El inicio precoz de la lactancia materna se ve favorecido por la realización de la educación maternal / Early initiation of breastfeeding is benefited by maternal education program

OBJETIVO: Determinar la influencia de la educación maternal (EM) sobre el inicio precoz de la lactancia materna (LM) y su mantenimiento hasta los dos meses de vida del recién nacido. Conocer la influencia de la EM sobre los motivos que argumenta la mujer para abandonar la LM. MÉTODO: Estudio multicéntrico observacional llevado a cabo en cuatro hospitales de Andalucía en 2011 sobre mujeres primíparas. Los datos se recogieron a través de una entrevista y la historia clínica. En el análisis se estimaron odds ratios crudas y ajustadas. RESULTADOS: La realización de EM por parte de la madre se asoció con el inicio precoz de la LM (ORa = 1.78, IC 95% = 1.14-2.78) y el mantenimiento de esta (ORa = 1.73, IC 95% = 1.15-2.61). No hubo diferencias en los motivos que las mujeres argumentaron para abandonar la LM. CONCLUSIONES: La EM favorece el inicio y mantenimiento de la LM.

OBJECTIVE: To determine the influence of maternal education (ME) on early initiation of breastfeeding (BF) and its maintenance during the first two months of the infant's life, as well as to understand the influence of ME on the reasons for BF discontinuation. METHOD: This was a multicenter observational study carried out with primiparous women in four hospitals of Andalucía during 2011. Data was collected through interviews and from clinical charts. Raw and adjusted odds ratios were estimated during the analysis. RESULTS: Mothers who attended ME classes showed early initiation of BF (aOR = 1.78, 95% CI = 1.14-2.78) and maintenance of BF (aOR = 1.73, 95% CI = 1.15-2.61). There were no differences related to women's reasons to discontinue BF. CONCLUSIONS: ME positively impacts the initiation and maintenance of BF.

Role of traditional birth-practices causing maternal and neonatal mortality in Faisalabad: an anthropological approach of household decision making

Anthropology is a holistic science that targets the study of man in its social, cultural, economic, psychological, political, geographical and ecological settings. Anthropology views major's interventions in areas of health to be planned with the complete cognizance of cultural factors that largely effect the target populations regarding their participation in all such major interventions. The Social Impact Assessment [SIA] referred by Anthropology basically demand scientific verifications of all such hurdles that may later on impede the acceleration of such heavy funded programs. The objective of the study was to investigate the decision-making regarding Safe Child Birthing Process among pregnant females and role of their in-laws. Cross Sectional Study This study was commissioned to the research team on behalf of Pakistan National Council on Ageing [PNCA] based in Islamabad. The data collection was done in the BHU of Chak # 474 GB, Tehsil Samundari, District Faisalabad. The study duration was three months and lasted from July 2012 to September 2012. Structured questionnaire was developed to collect information on child birth practices as well as opinion of females of respective sample area. In this regard, an extensive questionnaire was designed and pre-tested vigorously. Questionnaire contained bio-informatics including demographic information of clients and the second part covered areas of decision making, role, agents and other stakeholders. Questionnaires were filled with the help of LHVs and LHWs after getting the permission from their senior authorities. Results show that 29.2% of the respondents were illiterate, while 33.4% of the respondents pass their primary education. Ratio of birth attendant at last delivery was 58.1% for TBA/Dai and 17.2% respondents used the services of doctor for delivery proposes. Mother-in-law was the most influential decision maker in the family. As result explains that, for antenatal visit 118 time, for normal delivery 135 times and for EmONC 128 times decision taken by mother-in-law [n=267]. The decisions regarding child birth largely remain a female issue and rest with the mother-in-law mostly. The second dominant agents are husband and the father-in-law/brother-in-law. On statistical level, the result show strong association between clients and in-laws. The study verifies that the para-medical staff is also required to get training on the importance of cultural factors and means to convince the target population with threatening their cultural mind-set. A complete cognizance of such cultural variable may lead to promotion of safe child birthing as well as contributed in reducing the maternal mortality rates among the rural women

Problemática de la muerte materna en Villa Clara / Problem related to mother death in Villa Clara province

