Flora Maria Barbosa da Silva

Risk factors for birth‐related perineal trauma: a cross‐sectional study in a birth centre

AIM AND OBJECTIVES To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. BACKGROUND Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. DESIGN Cross-sectional study. METHODS Data were retrospectively collected from one independent birth centre in Brazil, during 2006-2009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). RESULTS There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. CONCLUSIONS Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. RELEVANCE TO CLINICAL PRACTICE The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

O efeito do banho de imersão na duração do trabalho de parto

The objectives of this experi-mental, randomized, controlled trial study were to evaluate the effect of immersion baths on the length of the first stage of child-birth labor and on the frequency and length of the uterine contractions. Data were collected in a philanthropic public maternity hospital of the city of Sao Paulo whose month average is 1,100 births. The sample was comprised of 108 women in labor - 54 in the control group and 54 in the experimental group that had immersion baths. The results showed that immersion baths did not have any influence on the length of labor and on the frequency of uterine contractions. However, the length of contractions was statistically shorter in the experimental group (experimental 41.9 versus control 44.6 min). The conclusion was that immersion baths are an alternative for the womans comfort during labor, since it provides relief to her without interfering on the labor progression or jeopardizing the baby.The objectives of this experi-mental, randomized, controlled trial study were to evaluate the effect of immersion baths on the length of the first stage of child-birth labor and on the frequency and length of the uterine contractions. Data were collected in a philanthropic public maternity hospital of the city of Sao Paulo whose month average is 1,100 births. The sample was comprised of 108 women in labor - 54 in the control group and 54 in the experimental group that had immersion baths. The results showed that immersion baths did not have any influence on the length of labor and on the frequency of uterine contractions. However, the length of contractions was statistically shorter in the experimental group (experimental 41.9 versus control 44.6 min). The conclusion was that immersion baths are an alternative for the womans comfort during labor, since it provides relief to her without interfering on the labor progression or jeopardizing the baby.

Women's experiences of perineal pain during the immediate postnatal period: A cross-sectional study in Brazil

OBJECTIVE To identify the severity and prevalence of perineal pain during the post partum in-patient period and associated obstetric, maternal and newborn baby factors following birth. DESIGN Cross-sectional study. SETTING A postnatal ward of a hospital in São Paulo, Brazil. PARTICIPANTS 303 Postnatal women. MEASUREMENTS Interviews and perineal assessment were conducted to evaluate the perineal outcomes (trauma and pain). Data on maternal characteristics and infant anthropometric variables were collected. RESULTS Among all women, 80.5% had perineal trauma (60.7% had episiotomy) and 18.5% reported perineal pain. The mean pain intensity score was 4.8 ± 1.9 on the visual analogue scale. Only maternal age (ORa = 1.08) and performance of episiotomy (ORa = 3.80) remained as independent predictors of perineal pain in the final logistic regression model. KEY CONCLUSIONS Perineal pain in the immediate postnatal period was highly associated with older maternal age and use of episiotomy, although the overall reporting of perineal pain was low. IMPLICATIONS FOR PRACTICE Perineal pain following vaginal birth is associated with interventions during labour as well as with maternal characteristics. Despite the negative impact on a womans daily activities, perineal pain following birth is neglected by care givers and usually not reported by women who may consider it to be a normal outcome of giving birth. Care providers need to ensure all interventions during labour and birth are informed by evidence of benefit and that barriers to implementation of evidence are addressed. Further work is needed to obtain the views of women in Brazil on their health and well-being following birth.

Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial.

INTRODUCTION This study evaluated the effectiveness of an ice pack applied for 20 minutes to alleviate perineal pain after spontaneous vaginal birth. METHODS We conducted a randomized controlled trial at the Amparo Maternal Birth Center in São Paulo, Brazil. Study participants included 114 nulliparous women divided into 3 groups (n = 38 per group): experimental (ice packs on the perineum), placebo (water packs at set temperature), and control (no treatment). RESULTS A numerical scale (0 to 10) was used for pain assessment. A comparison of the average pain at the beginning and after 20 minutes showed a significant reduction of pain (P < .001) in the 3 groups, and the experimental group had a lower average score for pain compared with the control group (1.6 versus 3.3, P = .032). DISCUSSION The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

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.

