Um estudo descritivo dos resultados obstétricos e neonatais em dois modelos de assistência ao parto em primíparas

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.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.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

Bonding in neonatal intensive care units: Experiences of extremely preterm infants’ mothers

Background The birth of an extremely preterm infant can disrupt normal mother–infant physical contact and the care provided by the mother. This situation has an impact on the process of bonding between the mother and the child. Aim The objective of this study was to describe and understand the experiences of mothers who have extremely preterm infants admitted in Neonatal Intensive Care Units with regard to their bonding process. Methods An interpretive, qualitative research methodology using Gadamer’s philosophical hermeneutics was carried out. A focus group and eleven in-depth, semi-structured interviews were conducted. Data were collected between June and September of 2016. Findings Sixteen women with a mean age of 34.4 years participated in the study. Two themes emerged from the data analysis: (1) premature labour and technological environment, a distorted motherhood, with the subthemes ‘feeling of emptiness and emotional crisis’ and ‘the complexity of the environment and care generate an emotional swing’; (2) learning to be the mother of an extremely preterm infant, with the subthemes “the difficulty of relating to a stranger” and ‘forming the bond in spite of difficulties’. Conclusions The bonding with extremely preterm infants is interrupted after giving birth. The maternal emotional state and the environment of the neonatal intensive care unit limit its development. Nursing care can facilitate mother–infant bonding by encouraging communication, participation in care, massaging or breastfeeding

Sexuality and affectivity after a grieving process for an antenatal death: a qualitative study of fathers’ experiences

The loss of an infant at the prenatal stage is one of the most traumatic events parents can experience. Prenatal losses have several negative implications for parents’ physical, psychological, and social well-being, including intimacy and sexuality. Fathers who suffer from this experience have to cope not only with their grief, but also with the physical and emotional suffering of their partners. The social context gives the father a masculine role of strength, insensitivity, and protection of the mother, with the result that his pain and grief become invisible. The objective of this study is to understand fathers’ experience of affective-sexual relationships after a grieving process for an antenatal death; A qualitative study based on interviews with 11 fathers in Spain who have experienced an antenatal death was conducted. Data were analyzed with the help of ATLAS.ti software to discover emerging themes. 6 sub-themes were developed from the analysis, grouped into two main themes: the invisibility of grieving fathers and the relationships between the grieving parents are influenced by the death of their infants. The sexuality of fathers who suffer an antenatal death is altered. Gender stereotypes and the lack of social and professional awareness make their grief invisible. Fathers need to express their emotions to cope with their own grief and break the stereotypical gendered bereavement. In most cases, the couple’s relationship is altered, from a close union to a more distant relationship, in addition to a decrease in sexual desire and arousal. However, other fathers experienced greater closeness and intimacy in the couple. A communication based on sincerity, exposing their own grief, feelings, emotions and needs could help the couple’s relationship

Nursing Interventions to Facilitate the Grieving Process after Perinatal Death: A Systematic Review

Perinatal death is the death of a baby that occurs between the 22nd week of pregnancy (or when the baby weighs more than 500 g) and 7 days after birth. After perinatal death, parents experience the process of perinatal grief. Midwives and nurses can develop interventions to improve the perinatal grief process. The aim of this review was to determine the efficacy of nursing interventions to facilitate the process of grief as a result of perinatal death. A systematic review of the literature was carried out. Studies that met the selection criteria underwent a quality assessment using the Joanna Briggs Institute critical appraisal tool. Four articles were selected out of the 640 found. Two are quasi-experimental studies, and two are randomized controlled clinical studies. The interventions that were analyzed positively improve psychological self-concept and role functions, as well as mutual commitment, depression, post-traumatic stress and symptoms of grief. These interventions are effective if they are carried out both before perinatal loss and after it has occurred. The support of health professionals for affected parents, their participation in the loss, expressing feelings and emotions, using distraction methods, group sessions, social support, physical activity, and family education are some of the effective interventions

Impact of Perinatal Death on the Social and Family Context of the Parents

Background: Perinatal death (PD) is a painful experience, with physical, psychological and social consequences in families. Each year, there are 2.7 million perinatal deaths in the world and about 2000 in Spain. The aim of this study was to explore, describe and understand the impact of perinatal death on parents’ social and family life. Methods: A qualitative study based on Gadamer’s hermeneutic phenomenology was used. In-depth interviews were conducted with 13 mothers and eight fathers who had suffered a perinatal death. Inductive analysis was used to find themes based on the data. Results: Seven sub-themes emerged, and they were grouped into two main themes: 1) perinatal death affects family dynamics, and 2) the social environment of the parents is severely affected after perinatal death. Conclusions: PD impacts the family dynamics of the parents and their family, social and work environments. Parents perceive that society trivializes their loss and disallows or delegitimizes their grief. Implications: Social care, health and education providers should pay attention to all family members who have suffered a PD. The recognition of the loss within the social and family environment would help the families to cope with their grief

Experience of parents who have suffered a perinatal death in two Spanish hospitals: a qualitative study

