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Meleis (2000) afirma que a gestação, o parto e o puerpério devem ser vistos como processos de transição desenvolvimental e situacional que requerem uma definição ou redefinição dos papéis a que o cliente ou familiar está envolvido. As demandas de cuidado de enfermagem para essas mulheres vão além das questões biológicas, a enfermeira obstetra deve dar ouvidos às demandas que as puérperas apresentam, a fim de facilitar o processo de transição no puerpério. Diante do exposto, este estudo tem por objeto o puerpério como um processo de transição. Objetivos: Descrever as vivências das mulheres no processo de transição puerperal; Analisar as vulnerabilidades que surgem nesse processo; Sugerir um modelo de cuidado de enfermagem a mulheres que estejam vivenciando o processo de transição puerperal à luz da Teoria das Transições de Afaf Meleis. Metodologia: A pesquisa foi um estudo do tipo descritivo e exploratório com abordagem qualitativa. Os participantes desta pesquisa foram mulheres que passaram por um parto normal e consequentemente vivenciaram a experiência do puerpério. Decidiu-se utilizar o método Narrativa de Vida e a análise temática. Este estudo respeitou os princípios éticos conforme preconizado na Resolução CNS-466/12. Resultados e discussão: A maternagem é um fenômeno do processo de transição puerperal, que traz consigo vivências tais como sentir-se mais responsável após o nascimento do bebê; abrir mão de suas necessidades em prol do bebê; a amamentação, com suas vivências positivas e negativas; sentimento de posse pelo bebê; e (re)sigificação do corpo; a maternagem apareceu como um indicador de processo. Esta pesquisa demonstrou que o puerpério põe a mulher em situação de vulnerabilidade e estes são fatores de inibição para uma transição saudável, são as vulnerabilidades sociais e individuais.

Meleis (2000) states that pregnancy, childbirth and the postpartum period should be viewed as developmental and situational transition processes that require a definition or redefinition of the roles that the client or family is involved. The nursing care demands for these women go beyond biological questions, the midwife must heed the demands that mothers can have in order to facilitate the transition process in the postpartum period. Given the above, this study is engaged in the postpartum period as a transition. Objectives: To describe the experiences of women in the puerperal transition process; Analyze the vulnerabilities that arise in this process; Suggest a nursing model of care to women who are experiencing the puerperal transition process in the light of the theory of transitions Afaf Meleis Methodology: The research was a descriptive and exploratory study with a qualitative approach. The subjects were women who had a vaginal delivery and therefore experienced the postpartum experience. It was decided to use the Life History method and thematic analysis. This study complied with the ethical principles as recommended in Resolution CNS-466/12 (BRAZIL, MS, 2012). Results and discussion: The mothering is a phenomenon of puerperal transition process that brings experiences such as feeling more responsible after the baby's birth; give up their needs for the sake of the baby; breastfeeding, with their positive and negative experiences; sense of ownership for the baby; and (re)significance of the body; the mothering appeared as a process indicator. This research demonstrated that postpartum puts women in vulnerable situations and these are inhibiting factors for a healthy transition, they are the social and individual vulnerabilities.

