La atención a la salud materno-infantil en el área de salud de La Ribera (Valencia) desde la perspectiva de las gestantes y las matronas: aproximaciones desde la fenomenología y el Análisis de Redes Sociales

Justificación e introducción La atención al parto experimentó profundos cambios durante la segunda mitad del siglo XX con la introducción del parto en el ámbito hospitalario. Como reacción a ello surge el movimiento del parto normal, que pretende humanizar la asistencia al parto que se presta dentro de los hospitales. En cada hospital este proceso se ha desarrollado en diferente tiempo y forma. En el caso del Hospital Universitario de La Ribera (Alzira, Valencia), la introducción de los protocolos de atención al parto normal se produce de forma progresiva entre los años 2011 y 2014. En ese momento, surge la necesidad de explorar la acogida de estos cambios entre las gestantes del área de salud y su posible relación con la coordinación entre las matronas del área, que tienen como peculiaridad trabajar para dos modelos de gestión de recursos humanos diferentes (ya que el Modelo Alzira es la primera colaboración público-privada en el ámbito sanitario en España). Los objetivos generales de las investigaciones que forman el cuerpo de la tesis doctoral son los siguientes: - Conocer el grado de conocimiento y el deseo de inclusión de los protocolos de atención al parto normal por parte de las gestantes del área de salud - Determinar qué porcentaje de gestantes acuden a las actividades formativas programadas y sus posibles diferencias en función de su paridad - Explorar cuáles son sus expectativas de parto y en qué medida los protocolos de atención al parto normal se incluyen en ellas - Identificar y analizar las fuentes de información más utilizadas y más influyentes para las embarazadas en relación con la generación de sus expectativas de parto y sus procesos de toma de decisiones; - Conocer la calidad y utilidad de las fuentes de información que utilizan las gestantes - Identificar las fuentes de información consideradas deficientes por las gestantes, su respuesta a las contradicciones en la búsqueda de información y las posibles diferencias en función de su paridad - Explorar la percepción de las matronas sobre su coordinación entre diferentes niveles asistenciales y modelos de gestión de recursos humanos en el área de salud de La Ribera, así como las estrategias propuestas por ellas mismas para mejorar su coordinación - Definir el grado de cohesión de la red social que conforman las matronas del área de salud, sus pautas reticulares y la colaboración entre actores en base a sus principales atributos.Justification and introduction Childbirth care experienced deep changes during the second half of the 20th century with the introduction of childbirth attendance at hospitals. In response to this, the normal childbirth movement emerged, which aimed to humanise the childbirth care provided within hospitals. In each hospital this process has been developed in different times and ways. In the case of La Ribera University Hospital (Alzira, Valencia), the introduction of normal childbirth care protocols has taking place progressively between 2011 and 2014. At that time, the challenge is to explore the acceptance of these changes among pregnant women, and their possible relationship with the coordination between the midwives in the health area, which have the peculiarity of working for two different human resource management models (since the Alzira Model was the first public-private partnership in the Spanish National Health System). The general objectives of the research that forms the corpus of the PhD thesis are as follow: - To assess the knowledge and the wish of pregnant women of the health area to include the normal childbirth care protocols - To determine the percentage of pregnant women attending the antepartum training activities and their possible differences according to parity - To explore the childbirth expectations of La Ribera pregnant women and the extent to which normal birth care protocols are included in them - To identify and analyse the most widely used and influential sources of information among pregnant women in relation to the definition of their birth expectations and their process of decision making about that - To assess the quality and usefulness of the sources of information used by pregnant women - To identify the sources of information regarded as deficient by pregnant women, their response to contradictions in the search for information and possible differences according to women parity - To explore the perception of midwives about their coordination through and between different care levels and human resource management models of midwives in La Ribera health area, as well as the strategies proposed by them to improve their coordination - To define the degree of the midwives’ social network’s cohesion in the La Ribera health area, their reticular patterns and the collaboration between actors according to their main attributes

A Contribution to the analysis of the first Spanish public-private partnership in primary and specialized maternity care: a social network analysis approach

The first experience of public-private partnership in the Spanish National Health System. In addition to the need to coordinate two levels of health care (primary/specialised), two models of human resource management (public/private) had to be coordinated. To illustrate this complexity, the group of midwives in the health area has been taken, analysing their relational patterns through the methodological approach of Social Network Analysis. In terms of results, out of a population of 31 midwives, those of the public model occupy peripheral positions and cooperate poorly, both internally and externally. However, those of the private model constitute a cohesive subgroup, which proves to be both a strength and a weakness. Midwives in primary care and in the private model bridge subgroups. Therefore, the presence of two management models determines the efficiency of maternal care rather than the division of care into two levels

Expectativas de parto de las gestantes de La Ribera: una aproximación cualitativa

