Camilla Alexsandra Schneck

Parto domiciliar planejado: resultados maternos e neonatais

The hospitalization of all women in labour, in the interests of thesafety and well-being of mother and baby introduced mechanical,impersonal and interven...

Resultados maternos e neonatais em centro de parto normal peri-hospitalar e hospital

OBJECTIVE: To compare maternal and neonatal outcomes in low-risk women assisited in an alongside birth center and at a hospital. METHODS: A cross-sectional study was conducted with a representative sample of low-risk women in Sao Paulo (Southeastern Brazil), from 2003 to 2006. The study included 991 women who delivered a child at the alongside birth center and 325 who delivered a child at a hospital. Data were obtained from medical records. A comparative analysis was performed for all of the women, who were stratified according to parity. The chi-square test and Fishers exact test were used to compare outcomes between women who delivered in alongside birth center and those who gave birth in the hospital. RESULTS: There was a homogeneous distribution of women according to parity (45.4% were nulliparous, and 54.6% had one or more previous deliveries). Statistically significant differences were found in the frequency of amniotomy (more frequent in nulliparous women treated at the hospital), the use of oxytocin during labor, and the use of postpartum analgesia (both more frequent among women of any parity treated at the hospital). The rate of episiotomy was higher in nulliparous women, both in the alongside birth center and at the hospital. Neonatal interventions were more frequent at the hospital and included aspiration of the upper airways, gastric aspiration, gastric lavage, and the use of an open oxygen mask. Other events that occurred with greater frequency at the hospital included caput succedaneum, respiratory discomfort, and admittance to the neonatal unit. There was no difference in Apgar scores at the fifth minute or cases of maternal or perinatal death. CONCLUSIONS: Care at the alongside birth center involved fewer interventions and had maternal and neonatal outcomes similar to those of the hospital setting.

Reflexões sobre o excesso de cesarianas no Brasil e a autonomia das mulheres

O objetivo deste estudo foi investigar a qualidade de vida de mulheres integrantes de um Grupo de Apoio acometidas de câncer de mama e comparar a qualidade apurada entre as mulheres mastectomizadas que fizeram reconstrucao mamaria com aquelas que nao fizeram alem daquelas submetidas a quadrantectomia que nao necessitavam da reconstrucao com aquelas que nao fizeram a reconstrucao. Trata-se de estudo transversal quantitativo, cuja coleta de dados se deu por meio da aplicacao de questionario de caracterizacao das entrevistadas e pelo SF-36 da OMS. Participaram 50 mulheres com idade media de 57,2 anos. Os grupos foram comparados entre si - dois a dois - considerando os tipos de cirurgia, por meio do Teste de Mann Whitney, ao nivel de 5% de significância. Os resultados apontaram que as mulheres que realizaram a cirurgia de quadrantectomia e nao necessitaram de reconstrucao sao as que possuem os melhores escores medios em todos os dominios e, portanto, tem melhor qualidade de vida, seguido do grupo de mastectomizadas que fizeram reconstrucao. O grupo das mastectomizadas que nao fizeram a reconstrucao tem um nivel muito baixo de qualidade de vida, seguido pelo grupo das mulheres que realizaram a quadrantectomia e tambem nao fizeram a reconstrucao.A medicalizacao do parto, como resultado da medicalizacao social, tem sido descrita como um processo sociocultural complexo que transforma em necessidades medicas, vivencias, sofrimentos e dores antes administradas no proprio ambiente familiar ou comunitario. O objetivo e refletir sobre o excesso de cesarianas no Brasil, em uma perspectiva critica e propositiva. Dados sobre taxas de cesariana e estudos sobre a preferencia das mulheres sobre a via de parto sao discutidos com a finalidade de contribuir para o debate sobre autonomia das usuarias do sistema de saude. A medicalizacao e uma transformacao cultural que influenciou a capacidade de enfrentamento autonomo da experiencia de parir, visto que implica em dependencia excessiva, heteronomia e consumo abusivo de cesarianas. Alem disso, discutem-se as redes e os movimentos sociais como possiveis facilitadores da autonomia das mulheres, na medida em que possibilitam apoio mutuo e compartilhamento de experiencias, contribuindo para a construcao de relacoes mais igualitarias entre as mulheres e os profissionais de saude. A participacao nessas redes possibilita a mobilizacao coletiva das mulheres no sentido de reivindicarem seus direitos junto as diversas instâncias da sociedade.

Resultados maternos e neonatais em Centro de Parto Normal peri-hospitalar na cidade de São Paulo, Brasil

The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of Sao Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of São Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.

Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional nascer no Brasil

Robust evidence of the benefits of continuous support during childbirth led to the recommendation that it should be offered for all women. In Brazil, it has been guaranteed by law since 2005, but scarce data on implementation is available. We aimed to estimate the frequency and associated socio-demographic, obstetric and institutional predictors of women having companionship during childbirth in the Birth in Brazil survey. Descriptive statistical analysis was done for the characterization of companions (at different moments of hospital stay), maternal and institutional factors; associations were investigated in bivariate and multivariate models. We found that 24.5% of women had no companion at all, 18.8% had continuous companionship and 56.7% had partial companionship. Independent predictors of having no or partial companionship at birth were: lower income and education, brown color of skin, using the public sector, multiparity, and vaginal delivery. Implementation of companionship was associated with having an appropriate environment, and clear institution al rules about womens rights to companionship.As evidencias sobre os beneficios do apoio continuo durante o parto levou a recomendacao de que este apoio deve ser oferecido a todas as mulheres. No Brasil, ele e garantido por lei desde 2005, mas os dados sobre a sua implementacao sao escassos. Nosso objetivo foi estimar a frequencia e fatores sociodemograficos, obstetricos e institucionais associados a presenca de acompanhantes durante o parto na pesquisa Nascer no Brasil. Foi feita analise estatistica descritiva para a caracterizacao dos acompanhantes (em diferentes momentos do tempo da internacao), fatores maternos e institucionais; as associacoes foram investigadas em modelos bi e multivariada. Vimos que 24,5% das mulheres nao tiveram acompanhante algum, 18,8% tinham companhia continua, 56,7% tiveram acompanhamento parcial. Preditores independentes de nao ter algum, ou parcial, foram: menor renda e escolaridade, cor parda da pele, usar o setor publico, multiparidade e parto vaginal. A implementacao do acompanhante foi associada com ambiencia adequada e regras institucionais claras sobre os direitos das mulheres ao acompanhante.

Maternal and perinatal outcomes of an alongside hospital Birth Center in the city of São Paulo, Brazil

The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of Sao Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.The aim of this study was to describe the maternal and perinatal results of care in the alongside hospital birth center Casa de Maria (CPN-CM), located in the city of São Paulo. The random sample included 991 women and their newborns, attended between 2003 and 2006. The results showed that 92.2% of women had a companion of her choice during childbirth and the practices commonly used were shower or immersion bath (92.9%), amniotomy (62.6%), walking (47.6%), massage comfort (29.8%) and episiotomy (25.7%). Regarding newborns, 99.9% of them had Apgar scores =7 in the fifth minute, 9.3% received aspiration of the upper airway, no one needed to be intubated and 1.4% were removed to the hospital. The model of care in the CPN-CM provides maternal and perinatal outcomes expected for low obstetric risk women, and means a safe option and less interventionist model in normal childbirth.

Risk factors for neonatal transfers from the Sapopemba free-standing birth centre to a hospital in São Paulo, Brazil

OBJECTIVE to identify risk factors associated with neonatal transfers from a free-standing birth centre to a hospital. DESIGN epidemiological case-control study. SETTING midwifery-led free-standing birth centre in São Paulo, Brazil. PARTICIPANTS 96 newborns were selected from 2840 births between September 1998 and August 2005. Cases were defined as all newborns transferred from the birth centre to a hospital (n=32), and controls were defined as newborns delivered at the same birth centre, during the same time period, and who had not been transferred to a hospital (n=64). MEASUREMENTS AND FINDINGS data were collected from medical records available at the birth centre. Univariate and multivariate analyses were performed using logistic regression. The multivariate analysis included outcomes with p<0.25, specifically: smoking during pregnancy, prenatal care appointments, labour complications, weight in relation to gestational age, and one-minute Apgar score. Of the foregoing outcomes, those that remained in the full regression model as a risk factor associated with neonatal transfer were: smoking during pregnancy [p=0.009, odds ratio (OR)=4.1, 95% confidence interval (CI) 1.03-16.33], labour complications (p<0.001, OR=5.5, 95% CI 1.06-28.26) and one-minute Apgar score ≤ 7 (p<0.001, OR=7.8, 95% CI 1.62-37.03). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE smoking during pregnancy, labour complications and one-minute Apgar score ≤ 7 were confirmed as risk factors for neonatal transfer from the birth centre to a hospital. The identified risk factors can help to improve institutional protocols and formulate hypotheses for other studies.