Uso da bola suíça no trabalho de parto

Objectives: To characterize the use of the Swiss ball for the care of laboring women in obstetric care services linked to the Unified Health System in Sao Paulo, and to identify the characteristics of its use in assisting laboring women by nurse-midwives. Methods: A descriptive study based on structured interviews with 35 nurses who were providing assistance to laboring women. Results: We found that 100% of Normal Birthing Centers and 40.9% of obstetric centers owned the Swiss ball. The indications for the use of Swiss ball were: promoting fetal descent (32.4%), relaxation (19.7%), progression of labor (17.1%), exercise of the perineum (14.5%), pain relief (11.8%), psychological benefits and maternal movement. Nearly all of the institutions visited (96.8%) had no protocol for its use. Conclusion: The study found that nurses ascribe benefits to using the Swiss ball during labor. Clinical trials are needed to evaluate its effects and support the development of guidelines for its use.

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.

Avaliação e tratamento da dor perineal no pós-parto vaginal

Objectives: To identify the prevalence, intensity and therapeutic measures for relief of perineal pain in the vaginal postpartum. Methods: Cross-sectional study in a University Hospital Rooming Unit of the University of Sao Paulo; data were collected through interviews with 303 postpartum women who delivered vaginally (numeric scale from 0 to 10) to assess: perineal pain, perineal assessment and medical record data. Results: The prevalence of perineal pain was 18.5%, with moderate intensity (51.8%) associated with presence of episiotomy (p = 0.001). There were 303 vaginal deliveries, 80.5% had perineal trauma, episiotomy, 75.4% and 24.6% lacerations. The oral analgesic was the method used to relieve perineal pain. Conclusion: There are several treatments for perineal pain relief and there are no effective methods for complete resolution of the problem.

Care in a birth center according to the recommendations of the World Health Organization

Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO), with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls); maternal positions during delivery: semi-sitting (82.3%), side-lying (16.0%), other positions (1.7%), oral intake (95.6%); companionship (93.3%); exposure to up to three vaginal examinations (85.4%), shower bathing (84.0%), walking (68.0%), massage (60.1%), exercising with a Swiss ball (51.7%); amniotomy (53.4%), oxytocin use during the first (31.0%) and second stages of labor (25.8%), bath immersion (29.3%) and episiotomy (14.1%). In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO), with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, Sao Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls); maternal positions during delivery: semi-sitting (82.3%), side-lying (16.0%), other positions (1.7%), oral intake (95.6%); companionship (93.3%); exposure to up to three vaginal examinations (85.4%), shower bathing (84.0%), walking (68.0%), massage (60.1%), exercising with a Swiss ball (51.7%); amniotomy (53.4%), oxytocin use during the first (31.0%) and second stages of labor (25.8%), bath immersion (29.3%) and episiotomy (14.1%). In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.

LOW-LEVEL LASER THERAPY FOR PAIN RELIEF AFTER EPISIOTOMY: A DOUBLE-BLIND RANDOMISED CLINICAL TRIAL

AIMS AND OBJECTIVES To evaluate the effectiveness of a low-level laser therapy for pain relief in the perineum following episiotomy during childbirth. BACKGROUND Laser irradiation is a painless and non-invasive therapy for perineal pain treatment and its effects have been investigated in several studies, with no clear conclusion on its effectiveness. DESIGN A double-blind randomised controlled clinical trial. METHOD One hundred and fourteen women who underwent right mediolateral episiotomies during vaginal birth in an in-hospital birthing centre in São Paulo, Brazil and reported pain ≥ 3 on a numeric scale (0-10) were randomised into three groups of 38 women each: two experimental groups (treated with red and infrared laser) and a control group. The experimental groups were treated with laser applied at three points directly on the episiotomy after suturing in a single session between 6-56 hours postpartum. We used a diode laser with wavelengths of 660 nm (red laser) and 780 nm (infrared laser). The control group participants underwent all laser procedures, excluding the emission of irradiation. The participants and the pain scores evaluator were blinded to the type of intervention. The perineal pain scores were assessed at three time points: before, immediately after and 30 minutes after low-level laser therapy. RESULTS The comparison of perineal pain between the three groups showed no significant differences in the three evaluations (p = 0.445), indicating that the results obtained in the groups treated with low-level laser therapy were equivalent to the control group. CONCLUSIONS Low-level laser therapy did not decrease the intensity of perineal pain reported by women who underwent right mediolateral episiotomy. RELEVANCE TO CLINICAL PRACTICE The effect of laser in perineal pain relief was not demonstrated in this study. The dosage may not have been sufficient to provide relief from perineal pain after episiotomy during a vaginal birth.