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ABSTRACT Objective: to design a qualitative and quantitative scale for measuring specific workloads for obstetric-gynecological nurses (midwives) within the delivery unit and based on the Nursing Interventions Classification (NIC). Method: this is a mixed qualitative study through focus groups and quantitative with real measurements of NIC times, descriptive and cross-sectional. From September 2020 to May 2021, an extensive bibliographic search, mapping, ad hoc scale development and configuration of three focus groups were carried out to agree on scale design. Moreover, a comparison was carried out on the subjective perception of the time spent providing care (NIC) during the delivery process by focus groups with respect to times actually measured between March and April 2021 in a delivery unit. Results: the qualitative data obtained in focus groups were analyzed and related, agreeing on the ad hoc measuring instrument's final structure and the importance of having this measuring instrument representative of their work, with standardized language adapted to real health demands. Furthermore, when comparing the subjective and real execution times of each of the NIC, we found a significant correlation when presenting different mean execution times with a variation of 13 minutes. Conclusion: the midwives in this study determined the measurement instrument construct validity for their workloads.

RESUMO Objetivo: elaborar uma escala qualitativa e quantitativa para mensuração de cargas de trabalho específicas para enfermeiras obstétrico-ginecológicas (parteiras) na unidade de parto e baseada na Classificação das Intervenções de Enfermagem (NIC). Método: trata-se de um estudo qualitativo misto por meio de grupos focais e quantitativo com medidas reais de tempos NIC, descritivo e transversal. De setembro de 2020 a maio de 2021, foi realizada uma extensa pesquisa bibliográfica, mapeamento, desenvolvimento de escala ad hoc e configuração de três grupos focais para chegar a um acordo sobre o desenho da escala. Além disso, foi realizada uma comparação da percepção subjetiva do tempo gasto na prestação de cuidados (NIC) durante o processo de parto pelos grupos focais com os tempos efetivamente medidos entre março e abril de 2021 em uma unidade de parto. Resultados: os dados qualitativos obtidos nos grupos focais foram analisados ​​e relacionados, concordando com a estrutura final do instrumento de medição ad hoc e a importância de ter este instrumento de medição representativo do seu trabalho, com linguagem padronizada e adaptada às reais demandas de saúde. Além disso, ao comparar os tempos de execução subjetivos e reais de cada uma das NIC, encontramos correlação significativa ao apresentar tempos médios de execução diferentes com variação de 13 minutos. Conclusão: as parteiras deste estudo determinaram a validade de construto do instrumento de medida para suas cargas de trabalho.

RESUMEN Objetivo: diseñar cualitativa y cuantitativa, una escala de medición de cargas de trabajo, específica para las enfermeras obstétrico-ginecológicas (matronas), dentro de la unidad de partos y basada en la Clasificación de Intervenciones de Enfermería (NIC). Método: estudio mixto cualitativo mediante grupos focales y cuantitativo con mediciones reales de tiempos NIC, descriptivo y transversal. Durante los meses de septiembre de 2020 a mayo de 2021, se realizó una extensa búsqueda bibliográfica, mapeo, elaboración ad hoc de la escala, y la configuración de tres grupos focales, para consensuar el diseño de la escala. Además, se ejecutó una comparativa sobre la percepción subjetiva del tiempo empleado en la prestación de cuidados (intervenciones NIC) durante el proceso de parto por parte de los grupos focales, con respecto a los tiempos medidos realmente entre marzo y abril del 2021 en una unidad de partos. Resultados: se analizaron y relacionaron los datos cualitativos obtenidos de los grupos focales, coincidiendo en la estructura final del instrumento ad hoc de medida, y en la importancia de tener este instrumento de medida representativo de su trabajo, con un leguaje estandarizado y adaptado a la demanda sanitaria real. Además, al comparar los tiempos subjetivos y reales de ejecución de cada una de las intervenciones NIC, encontramos una correlación significativa, al presentar distintos promedios de tiempos de ejecución con una variación de 13 minutos. Conclusión: las matronas de este estudio determinaron la validez del constructo del instrumento de medición para sus cargas de trabajo.

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ABSTRACT Objectives: to evaluate the outcomes of Interval Copper Intrauterine Device (IUD) insertion performed by certified midwives and obstetric nurse practitioners at a Peri-Hospital Birth Center. Methods: a cross-sectional study was conducted involving 75 women who underwent IUD insertion between January 2018 and February 2020. Data collection was carried out using medical records and telephone interviews. Results: no instances of uterine perforation were observed. Expulsion rates of the devices were 1.3% within 30 to 45 days of use and 5.3% within the first year of use. The follow-up removal rate was 4.0%. The average pain score reported was 4.2 (SD = 3.3). Among those who continued using the device, 93.1% expressed satisfaction. Conclusions: the findings demonstrate that IUD insertion by certified midwives and obstetric nurse practitioners is a safe procedure, yielding outcomes comparable to those reported in the existing literature.

RESUMEN Objetivos: evaluar los resultados de la inserción del dispositivo intrauterino de cobre (DIU) realizado por matronas certificadas y enfermeras obstétricas especializadas en un Centro de Nacimientos Peri-Hospitalario. Métodos: se realizó un estudio transversal que incluyó a 75 mujeres sometidas a la inserción del DIU entre enero de 2018 y febrero de 2020. La recopilación de datos se realizó mediante registros médicos y entrevistas telefónicas. Resultados: no se observaron casos de perforación uterina. Las tasas de expulsión del dispositivo fueron del 1,3% en los primeros 30 a 45 días de uso y del 5,3% durante el primer año de uso. La tasa de retirada durante el seguimiento fue del 4,0%. La puntuación promedio del dolor informada fue de 4,2 (DE = 3,3). Entre aquellas que continuaron utilizando el dispositivo, el 93,1% manifestó satisfacción. Conclusiones: los hallazgos demuestran que la inserción del DIU por parte de matronas certificadas y enfermeras obstétricas especializadas es un procedimiento seguro, que produce resultados comparables a los reportados en la literatura existente.