O Partograma como instrumento de análise da assistência ao parto

Both the World Health Organization and the Brazilian Ministry of Health recommend using the partogram to follow labor. The objective of this study was to analyze the use of obstetrical interventions, the types of delivery, and perinatal outcomes according to zones I, II and III of the partogram. This cross-sectional study was performed with 233 low-risk pregnant women between December 2004 and March 2005 at a public maternity hospital located in the city of Itapecerica da Serra, in the state of São Paulo. Comparative analysis was performed using Chi-square and Fischer exact tests. The practices used in the different partogram zones with statistical significance of (p = 0.05) were: bath, movement and walking (zone-III); artificial rupture of the membranes (zone-II) and oxytocin (zone-I). Caesarean sections were performed on 24% of women in zone-III. The interventions occurred at a timely moment, indicating that the partogram is an instrument that can be used as a guide when adopting interventions during labor.Both the World Health Organization and the Brazilian Ministry of Health recommend using the partogram to follow labor. The objective of this study was to analyze the use of obstetrical interventions, the types of delivery, and perinatal outcomes according to zones I, II and III of the partogram. This cross-sectional study was performed with 233 low-risk pregnant women between December 2004 and March 2005 at a public maternity hospital located in the city of Itapecerica da Serra, in the state of Sao Paulo. Comparative analysis was performed using Chi-square and Fischer exact tests. The practices used in the different partogram zones with statistical significance of (p = 0.05) were: bath, movement and walking (zone-III); artificial rupture of the membranes (zone-II) and oxytocin (zone-I). Caesarean sections were performed on 24% of women in zone-III. The interventions occurred at a timely moment, indicating that the partogram is an instrument that can be used as a guide when adopting interventions during labor.

Centros de Parto no Brasil: revisão da produção científica

Este articulo es una revision narrativa, con el objetivo de identificar la produccion cientifica brasilena relacionada con la atencion y los resultados maternos y perinatales en centros de nacimiento (CN). Las publicaciones fueron recuperadas en las bases de datos y portales PubMed/MEDLINE, CINAHAL, SciELO y REVENF. Fueron incluidos tambien libro publicado y los trabajos no publicados de un grupo de investigadores. Fueron seleccionados ocho estudios de tipo descriptivo, dos transversales y dos casos-control, realizados con 5.407 mujeres y 5.395 recien-nacidos, divulgados en el periodo de 2005 a 2009. Los estudios analizaron variables socio-demograficas y obstetricas, practicas en la atencion al parto y nacimiento y el traslado materno y neonatal hacia al hospital. La produccion cientifica sobre CN presenta datos de la ultima decada, relativos a siete servicios. Son estudios principalmente descriptivos, con enfoque en las practicas obstetricas y en los resultados maternos, con menos enfasis en la atencion neonatal.

The partogram as an instrument to analyze care during labor and delivery

Both the World Health Organization and the Brazilian Ministry of Health recommend using the partogram to follow labor. The objective of this study was to analyze the use of obstetrical interventions, the types of delivery, and perinatal outcomes according to zones I, II and III of the partogram. This cross-sectional study was performed with 233 low-risk pregnant women between December 2004 and March 2005 at a public maternity hospital located in the city of Itapecerica da Serra, in the state of São Paulo. Comparative analysis was performed using Chi-square and Fischer exact tests. The practices used in the different partogram zones with statistical significance of (p = 0.05) were: bath, movement and walking (zone-III); artificial rupture of the membranes (zone-II) and oxytocin (zone-I). Caesarean sections were performed on 24% of women in zone-III. The interventions occurred at a timely moment, indicating that the partogram is an instrument that can be used as a guide when adopting interventions during labor.Both the World Health Organization and the Brazilian Ministry of Health recommend using the partogram to follow labor. The objective of this study was to analyze the use of obstetrical interventions, the types of delivery, and perinatal outcomes according to zones I, II and III of the partogram. This cross-sectional study was performed with 233 low-risk pregnant women between December 2004 and March 2005 at a public maternity hospital located in the city of Itapecerica da Serra, in the state of Sao Paulo. Comparative analysis was performed using Chi-square and Fischer exact tests. The practices used in the different partogram zones with statistical significance of (p = 0.05) were: bath, movement and walking (zone-III); artificial rupture of the membranes (zone-II) and oxytocin (zone-I). Caesarean sections were performed on 24% of women in zone-III. The interventions occurred at a timely moment, indicating that the partogram is an instrument that can be used as a guide when adopting interventions during labor.