitative approach developed in a Federal Maternity-School. Semi-structured interviews were conducted with 20 nurse midwives, and the speeches were categorized according to the thematic content analysis proposed by Franco. RESULTS: the study reveals that care based on best practices should be based on scientific knowledge, avoiding unnecessary interventions and encourages the use of non-pharmacological techniques for pain relief, appropriate environment, individualized care, the bond between professional and parturient, as well as its role. FINAL CONSIDERATION: while criticizing the excess of interventions, nurse midwives value noninvasive techniques and interpersonal relationships, as well as the subjectivities of the parturient that contributes to the humanized care in the delivery process.
Asunto(s)
Enfermeras Obstetrices/psicología , Guías de Práctica Clínica como Asunto , Adulto , Actitud del Personal de Salud , Brasil , Femenino , Humanos , Entrevistas como Asunto/métodos , Enfermeras Obstetrices/normas , Embarazo , Investigación Cualitativa , Calidad de la Atención de Salud/normasRESUMEN
ABSTRACT Objective: to know the conceptions of nurse midwives about the care guided in the best practices to the women in the delivery process. Method: descriptive research with a qualitative approach developed in a Federal Maternity-School. Semi-structured interviews were conducted with 20 nurse midwives, and the speeches were categorized according to the thematic content analysis proposed by Franco. Results: the study reveals that care based on best practices should be based on scientific knowledge, avoiding unnecessary interventions and encourages the use of non-pharmacological techniques for pain relief, appropriate environment, individualized care, the bond between professional and parturient, as well as its role. Final Consideration: while criticizing the excess of interventions, nurse midwives value noninvasive techniques and interpersonal relationships, as well as the subjectivities of the parturient that contributes to the humanized care in the delivery process.
RESUMEN Objetivo: conocer las concepciones de enfermeras obstetrices sobre el cuidado pautado en las buenas prácticas a las mujeres en el proceso de parto. Método: investigación descriptiva con abordaje cualitativo desarrollada en una Maternidad-Escuela Federal. Se realizaron entrevistas semiestructuradas con 20 enfermeras obstetrices, siendo las palabras categorizadas conforme análisis de contenido temático, propuesta por Franco. Resultados: el estudio revela que el cuidado pautado en las buenas prácticas debe basarse en conocimiento científico, evitar intervenciones innecesarias e incentivar el uso de técnicas no farmacológicas para alivio del dolor, el ambiente apropiado, la atención individualizada, el vínculo y sintonía entre profesional y parturienta , así como su protagonismo. Consideraciones Finales: al tiempo que critican el exceso de intervenciones, las enfermeras obstetrices valoran las técnicas no invasivas y las relaciones interpersonal, así como las subjetividades de la parturienta, lo que contribuye al cuidado humanizado en el proceso de parto.
RESUMO Objetivo: conhecer as concepções de enfermeiras obstétricas sobre o cuidado pautado nas boas práticas às mulheres no processo de parto. Método: pesquisa descritiva com abordagem qualitativa desenvolvida em uma Maternidade-Escola Federal. Realizaram-se entrevistas semiestruturadas com 20 enfermeiras obstétricas, sendo as falas categorizadas conforme análise de conteúdo temática, proposta por Franco. Resultados: o estudo revela que o cuidado pautado nas boas práticas deve embasar-se em conhecimento científico, evitar intervenções desnecessárias e incentivar o uso de técnicas não farmacológicas para alívio da dor, a ambiência apropriada, a atenção individualizada, o vínculo e sintonia entre profissional e parturiente, bem como o seu protagonismo. Considerações Finais: ao tempo que criticam o excesso de intervenções, as enfermeiras obstétricas valorizam as técnicas não invasivas e as relações interpessoais, bem como as subjetividades da parturiente, o que contribui para o cuidado humanizado no processo de parto.
Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Adulto , Guías de Práctica Clínica como Asunto , Enfermeras Obstetrices/psicología , Calidad de la Atención de Salud/normas , Brasil , Actitud del Personal de Salud , Entrevistas como Asunto/métodos , Investigación Cualitativa , Enfermeras Obstetrices/normasRESUMEN
OBJECTIVE: in 2010, a pilot study was conducted among women who were attended by midwives in the public sector in Santiago, Chile. The purpose of that study was to evaluate the implementation of the 'Model of Integrated and Humanized Health Services', and the Clinical Guide for Humanized Attention during Labour and Childbirth. Results of that study indicated 92.7% of women had medically augmented labours (artificial rupture of the membranes, oxytocin and epidural analgesia). One third of the women reported discontent with the care they received. This study replicated the pilot study (2010) and was conducted in seven regional hospitals across Chile. The objectives were to : (i) describe selected obstetric and neonatal outcomes of women who received care according to this new guide, (ii) identify the level of maternal-neonatal well-being after experiencing this modality of attention, and (iii) explore professionals' perceptions (obstetricians and midwives), as well as consumers' perceptions of this humanised assistance during labour and childbirth. DESIGN: this is a cross sectional and descriptive, mixed methods study, conducted in two phases. The first phase was quantitative, measuring midwifery processes of care and maternal perceptions of well-being in labour and childbirth. The second phase was qualitative, exploring the perceptions of women, midwives and obstetricians regarding the discrepancy between the national guidelines and actual practice. SETTING: maternity units from seven regional hospitals from the northern, central and southern regions and two metropolitan hospitals across Chile. PARTICIPANTS: 1882 parturient women in the quantitative phase (including the two Metropolitan hospitals published previously). Twenty-six focus groups discussions (FGD) participated from the regional and metropolitan hospitals for the qualitative phase. MEASUREMENTS/FINDINGS: all women started labour spontaneously; 74% of women had spontaneous vaginal childbirth. Caesarean section was the outcome for 20%, and 6% had childbirth assisted with forceps. A high number of medical interventions continued to be performed in all regions, deviating widely from adherence to the national clinical guidelines. Most of the women did not receive any oral hydration, almost all received intravenous hydration; most were under continuous foetal monitoring and medically augmented labour. The majority of women received artificial rupture of membranes, epidural anaesthesia and episiotomy. Most delivered in the lithotomy position. Two thirds of women surveyed perceived adequate well-being in labour and childbirth. Findings from focus group discussions of women (FGD=9; n=27 women), midwives (FGD=9; n=40) and doctors (FGD=8; n=29) indicated lack of infrastructure for family participation in birth, inadequate training and orientation to the national guidelines for practice, and lack of childbirth preparation among women. Some women reported mistreatment by personnel. Some midwives reported lack of autonomy to manage birth physiologically. KEY CONCLUSIONS: birth is managed by midwives across the public sector in Chile. Despite evidence-based guidelines published in 2007 by the Ministry of Health, birth is not managed according to the guidelines in most cases. Women feel that care is adequate, although some women report mistreatment. IMPLICATIONS FOR PRACTICE: efforts to provide midwife-led care and include women in participatory models of antenatal care are recommended to promote women-centred care in accordance with the Chilean national guidelines.
