Roles and functions of rural health midwives in Cordillera Administrative Region: A qualitative pilot study

Background@#Midwives have been frontline health professionals at the grassroots level, especially in rural communities. Their role was expanded from maternal and child healthcare providers to primary healthcare services providers. Despite their expanded functions, there have been limited studies investigating the professional practice of midwifery in the Philippines in a rural setting.@*Objective@#This study aimed to investigate the professional practice of midwives in selected rural areas in the Cordillera Administrative Region, Philippines.@*Methods@#This research is a qualitative pilot study using a semi-structured interview guide to collect the data. Key informant interviews were conducted through mobile phone calls convenient for the participants from September to October 2021. Data were analyzed through qualitative content analysis.@*Results@#A total of seven rural health midwives participated in this study. From the data analysis, six themes emerged related to the professional functions of rural Filipino midwives: 1) antenatal and postnatal care, 2) basic emergency obstetrical and newborn care, 3) health education and counseling, 4) treating common children and adult infections, 5) health promotion, and 6) beyond midwifery role.@*Conclusion@#Rural midwives play a role in providing several primary healthcare services mandated by the government and the profession. They also offer health services beyond their scope as midwives because of geographical difficulties and logistic issues. The findings inform the policymaker to review and amend the expanded roles of practicing midwives so that they will be empowered in providing quality and legal healthcare services. The study results will also be important in preparing midwives for rural midwifery practice.

Outcomes of Intrauterine Device Insertion by Certified Midwives and Obstetric Nurse Practitioners / Resultados de la inserción del dispositivo intrauterino de intervalo por parte de parteras y enfermeras obstetrices / Desfechos da inserção do Dispositivo Intrauterino de Intervalo por obstetrizes e enfermeiras obstetras

ABSTRACT Objectives: to evaluate the outcomes of Interval Copper Intrauterine Device (IUD) insertion performed by certified midwives and obstetric nurse practitioners at a Peri-Hospital Birth Center. Methods: a cross-sectional study was conducted involving 75 women who underwent IUD insertion between January 2018 and February 2020. Data collection was carried out using medical records and telephone interviews. Results: no instances of uterine perforation were observed. Expulsion rates of the devices were 1.3% within 30 to 45 days of use and 5.3% within the first year of use. The follow-up removal rate was 4.0%. The average pain score reported was 4.2 (SD = 3.3). Among those who continued using the device, 93.1% expressed satisfaction. Conclusions: the findings demonstrate that IUD insertion by certified midwives and obstetric nurse practitioners is a safe procedure, yielding outcomes comparable to those reported in the existing literature.

RESUMEN Objetivos: evaluar los resultados de la inserción del dispositivo intrauterino de cobre (DIU) realizado por matronas certificadas y enfermeras obstétricas especializadas en un Centro de Nacimientos Peri-Hospitalario. Métodos: se realizó un estudio transversal que incluyó a 75 mujeres sometidas a la inserción del DIU entre enero de 2018 y febrero de 2020. La recopilación de datos se realizó mediante registros médicos y entrevistas telefónicas. Resultados: no se observaron casos de perforación uterina. Las tasas de expulsión del dispositivo fueron del 1,3% en los primeros 30 a 45 días de uso y del 5,3% durante el primer año de uso. La tasa de retirada durante el seguimiento fue del 4,0%. La puntuación promedio del dolor informada fue de 4,2 (DE = 3,3). Entre aquellas que continuaron utilizando el dispositivo, el 93,1% manifestó satisfacción. Conclusiones: los hallazgos demuestran que la inserción del DIU por parte de matronas certificadas y enfermeras obstétricas especializadas es un procedimiento seguro, que produce resultados comparables a los reportados en la literatura existente.

RESUMO Objetivos: avaliar os desfechos da inserção do Dispositivo Intrauterino de Cobre de Intervalo por obstetrizes e enfermeiras obstetras em um Centro de Parto Normal Peri-hospitalar. Métodos: estudo transversal conduzido com 75 mulheres que tiveram o dispositivo inserido entre janeiro de 2018 e fevereiro de 2020. A coleta de dados foi realizada a partir de prontuários e contato telefônico. Resultados: não houve nenhuma perfuração uterina; 1,3% dos dispositivos foram expulsos com 30 a 45 dias de uso e 5,3% no primeiro ano de uso; a taxa de necessidade de remoção no retorno foi de 4,0%; e a pontuação média de dor foi 4,2 (DP = 3,3). Entre aquelas que ainda usavam o dispositivo, 93,1% se consideraram satisfeitas. Conclusões: a inserção do dispositivo por enfermeiras obstetras e obstetrizes mostrou ser segura, com desfechos similares aos observados na literatura.

Estudio descriptivo de los resultados obstétricos y neonatales en dos modelos de asistencia al parto en primíparas

Resumen: 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.

Resumo: 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.

Abstract: 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.