RESUMO Objetivos: avaliar os desfechos da inserção do Dispositivo Intrauterino de Cobre de Intervalo por obstetrizes e enfermeiras obstetras em um Centro de Parto Normal Peri-hospitalar. Métodos: estudo transversal conduzido com 75 mulheres que tiveram o dispositivo inserido entre janeiro de 2018 e fevereiro de 2020. A coleta de dados foi realizada a partir de prontuários e contato telefônico. Resultados: não houve nenhuma perfuração uterina; 1,3% dos dispositivos foram expulsos com 30 a 45 dias de uso e 5,3% no primeiro ano de uso; a taxa de necessidade de remoção no retorno foi de 4,0%; e a pontuação média de dor foi 4,2 (DP = 3,3). Entre aquelas que ainda usavam o dispositivo, 93,1% se consideraram satisfeitas. Conclusões: a inserção do dispositivo por enfermeiras obstetras e obstetrizes mostrou ser segura, com desfechos similares aos observados na literatura.

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Introducción: la competencia "asistencia del parto vaginal" se adquiere, parcialmente, mediante simulación en estudiantes de enfermería/obstetricia. Sin embargo, no se ha reportado cuantos partos simulados son necesarios para que estos estudiantes adquieran la mínima competencia. Métodos: estudio cuasi experimental que incluyó a todos los alumnos del internado hospitalario en salud de la mujer, en el segundo semestre del año 2020, excluyendo aquellos que hubieran tenido exposición a la simulación o atención clínica de partos vagina-les. Se evaluó una intervención de práctica simulada en la atención del parto normal en tres etapas: 1) texto, 2) video y 3) simulación. Los estudiantes efectúan tres atenciones simuladas, un evaluador ciego evaluó su rendimiento con una pauta de cotejo (máximo 37 puntos) y se midió la satisfacción con una pauta de evaluación validada. Resultados: el rendimiento de los alumnos mejora significativamente (p < 0.001) con la repetición de la simulación (28,3; 34,3 y 36,7 puntos en 1°, 2° y 3° intento). El porcentaje de estudiantes que logra el umbral de mínima competencia es de 6%, 67% y 100 %, en cada repetición (p < 0.001) Conclusiones: en este grupo de estudiantes, tres repeti-ciones de la simulación/debriefing son suficientes para superar el umbral de mínima competencia. Esta información es útil para definir los recursos necesarios en simulación en atención del parto vaginal en estudiantes de enfermería/obstetricia.

Introduction: Vaginal delivery assistance competence is acquired partially by simulation in nursing/midwifery students. However, it has yet to be reported how many simulated deliveries are necessary for these students to develop the minimum competence. Methods: Quasi-experimental study, all the hospital internship in women>s health students were included in the second semester of 2020, excluding those exposed to the simulation or clinical care of vaginal births. A simulated practice intervention in vaginal delivery care in three stages: 1) text, 2) video, and 3) simulation, was evaluated. The students performed three simulations, a blind observer evaluated their performance with a comparison guideline (maximum 37 points), and their satisfaction was measured with a validated evaluation guideline. Results: The performance of the students improve significantly (p <0.001) with the repetition of the simulation (28.3, 34.3, and 36.7 points in the first, second and third attempts). The percentage of students who achieve the minimum proficiency threshold is 6%, 67%, and 100% in each repetition (p <0.001). Conclusions: In this group of students, three repetitions of the simulation/debriefing are sufficient to exceed the threshold of minimum competence. This information is helpful in defining the necessary resources in simulation in vaginal delivery care in nursing/midwifery students.

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Resumen: Introducción: En el siglo XX el parto pasó de ser atendido en casa al ámbito hospitalario. Se adoptaron de forma acrítica intervenciones inapropiadas e innecesarias que condujeron a una deshumanización del parto. Este es el modelo que existe actualmente en la mayoría de los hospitales españoles y que fue cuestionado por la OMS ya en 1996. Objetivo: Describir las diferencias que existen en los resultados obstétricos y neonatales en primíparas en dos modelos distintos de asistencia al parto (biomédico y humanizado). Método: Se llevó a cabo un estudio descriptivo, de corte transversal. Se obtuvo una muestra por conveniencia de 205 primíparas, 110 del modelo biomédico y 95 del humanizado. Se compararon los resultados obstétricos y neonatales en dos hospitales con modelos diferentes de asistencia al parto en España. Resultados: En el modelo humanizado de asistencia al parto se obtuvieron unos mejores resultados obstétricos (inicio espontáneo, parto eutócico, periné íntegro o desgarro de I grado y menos episiotomías) que en el biomédico. No hubo diferencias en los resultados neonatales. Conclusión: Los beneficios de instaurar un modelo humanizado de asistencia al parto deberían ser considerados por los responsables de políticas sanitarias y reflejados en la mujer y su criatura.

Resumo: Introdução: No século XX, o parto deixou de ser realizado em casa para ser realizado no ambiente hospitalar. Intervenções inadequadas e desnecessárias foram adotadas acriticamente, levando a uma desumanização do parto. Este é o modelo que existe atualmente na maioria dos hospitais espanhóis e que foi questionado pela Organização Mundial da Saúde já em 1996. Objetivo: O objetivo principal desse estudo é descrever as diferenças existentes nos resultados obstétricos e neonatais em primíparas em dois modelos distintos de assistência ao parto (biomédico e humanizado). Método: Foi realizado um estudo descritivo, transversal. Obteve-se uma amostra por conveniência de 205 primíparas, 110 do modelo biomédico e 95 do modelo humanizado. Os resultados obstétricos e neonatais foram comparados em dois hospitais com diferentes modelos de assistência ao parto na Espanha. Resultados: No modelo humanizado de assistência ao parto obtiveram-se melhores resultados obstétricos (início espontâneo, parto eutócico, períneo íntegro ou laceração grau I e menos episiotomias) do que no modelo biomédico. Não houve diferença nos resultados neonatais. Conclusão: Os benefícios da implementação de um modelo humanizado de assistência ao parto devem ser considerados pelos formuladores de políticas de saúde e refletidos na mulher e em seu bebê.