Asunto(s)
Parto Obstétrico , Servicios de Salud Materna , Partería , Enfermeras Obstetrices , Parto/psicología , Adulto , Actitud del Personal de Salud , Chile , Estudios Transversales , Parto Obstétrico/métodos , Parto Obstétrico/psicología , Femenino , Grupos Focales , Humanos , Servicios de Salud Materna/organización & administración , Servicios de Salud Materna/normas , Partería/métodos , Partería/normas , Modelos Organizacionales , Enfermeras Obstetrices/psicología , Enfermeras Obstetrices/normas , Prioridad del Paciente , Proyectos Piloto , Embarazo , Mejoramiento de la CalidadRESUMEN
OBJECTIVES: during 2007 the Chilean Ministry of Public Health introduced the Model of Integrated and Humanized Health Services, in addition to the Clinical Guide for Humanized Care during Delivery. Three years after its implementation, a study was conducted (i) to describe selected clinical outcomes of women who received care within this model, (ii) to identify the degree of maternal-newborn well-being and (iii) to explore the perception of this humanised attention during labour and delivery by both the professional staff (obstetricians and midwives) and consumers. DESIGN AND METHOD: a cross-sectional, descriptive study using both quantitative and qualitative methods was conducted with 508 women who delivered in two major hospitals within the National Health System in the metropolitan area of Santiago, Chile, from September 2010 until June 2011. The quantitative methods included a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardised antepartum and intrapartum data set. The qualitative methods included six focus groups discussions (FGDs), with midwives, obstetricians and consumers. Additionally, two in depth interviews were carried out with the directors of the maternity units. FINDINGS: the quantitative findings showed poor implementation of the guidelines: 92.7% of the women had medically induced labours (artificial rupture of the membranes and received oxytocin and epidural anaesthesia), and almost one-third of the women reported discontent with the care they received. The qualitative findings showed that the main complaint perceived by the midwives was that the health system was highly hierarchical and medicalised and that the obstetricians were not engaged in this modality of assistance. The women (consumers) highlighted that professionals (midwives and obstetricians) were highly technically skilled, and they felt confident in their assistance. However, women complained about receiving inadequate personal treatment from these professionals. The obstetricians showed no self-critique, stating that they always expressed concern for their patients and that they provided humanised professional assistance. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: by illuminating the main strengths and weakness with regard to the application of the model, these findings can help to inform strategies and actions to improve its implementation.
Asunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Parto Obstétrico , Partería , Enfermeras Obstetrices , Obstetricia , Actitud del Personal de Salud , Chile , Estudios Transversales , Parto Obstétrico/métodos , Parto Obstétrico/psicología , Parto Obstétrico/normas , Inteligencia Emocional , Femenino , Humanos , Servicios de Salud Materna/organización & administración , Partería/métodos , Partería/normas , Modelos Organizacionales , Evaluación de Necesidades , Enfermeras Obstetrices/psicología , Enfermeras Obstetrices/normas , Obstetricia/métodos , Obstetricia/normas , Prioridad del Paciente , Atención Perinatal/organización & administración , Embarazo , Resultado del Embarazo , Mejoramiento de la CalidadRESUMEN
Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for health education on Pap smears and other preventive women's health behaviors during women's visits to a health care provider. Various types of health establishments, provider settings, and provider types were observed. Opportunities for patient education on the importance of prevention were rarely exploited. In fact, health education provided was minimal. Policy and programmatic implications are discussed.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Prueba de Papanicolaou , Educación del Paciente como Asunto/estadística & datos numéricos , Neoplasias del Cuello Uterino/prevención & control , Frotis Vaginal/estadística & datos numéricos , Servicios de Salud para Mujeres/estadística & datos numéricos , Adolescente , Adulto , Anciano , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Ginecología/normas , Ginecología/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Obstetrices/normas , Enfermeras Obstetrices/estadística & datos numéricos , Observación , Educación del Paciente como Asunto/normas , Perú , Neoplasias del Cuello Uterino/diagnóstico , Servicios de Salud para Mujeres/normas , Recursos Humanos , Adulto JovenRESUMEN
OBJECTIVES: To develop a standardized verbal autopsy (VA) training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death (COD) by physicians and non-physicians. METHODS: Training materials, case studies, and written and mock scenarios for this VA program were developed using conventional VA and ICD-10 guidelines. This program was used to instruct physicians and non-physicians in VA methodology using a train-the-trainer model. Written tests of cognitive and applied knowledge required to classify perinatal COD were administered before and after training to evaluate the effect of the VA training program. RESULTS: Fifty-three physicians and non-physicians (nurse-midwives/nurses and Community Health Workers [CHW]) from Pakistan, Zambia, the Democratic Republic of Congo, and Guatemala were trained. Cognitive and applied knowledge mean scores among all trainees improved significantly (12.8 and 28.8% respectively, P < 0.001). Cognitive and applied knowledge post-training test scores of nurse-midwives/nurses were comparable to those of physicians. CHW (high-school graduates with 15 months or less formal health/nursing training) had the largest improvements in post-training applied knowledge with scores comparable to those of physicians and nurse-midwives/nurses. However, CHW cognitive knowledge post-training scores were significantly lower than those of physicians and nurses. CONCLUSIONS: With appropriate training in VA, cognitive and applied knowledge required to determine perinatal COD is similar for physicians and nurses-midwives/nurses. This suggests that midwives and nurses may play a useful role in determining COD at the community level, which may be a practical way to improve the accuracy of COD data in rural, remote, geographic areas.