Humanization of birth, women's empowerment, and midwives' actions and knowledge: experiences from Quebec and Chile / A humanização do nascimento, o empoderamento das mulheres e a reapropriação de ações e conhecimentos das parteiras: experiências do Québec e do Chile

ABSTRACT Whether in pre-pregnancy, pregnancy, birth and/or the postnatal and neonatal periods, midwives' practices are underpinned by humanism. However, in this era of postmodernity, there is an ever-growing need for rehumanization. This article adopts an auto-ethnographic approach in order to undertake a reflective analysis on the humanization of birth based on the practice of midwifery in two different contexts, namely Quebec (Canada) and Chile. In light of the evolution of the profession in these two countries, and the influence of health policies and social movements, there are factors such as the systematic use of technology and the hypermedicalization of reproductive processes which are maintaining women's ignorance and keeping them from being able to participate in their maternity process. Women's autonomy and empowerment become a key element for their participation in decisions regarding their maternity, assistance methods, or type of care. Concurrently, midwives' autonomy is a prerequisite for fully exercising their role in supporting and assisting women in this re-appropriation of their power by means of a comprehensive approach that takes into account psychological and social aspects as well as biomedical ones.

RESUMO Seja na pré-gravidez, na gravidez, no nascimento, seja nos períodos pós-natal e neonatal, as práticas das parteiras são sustentadas pelo humanismo. Entretanto, na atual era de pós-modernidade, há uma necessidade cada vez maior de reumanização. Este artigo adota uma abordagem autoetnográfica, a fim de realizar análise reflexiva sobre a humanização do nascimento baseada na prática da obstetrícia em dois contextos diferentes: Quebec (Canadá) e Chile. À luz da evolução da profissão nestes dois países e da influência das políticas de saúde e dos movimentos sociais, existem fatores, como o uso sistemático da tecnologia e a hipermedicalização dos processos reprodutivos, que estão mantendo as mulheres desinformadas e impedindo-as de participar de seu processo de maternidade. A autonomia e o empoderamento das mulheres tornam-se um elemento-chave para sua participação nas decisões relativas à sua maternidade, métodos de assistência ou tipo de cuidado. Ao mesmo tempo, a autonomia das parteiras é um requisito para o pleno exercício de seu papel de apoio e assistência às mulheres nesta reapropriação de seu poder, por meio de uma abordagem abrangente, que leve em conta tanto aspectos psicológicos e sociais quanto biomédicos.

Eficiencia del entrenamiento simulado del parto vaginal en estudiantes de enfermería/obstetricia / The efficiency of simulated vaginal birth training in nursing/midwifery students

Introducción: la competencia "asistencia del parto vaginal" se adquiere, parcialmente, mediante simulación en estudiantes de enfermería/obstetricia. Sin embargo, no se ha reportado cuantos partos simulados son necesarios para que estos estudiantes adquieran la mínima competencia. Métodos: estudio cuasi experimental que incluyó a todos los alumnos del internado hospitalario en salud de la mujer, en el segundo semestre del año 2020, excluyendo aquellos que hubieran tenido exposición a la simulación o atención clínica de partos vagina-les. Se evaluó una intervención de práctica simulada en la atención del parto normal en tres etapas: 1) texto, 2) video y 3) simulación. Los estudiantes efectúan tres atenciones simuladas, un evaluador ciego evaluó su rendimiento con una pauta de cotejo (máximo 37 puntos) y se midió la satisfacción con una pauta de evaluación validada. Resultados: el rendimiento de los alumnos mejora significativamente (p < 0.001) con la repetición de la simulación (28,3; 34,3 y 36,7 puntos en 1°, 2° y 3° intento). El porcentaje de estudiantes que logra el umbral de mínima competencia es de 6%, 67% y 100 %, en cada repetición (p < 0.001) Conclusiones: en este grupo de estudiantes, tres repeti-ciones de la simulación/debriefing son suficientes para superar el umbral de mínima competencia. Esta información es útil para definir los recursos necesarios en simulación en atención del parto vaginal en estudiantes de enfermería/obstetricia.

Introduction: Vaginal delivery assistance competence is acquired partially by simulation in nursing/midwifery students. However, it has yet to be reported how many simulated deliveries are necessary for these students to develop the minimum competence. Methods: Quasi-experimental study, all the hospital internship in women>s health students were included in the second semester of 2020, excluding those exposed to the simulation or clinical care of vaginal births. A simulated practice intervention in vaginal delivery care in three stages: 1) text, 2) video, and 3) simulation, was evaluated. The students performed three simulations, a blind observer evaluated their performance with a comparison guideline (maximum 37 points), and their satisfaction was measured with a validated evaluation guideline. Results: The performance of the students improve significantly (p <0.001) with the repetition of the simulation (28.3, 34.3, and 36.7 points in the first, second and third attempts). The percentage of students who achieve the minimum proficiency threshold is 6%, 67%, and 100% in each repetition (p <0.001). Conclusions: In this group of students, three repetitions of the simulation/debriefing are sufficient to exceed the threshold of minimum competence. This information is helpful in defining the necessary resources in simulation in vaginal delivery care in nursing/midwifery students.