Abstract: Introduction: In the 20th century, childbirth went from being attended at home to the hospital setting. Inappropriate and unnecessary interventions were uncritically adopted, leading to a dehumanization of childbirth. This is the model that currently exists in most Spanish hospitals, which has been questioned by the World Health Organization as early as 1996. Objective: The aim is to describe the differences in obstetrical and neonatal results across two different models of maternity care (biomedical model and humanised birth). Method: A correlational descriptive and multicenter study was carried out. A convenience sample of 205 primiparous women, 110 biomedical model and 95 humanised model, were recruited. Obstetrical and neonatal results were compared in two hospitals with different models of maternity care in Spain. Results: The humanised model of maternity care produces better obstetrical outcomes (spontaneous beginning of labour, normal vaginal birth, intact perineum and I degree tear and less episiotomies) than the biomedical model. There were no differences in neonatal outcomes. Conclusion: The benefits of implementing a humanised model of delivery care should be considered by health policy makers and reflected in the woman and her baby.

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ABSTRACT Whether in pre-pregnancy, pregnancy, birth and/or the postnatal and neonatal periods, midwives' practices are underpinned by humanism. However, in this era of postmodernity, there is an ever-growing need for rehumanization. This article adopts an auto-ethnographic approach in order to undertake a reflective analysis on the humanization of birth based on the practice of midwifery in two different contexts, namely Quebec (Canada) and Chile. In light of the evolution of the profession in these two countries, and the influence of health policies and social movements, there are factors such as the systematic use of technology and the hypermedicalization of reproductive processes which are maintaining women's ignorance and keeping them from being able to participate in their maternity process. Women's autonomy and empowerment become a key element for their participation in decisions regarding their maternity, assistance methods, or type of care. Concurrently, midwives' autonomy is a prerequisite for fully exercising their role in supporting and assisting women in this re-appropriation of their power by means of a comprehensive approach that takes into account psychological and social aspects as well as biomedical ones.

RESUMO Seja na pré-gravidez, na gravidez, no nascimento, seja nos períodos pós-natal e neonatal, as práticas das parteiras são sustentadas pelo humanismo. Entretanto, na atual era de pós-modernidade, há uma necessidade cada vez maior de reumanização. Este artigo adota uma abordagem autoetnográfica, a fim de realizar análise reflexiva sobre a humanização do nascimento baseada na prática da obstetrícia em dois contextos diferentes: Quebec (Canadá) e Chile. À luz da evolução da profissão nestes dois países e da influência das políticas de saúde e dos movimentos sociais, existem fatores, como o uso sistemático da tecnologia e a hipermedicalização dos processos reprodutivos, que estão mantendo as mulheres desinformadas e impedindo-as de participar de seu processo de maternidade. A autonomia e o empoderamento das mulheres tornam-se um elemento-chave para sua participação nas decisões relativas à sua maternidade, métodos de assistência ou tipo de cuidado. Ao mesmo tempo, a autonomia das parteiras é um requisito para o pleno exercício de seu papel de apoio e assistência às mulheres nesta reapropriação de seu poder, por meio de uma abordagem abrangente, que leve em conta tanto aspectos psicológicos e sociais quanto biomédicos.

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A Traditional Partera refers to a woman who assists, by traditional practices, women during gestation, birth, and reproductive life, aside of the formal health care system. Their practice, Traditional Partería, is considered a key ancestral cultural component in marginalized communities in Colombia. A comprehensive description of the essence of Colombian Traditional Partería is currently missing, and this practice is facing the loss of its body of knowledge. Here, we describe the essence of being a Colombian Traditional Partera. Eight Traditional Parteras participated in phenomenological interviews and body maps focused on their embodied conscious experience of being a Traditional Partera in Colombia. Seventeen general meaning units were identified and grouped in three embodied components (Head, Heart, and Hands) related to practice, knowledge, feelings, perceptions, context, and culture. We discuss philosophical reflections and implications of knowing other's world perspectives, describing a sensitive triad central in the Traditional Partería practice.

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ABSTRACT Objective: to analyze midwives' employment situation of midwives and detect their workload measurement needs. Methods: a mixed methodology (quantitative and qualitative), observational, descriptive and cross-sectional study. Two phases were carried out. The first methodological phase consisted of conducting semi-structured individual interviews. The second methodological phase analyzed the Nursing Intervention Classification (NIC) interventions that midwives perform in the labor room during daily practice. Results: 90.3% of midwives have work overload, since for 80.6% the midwife-pregnant mother ratio is not well established, since the mean execution time of a Nursing Intervention Classification (NIC) intervention is 20 minutes. For this reason, 100% of the sample considers the development of workload measurement tools to be highly useful. Conclusions: the need to generate an instrument that considers the diversity of Nursing Intervention Classification (NIC) interventions that develop within the labor room is ratified.

RESUMO Objetivo: analisar a situação laboral das parteiras e detectar suas necessidades de mensuração da carga de trabalho. Métodos: estudo de metodologia mista (quantitativa e qualitativa), observacional, descritivo e transversal. Duas fases foram realizadas. A primeira fase metodológica consistiu na realização de entrevistas individuais semiestruturadas. A segunda fase metodológica analisou as intervenções da Classificação de Intervenção de Enfermagem (NIC) que as parteiras realizam na sala de parto durante o dia de atendimento. Resultados: 90,3% das parteiras apresentam sobrecarga de trabalho, pois, para 80,6%, a relação obstetriz-gestante não está bem estabelecida, pois o tempo médio de execução de uma intervenção Classificação de Intervenção de Enfermagem (NIC) é de 20 minutos. Por esse motivo, 100% da amostra considera muito útil o desenvolvimento de ferramentas de medição de carga de trabalho. Conclusões: ratifica-se a necessidade de gerar um instrumento que considere a diversidade de intervenções Classificação de Intervenção de Enfermagem (NIC) que se desenvolvem na sala de parto.