Objetivo:El cambio de modelo asistencial en la atención al parto normal, el interés por parte de las autoridades sanitarias en que se exploren las expectativas de parto de las gestantes, y su especificidad cultural y social, hacen que el estudio de tales expectativas sea pertinente en este momento. El objetivo del presente estudio es conocer cuáles son las expectativas de parto de una muestra de gestantes españolas y estudiar las diferencias entre las expectativas de las gestantes primíparas y multíparas.Metodología: Estudio cualitativo basado en una pregunta de respuesta libre sobre expectativas de parto. Se recogieron datos a gestantes de tercer trimestre del área de salud de La Ribera (Alzira, Valencia) durante 2014-2015. Se analizaron los datos mediante análisis del contenido.Resultados: Muestra de 213 gestantes cuyas principales expectativas de parto fueron tener un parto rápido, con buen resultado obstétrico, sin dolor y con apoyo de los profesionales. Las expectativas relacionadas con los protocolos de atención al parto normal supusieron un 5.2% del total de las respuestas. No se encontraron diferencias estadísticamente significativas entre gestantes primíparas y multíparas. Conclusiones: El conocimiento de las expectativas resulta importante, ya que las gestantes miden su satisfacción con el parto en base al cumplimiento de tales expectativas. Ayudarlas a desarrollar expectativas realistas aumentará su satisfacción. Las matronas tienen un importante papel a través de la formación que imparten (educación maternal) y del apoyo en el momento del parto (fundamental para que las gestantes se sientan protagonistas del mismo).Objective: Change of healthcare model in normal childbirth, health authorities interest in exploring childbirth expectations of pregnant women, and their cultural and social specificity make relevant the study of these expectations at this moment. The aim is to know what are the childbirth expectations from a sample of Spanish pregnant women and to study the differences between primiparous and multiparous pregnant women expectations.Methodology: Qualitative study based on an open-ended question about childbirth expectations. Data were collected during 2014-2015 to third trimester pregnant women in La Ribera health area (Alzira, Valencia). Data were analyzed using content analysis.Results: Sample of 213 pregnant women whose main expectations were to have a fast delivery, with good obstetric outcome, painlessly and with professional support. Expectations regarding normal childbirth protocols accounted for 5.2% of total responses. No statistically significant differences between primiparous and multiparous pregnant women were found.Conclusions: Knowledge about childbirth expectations is highly relevant because pregnant women measure their satisfaction with childbirth through the fulfillment of these expectations. Helping them to develop realistic expectations will increase their satisfaction. Midwives play an important role through the training they give (maternal education) and through the support during delivery (this is essential for the pregnant women in order to feel themselves protagonist of their delivery)

Social network analysis applied to a historical ethnographic study surrounding home birth

Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health

Childbirth expectations of La Ribera pregnant women: a qualitative approach

Objetivo: El cambio de modelo asistencial en la atención al parto normal, el interés por parte de las autoridades sanitarias en que se exploren las expectativas de parto de las gestantes, y su especificidad cultural y social, hacen que el estudio de tales expectativas sea pertinente en este momento. El objetivo del presente estudio es conocer cuáles son las expectativas de parto de una muestra de gestantes españolas y estudiar las diferencias entre las expectativas de las gestantes primíparas y multíparas. Metodología: Estudio cualitativo basado en una pregunta de respuesta libre sobre expectativas de parto. Se recogieron datos a gestantes de tercer trimestre del área de salud de La Ribera (Alzira, Valencia) durante 2014-2015. Se analizaron los datos mediante análisis del contenido. Resultados: Muestra de 213 gestantes cuyas principales expectativas de parto fueron tener un parto rápido, con buen resultado obstétrico, sin dolor y con apoyo de los profesionales. Las expectativas relacionadas con los protocolos de atención al parto normal supusieron un 5.2% del total de las respuestas. No se encontraron diferencias estadísticamente significativas entre gestantes primíparas y multíparas. Conclusiones: El conocimiento de las expectativas resulta importante, ya que las gestantes miden su satisfacción con el parto en base al cumplimiento de tales expectativas. Ayudarlas a desarrollar expectativas realistas aumentará su satisfacción. Las matronas tienen un importante papel a través de la formación que imparten (educación maternal) y del apoyo en el momento del parto (fundamental para que las gestantes se sientan protagonistas del mismo).ABSTRACT: Objective: Change of healthcare model in normal childbirth, health authorities interest in exploring childbirth expectations of pregnant women, and their cultural and social specificity make relevant the study of these expectations at this moment. The aim is to know what are the childbirth expectations Enfermería Global Nº 49 Enero 2018 Página 325 from a sample of Spanish pregnant women and to study the differences between primiparous and multiparous pregnant women expectations. Methodology: Qualitative study based on an open-ended question about childbirth expectations. Data were collected during 2014-2015 to third trimester pregnant women in La Ribera health area (Alzira, Valencia). Data were analyzed using content analysis. Results: Sample of 213 pregnant women whose main expectations were to have a fast delivery, with good obstetric outcome, painlessly and with professional support. Expectations regarding normal childbirth protocols accounted for 5.2% of total responses. No statistically significant differences between primiparous and multiparous pregnant women were found. Conclusions: Knowledge about childbirth expectations is highly relevant because pregnant women measure their satisfaction with childbirth through the fulfillment of these expectations. Helping them to develop realistic expectations will increase their satisfaction. Midwives play an important role through the training they give (maternal education) and through the support during delivery (this is essential for the pregnant women in order to feel themselves protagonist of their delivery)