Experience of Midwives in communicating non-Japanese speaking women during the perinatal care / 国際保健医療

Introduction  In Japan, midwives have difficulty communicating non-Japanese speaking women. The study aims to explore the midwives’ experience in communicating with them during the perinatal period. Methods  The semi-structured interviews were conducted for five midwives who have had experienced perinatal care for non-Japanese women.Results  Four categories were emerged during the pregnancy of the women: «Midwives desire to provide accurate information when giving medical and health related explanations», «Means and methods of health guidance depend on the contents», «It is much easier to interact with clients if verbal communication means are available during the prenatal check-ups» and «It is difficult to communicate by telephone about signs of onset of labor without having verbal communication means». Five categories have emerged in the intrapartum period including «Appropriate means and continuous involvement make communication smoother during delivery», «Non-verbal communication measures are useful in providing intrapartum care and «In case of an emergency of mother and fetus, ability of mother’s understanding and selection of appropriate means of communication are critical». Four categories have emerged in the postpartum period including «Midwives can communicate with non-verbal means for the health guidance» and «Midwives feel helpless when they cannot communicate verbally during the postpartum follow-ups». One thematic category «Midwives genuinely desire to provide quality communication despite the differences in language and culture»has emerged from over all period.Conclusions  It is important to prepare linguistic communication measures which help midwives to accurately communicate with their clients during the perinatal periods.

Analysis of midwives' situation and the need to measure their workloads / Análise da situação das parteiras e a necessidade de medir suas cargas de trabalho / Análisis de la situación de las matronas y necesidad de medir sus cargas de trabajo

ABSTRACT Objective: to analyze midwives' employment situation of midwives and detect their workload measurement needs. Methods: a mixed methodology (quantitative and qualitative), observational, descriptive and cross-sectional study. Two phases were carried out. The first methodological phase consisted of conducting semi-structured individual interviews. The second methodological phase analyzed the Nursing Intervention Classification (NIC) interventions that midwives perform in the labor room during daily practice. Results: 90.3% of midwives have work overload, since for 80.6% the midwife-pregnant mother ratio is not well established, since the mean execution time of a Nursing Intervention Classification (NIC) intervention is 20 minutes. For this reason, 100% of the sample considers the development of workload measurement tools to be highly useful. Conclusions: the need to generate an instrument that considers the diversity of Nursing Intervention Classification (NIC) interventions that develop within the labor room is ratified.

RESUMO Objetivo: analisar a situação laboral das parteiras e detectar suas necessidades de mensuração da carga de trabalho. Métodos: estudo de metodologia mista (quantitativa e qualitativa), observacional, descritivo e transversal. Duas fases foram realizadas. A primeira fase metodológica consistiu na realização de entrevistas individuais semiestruturadas. A segunda fase metodológica analisou as intervenções da Classificação de Intervenção de Enfermagem (NIC) que as parteiras realizam na sala de parto durante o dia de atendimento. Resultados: 90,3% das parteiras apresentam sobrecarga de trabalho, pois, para 80,6%, a relação obstetriz-gestante não está bem estabelecida, pois o tempo médio de execução de uma intervenção Classificação de Intervenção de Enfermagem (NIC) é de 20 minutos. Por esse motivo, 100% da amostra considera muito útil o desenvolvimento de ferramentas de medição de carga de trabalho. Conclusões: ratifica-se a necessidade de gerar um instrumento que considere a diversidade de intervenções Classificação de Intervenção de Enfermagem (NIC) que se desenvolvem na sala de parto.

RESUMEN Objetivo: Analizar la situación laboral de las matronas y detectar sus necesidades de medición de cargas de trabajo. Métodos: Estudio de metodología mixta (cuantitativo y cualitativo), observacional, descriptivo y transversal. Se realizaron dos fases: La primera fase metodológica, consistió en la realización de entrevistas individuales semiestructuradas. Y en la segunda fase metodológica, se analizaron las intervenciones de enfermería (NIC) que las matronas efectúan en paritorio durante su jornada asistencial. Resultados: El 90,3% de las matronas presentan sobrecarga en el trabajo, pues para el 80,6% el ratio matrona- gestante no se encuentra bien establecido; pues tiempo medio de ejecución de una intervención de enfermería (NIC), es de 20 minutos. Por ello, el 100% de la muestra considera de máxima utilidad el desarrollo de herramientas de medición de cargas de trabajo. Conclusiones: Se ratifica la necesidad de generar un instrumento que considere la diversidad de intervenciones de enfermería (NIC) que desarrollan dentro del paritorio.

The influence of midwives' hope trait on empathy: the mediating role of resilience / 中国实用护理杂志

Objective:To analyze the relationship among hope trait, resilience and empathy of midwives, and to explore the mediating role of resilience between hope trait and empathy.Methods:A total of 370 midwives were investigated by general information questionnaire, Adult Hope Quality Scale, short version of Resilience Scale and Interpersonal Response Scale. Pearson correlation analysis was used to analyze the correlation among hope trait, resilience and empathy. Amos21.0 structural equation model was used to verify the mediating effect of resilience between hope trait and empathy. The mediating effects of empathy, hope and resilience were analyzed.Results:Hope trait was positively correlated with resilience and empathy ( r value was 0.504, 0.133, P<0.01 or 0.05), and resilience was positively correlated with empathy ( r value was 0.309, P<0.01) in midwives. Resilience partially mediated the relationship between hope trait and empathy, the mediating effect of resilience was 0.38. Conclusions:Managers should pay attention to the cultivation of midwives′ hope traits and psychological resilience, and actively improve the midwives′ psychological quality, so as to effectively improve the empathy ability and establish a harmonious and high-quality nurse patient relationship.