RESUMEN Objetivo: Analizar la situación laboral de las matronas y detectar sus necesidades de medición de cargas de trabajo. Métodos: Estudio de metodología mixta (cuantitativo y cualitativo), observacional, descriptivo y transversal. Se realizaron dos fases: La primera fase metodológica, consistió en la realización de entrevistas individuales semiestructuradas. Y en la segunda fase metodológica, se analizaron las intervenciones de enfermería (NIC) que las matronas efectúan en paritorio durante su jornada asistencial. Resultados: El 90,3% de las matronas presentan sobrecarga en el trabajo, pues para el 80,6% el ratio matrona- gestante no se encuentra bien establecido; pues tiempo medio de ejecución de una intervención de enfermería (NIC), es de 20 minutos. Por ello, el 100% de la muestra considera de máxima utilidad el desarrollo de herramientas de medición de cargas de trabajo. Conclusiones: Se ratifica la necesidad de generar un instrumento que considere la diversidad de intervenciones de enfermería (NIC) que desarrollan dentro del paritorio.

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ABSTRACT: Objective: To investigate how women experienced perineal trauma during a humanized birth.Methods: A qualitative study with 22 postpartum women was performed from January to December 2018. The Husserlian phenomenology was used as theoretical framework using individual, in-depth interviews that were audio-taped and transcribed verbatim. Results: Twenty-four categories emerged from women ́s reports. During the prenatal phase, we found lack of information regarding perineal trauma, the alterity as a facilitating process to incentive women towards vaginal delivery and the perception of the beginning of an existential transition. During labor, it was noticed trust and attachment with the health professional giving physical and emotional support, the fear of the unknown linking to insecurity, the need for internal surrender to the process, empowerment as a result of trust and commitment, to give herself to the moment and no concerns with intrapartum injury but at the same time, having the possibility to share a decision-making process of suturing(or not). The postpartum period has shown the completion of the existential transition, the body as a place of estrangement, the loosening of some ties, but the construction of new networks of personal support to overcome postpartum. Conclusions: Most of women after humanized birth perceived perineal trauma as an existential transition that was initiated during antenatal period. (AU)

RESUMO: Objetivos: Investigar como as mulheres experienciaram o trauma perineal durante um parto humanizado. Métodos: Um estudo qualitativo com 22 mulheres pós-parto foi realizado de janeiro a dezembro 2018. A fenomenologia Husserliana foi usada como referencial teórico usando entrevistas individuais que foram audiogravadas e transcritas verbatim. Resultados: Vinte e quatro categorias emergiram durante os relatos. Durante o período pré-natal, a falta de informação sobre o trauma perineal, a alteridade como processo facilitador para incentivar as mulheres em direção ao parto vaginal e a percepção do começo de uma transição existencial. Durante o parto, a confiança e ligação com o(a) profissional de saúde com suporte físico e emocional, o medo do desconhecido e a insegurança, a necessidade de se entregar ao processo, o empoderamento como resultado de confiança e comprometimento, e o processo de tomada de decisão compartilhada da sutura (ou não). O período pós-parto mostra a completude da transição existencial, o corpo como local de estranhamento, o afrouxamento de alguns laços, mas a construção de novas redes de suporte pessoal para superar esse período. Conclusão: A maior parte das mulheres depois do parto humanizado percebe o trauma perineal como uma transição existencial que fora iniciada durante o período antenatal. (AU)

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INTRODUCCIÓN Y OBJETIVO Una enfermedad nueva, COVID-19, está afectando dramáticamente al mundo. Conocer los riesgos para la salud reproductiva es un imperativo para la práctica obstétrica y ginecológica. Esta investigación analiza los riesgos maternos y perinatales asociados a COVID-19, con el objetivo de identificar desafíos que la enfermedad plantea a la práctica de la matronería. MÉTODOS Revisión narrativa. Se consultaron artículos científicos de fuentes primarias indexados en las bases Scielo, Pubmed, Scope, WOS, mediante los siguientes términos de búsqueda: "embarazo" "transmisión vertical" "salud materna y perinatal", "riesgos maternos y perinatales" "lactancia materna", COVID-19", "Coronavirus". Se realizaron 3 fases de selección. Los tópicos de análisis fueron: Transmisión vertical, Riesgo materno y perinatal, Lactancia materna. RESULTADOS. En mujeres embarazadas las formas severas de COVID-19 se presentan en presencia de enfermedades crónicas. A nivel perinatal el riesgo mayor es el parto prematuro, generalmente por indicación médica y por cesárea. Aunque no hay evidencias de transmisión vertical, tampoco puede descartarse. Los riesgos neonatales se relacionan con el contagio por proximidad y con medidas restrictivas que pueden afectar la lactancia materna y la interacción madre-hija(o). CONCLUSIONES. La COVID-19 aporta varios desafíos para la práctica de la matronería: implementación de métodos de prevención del contagio a la gestante y a su entorno cercano; adecuación de la preparación al parto en caso de positividad; prevención del estrés y desgaste emocional materno desde el inicio de la gestación hasta el postparto; adecuación de cuidados al recién nacido; investigación aplicada en Latinoamérica, y evaluación de nuevos protocolos.

