Marlise de Oliveira Pimentel Lima

Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean

OBJECTIVE over the past three decades there has been a social movement in Latin American countries (LAC) to support humanised, physiologic birth. Rates of caesarean section overall in Latin America are approximately 35%, increasing up to 85% in some cases. There are many factors related to poor outcomes with regard to maternal and newborn/infant health in LAC countries. Maternal and perinatal outcome data within and between countries is scarce and inaccurate. The aims of this study were to: i) describe selected obstetric and neonatal outcomes of women who received midwifery care, ii) identify the level of maternal well-being after experiencing midwifery care in 6 Latin America countries. DESIGN this was a cross sectional and descriptive study, conducted in selected maternity units in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay. Quantitative methods were used to measure midwifery processes of care and maternal perceptions of well-being in labour and childbirth through a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardized antepartum and intrapartum data set. SETTING Maternity units from 6 Latin American countries. PARTICIPANTS the final sample was a convenience sample, and the total participants for all sites in the six countries was 3009 low risk women. FINDINGS for the countries reporting, overall, 82% of these low risk women had spontaneous vaginal deliveries. The rate of caesarean section was 16%; the Dominican Republic had the highest rate of Caesarean sections (30%) and Peru had the lowest rate (4%). The use of oxytocin in labour was widely variable, although overall there was a high proportion of women whose labour was augmented or induced. Ambulation was common, with the lowest proportion (48%) of women ambulating in labour in Chile, Uruguay (50%), Peru (65%), Brazil (85%). The presence of continuous support was highest in Uruguay (93%), Chile (75%) and Argentina (55%), and Peru had the lowest (22%). Episiotomies are still prevalent in all countries, the lowest rate was reported in the Dominican Republic (22%), and the highest rates were 52 and 53% (Chile and Peru, respectively). The Optimal Maternal well-being score had a prevalence of 43.5%, adequate score was 30.8%; 25% of the total sample of women rated their well-being during labour and childbirth as poor. KEY CONCLUSIONS despite evidence-based guidelines and recommendations, birth is not managed accordingly in most cases. Women feel that care is adequate, although some women report mistreatment. IMPLICATIONS FOR PRACTICE More research is needed to understand why such high levels of intervention exist and to test the implementation of evidence-based practices in local settings.

Sintomas depressivos na gestação e fatores associados: estudo longitudinal

Objetivo Identificar a frequencia de sintomas depressivos no decorrer da gestacao e verificar sua associacao com variaveis sociodemograficas, obstetricas e de saude. Metodos Estudo longitudinal realizado com 272 gestantes de 12 unidades de saude do Municipio de Sao Paulo. Os dados foram obtidos por meio de um formulario para as variaveis independentes e da Escala de depressao pos-parto de Edimburgo aplicada nas 20a, 28a e 36a semanas gestacionais. Utilizou-se modelo de equacoes de estimacao generalizadas para avaliar os fatores associados e chances de risco. Resultados A frequencia de sintomas depressivos foi de 27,2%, 21,7% e 25,4%. Maior escolaridade, gestacao planejada e continuidade da gestacao foram fatores de protecao. Sofrer ou ter sofrido violencia psicologica foi fator de risco independente do periodo gestacional. Conclusao A frequencia de sintomas depressivos na gestacao foi elevada. Os fatores associados foram maior escolaridade, gestacao planejada, continuidade da gestacao e sofrer ou ter sofrido violencia psicologica.

Avaliação da assistência pré-natal em unidade com estratégia saúde da família

Se evaluo el prenatal (PN) de un servicio de salud que cuenta con Estrategia Salud de la Familia, de la ciudad de Sao Paulo, conforme indicadores del Programa de Humanizacion del Prenatal y Nacimiento (PHPN) y se comparo la adecuacion del PN con variables sociodemograficas, procedimientos, examenes y los resultados maternos y perinatales. Estudio transversal con datos de los registros de 308 embarazadas inscritas en 2011. Se observo el inicio precoz de PN (82,1%), realizacion del minimo de seis consultas (84,1%) y la consulta puerperal (89%) y, en la medida en que hay una suma de las acciones, hay una caida significativa en coeficiente de adecuacion. El PN fue adecuado para el 67,9%, con una diferencia significativa entre los grupos de adecuacion en relacion a la edad gestacional y el peso al nacer. Hay deficiencias en el PN, especialmente en los registro de procedimientos, examenes y vacunas. La diferencia entre los grupos en adecuacion con respecto a los resultados perinatales refuerza la importancia de un PN conforme parametros del PHPN.We analyzed prenatal care (PN) provided at a unit of the Family Health Strategy Service in São Paulo, according to the indicators of the Program for the Humanization of Prenatal and Birth (PHPB). We compared adequacy of PN in terms of sociodemographic variables, procedures, examinations and maternal and perinatal outcomes. Cross-sectional study with data from records of 308 pregnant women enrolled in 2011. We observed early initiation of PN (82.1%), conducting of a minimum of six consultations (84.1%), puerperal consultation (89.0%); to the extent that there is a sum of the actions, there is a significant drop in the proportion of adequacy. Prenatal care was adequate for 67.9%, with a significant difference between adequacy groups in relation to gestational age and birth weight. Prenatal care deficiencies exist, especially in regards to registration of procedures, exams and immunization. The difference between adequacy groups with respect to perinatal outcomes reinforces the importance of prenatal care that adheres to the parameters of the PHPB.