Perineal trauma as an existential change: a qualitative study with women experiencing humanized birth / Trauma perineal como mudança existencial: um estudo qualitativo com mulheres vivenciando o parto humanizado

ABSTRACT: Objective: To investigate how women experienced perineal trauma during a humanized birth.Methods: A qualitative study with 22 postpartum women was performed from January to December 2018. The Husserlian phenomenology was used as theoretical framework using individual, in-depth interviews that were audio-taped and transcribed verbatim. Results: Twenty-four categories emerged from women ́s reports. During the prenatal phase, we found lack of information regarding perineal trauma, the alterity as a facilitating process to incentive women towards vaginal delivery and the perception of the beginning of an existential transition. During labor, it was noticed trust and attachment with the health professional giving physical and emotional support, the fear of the unknown linking to insecurity, the need for internal surrender to the process, empowerment as a result of trust and commitment, to give herself to the moment and no concerns with intrapartum injury but at the same time, having the possibility to share a decision-making process of suturing(or not). The postpartum period has shown the completion of the existential transition, the body as a place of estrangement, the loosening of some ties, but the construction of new networks of personal support to overcome postpartum. Conclusions: Most of women after humanized birth perceived perineal trauma as an existential transition that was initiated during antenatal period. (AU)

RESUMO: Objetivos: Investigar como as mulheres experienciaram o trauma perineal durante um parto humanizado. Métodos: Um estudo qualitativo com 22 mulheres pós-parto foi realizado de janeiro a dezembro 2018. A fenomenologia Husserliana foi usada como referencial teórico usando entrevistas individuais que foram audiogravadas e transcritas verbatim. Resultados: Vinte e quatro categorias emergiram durante os relatos. Durante o período pré-natal, a falta de informação sobre o trauma perineal, a alteridade como processo facilitador para incentivar as mulheres em direção ao parto vaginal e a percepção do começo de uma transição existencial. Durante o parto, a confiança e ligação com o(a) profissional de saúde com suporte físico e emocional, o medo do desconhecido e a insegurança, a necessidade de se entregar ao processo, o empoderamento como resultado de confiança e comprometimento, e o processo de tomada de decisão compartilhada da sutura (ou não). O período pós-parto mostra a completude da transição existencial, o corpo como local de estranhamento, o afrouxamento de alguns laços, mas a construção de novas redes de suporte pessoal para superar esse período. Conclusão: A maior parte das mulheres depois do parto humanizado percebe o trauma perineal como uma transição existencial que fora iniciada durante o período antenatal. (AU)

Revisión de los riesgos maternos y perinatales en tiempos de COVID-19: desafíos para el rol de la Matronería / Review of maternal and perinatal risks in times of COVID-19: challenges for the role of Midwifery

INTRODUCCIÓN Y OBJETIVO Una enfermedad nueva, COVID-19, está afectando dramáticamente al mundo. Conocer los riesgos para la salud reproductiva es un imperativo para la práctica obstétrica y ginecológica. Esta investigación analiza los riesgos maternos y perinatales asociados a COVID-19, con el objetivo de identificar desafíos que la enfermedad plantea a la práctica de la matronería. MÉTODOS Revisión narrativa. Se consultaron artículos científicos de fuentes primarias indexados en las bases Scielo, Pubmed, Scope, WOS, mediante los siguientes términos de búsqueda: "embarazo" "transmisión vertical" "salud materna y perinatal", "riesgos maternos y perinatales" "lactancia materna", COVID-19", "Coronavirus". Se realizaron 3 fases de selección. Los tópicos de análisis fueron: Transmisión vertical, Riesgo materno y perinatal, Lactancia materna. RESULTADOS. En mujeres embarazadas las formas severas de COVID-19 se presentan en presencia de enfermedades crónicas. A nivel perinatal el riesgo mayor es el parto prematuro, generalmente por indicación médica y por cesárea. Aunque no hay evidencias de transmisión vertical, tampoco puede descartarse. Los riesgos neonatales se relacionan con el contagio por proximidad y con medidas restrictivas que pueden afectar la lactancia materna y la interacción madre-hija(o). CONCLUSIONES. La COVID-19 aporta varios desafíos para la práctica de la matronería: implementación de métodos de prevención del contagio a la gestante y a su entorno cercano; adecuación de la preparación al parto en caso de positividad; prevención del estrés y desgaste emocional materno desde el inicio de la gestación hasta el postparto; adecuación de cuidados al recién nacido; investigación aplicada en Latinoamérica, y evaluación de nuevos protocolos.