INTRODUCTION AND OBJECTIVE A new disease, COVID-19, is dramatically affecting the world. Knowing the risks for the reproductive health is an imperative for the obstetric and gynecological practice. This research analyzes the maternal and perinatal risks associated with COVID-19, with the aim of identifying challenges that the disease poses to the practice of midwifery. METHODS Narrative review. Scientific articles from primary sources indexed in Scielo, Pubmed, Scope, and WOS, are consulted by using the following search terms: "pregnancy" "vertical transmission" "maternal and perinatal health", "maternal and perinatal risks" "breastfeeding", COVID-19", "Coronavirus". Three selection phases were carried out. The topics of analysis were vertical transmission, maternal and perinatal risk, breastfeeding. RESULTS In pregnant women severe forms of COVID-19 occur in the presence of chronic diseases. At the perinatal level, the biggest risk is premature delivery, generally for medical indications and by cesarean section. Although there is no evidence of vertical transmission, it cannot be ruled out either. Neonatal risks are related to transmission by proximity and restrictive measures that may affect breastfeeding and mother-child interaction. CONCLUSIONS COVID-19 brings several challenges to the practice of midwifery: implementation of methods to prevent infection of the pregnant woman and her close environment; adaptation of birth preparation in case of positivity; prevention of maternal stress and emotional distress from the beginning of pregnancy to postpartum; adequacy of care for the newborn; research in Latin America, and evaluation of new protocols.

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INTRODUCCIÓN Y OBJETIVOS: La visita domiciliaria (VD) es una actividad clave del Programa de Apoyo al Desarrollo Biopsicosocial (PADB) del Chile Crece Contigo (ChCC). Para mejorar su implementación, esta investigación tiene como objetivo analizar la relación entre matrones y la familia que accede a la VD, considerando las competencias y habilidades relacionales de los visitadores. MÉTODOS: Se utilizó un diseño observacional con enfoque cualitativo, de alcance exploratorio. Tres matrones que realizan VD en centros de salud familiar rurales de la provincia de Aconcagua aceptaron participar y ocho visitas del programa ChCC fueron grabadas, de 30 minutos promedio. El análisis cualitativo se realizó en base al Home Visit Rating Scale A+. RESULTADOS: Las cuatro categorías que orientaron la evaluación de las visitas fueron responsividad de la familia, relación con la familia, facilitación de la interacción padres - hijo/a y no intrusividad y colaboración. Estas categorías, en su mayoría,puntuaron con un nivel adecuado. No obstante, se requiere entrenamiento en habilidades relacionales para cumplir con una visita catalogada como buena o excelente, sobre todo en las áreas en las que hay que facilitar el vínculo y la interacción entre padre e hijo/a, con el fin de evitar una atención de carácter paternalista. CONCLUSIONES: Esta investigación pionera en el área rural, entregó información relevante para mejorar la VD en este contexto. Aunque los matrones cuentan con formación técnica en el área biomédica, es importante reforzar y/o capacitar en las características esenciales de una VD, para fortalecer la alianza entre el profesional y la familia.

INTRODUCTION AND OBJECTIVES: The home visit (HV) is a key activity in the Support Program for Biopsychosocial Development of Chile Crece Contigo (ChCC). To improve its implementation, this research aims to analyze the relationship between a midwife and the family that accesses the HV based on the competence and relational skills of the visitor. METHODS: An observational design with a qualitative approach of exploratory scope was used. Three midwives performing HV in rural family health centers in the Aconcagua province accepted to participate, and eight visits of the ChCC program were recorded, with an average of 30 minutes. The Home Visit Rating Scale A + was applied to these visits, for further qualitative analysis. RESULTS: The four categories that guided the evaluation of the visits were family responsiveness, relationship with the family, facilitation of parent-child interaction and non-intrusion and collaboration. These scored mostly with an adequate level but requires training in relational skills is required to meet a visit rated as good or excellent, especially in areas where it is necessary to facilitate the link and interaction between father and son, evidencing a paternalistic character of the attention model. CONCLUSIONS: This pioneering research in the rural area, provided relevant information to improve the HV in this context. Although midwives have technical training in the biomedical area, it is important to reinforce and / or train in the essential characteristics of a HV, to strengthen the alliance between the professional and the family.

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Com as transformações advindas do surgimento das tecnologias, o modelo obstétrico passou por mudanças significativas, onde o protagonismo do parto já não pertence às mulheres. Passando a ser regido pelo complexo médico-industrial, criando uma forte oposição na simplificação do modelo e elevando, em muito, seus custos. Entender que o Parto Domiciliar Planejado é uma alternativa real, prevista, disponível e de menor custo, capaz de atuar como ferramenta de redução da morbimortalidade materna e neonatal, é, sem dúvida um enorme avanço para a saúde no Brasil. É reconhecido, desde 1996, pela Organização Mundial de Saúde como um local seguro para o acompanhamento de partos de gestantes de baixo risco. Diante deste contexto, somado à ausência de estudos sobre custos com este trabalho, teve como objetivo principal levantar os custos com PDP, comparar com outros tipos de nascimento e associar algumas variáveis aos seus desfechos. Os dados foram coletados a partir de prontuários físicos de mulheres (n=197) que tiveram Parto Domiciliar Planejado, entre 2013-2017, na Região Metropolitana do Recife e aplicado questionário de satisfação por e-mail. Por tratar-se de procedimentos privados, com profissionais autônomas, foram apenas considerados os custos com materiais e equipamentos, pois os custos com Recursos Humanos equivalem ao lucro das profissionais, após retirados tais custos. Com custos variando entre R$82,02 (2016) e R$151,01 (2014); os Elevados Níveis de Satisfação das mulheres (94,2% de satisfação com a qualidade dos cuidados e 91,3% de satisfação com a forma de decorreu o TP, parto e pós-parto) e os Desfechos positivos (71,07% sem intercorrências maternas ou neonatais e 9,69% de transferência por intercorrência). Os resultados e conclusões se apresentam em consonância com a hipótese levantada, que o modelo é de alta satisfação e baixo custo comparado ao valor pago pelo SUS (R$267,60). Concluindo que se trata de um modelo seguro de assistência e uma boa opção para melhoria da qualidade na atenção obstétrica, que contribui para a redução de intervenções desnecessárias e consequentemente para melhores desfechos.