Background: Perinatal grief is a process that affects families in biological, psychological, social and spiritual terms. It is estimated that every year there are 2.7 million perinatal deaths worldwide and 4.43 deaths for every 1000 births in Spain. The aim of this study is to describe and understand the experiences and perceptions of parents who have suffered a perinatal death. Methods: A qualitative study based on Gadamer’s hermeneutic phenomenology. The study was conducted in two hospitals in the South of Spain. Thirteen mothers and eight fathers who had suffered a perinatal death in the 5 years prior to the study participated in this study. In-depth interviews were carried out for data collection. Inductive analysis was used to find themes based on the data. Results: Eight sub-themes emerged, and they were grouped into three main themes: ‘Perceiving the threat and anticipating the baby’s death: “Something is going wrong in my pregnancy”’; ‘Emotional outpouring: the shock of losing a baby and the pain of giving birth to a stillborn baby’; “We have had a baby”: The need to give an identity to the baby and legitimise grief’. Conclusion: The grief suffered after a perinatal death begins with the anticipation of the death, which relates to the mother’s medical history, symptoms and premonitions. The confirmation of the death leads to emotional shock, characterised by pain and suffering. The chance to take part in mourning rituals and give the baby the identity of a deceased baby may help in the grieving and bereavement process. Having empathy for the parents and notifying them of the death straightaway can help ease the pain. Midwives can help in the grieving process by facilitating the farewell rituals, accompanying the family, helping in honouring the memory of the baby, and supporting parents in giving the deceased infant an identity that makes them a family member

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Efectividad de las propiedades de la col en el tratamiento de la ingurgitación mamaria postparto

[spa] La ingurgitación mamaria es una afección dolorosa que afecta a un gran porcentaje de mujeres en el período posparto temprano que suele llevar a un destete prematuro y otras consecuencias entre las que se encuentran pezones agrietados, mastitis y absceso mamario. Dentro de los tratamientos alternativos más utilizados, las compresas de gel frío y la aplicación de hojas de col fría son las acciones más populares. Por ello, el objetivo que se pretende alcanzar en el presente trabajo consiste en examinar la efectividad de las hojas de col frías en la mejora de los resultados en mujeres con ingurgitación mamaria. La muestra será de una N=342 obtenida de una muestra de mujeres que acudan a los Hospitales de las Islas Baleares durante el tiempo de investigación con sistemas de ingurgitación mamaria y que accedan a participar en el estudio. Así, se tendrá en cuenta el tipo de tratamiento utilizado siendo no tratamiento, tratamiento con hojas de col, paquete de gel frío y compresas de calor/frío u otros tratamientos. Por otro lado, se medirá la temperatura corporal, dureza y dolor de los senos, calidad de vida y análisis alimentario. El estudio se estima de una duración total de 24 meses

A Phenomenological study about families´ experience in perinatal grief

Resumen Introducción: lLa muerte y el duelo perinatal es uno de los eventos más duros y estresantes en la vida de los padres, afectando tanto en el plano biológico, psicológico, social y espiritual. Con más de 2,6 millones de muertes perinatales en el mundo y más de 2000 en España, es importante dar el mejor cuidado a las madres y padres que pasan por el duro momento de la muerte de su bebé. Los cuidados son esenciales, tanto del sistema sanitario como por la sociedad en general, una sociedad que en la actualidad no reconoce ni legitima el duelo perinatal. Objetivos: Explorar, describir y comprender las experiencias de madres y padres que han vivido un duelo perinatal. Metodología: Se realizó un estudio cualitativo basado en la fenomenología hermenéutica de Gadamer. Se realizaron entrevistas en profundidad y se hizo un análisis inductivo para encontrar los temas principales. Se entrevistaron a 13 madres y 8 padres que fueron atendidos en los Hospitales de Torrevieja y Vinalopó, ambos en Alicante. Estos padres sufrieron la muerte perinatal de un bebé 5 años previos al estudio y reunieron los criterios de inclusión. Resultados: En el análisis de los datos se obtuvieron 33 subtemas y estos se agruparon en 9 temas; a su vez, de estos temas emergieron 4 temas principales: "Experimentando la muerte de un hijo", "Secuelas físicas y psicológicas de la muerte perinatal", “Impacto de la muerte perinatal en el contexto sociofamiliar de los padres” y “Experiencias de los padres sobre el apoyo después de la muerte fetal y neonatal". Conclusiones: El duelo perinatal es una experiencia devastadora tanto para la madre y el padre, como para los hermanos y el resto del entorno familiar afectando de forma física, psicológica y emocional. Por ello, es necesaria una alta calidad en la asistencia sanitaria, con una unificación de criterios y de cuidados basados en la evidencia científica, así como en los deseos y expectativas de los padres. Abstract Introduction: Death and perinatal grief is one of the hardest and most stressful events in parents' lives, affecting the biological, psychological, social and spiritual levels. With more than 2,6 million perinatal deaths in the world and more than 2000 of cases in Spain, it is important to give the best care to mothers and fathers who go through the hard time of baby. Care is essential from the health system and society in general, a society that currently does not recognize and legitimize perinatal grief. Objectives: Describe and understand the experiences of mothers and fathers who have lived a perinatal death. Methodology: A qualitative study based on the hermeneutic phenomenology of Gadamer was carried out. In-depth interviews were conducted and an inductive analysis was done to find the main topics. We interviewed 13 mothers and 8 fathers who were treated at the Hospitals of Torrevieja and Vinalopó, both in Alicante. These parents experienced the perinatal death of a baby 5 years prior to the study and met the inclusion criteria. Results: 33 subthemes were obtained from the data analysis and these were grouped into 9 themes; four main themes emerged: "Experiencing the death of a baby", "Physical and psychological consequences of perinatal death", "Impact of perinatal death in the sociofamiliar context of parents" and "Parents´ experiences about support following stillbirth and neonatal death”. Conclusions: Perinatal grief is a devastating experience for both mother and father, as well as for siblings and the rest of the family environment, affecting physically, psychologically and emotionally. Therefore, high quality of health care is necessary, with a unification of criteria and care based on scientific evidence, as well as parents' wishes and expectations