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OBJECTIVE: to evaluate the effects of low-level laser therapy for perineal pain and healing after episiotomy. DESIGN: a double-blind, randomised, controlled clinical trial comparing perineal pain scores and episiotomy healing in women treated with low-level laser therapy (LLLT) and with the simulation of the treatment. SETTING: the study was conducted in the Birth Centre and rooming-in units of Amparo Maternal, a maternity service located in the city of São Paulo, Brazil. PARTICIPANTS: fifty-two postpartum women who had had mediolateral episiotomies during their first normal delivery were randomly divided into two groups of 26: an experimental group and a control group. INTERVENTION: in the experimental group, the women were treated with LLLT. Irradiation was applied at three points directly on the episiotomy after the suture and in three postpartum sessions: up to 2 hrs postpartum, between 20 and 24 hrs postpartum and between 40 and 48 hrs postpartum. The LLLT was performed with diode laser, with a wavelength of 660 nm (red light), spot size of 0.04 cm(2), energy density of 3.8 J/cm(2), radiant power of 15 mW and 10s per point, which resulted in an energy of 0.15 J per point and a total energy of 0.45 J per session. The control group participants also underwent three treatment sessions, but without the emission of radiation (simulation group), to assess the possible effects of placebo treatment. MAIN OUTCOMES: perineal pain scores, rated on a scale from 0 to 10, were evaluated before and immediately after the irradiation in the three sessions. The healing process was assessed using the REEDA scale (Redness, Edema, Echymosis, Discharge Aproximation) before each laser therapy session and 15 and 20 days after the women's discharge. FINDINGS: comparing the pain scores before and after the LLLT sessions, the experimental group presented a significant within-group reduction in mean pain scores after the second and third sessions (p=0.003 and p<0.001, respectively), and the control group showed a significant reduction after the first treatment simulation (p=0.043). However, the comparison of the perineal pain scores between the experimental and control groups indicated no statistical difference at any of the evaluated time points. There was no significant difference in perineal healing scores between the groups. All postpartum women approved of the low-level laser therapy. CONCLUSIONS: this pilot study showed that LLLT did not accelerate episiotomy healing. Although there was a reduction in perineal pain mean scores in the experimental group, we cannot conclude that the laser relieved perineal pain. This study led to the suggestion of a new research proposal involving another irradiation protocol to evaluate LLLT's effect on perineal pain relief.

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Os transtornos psíquicos puerperais são alterações mentais que podem começar dentro de dias ou semanas após o parto e se manifestam por desequilíbrios de humor psicóticos e não psicóticos. Este trabalho objetivou analisar o conhecimento dos enfermeiros da Saúde da Família sobre os transtornos psíquicos associados ao período puerperal e as intervenções necessárias ao acolhimento dessas demandas. Estudo exploratório-descritivo, realizado com dez enfermeiros de Campina Grande - PB, em 2009. O material empírico foi coletado através de entrevista semiestruturada e tratado através da análise de conteúdo. Os resultados mostraram que os enfermeiros possuem pouco conhecimento sobre os transtornos psíquicos puerperais, desconsiderando a importância da intervenção precoce para minimizar os danos decorrentes dos mesmos para a saúde da mãe e do bebê. Conclui-se que é imprescindível uma atualização para estes profissionais para que possam ter maior conhecimento sobre a temática, intervindo na prevenção desses transtornos e consequentemente fortalecendo o processo de cuidar...

The puerperal psychiatric disorders are characterized as mental changes that may start just few days or weeks after childbirth and manifests as psychotic and non-psychotic imbalances of mood. This paper's aim is to analyze nurses' knowledge about psychiatric disorders associated with the postpartum period and interventions necessary to promote health care assistance. This descriptive an exploratory studywas carried out with tennurses fromCampinaGrande, Paraíba, in 2009.The empirical materialwas produced fromsemi-structured interviewsandanalyzed bycontent analysis.Resultseviudencethat nurseshave lowknowledge aboutpostpartumpsychiatric disorders,disregardingthe importanceof early intervention tominimize damageby the same forthe health of motherand baby. We conclude thatanupdateisessentialfor these professionalsso they can havemore knowledgeon this subject, intervening in the preventionof these disordersand thusstrengtheningthecare process...

Los trastornos psíquicos puerperales se caracterizan por cambios mentales que pueden comenzar algunos días o semanas después del parto, y manifiéstense como desequilibrios de humor psicóticos y no psicóticos. En este artículo se objetivó analizar el conocimiento de los enfermeros de Salud de la Familia sobre los trastornos psíquicos asociados al período puerperal. Estudio exploratorio-descriptivo, realizado con diez enfermeros de Campina Grande - PB, en 2009. El material empírico fue obtenido mediante entrevista semi-estructurada, y analizado por medio del análisis de contenido. Los resultados mostraron que los enfermeros poseen poco conocimiento sobre los trastornos psíquicos puerperales, desconsiderando la importancia de la intervención precoz para minimizar los daños derivados de los mismos para la salud de la madre y del bebé. Se concluye que es imprescindible una actualización para estos profesionales para que puedan tener mayores conocimientos sobre la temática, interviniendo en la prevención de estos trastornos y consecuentemente fortaleciendo el proceso de cuidar...