With the transformations resulting from the emergence of technologies, the obstetric model underwent significant changes, where the protagonism of childbirth no longer belongs to women. Becoming governed by the medical-industrial complex, creating a strong opposition in simplifying the model and greatly increasing its costs. Understanding that Planned Home Birth is a real, predictable, affordable and affordable alternative that can act as a tool to reduce maternal and neonatal morbidity and mortality is undoubtedly a huge advance for health in Brazil. Since 1996, it has been recognized by the World Health Organization as a safe place to monitor the delivery of low-risk pregnant women. Given this context, in addition to the lack of studies on costs with this work, while an exploratory and descriptive study, the main objective was to raise the costs with PDP, compare with other types of birth and associate some variables with their outcomes., The data were collected from women's medical records (n = 197) who had Planned Home Birth, between 2013-2017, in the Metropolitan Region of Recife and applied an email satisfaction questionnaire. As these are private procedures, with autonomous professionals, only the costs with materials and equipment were considered, since the costs with Human Resources are equivalent to the profit of the professionals, after removing these costs. With costs ranging from R$ 82.02 (2016) to R$ 151.01 (2014); Women's High Levels of Satisfaction (94.2% satisfaction with quality of care and 91.3% satisfaction with the way in which PT, delivery, and postpartum elapsed) and Positive Outcomes (71.07% without maternal or neonatal complications and 9.69% of intercurrent transfer). The results and conclusions are in line with the hypothesis raised, that the model is of high satisfaction and low cost compared to the amount paid by SUS (R$ 267.60). In conclusion, this is a safe care model and a good option for improving the quality of obstetric care, which contributes to the reduction of unnecessary interventions and, consequently, to better outcomes.

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RESUMEN OBJETIVO Conocer la evolución de la formación académica de la enfermería española (1850-1950), describiendo los cambios que la transformaron en profesión sanitaria. MÉTODO Investigación histórica en la modalidad exploratoria-descriptiva, con análisis e interpretación de información obtenida en bases de datos electrónicas, archivos nacionales, provinciales y municipales, Boletines Oficiales y Bibliotecas. RESULTADOS En 1850 coexistían diferentes categorías sanitarias, sin embargo, el título de enfermera no surgió hasta 1915. Con el auge que alcanzó la Salud Comunitaria durante esa época, en 1924, se funda la Escuela Nacional de Sanidad, creándose en 1932 las especialidades de Enfermero Psiquiátrico, Enfermeras Pediátricas y Enfermeras Visitadoras. CONCLUSIONES E IMPLICACIÓN PARA LA PRÁCTICA Entre 1915 y 1950 los profesionales de enfermería poseían formación universitaria, por tanto, a través del conocimiento científico estos sanitarios adquirieron una identidad propia dentro de las profesiones de la salud. Se logró proporcionar una asistencia especializada para el cuidado de personas.

ABSTRACT OBJECTIVE To know the evolution of the academic formation of the Spanish infirmary (1850-1950), describing the changes that transformed it into sanitary profession. METHOD Historical research in the exploratory-descriptive modality, with analysis and interpretation of information obtained from electronic databases, national, provincial and municipal archives, official gazettes and libraries. RESULTS In 1850 different health categories coexisted, however, the title of nurse did not emerge until 1915. With the boom that Community Health reached during that time, in 1924, the National School of Health was founded, creating in 1932 the specialties of Psychiatric Nurse, Pediatric Nurse and Visiting Nurse of Mental Hygiene. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Between 1915 and 1950 all nursing professionals had university training, therefore, through scientific knowledge these health professionals acquired their own identity within the health professions and they were able to provide specialized assistance for the care of people.

ABSTRACT OBJECTIVE To know the evolution of the academic formation of the Spanish infirmary (1850-1950), describing the changes that transformed it into sanitary profession. METHOD Historical research in the exploratory-descriptive modality, with analysis and interpretation of information obtained from electronic databases, national, provincial and municipal archives, official gazettes and libraries. RESULTS In 1850 different health categories coexisted, however, the title of nurse did not emerge until 1915. With the boom that Community Health reached during that time, in 1924, the National School of Health was founded, creating in 1932 the specialties of Psychiatric Nurse, Pediatric Nurse and Visiting Nurse of Mental Hygiene. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Between 1915 and 1950 all nursing professionals had university training, therefore, through scientific knowledge these health professionals acquired their own identity within the health professions and they were able to provide specialized assistance for the care of people.

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Introducción: Los partos de los pueblos étnicos en América Latina, siguen siendo atendidos por parteras tradicionales. La mirada conceptual y teórica de esta práctica varía entre los diferentes actores, lo que influye en las políticas e intervenciones propuestas para este gremio. Objetivo: Analizar desde una postura intercultural crítica, el panorama político que enfrentan las parteras tradicionales en América Latina. Fuente de datos: Este es un estudio de revisión de artículos académicos, documentos técnicos y normativos, que se clasificaron en temas conceptuales, de enfoques y políticos relacionados con las parteras tradicionales. Los datos se consolidaron en matrices y se analizaron a partir del método de aproximaciones sucesivas. Se realizó una triangulación entre investigadores y teórica sobre el tema. Síntesis de los datos: el sector académico realiza una diferenciación entre parteras tradicionales y parteras profesionales. Los organismos Internacionales envían a la partería tradicional solo a lugares de difícil acceso geográfico. Los Gobiernos de América Latina presentan diversas posturas desde la mirada hegemónica del modelo biomédico de salud frente a la partería tradicional. Conclusiones: Las parteras tradicionales siguen en un terreno políticamente ambiguo que debilita su rol, lo que genera la pérdida del patrimonio cultural de los países ante su no reconocimiento, no vinculación a los sistemas de salud como prestadoras de servicio y sí como actores comunitarios encargados de informar, educar, y remitir a los prestadores de servicios de salud los casos de salud materna y neonatal(AU)