INTRODUCTION AND OBJECTIVE A new disease, COVID-19, is dramatically affecting the world. Knowing the risks for the reproductive health is an imperative for the obstetric and gynecological practice. This research analyzes the maternal and perinatal risks associated with COVID-19, with the aim of identifying challenges that the disease poses to the practice of midwifery. METHODS Narrative review. Scientific articles from primary sources indexed in Scielo, Pubmed, Scope, and WOS, are consulted by using the following search terms: "pregnancy" "vertical transmission" "maternal and perinatal health", "maternal and perinatal risks" "breastfeeding", COVID-19", "Coronavirus". Three selection phases were carried out. The topics of analysis were vertical transmission, maternal and perinatal risk, breastfeeding. RESULTS In pregnant women severe forms of COVID-19 occur in the presence of chronic diseases. At the perinatal level, the biggest risk is premature delivery, generally for medical indications and by cesarean section. Although there is no evidence of vertical transmission, it cannot be ruled out either. Neonatal risks are related to transmission by proximity and restrictive measures that may affect breastfeeding and mother-child interaction. CONCLUSIONS COVID-19 brings several challenges to the practice of midwifery: implementation of methods to prevent infection of the pregnant woman and her close environment; adaptation of birth preparation in case of positivity; prevention of maternal stress and emotional distress from the beginning of pregnancy to postpartum; adequacy of care for the newborn; research in Latin America, and evaluation of new protocols.

Calidad de la relación entre matrones y cuidadores en la visita domiciliaria del Chile crece contigo en localidades rurales del valle de Aconcagua / Quality of the relationship between midwives and caregivers in Chile crece contigo home visit in rural locations from the Aconcagua valley

INTRODUCCIÓN Y OBJETIVOS: La visita domiciliaria (VD) es una actividad clave del Programa de Apoyo al Desarrollo Biopsicosocial (PADB) del Chile Crece Contigo (ChCC). Para mejorar su implementación, esta investigación tiene como objetivo analizar la relación entre matrones y la familia que accede a la VD, considerando las competencias y habilidades relacionales de los visitadores. MÉTODOS: Se utilizó un diseño observacional con enfoque cualitativo, de alcance exploratorio. Tres matrones que realizan VD en centros de salud familiar rurales de la provincia de Aconcagua aceptaron participar y ocho visitas del programa ChCC fueron grabadas, de 30 minutos promedio. El análisis cualitativo se realizó en base al Home Visit Rating Scale A+. RESULTADOS: Las cuatro categorías que orientaron la evaluación de las visitas fueron responsividad de la familia, relación con la familia, facilitación de la interacción padres - hijo/a y no intrusividad y colaboración. Estas categorías, en su mayoría,puntuaron con un nivel adecuado. No obstante, se requiere entrenamiento en habilidades relacionales para cumplir con una visita catalogada como buena o excelente, sobre todo en las áreas en las que hay que facilitar el vínculo y la interacción entre padre e hijo/a, con el fin de evitar una atención de carácter paternalista. CONCLUSIONES: Esta investigación pionera en el área rural, entregó información relevante para mejorar la VD en este contexto. Aunque los matrones cuentan con formación técnica en el área biomédica, es importante reforzar y/o capacitar en las características esenciales de una VD, para fortalecer la alianza entre el profesional y la familia.

INTRODUCTION AND OBJECTIVES: The home visit (HV) is a key activity in the Support Program for Biopsychosocial Development of Chile Crece Contigo (ChCC). To improve its implementation, this research aims to analyze the relationship between a midwife and the family that accesses the HV based on the competence and relational skills of the visitor. METHODS: An observational design with a qualitative approach of exploratory scope was used. Three midwives performing HV in rural family health centers in the Aconcagua province accepted to participate, and eight visits of the ChCC program were recorded, with an average of 30 minutes. The Home Visit Rating Scale A + was applied to these visits, for further qualitative analysis. RESULTS: The four categories that guided the evaluation of the visits were family responsiveness, relationship with the family, facilitation of parent-child interaction and non-intrusion and collaboration. These scored mostly with an adequate level but requires training in relational skills is required to meet a visit rated as good or excellent, especially in areas where it is necessary to facilitate the link and interaction between father and son, evidencing a paternalistic character of the attention model. CONCLUSIONS: This pioneering research in the rural area, provided relevant information to improve the HV in this context. Although midwives have technical training in the biomedical area, it is important to reinforce and / or train in the essential characteristics of a HV, to strengthen the alliance between the professional and the family.

Regulación de la Enfermería Española: incorporación a la profesión sanitaria (1850-1950) / Regulation of Spanish Nursing: incorporation into the health profession (1850-1950) / Regulation of Spanish Nursing: incorporation into the health profession (1850-1950)

RESUMEN OBJETIVO Conocer la evolución de la formación académica de la enfermería española (1850-1950), describiendo los cambios que la transformaron en profesión sanitaria. MÉTODO Investigación histórica en la modalidad exploratoria-descriptiva, con análisis e interpretación de información obtenida en bases de datos electrónicas, archivos nacionales, provinciales y municipales, Boletines Oficiales y Bibliotecas. RESULTADOS En 1850 coexistían diferentes categorías sanitarias, sin embargo, el título de enfermera no surgió hasta 1915. Con el auge que alcanzó la Salud Comunitaria durante esa época, en 1924, se funda la Escuela Nacional de Sanidad, creándose en 1932 las especialidades de Enfermero Psiquiátrico, Enfermeras Pediátricas y Enfermeras Visitadoras. CONCLUSIONES E IMPLICACIÓN PARA LA PRÁCTICA Entre 1915 y 1950 los profesionales de enfermería poseían formación universitaria, por tanto, a través del conocimiento científico estos sanitarios adquirieron una identidad propia dentro de las profesiones de la salud. Se logró proporcionar una asistencia especializada para el cuidado de personas.