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The study aimed at implementing the nursing process for a post-partum woman with cardiomyopathy after cardiorespiratory arrest. We conducted a clinical case study, in an intensive care unit of Fortaleza, Ceará, Brazil, in the period from September to October, 2005. The data were obtained after evaluation for elaboration of Nursing Diagnoses according to NANDA Taxonomy II, clinical judgment, intervention and goals. The nursing diagnoses found were: impaired verbal communication, decreased cardiac output, inefficient respiratory pattern, excessive volume of fluids, diarrhea, impaired physical mobility and deficit in selfcare. We highlighted the importance of the process as focus of the nurse's work in the clinic, in order to favor the patient's return to his family context as well as give credibility to the nurse's job.

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O estudo objetivou implementar o processo de enfermagem, no cuidado a uma puerpera portadora de miocardiopatia periparto depois de parada cardiorrespiratória. Realizamos um estudo de caso clínico, em uma unidade intensiva do Município de Fortaleza, no período de setembro a outubro de 2005. Os dados foram obtidos após avaliação para elaboração dos diagnósticos NANDA taxonomia II, julgamento clínico, intervenção e metas. Os diagnósticos de enfermagem encontrados foram: comunicação verbal prejudicada, débito cardíaco diminuído, padrão respiratório ineficaz, volume excessivo de líquidos, diarréia, mobilidade física prejudicada e déficit no autocuidado. Ressaltamos a importância do processo como foco do trabalho do enfermeiro na clínica, na perspectiva de favorecer o retorno dos pacientes ao seu contexto familiar, bem como permitir credibilidade do trabalho de enfermagem.

The study aimed at implementing the nursing process for a post-partum woman with cardiomyopathy after cardiorespiratory arrest. We conducted a clinical case study, in an intensive care unit of Fortaleza, Ceará, Brazil, in the period from September to October, 2005. The data were obtained after evaluation for elaboration of Nursing Diagnoses according to NANDA Taxonomy II, clinical judgment, intervention and goals. The nursing diagnoses found were: impaired verbal communication, decreased cardiac output, inefficient respiratory pattern, excessive volume of fluids, diarrhea, impaired physical mobility and deficit in selfcare. We highlighted the importance of the process as focus of the nurse's work in the clinic, in order to favor the patient's return to his family context as well as give credibility to the nurse's job.

El estudio objetivó implementar el proceso de enfermería, en el cuidado a una parturienta portadora de miocardiopatía peripato después de parada cardiorrespiratoria. Realizamos un estudio de caso clínico, en una Unidad Intensiva del Municipio de Fortaleza, en el período de septiembre a octubre de 2005. Los datos fueron obtenidos después de evaluación para la elaboración de los diagnósticos NANDA taxonomia II, juicio clínico, intervención y metas. Los diagnósticos de enfermería fueron: comunicación verbal perjudicada, débito cardíaco diminuido, padrón respiratorio ineficaz, volumen excesivo de líquidos, diarrea, mobilidad física perjudicada y déficit en el auto cuidado. Resaltamos la importancia del proceso como foco del trabajo del enfermero en la clínica, en la perspectiva de favorecer el retorno de los pacientes al su contexto familiar y también permitir credibilidad del trabajo de enfermería.

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The present study have found out the number of patients assisted at the sector of Psychiatric Urgencies (SUP) and at the Midwifery Clinic of the University Hospital at Ribeirão Preto (HC), with the diagnosis 648.4 (Mental Disorders in Pregnancy, Childbirth and Puerperium), according to CID-9, from 1988 to 1993. Authors searched for reports containing informations on the care provided in these services. The sample was formed by women from 15 to 29 old years, whose disorders include psychotic disorders, depressive cases with or without attempts of suicide and non-specified mental disorders. Some of this disorders showed in comorbidity with others diagnostics. Resulting showed the need of nurses paying more attention to manifestations of these disorders and search for means to enable the identifications in the care provided at emergencies.

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