Introduction: Births in ethnic populations in Latin America are still being attended by traditional midwifes. The conceptual and theoretical outlook to this practice varies among different actors, influencing on proposed policies and interventions for this group. Objectives: To analyze the political overview of traditional midwives through a critic intercultural scope. Data sources: In this descriptive study, a review of academic documents, technical documents and regulations was made, identifying conceptual, approach and political topics related to traditional midwives. The data was summarized in a matrix and analyzed through the method of consecutive approximations. Methodological triangulation was made among researchers, disciplines, techniques and information sources on the topic. Data synthesis: The academic community makes a distinction among traditional midwives and professional midwives. International organizations promote professional midwifery just for difficult geographical access locations. Latin-American governments have different positions from the hegemonic overview of the biomedical model in health toward midwifery. Conclusions: Traditional midwives remain in an ambiguous political arena undermining their role, generating a loss of the cultural heritage of the countries as they are not being recognized, not being linked to the health system as service providers, but being community actors that inform, educate and refer to the health services the maternal and neonatal cases(AU)

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BACKGROUND: Episiotomy and perineal tears remain common in vaginal deliveries. This study estimated the frequency of and factors associated with perineal tears, episiotomies, and postnatal infections among women in two predominantly indigenous municipalities in southern Mexico, where traditional midwives play an important role in women's health. METHODS: A cross-sectional study contacted women who gave birth in the previous three years. An administered questionnaire asked about place of delivery, birthing position, birth attendant, episiotomy, perineal tears, and wound infection after delivery. Cluster adjusted bivariate and then multivariate analysis examined factors potentially associated with self-reported perineal trauma (episiotomy and/or perineal tear). Key informant interviews sought insights into some of the findings. RESULTS: Among women with a vaginal delivery, 71% (876/1238) of indigenous women and 18% (36/197) of non-indigenous women delivered at home. Some 17% (247/1416) of women overall, and 33% (171/525) of those delivering in a health facility, reported an episiotomy during delivery. Among 171 women reporting an episiotomy in a health facility, 30% (52) also reported a perineal tear. Overall, 13% (190/1412) of women reported they had a perineal tear during delivery, 17% (86/515) of those delivering in a health facility and 12% (104/897) of those delivering at home. A quarter of the women had self-reported perineal trauma during their last delivery, 38% (196/511) of those delivering in a health facility and 18% (160/893) of those delivering at home. In bivariate analysis, indigenous ethnicity, home delivery, upright posture in labour, and delivery by a traditional midwife were associated with a lower risk of perineal trauma, while primiparas had a higher risk. In the final multivariate model, delivery by a traditional midwife was protective (ORa 0.41, 95%CIca 0.32-0.54) and primiparity was a risk factor (ORa 2.01, 95%CIca 1.5-2.68) for perineal trauma. Women suggested that fear of bad treatment and being cut made them unwilling to deliver in health facilities. CONCLUSIONS: The rate of perineal trauma among women giving birth in indigenous communities could be reduced by efforts to decrease the use of episiotomies in health facilities, and by opening a dialogue with traditional midwives to increase their interaction with formal health services.

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RESUMO Objetivo: compreender o processo histórico do ofício das parteiras do semiárido nordestino brasileiro por meio da história oral. Método: estudo qualitativo realizado em nove municípios do Cariri cearense com 16 parteiras, por meio do método da história oral. Foi utilizada, como instrumento de coleta de dados, a entrevista semiestruturada, com gravação das entrevistas em vídeo. Os relatos foram transcritos, textualizados e transcriados, sendo analisados segundo o método da história oral de vida. Resultados: a inserção de mulheres no ofício de parteiras ocorreu de forma transcendental ou essencial. Foi considerado um dom autônomo, divino ou aprendido pelo convívio com outras parteiras mais experientes. Seus conhecimentos variaram entre os saberes empírico e científico, tendo sido modificados ao longo do tempo, por conta do crescimento da medicalização, instigando a reflexão diante da atuação profissional voltada à saúde da mulher. Isto valorizou o parto, tornado um momento único, respeitando todos seus significados e devolvendo à mulher seu direito de ser mãe com humanidade e segurança. Conclusão: ficou evidente a forma natural e transcendental com que as parteiras foram inseridas neste ofício, motivadas pelo sentimento de altruísmo em um contexto histórico e social de ausência de acesso universal à saúde, de localização geográfica rural e de pouca disponibilidade de recursos humanos na saúde. Ficaram evidentes, deste modo, seus valores e sua importância no cenário da saúde obstétrica brasileira.

RESUMEN Objetivo: comprender el proceso histórico del oficio de las parteras del semiárido nordestino brasileño por medio de la historia oral. Método: estudio cualitativo realizado en nueve municipios del Cariri cearense con 16 parteras, por medio del método de la historia oral. Se utilizó, como instrumento de recolección de datos, la entrevista semiestructurada, con grabación de las entrevistas en video. Los relatos fueron transcritos, textualizados y transcribados, siendo analizados según el método de la historia oral de vida. Resultados: la inserción de mujeres en el oficio de parteras ocurrió de forma trascendental o esencial. Fue considerado un don autónomo, divino o aprendido por la convivencia con otras parteras más experimentadas. Sus conocimientos variaron entre los saberes empírico y científico, habiendo sido modificados a lo largo del tiempo, por el crecimiento de la medicalización, instigando la reflexión ante la actuación profesional orientada a la salud de la mujer. Esto valoró el parto, convertido en un momento único, respetando todos sus significados y devolviendo a la mujer su derecho de ser madre con humanidad y seguridad. Conclusión: quedó evidente la forma natural y trascendental con que las parteras fueron insertadas en este oficio, motivadas por el sentimiento de altruismo en un contexto histórico y social de ausencia de acceso universal a la salud, de localización geográfica rural y de poca disponibilidad de recursos humanos en la salud . Se quedaron evidentes, de este modo, sus valores y su importancia en el escenario de la salud obstétrica brasileña.