ABSTRACT OBJECTIVE To know the evolution of the academic formation of the Spanish infirmary (1850-1950), describing the changes that transformed it into sanitary profession. METHOD Historical research in the exploratory-descriptive modality, with analysis and interpretation of information obtained from electronic databases, national, provincial and municipal archives, official gazettes and libraries. RESULTS In 1850 different health categories coexisted, however, the title of nurse did not emerge until 1915. With the boom that Community Health reached during that time, in 1924, the National School of Health was founded, creating in 1932 the specialties of Psychiatric Nurse, Pediatric Nurse and Visiting Nurse of Mental Hygiene. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Between 1915 and 1950 all nursing professionals had university training, therefore, through scientific knowledge these health professionals acquired their own identity within the health professions and they were able to provide specialized assistance for the care of people.

ABSTRACT OBJECTIVE To know the evolution of the academic formation of the Spanish infirmary (1850-1950), describing the changes that transformed it into sanitary profession. METHOD Historical research in the exploratory-descriptive modality, with analysis and interpretation of information obtained from electronic databases, national, provincial and municipal archives, official gazettes and libraries. RESULTS In 1850 different health categories coexisted, however, the title of nurse did not emerge until 1915. With the boom that Community Health reached during that time, in 1924, the National School of Health was founded, creating in 1932 the specialties of Psychiatric Nurse, Pediatric Nurse and Visiting Nurse of Mental Hygiene. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Between 1915 and 1950 all nursing professionals had university training, therefore, through scientific knowledge these health professionals acquired their own identity within the health professions and they were able to provide specialized assistance for the care of people.

Study on the effect of the quality control circle teaching mode in the midwife internship teaching / 中国实用护理杂志

Objective To explore the quality control circle (QCC) in midwife practice teaching activities for improving the quality of teaching effect, innovate the method for obstetric practice teaching and provide reference for other practice teaching methods. Methods Take the 84 midwifery interns as research object who entered the maternity ward within two years after the implementation of the QCC activities, and randomly divided into the experimental group and the control group and each group included 42 people. The experimental group adopted the teaching mode of integrating daily teaching into the QCC. The control group adopted the traditional one-on-one teaching mode based on teaching, and compared the learning effects of the two groups of interns. Results After the internship, the three levels of the Koch′s four-level training evaluation model method were used to evaluate the teaching effect. The reaction layer was evaluated through five aspects: teaching plan, teacher resources, internship environment, teaching form and content, and appraisal evaluation. It was found that the satisfaction of the teaching plan and teaching form evaluation of the experimental group was significantly higher than that of the control group; the learning level passed the theoretical test. The results of the scores, skills test scores and overall care were evaluated. It was found that the three results of the internship group were significantly higher than those of the control group. The behavioral level was evaluated by the satisfaction of the client and the maternal was proficient in the operation of the experimental group. The satisfaction evaluation of the mission and the mission was significantly higher than the control group. The difference in the above evaluation results was statistically significant (P<0.05). Conclusions The quality control circle teaching mode is feasible in the midwife internship teaching in the delivery room, which transforms the traditional passive teaching mode into a common and active participation teaching mode for teachers and students, enhances the level and enthusiasm of teachers to teach, and enhances service awareness and quality of care. It also plays a role in cultivating management talents and is worthy of further exploration and promotion.

Construction and application of the multi-module training program of core competence for junior midwives / 中国实用护理杂志

Objective Constructing and applying the multi-module training program for junior midwives to improve the training quality. Methods The training program was constructed according to different modules of core competence. 11 junior midwives were selected from a hospital in Zhengzhou as trainees. The training effect was evaluated. Results Their core competence has been enhanced in theory knowledge, operating skills and training satisfaction (P<0.05). After training, the rate of episiotomy and the rate of postpartum hemorrhage were lower than before (P<0.05). Conclusion The multi-module training program can improve the core competence of junior midwives, which provides effective training method and promotes the quality of training.

Study on the effect of the quality control circle teaching mode in the midwife internship teaching / 中国实用护理杂志

Objective@#To explore the quality control circle (QCC) in midwife practice teaching activities for improving the quality of teaching effect, innovate the method for obstetric practice teaching and provide reference for other practice teaching methods.@*Methods@#Take the 84 midwifery interns as research object who entered the maternity ward within two years after the implementation of the QCC activities, and randomly divided into the experimental group and the control group and each group included 42 people. The experimental group adopted the teaching mode of integrating daily teaching into the QCC. The control group adopted the traditional one-on-one teaching mode based on teaching, and compared the learning effects of the two groups of interns.@*Results@#After the internship, the three levels of the Koch′s four-level training evaluation model method were used to evaluate the teaching effect. The reaction layer was evaluated through five aspects: teaching plan, teacher resources, internship environment, teaching form and content, and appraisal evaluation. It was found that the satisfaction of the teaching plan and teaching form evaluation of the experimental group was significantly higher than that of the control group; the learning level passed the theoretical test. The results of the scores, skills test scores and overall care were evaluated. It was found that the three results of the internship group were significantly higher than those of the control group. The behavioral level was evaluated by the satisfaction of the client and the maternal was proficient in the operation of the experimental group. The satisfaction evaluation of the mission and the mission was significantly higher than the control group. The difference in the above evaluation results was statistically significant (P<0.05).@*Conclusions@#The quality control circle teaching mode is feasible in the midwife internship teaching in the delivery room, which transforms the traditional passive teaching mode into a common and active participation teaching mode for teachers and students, enhances the level and enthusiasm of teachers to teach, and enhances service awareness and quality of care. It also plays a role in cultivating management talents and is worthy of further exploration and promotion.