Métodos de proteção perineal: conhecimento e utilização

Objetivo: Analizar grado de conocimiento y utilización de los métodos de protección perineal durante el periodo expulsivo de los profesionales sanitarios implicados en el parto y si se corresponde con las recomendaciones de la Organización Mundial de la Salud. Método: Estudio descriptivo de corte transversal dirigido a sanitarios que asisten partos en España. Resultados: Participaron en el estudio 57 profesionales: matronas (47%), ginecólogos (25%), Enfermero Interno Residente (EIR) (14%) y Médico Interno Residente (MIR) (14%) en Obstetricia y Ginecología. Hubo diferencias respecto al grado de conocimiento y utilización según el cargo desempeñado, siendo muy limitado para ginecólogos y MIR. Los únicos métodos reconocidos por todos los cargos fueron “Hands On” (p = 0,05). “Hands off ” (p = 0.002), “Control de pujos” (p = 0.0001) y “Posturas en el periodo expulsivo” (0.03) sólo son conocidos por las matronas y EIR. “Control de deflexión de la cabeza fetal” (0.035) y el “Control de pujos” (p = 0.011) son efectivos para matronas y EIR. La “Episiotomía” se identificó erróneamente como protector del periné por ginecólogos y MIR (p = 0.003). Conclusión: El grado de conocimiento y uso de los métodos de protección del periné de los profesionales no se corresponde con las recomendaciones de la Organización Mundial de la Salud.Objetivo: Analisar o grau de conhecimento e utilização dos métodos de proteção perineal durante o período expulsivo por parte dos profissionais sanitários implicados no parto e se ele se corresponde com as recomendações da Organização Mundial da Saúde. Método: Estudo descritivo de corte transversal dirigido a sanitários que assistem partos na Espanha. Resultados: Participaram no estúdio 57 profissionais: obstetras (47%), ginecologistas (25%), Enfermeiro Interno Residente (EIR) (14%) e Médico Interno Residente (MIR) (14%) em Obstetrícia e Ginecologia. Houve diferencias no grau de conhecimento e utilização segundo o cargo desempenhado, sendo muito limitado para ginecologistas e MIR. Os únicos métodos reconhecidos por todos os cargos foram “Hands On” (p = 0,05). “Hands off ” (p = 0.002), “Controle de puxos” (p = 0.0001) y “Posturas no período expulsivo” (0.03) somente são conhecidos pelas obstetras e EIR. “Controle de deflexão da cabeça fetal” (0.035) e o “Controle de puxos” (p = 0.011) são efetivos para matronas e EIR. A “Episiotomia” se identificou erroneamente como protetor do períneo por ginecologistas e MIR (p = 0.003). Conclusão: O grau de conhecimento e uso dos métodos de proteção do períneo dos profissionais não se corresponde com as recomendações da Organização Mundial da Saúde.Objective: To analyse the knowledge and use of perineal protection methods during the expulsive stage by health professionals involved in childbirth and whether they correspond to the World Health Organization’s recommendations. Method: This was a cross-sectional descriptive study aimed at health workers involved in births in Spain. Results: Fifty-seven professionals participated in the study: midwives (47%), gynaecologists (25%), nurse residents (14%) and resident physicians (14%) in obstetrics and gynaecology. The degree of knowledge and use of perineal protection methods differed according to the position held and was very limited among gynaecologists and resident physicians. The only method recognized by all positions was “hands on” (p = 0.05). “Hands off ” (p = 0.002), “delayed pushing” (p = 0.0001) and “maternal posture” (p = 0.03) were only known to midwives and nurse residents. “Flexion technique” (p = 0.035) and “delayed pushing” (p = 0.011) were used effectively by midwives and nurse residents. “Episiotomy” was erroneously identified as a method to protect the perineum by gynaecologists and resident physicians (p = 0.003). Conclusion: The degree of knowledge and use of perineal protection methods by health care professionals does not correspond to the recommendations of the World Health Organization