ABSTRACT
RESUMEN Objetivo: Comprender la perspectiva de las parteras frente a los factores de riesgo, la detección y el manejo del embarazo de alto riesgo en Jalisco, México, 2013. Materiales y métodos: Estudio cualitativo fenomenológico desarrollado durante 2013; a partir del Censo Estatal de Parteras se aplicó muestreo teórico, definiendo tamaño de muestra por saturación teórica del eje: factores de riesgo, detección y manejo del embarazo de alto riesgo. El trabajo de campo inició con la identificación de informantes clave, quienes invitaron a parteras a un "Encuentro estatal"; se trabajó con las técnicas lluvia de ideas y entrevista grupal; posteriormente se llevaron a cabo 11 entrevistas a profundidad a parteras, realizando análisis semiótico de los datos. Resultados: Fueron 82 parteras informantes, mediana de edad 53 años, parteras tradicionales empíricas 21,95 %, parteras tradicionales capacitadas 42,69 % y parteras enfermeras 35,36 %; 59,75 % tienen 20 años o más como parteras, 63,42 % con estudios de primaria o menos y 78,05 % con más de 10 años sin recibir capacitación institucional. Cualitativamente, el embarazo de alto riesgo para parteras enfermeras implica complicaciones obstétricas o neonatales y el control prenatal debe ser en hospitales. En parteras tradicionales, empíricas y capacitadas, su perspectiva tiene elementos de la medicina institucional y tradicional, por lo que señalan que envían al médico a estas mujeres, asumiendo no poder atender estos embarazos; en parteras tradicionales de población indígena representa un embarazo "de peligro", configurado en el modelo mágico-religioso de la salud. Conclusiones: La perspectiva de las parteras frente al embarazo de alto riesgo está determinada por la medicina tradicional y algunos elementos de la medicina institucional, diferenciada según tipo de partera y zona geográfica de desempeño, señalando la disposición de formarse para alcanzar embarazos saludables y sin riesgos.
ABSTRACT Objective: To understand midwife perspective regarding risk factors, detection and management of high risk pregnancy in Jalisco, Mexico, 2013. Materials and methods: Qualitative phenomenological study conducted during the year 2013. A theoretical sampling was applied on the basis of the State Midwives Census and the sample size was defined by theoretical saturation of each axis: risk factors, detection and management of high risk pregnancy. The field work began by identifying key informants who then invited midwives to a "State Meeting", working with brainstorming techniques and group interviews. This was followed by 11 in-depth interviews with the midwives and a semiotic data analysis. Results: Overall, 82 informant midwives were included, with a median age of 53. Of them, 21.95 % were empirical, 42.69 % were traditional trained midwives, and 35.36 % were midwife nurses. In terms of practice, 59.75 % had been practicing for 20 years or more, 63.42 % had primary schooling or less, and 78.05 % had been working for more than 10 years without receiving institutional training. Qualitatively, high risk pregnancy for nurse midwives entails obstetric or neonatal complications, and antenatal control must take place in the hospital. As for traditional empirical and trained midwives, their perspectives include elements of institutional medicine whereby they refer these women to the physician because they assume that they cannot care for those pregnancies. For traditional midwives of indigenous origin, high risk pregnancy represents the "dangerous pregnancy" under the magical-religious model of health. Conclusions: Midwife perspective regarding high risk pregnancy is determine by traditional medicine and some elements of institutional medicine, differentiated according to the type of midwife and the geographic area where they perform their work. Midwives reported willingness to train in order to contribute to healthy, risk-free pregnancies.
Subject(s)
Female , Pregnancy , Midwifery , Pregnancy, High-RiskABSTRACT
Describir las condiciones socioculturales y la experiencia de adolescentes embarazadas en Guadalajara, Jalisco (México).Materiales y métodos: investigación cualitativa, con enfoque estudio de caso "típico", en el que se identificaron, en un listado de control prenatal a julio 2014, en un centro de salud de Guadalajara, Jalisco, adolescentes embarazadas que vivieran en la zona urbana, llevaran control prenatal en esta unidad de salud y aceptaran participar en el estudio con el consentimiento del tutor. Se analizaron las variables socioculturales en el expediente clínico, la tarjeta de control prenatal y una encuesta elaborada por investigadores. Se levantaron tres grupos focales, indagando: a) significación social del embarazo, b) experiencia del embarazo c) embarazo, familia, pareja y servicios de salud. Las variables socioculturales se analizaron en Epi-Info 7, calculando frecuencias, porcentajes, medidas de tendencia central y dispersión. Las entrevistas cualitativas se analizaron semióticamente.Resultados: se identificaron 48 adolescentes, de las cuales solo 42 reunieron criterios de selección. La mediana de edad fue de 18 (rango de 13 a 19 años); solo 19 % continuaron estudiando; 59,5 % eran amas de casa, 21,4 % tenían ingresos económicos propios y 78,6 % no utilizaron método de planificación familiar previo al embarazo. Cualitativamente, el embarazo les significó "madurar" y ser "más felices"...
To describe the social and cultural conditions and the experience of pregnancy among teenage girls in Guadalajara, Jalisco, Mexico.Materials and methods: Qualitative research with a "typical" case approach based on the identification, from the pre-natal care list of a healthcare centre in Guadalajara, Jalisco, of pregnant teenage girls living in the urban area who received antenatal care in that centre and who agreed to participate in the study with the consent of their guardians, until July 2014. The analysis was based on the social and cultural variables included in the clinical record, the pre-natal care card, and a questionnaire prepared by the researchers. The work was done with three focus groups and the questions covered: a) the social meaning of pregnancy; b) the experience of pregnancy; and c) pregnancy, family, couple and healthcare services. The social and cultural variables were analysed using the Epi-Info 7, estimating frequencies, percentages, central trend measurements and scatter. The semiotic analysis approach was used for the qualitative interviews.Results: Of the 48 teenagers identified, only 42 met the selection criteria. The mean age was 18 years (range 13 to 19). Only 19 % continued with their education, 59.5 % were housewives, 21.4 % earned their own income, and 78.6 % had not used any form of family planning before the pregnancy. Qualitatively, the pregnancy helped them "mature" and made them "happier". They reported having dropped out from school because of clinical symptoms and changes in their physical appearance. They also reported lack of privacy in the healthcare services, and pointed to online media as the primary source of information regarding the topic of sexuality...