Construction and application of the multi-module training program of core competence for junior midwives / 中国实用护理杂志

Objective@#Constructing and applying the multi-module training program for junior midwives to improve the training quality.@*Methods@#The training program was constructed according to different modules of core competence. 11 junior midwives were selected from a hospital in Zhengzhou as trainees. The training effect was evaluated.@*Results@#Their core competence has been enhanced in theory knowledge, operating skills and training satisfaction (P < 0.05). After training, the rate of episiotomy and the rate of postpartum hemorrhage were lower than before (P<0.05).@*Conclusion@#The multi-module training program can improve the core competence of junior midwives, which provides effective training method and promotes the quality of training.

A study on the predictability of midwifery workforce demand in Yunnan province / 中华医院管理杂志

Objective To evaluate the demand for midwives in Yunnan province utilizing Birthrate Plus for planning and development of such workforce. Methods A convenient sample method was used to investigate 8435 maternal cases at 9 hospitals in Yunnan province in four months from 9 - 12 in 2017, and Birthrate Plus was used to calculate the demand for midwifery at each hospital. We also analyzed the two core elements of Birthrate Plus- maternal category allocation and midwife hours of each hospital. Results Maternal cases fall into five categories and maternal category allocation in hospitals is roughly the same;Maternal in higher category tended to need longer midwife hours; the average birthrate of 9 hospitals was (194. 22 ± 44. 84) case/ ( year·midwife). The number of midwives in two tertiary hospitals is obviously insufficient. Midwives at 7 secondary hospitals are more than predicted. Conclusions Midwives in Yunnan are generally faced with a large workload, especially at secondary hospitals, and midwives need to bear numerous non-midwifery workload beyond Birthrate Plus. Therefore, the Birthrate Plus can reflect the midwifery workload scientifically and reasonably in the current situation of midwifery work. But the predication for midwifery workforce requires a study of the ratio of midwifery work in the entire clinical work of the hospital.

Panorama académico y político que enfrentan las parteras tradicionales en América Latina / Academic and political outlook to traditional midwives in Latin America

Introducción: Los partos de los pueblos étnicos en América Latina, siguen siendo atendidos por parteras tradicionales. La mirada conceptual y teórica de esta práctica varía entre los diferentes actores, lo que influye en las políticas e intervenciones propuestas para este gremio. Objetivo: Analizar desde una postura intercultural crítica, el panorama político que enfrentan las parteras tradicionales en América Latina. Fuente de datos: Este es un estudio de revisión de artículos académicos, documentos técnicos y normativos, que se clasificaron en temas conceptuales, de enfoques y políticos relacionados con las parteras tradicionales. Los datos se consolidaron en matrices y se analizaron a partir del método de aproximaciones sucesivas. Se realizó una triangulación entre investigadores y teórica sobre el tema. Síntesis de los datos: el sector académico realiza una diferenciación entre parteras tradicionales y parteras profesionales. Los organismos Internacionales envían a la partería tradicional solo a lugares de difícil acceso geográfico. Los Gobiernos de América Latina presentan diversas posturas desde la mirada hegemónica del modelo biomédico de salud frente a la partería tradicional. Conclusiones: Las parteras tradicionales siguen en un terreno políticamente ambiguo que debilita su rol, lo que genera la pérdida del patrimonio cultural de los países ante su no reconocimiento, no vinculación a los sistemas de salud como prestadoras de servicio y sí como actores comunitarios encargados de informar, educar, y remitir a los prestadores de servicios de salud los casos de salud materna y neonatal(AU)

Introduction: Births in ethnic populations in Latin America are still being attended by traditional midwifes. The conceptual and theoretical outlook to this practice varies among different actors, influencing on proposed policies and interventions for this group. Objectives: To analyze the political overview of traditional midwives through a critic intercultural scope. Data sources: In this descriptive study, a review of academic documents, technical documents and regulations was made, identifying conceptual, approach and political topics related to traditional midwives. The data was summarized in a matrix and analyzed through the method of consecutive approximations. Methodological triangulation was made among researchers, disciplines, techniques and information sources on the topic. Data synthesis: The academic community makes a distinction among traditional midwives and professional midwives. International organizations promote professional midwifery just for difficult geographical access locations. Latin-American governments have different positions from the hegemonic overview of the biomedical model in health toward midwifery. Conclusions: Traditional midwives remain in an ambiguous political arena undermining their role, generating a loss of the cultural heritage of the countries as they are not being recognized, not being linked to the health system as service providers, but being community actors that inform, educate and refer to the health services the maternal and neonatal cases(AU)