Asunto(s)
Causas de Muerte , Competencia Clínica/normas , Enfermeras Obstetrices/normas , Mortalidad Perinatal , Autopsia , República Democrática del Congo , Educación Continua en Enfermería , Femenino , Guatemala , Humanos , Servicios de Salud Materna/normas , Enfermeras Obstetrices/educación , Pakistán , Guías de Práctica Clínica como Asunto , Embarazo , Desarrollo de Programa , Materiales de Enseñanza , ZambiaRESUMEN
OBJECTIVE: to describe the specific characteristics of one model of training traditional birth attendants (TBAs) in Guatemala. DESIGN: participant observation, unstructured and semi-structured interviews undertaken between 1997 and 2003 to gather the data to report on the characteristics of this training programme as it is evolving in the field. SETTING: the birth centre site of Ixmucane in Antigua, Guatemala, as well as community sites in the Departments of Saquetepequez, Chimaltenango, and Quetzaltenango in the western highlands of Guatemala. PARTICIPANTS: traditional midwives, certified nurse-midwives and certified professional midwives, as well as many allied health professionals and volunteers. INTERVENTION: training philosophy, participant selection, curriculum content, intensity, and planned follow-up are the key components of the training programme described. MEASUREMENT AND FINDINGS: 93 TBAs have received training through the development of a 150 hrs contact course for self-selected TBAs in the Midwives for Midwives Program. Formal evaluation of this training is underway but results are not yet available. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the value of incorporating midwifery philosophy and praxis in TBA training has received scant attention in the TBA literature. This report suggests that TBA training programme characteristics are important considerations in any evaluation of training efficacy of TBAs to improve maternal-child health.
Asunto(s)
Competencia Clínica , Servicios de Salud del Indígena/normas , Capacitación en Servicio/métodos , Servicios de Salud Materna/normas , Partería/educación , Enfermeras Obstetrices/educación , Adulto , Femenino , Guatemala , Humanos , Partería/normas , Modelos de Enfermería , Enfermeras Obstetrices/normas , Rol de la Enfermera , Relaciones Enfermero-Paciente , Investigación Metodológica en Enfermería , EmbarazoAsunto(s)
Características Culturales , Cooperación Internacional , Partería/normas , Enfermeras Obstetrices/provisión & distribución , Rol de la Enfermera , Competencia Clínica , Congresos como Asunto , Femenino , Salud Holística , Humanos , México , Enfermeras Obstetrices/educación , Enfermeras Obstetrices/normas , Embarazo , Evaluación de Programas y Proyectos de Salud , Sociedades de Enfermería , Estados UnidosAsunto(s)
Actitud del Personal de Salud , Partería/normas , Enfermeras Obstetrices/psicología , Enfermeras Obstetrices/normas , Rol de la Enfermera , Bolivia , Femenino , Parto Domiciliario/métodos , Humanos , Licencia en Enfermería , Parto Normal/métodos , Relaciones Enfermero-Paciente , Embarazo , Garantía de la Calidad de Atención de Salud , Estados UnidosAsunto(s)
Características Culturales , Partería/normas , Enfermeras Obstetrices/provisión & distribución , América Central , Competencia Clínica , Femenino , Salud Holística , Humanos , Cooperación Internacional , México , Enfermeras Obstetrices/educación , Enfermeras Obstetrices/normas , Embarazo , Sociedades de Enfermería , América del SurAsunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Enfermería Obstétrica/métodos , Hospitales Comunitarios/normas , Maternidades , Servicios de Salud Materna/estadística & datos numéricos , Centros de Salud Materno-Infantil/normas , Enfermería Maternoinfantil/normas , Enfermeras Obstetrices/normasRESUMEN
Brain drain, the exodus of highly trained professionals from developing countries to better paying jobs in the developed world, threatens the structure of community health care in those developing countries. In the Caribbean Basin, as in many developing countries, midwives are the primary health care providers for mothers and their children. This paper describes the maternal and child health (MCH) system in the Caribbean island community of St. Vincent and the Grenadines (SVG); compares MCH indicators in SVG with those in developed and developing nations; describes the role of the nurse-midwife in the delivery of MCH services; and examines the growing problem of recruitment and retention (brain drain) of nurse-midwives. Suggestions made by the nurse-midwives of SVG will be used to explore some solutions to this major human resource problem threatening the MCH system and to identify the major obstacles to their implementation.