Evaluation of prenatal care in unit with family health strategy

Se evaluo el prenatal (PN) de un servicio de salud que cuenta con Estrategia Salud de la Familia, de la ciudad de Sao Paulo, conforme indicadores del Programa de Humanizacion del Prenatal y Nacimiento (PHPN) y se comparo la adecuacion del PN con variables sociodemograficas, procedimientos, examenes y los resultados maternos y perinatales. Estudio transversal con datos de los registros de 308 embarazadas inscritas en 2011. Se observo el inicio precoz de PN (82,1%), realizacion del minimo de seis consultas (84,1%) y la consulta puerperal (89%) y, en la medida en que hay una suma de las acciones, hay una caida significativa en coeficiente de adecuacion. El PN fue adecuado para el 67,9%, con una diferencia significativa entre los grupos de adecuacion en relacion a la edad gestacional y el peso al nacer. Hay deficiencias en el PN, especialmente en los registro de procedimientos, examenes y vacunas. La diferencia entre los grupos en adecuacion con respecto a los resultados perinatales refuerza la importancia de un PN conforme parametros del PHPN.We analyzed prenatal care (PN) provided at a unit of the Family Health Strategy Service in São Paulo, according to the indicators of the Program for the Humanization of Prenatal and Birth (PHPB). We compared adequacy of PN in terms of sociodemographic variables, procedures, examinations and maternal and perinatal outcomes. Cross-sectional study with data from records of 308 pregnant women enrolled in 2011. We observed early initiation of PN (82.1%), conducting of a minimum of six consultations (84.1%), puerperal consultation (89.0%); to the extent that there is a sum of the actions, there is a significant drop in the proportion of adequacy. Prenatal care was adequate for 67.9%, with a significant difference between adequacy groups in relation to gestational age and birth weight. Prenatal care deficiencies exist, especially in regards to registration of procedures, exams and immunization. The difference between adequacy groups with respect to perinatal outcomes reinforces the importance of prenatal care that adheres to the parameters of the PHPB.

A saúde neonatal na perspectiva de atenção contínua à saúde da mulher e da criança

The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of São Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of Sao Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.

Evaluación del cuidado prenatal en unidad con estrategia salud de la familia

Se evaluo el prenatal (PN) de un servicio de salud que cuenta con Estrategia Salud de la Familia, de la ciudad de Sao Paulo, conforme indicadores del Programa de Humanizacion del Prenatal y Nacimiento (PHPN) y se comparo la adecuacion del PN con variables sociodemograficas, procedimientos, examenes y los resultados maternos y perinatales. Estudio transversal con datos de los registros de 308 embarazadas inscritas en 2011. Se observo el inicio precoz de PN (82,1%), realizacion del minimo de seis consultas (84,1%) y la consulta puerperal (89%) y, en la medida en que hay una suma de las acciones, hay una caida significativa en coeficiente de adecuacion. El PN fue adecuado para el 67,9%, con una diferencia significativa entre los grupos de adecuacion en relacion a la edad gestacional y el peso al nacer. Hay deficiencias en el PN, especialmente en los registro de procedimientos, examenes y vacunas. La diferencia entre los grupos en adecuacion con respecto a los resultados perinatales refuerza la importancia de un PN conforme parametros del PHPN.We analyzed prenatal care (PN) provided at a unit of the Family Health Strategy Service in São Paulo, according to the indicators of the Program for the Humanization of Prenatal and Birth (PHPB). We compared adequacy of PN in terms of sociodemographic variables, procedures, examinations and maternal and perinatal outcomes. Cross-sectional study with data from records of 308 pregnant women enrolled in 2011. We observed early initiation of PN (82.1%), conducting of a minimum of six consultations (84.1%), puerperal consultation (89.0%); to the extent that there is a sum of the actions, there is a significant drop in the proportion of adequacy. Prenatal care was adequate for 67.9%, with a significant difference between adequacy groups in relation to gestational age and birth weight. Prenatal care deficiencies exist, especially in regards to registration of procedures, exams and immunization. The difference between adequacy groups with respect to perinatal outcomes reinforces the importance of prenatal care that adheres to the parameters of the PHPB.

La atención neonatal en la perspectiva de la atención continua a la salud de las mujeres y niños

The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of São Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of Sao Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.

The neonatal care from the perspective of continuous attention to woman and child's health

The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of São Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.The study is a literature review of theses and dissertations concluded from 2000 to 2009 developed by the Obstetric and Neonatal Nursing Research Group and Breastfeeding Center for Studies and Research of Nursing School, University of Sao Paulo, which focused on the maternal and perinatal impact on neonatal health. The scientific production shows agreement with the guidelines to promote neonatal and infant health established by national and international health agencies.