ABSTRACT Objective: to understand the historical process of the midwives' job in the Brazilian Northeastern semi-arid region through the oral history. Method: qualitative study carried out in nine municipalities of Cariri, in Ceará, with 16 midwives, using the oral history method. The semi-structured interview was used as a data collection instrument, with video interviews recorded. The reports were transcribed, textualized and transcreated, being analyzed according to the oral life history method. Results: the insertion of women working as midwives took place in a transcendental or essential way. It was considered an autonomous gift, divine or learned by living with other more experienced midwives. Their knowledge varied between the empirical and scientific knowledge, having been modified over time, due to the growth of the medicalization, instigating the reflection due to the professional action focused on women's health. This valued the childbirth, making it a unique moment, respecting all its meanings and giving back to the woman her right to be a mother with humanity and security. Conclusion: it was evident the natural and transcendental way in which the midwives were inserted in this role, motivated by the feeling of altruism in a historical and social context of absence to universal access to health, rural geographic location and little availability of human resources in health. Thus, their values and their importance in the Brazilian obstetric health scenario were evident.

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OBJECTIVE: to describe the experiences of midwives who graduated from the University of São Paulo's midwifery program and the characteristics of their work within the Brazilian National Health System (SUS). DESIGN: a descriptive, qualitative field study. SETTING: interviews were scheduled by telephone or e-mail and were held with the midwives outside their work environment. Interviews lasted for up to one hour and were recorded. PARTICIPANTS: ten midwives who had graduated from the University of São Paulo's midwifery program and were working or had worked in the SUS at the time of the study. ETHICAL ISSUES: the study protocol was approved by the internal review board of the School of Arts, Sciences and Humanities, University of São Paulo. All pertinent ethical principles were followed. MEASURES AND FINDINGS: data were collected at interviews focussing on the participants' work and their experiences while working in the SUS. The dialogues during the interview sessions allowed the participants to build on and extend the proposed topics. After the data had been transcribed and read, the discourses were grouped in accordance with the similarity of their content, resulting in four thematic categories: the inclusion of midwives into the obstetric team; dealing with contradictions: challenges of the profession; working in the SUS: between precariousness and guaranteeing access to health services; and making a difference. The findings provoke reflection on the challenges faced by midwives in their work within the SUS: challenges associated with the difficulties in working in the public healthcare sector, difficulties in their relationships with other healthcare professionals, difficulties related to a general lack of knowledge on this specific occupation in Brazil, the absence of a midwifery model of care, difficulty in dealing with obstetric abuse, and the dilemmas facing the midwives during their daily practice of midwifery. KEY CONCLUSION: despite the difficulties encountered, the midwives consider the care they provide to be differentiated. They perceive gradual changes in the care offered to women by the healthcare facilities and by other professionals, and believe that they make a difference in their workplaces. In addition, they want to work in the SUS and are committed to transforming the quality of care provided to women in Brazil. PRACTICAL IMPLICATIONS: the experiences related by midwives reflect the midwifery scenario nationwide, highlighting the perspectives for change. The emphasis placed by midwives on their social role and their commitment to changing current midwifery care models and to consolidating the SUS is noteworthy.

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BACKGROUND: The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections. METHODS: Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births. RESULTS: 16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower. CONCLUSIONS: The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.

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BACKGROUND: The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS: This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. RESULTS: The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife. CONCLUSIONS: The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.

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Resumo Estudo etnográfico sobre o trabalho de assistência ao parto prestado pelas parteiras tradicionais do Maranhão, que atendem gestantes residentes no bairro do Anjo da Guarda, na região da área Itaqui-Bacanga, zona periférica de São Luís, MA. Investigou-se o processo de surgimento do trabalho das parteiras a partir dos relatos de 18 parteiras e sua relação com a Secretaria Municipal de Saúde, bem como suas ações. Evidencia também este estudo as atividades desenvolvidas por essas parteiras tradicionais com as gestantes e parturientes da área Itaqui-Bacanga, como complemento ao Serviço Público de Saúde do Hospital e Maternidade Nossa Senhora da Penha. Investigou-se, ainda, o ritual do parto realizado pelas parteiras, tendo como fundamento o saber adquirido empiricamente. O resultado da pesquisa apontou que o trabalho desenvolvido pelas parteiras tradicionais contribui com o processo de conscientização das gestantes para a realização do pré-natal, além de proporcionar conforto psicológico para as gestantes e parturientes, humanizando, assim, o atendimento prestado à mulher no período gravídico.

Abstract Ethnographical study about the work of childbirth assistance provided by traditional midwives, who attend pregnant women residing in Anjo da Guarda, in the region of Itaqui-Bacanga, the metropolitan area of São Luís, MA., The research focused on investigating how the association was created, in accordance with the account of 18 associated midwives, their relationship with the local health care municipal department and the actions derived from such relationship. This study also points out the activities developed by traditional midwives that give assistance to pregnant and parturient women in the Itaqui-Bacanga area, as a complement to the health services rendered by Public Health Care of Nossa Senhora da Penha Hospital-Maternity. The research also focused on childbirth ritual performed by local midwives, considering such ritual as a result of empirical knowledge. The research points out that the tasks carried out by traditional midwives help pregnant women become conscious that they require prenatal care, as well as provide psychological comfort to pregnant and parturient women, humanizing the attendance of such patients.

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