História oral como método para a compreensão do ofício das parteiras do semiárido brasileiro / Historia oral como método para la comprensión del oficio de las parteiras del semiárido brasileño / The oral history as a method for understanding the brazilian semi-arid midwives' job

RESUMO Objetivo: compreender o processo histórico do ofício das parteiras do semiárido nordestino brasileiro por meio da história oral. Método: estudo qualitativo realizado em nove municípios do Cariri cearense com 16 parteiras, por meio do método da história oral. Foi utilizada, como instrumento de coleta de dados, a entrevista semiestruturada, com gravação das entrevistas em vídeo. Os relatos foram transcritos, textualizados e transcriados, sendo analisados segundo o método da história oral de vida. Resultados: a inserção de mulheres no ofício de parteiras ocorreu de forma transcendental ou essencial. Foi considerado um dom autônomo, divino ou aprendido pelo convívio com outras parteiras mais experientes. Seus conhecimentos variaram entre os saberes empírico e científico, tendo sido modificados ao longo do tempo, por conta do crescimento da medicalização, instigando a reflexão diante da atuação profissional voltada à saúde da mulher. Isto valorizou o parto, tornado um momento único, respeitando todos seus significados e devolvendo à mulher seu direito de ser mãe com humanidade e segurança. Conclusão: ficou evidente a forma natural e transcendental com que as parteiras foram inseridas neste ofício, motivadas pelo sentimento de altruísmo em um contexto histórico e social de ausência de acesso universal à saúde, de localização geográfica rural e de pouca disponibilidade de recursos humanos na saúde. Ficaram evidentes, deste modo, seus valores e sua importância no cenário da saúde obstétrica brasileira.

RESUMEN Objetivo: comprender el proceso histórico del oficio de las parteras del semiárido nordestino brasileño por medio de la historia oral. Método: estudio cualitativo realizado en nueve municipios del Cariri cearense con 16 parteras, por medio del método de la historia oral. Se utilizó, como instrumento de recolección de datos, la entrevista semiestructurada, con grabación de las entrevistas en video. Los relatos fueron transcritos, textualizados y transcribados, siendo analizados según el método de la historia oral de vida. Resultados: la inserción de mujeres en el oficio de parteras ocurrió de forma trascendental o esencial. Fue considerado un don autónomo, divino o aprendido por la convivencia con otras parteras más experimentadas. Sus conocimientos variaron entre los saberes empírico y científico, habiendo sido modificados a lo largo del tiempo, por el crecimiento de la medicalización, instigando la reflexión ante la actuación profesional orientada a la salud de la mujer. Esto valoró el parto, convertido en un momento único, respetando todos sus significados y devolviendo a la mujer su derecho de ser madre con humanidad y seguridad. Conclusión: quedó evidente la forma natural y trascendental con que las parteras fueron insertadas en este oficio, motivadas por el sentimiento de altruismo en un contexto histórico y social de ausencia de acceso universal a la salud, de localización geográfica rural y de poca disponibilidad de recursos humanos en la salud . Se quedaron evidentes, de este modo, sus valores y su importancia en el escenario de la salud obstétrica brasileña.

ABSTRACT Objective: to understand the historical process of the midwives' job in the Brazilian Northeastern semi-arid region through the oral history. Method: qualitative study carried out in nine municipalities of Cariri, in Ceará, with 16 midwives, using the oral history method. The semi-structured interview was used as a data collection instrument, with video interviews recorded. The reports were transcribed, textualized and transcreated, being analyzed according to the oral life history method. Results: the insertion of women working as midwives took place in a transcendental or essential way. It was considered an autonomous gift, divine or learned by living with other more experienced midwives. Their knowledge varied between the empirical and scientific knowledge, having been modified over time, due to the growth of the medicalization, instigating the reflection due to the professional action focused on women's health. This valued the childbirth, making it a unique moment, respecting all its meanings and giving back to the woman her right to be a mother with humanity and security. Conclusion: it was evident the natural and transcendental way in which the midwives were inserted in this role, motivated by the feeling of altruism in a historical and social context of absence to universal access to health, rural geographic location and little availability of human resources in health. Thus, their values and their importance in the Brazilian obstetric health scenario were evident.

Effect of continuity of midwifery service model on delivery outcomes in pregnant women / 中国实用护理杂志

Objective To explore the effect of continuity of midwifery service model on delivery outcomes in pregnant women. Methods From January 2015 to June 2016,100 single pregnant women with full-term and cephalic presentation who accepted midwife outpatient education were selected from our hospital and divided into observation group, at the same time,100 cases of full-term and cephalic presentation accepting obstetrics regular check as control group. Both delivery methods and total labor time were compared between two groups; the rates of episiotomy, weight gain during pregnancy, postpartum hemorrhage, neonatal asphyxia and macrosomia were all observed. Results The observation group maternal weight gained, the total labor time were (12.26±0.95) kg, (445.21±246.34) min, the control group were (14.48± 1.89) kg, (642.26±258.81) min, there wwa significant difference (t=-10.534,-3.456, P 0.05). Conclusions Continuous care provided by midwife can effectively promote natural birth, reduce the incidences of macrosomia and postpartum hemorrhage, enhance the quality of obstetric services, is worth promoting in clinical application.