PIP: The background, history, sociodemographic characteristics, and health services in St. Vincent and the Grenadines are described. In the discussion of the status of maternal and child health (MCH) and the role of nurse-midwife, information is provided on how midwives view their role, the benefits and rewards, drawbacks, and problems of recruitment and retention. 6 strategies for change are presented to address the concerns of nurse-midwives, and the constraints to implementation are noted. Interviews were conducted in August 1990 and validated. Statistical documents and records were consulted and hospital delivery observed. The current health personnel situation is one of shortages of trained physicians and nurses and a burgeoning population creating additional demand for health services. 9 health districts with 36 clinics and 5 rural hospitals and 1 general hospital in Kingston provide services for the 113,570 population. There are 2 privately owned hospitals in Kingston and private practice physicians. The district health center is the primary care facility with a nurse-to-patient ratio of 2/10,000 in 1987 and 4 trained obstetricians for the island. Of these 36 clinics, 16 are without a district nurse. MCH statistics are impressive with no maternal deaths since 1982 and rates comparable to developed countries. Nurse-midwives provide almost all prenatal and postnatal care and delivery. Midwives felt their roles were important and rewarding and are viewed as professional, knowledgeable, compassionate and trustworthy. Benefits were independence, personal satisfaction, career opportunities, and the rewards of contributing to the health of the Islands. Drawbacks were understaffing, lack of modern equipment, inadequate supervision, insufficient orientation to community health principles, lack of career mobility or financial incentives or improvement opportunities, and falling status. To halt the brain drain (exodus of trained professionals from developing countries to higher paying jobs in developed countries) a bond contract making those fiscally liable for their education has been implemented. Recruitment needs to be made from within the community being served. Greater financial incentives are needed. The role and image of the district nurse needs to be upgraded. Decentralized training and greater emphasis on community health must be given during nursing education. The age limit for nursing students needs to be increased and job sharing allowed. The constraints to implementation are lack of funding and resistance to change by those in power.
Asunto(s)
Enfermeras Obstetrices/normas , Atención a la Salud , Indicadores de Salud , Humanos , Perfil Laboral , Enfermeras Obstetrices/psicología , Enfermeras Obstetrices/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Indias OccidentalesRESUMEN
Brain drain, the exodus of highly trained professionals from developing countries to better paying jobs in the developed world, threatens the structure of community health care in those developing countries. In the Caribbean Basin, as in many developing countries, midwives are the primary health care providers for mothers and their children. This paper describes the maternal and child health (MCH) system in the Caribbean island community of St. Vincent and the Grenadines (SVG); compares MCH indicators in SVG with those in developed and developing nations; describes the role of the nurse-midwife in the delivery of MCH services; and examines the growing problem of recruitment and retention (brain drain) of nurse-midwives. Suggestions made by the nurse-midwives of SVG will be used to explore some solutions to this major human resource problem threatening the MCH system and to identify the major obstacles to their implementation. (AU)