Introducción: la Organización Mundial de la Salud define la mortalidad materna (MM) como la muerte de una mujer durante su embarazo, parto, o dentro de los 42 días después de su terminación. Objetivo: caracterizar la problemática de las muertes maternas (MM) ocurridas en la provincia de Villa Clara en un decenio. Métodos: estudio observacional, descriptivo retrospectivo de las MM ocurridas de enero del 2001 a diciembre del 2010 en la provincia de Villa Clara, Cuba. Resultados: las defunciones maternas en la provincia ha sido estables oscilando entre 1 y 5 MM anuales durante el decenio, en 2004 y 2010 no se registraron MM. El total de MM directas e indirectas resultó en 22 en relación con las 533 reportadas en todo el país. La edad más representada fue los 36 años (4 MM, 16,6 por ciento). En las adolescentes como grupo riesgo se produjeron dos muertes 8,3 por ciento y 8 mujeres mayores de 35 años, 36,8 por ciento. Entre ambos grupos de edades se produjo el 45,1 por ciento de los fallecimientos. Entre las principales causas los trastornos hemorrágicos 6, como causa fundamental de MM directa, y las afecciones cardiovasculares 6, que son las principales afecciones que inciden en el territorio, seguidos del embolismo de líquido amniótico, el embarazo ectópico y la enfermedad tromboembólica. Conclusiones: en el decenio en estudio se ha mantenido una estabilidad en la incidencia de MM en el territorio y en 2 de esos años no se reportó ninguna. Las causas de muerte fueron: la hemorragia y las afecciones cardiovasculares, así como otras asociadas al embarazo

Introduction: the World Health Organization (WHO) defines the mother mortality (MM) as the death of a woman during its pregnancy, delivery or within the 42 days after its termination. Objective: to characterize the problem of the MM occurred in the Villa Clara province in a decade. Methods: A retrospective, descriptive and observational study was conducted on the MMs occurred from January, 2001 to December, 2010 in the Villa Clara province, Cuba. Results: The mother deceases in this province have been stables fluctuating between 1 and 55 MM during the decade, in 2004 and 2010 there were not MM. The total of direct or indirect MM was of 22 in relation to the 533 reported in all the country. The more represented age was 36 years (4 MM, 16.6 percent). In adolescents as a risk group there were two deaths for a 8.3 percent and 8 women aged over 35 for a 36.8 percent). Between both age groups occurred the 45.1 percent of deceases. Among the major causes, the hemorrhagic disorders: 6 as main cause of direct MM and 6 cardiovascular affections are the major affections with great impact in the territory, followed by the amniotic fluid embolism, the ectopic pregnancy and the thromboembolism disease. Conclusions: In the study decade there is a maintained stability in the MM incidence in territory and in two of those years there was not any incidence. The death causes were: hemorrhage and the cardiovascular affections and other associated with pregnancy

Características da assistência ao trabalho de parto e parto em três modelos de atenção no SUS, no Município de Belo Horizonte, Minas Gerais, Brasil / Characteristics of labor and delivery care in three healthcare models within the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil

Estudo transversal com 831 gestantes, de risco habitual, sobre o manejo do trabalho de parto num Centro de Parto Normal (CPN), num hospital vencedor do título "Galba de Araújo" (HG) e numa maternidade com modelo assistencial prevalente (HP). O uso da ocitocina no CPN foi de 27,9 por cento, no HG 59,5 por cento e no HP 40,1 por cento, enquanto a amniotomia foi realizada em 67,6 por cento, 73,6 por cento e 82,2 por cento das mulheres, respectivamente. A realização da episiotomia foi menor nas modalidades com incorporação de práticas humanizadas: 7,2 por cento no CPN e 14,8 por cento no HG versus 54,9 por cento no HP. A prática de oferta liberal no HG resultou numa taxa de analgesia superior (54,4 por cento) à do HP (7,7 por cento). O percentual de internação dos recém-nascidos e o de parto a fórceps foram mais altas no HP, mas não houve diferenças para o índice de Apgar e para a taxa de cesárea. Os resultados sugerem resistência ao uso seletivo de intervenções em todos os modelos assistenciais, embora favoreçam o CPN como estratégia no controle das intervenções durante o trabalho de parto e parto nas gestantes de risco habitual sem prejuízos para as mulheres e os recém-nascidos.

This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care), and a standard-protocol maternity facility. The rates for use of ocytocin during labor were 27.9 percent, 59.5 percent, and 40.1 percent, while amniotomy was performed in 67.6 percent, 73.6 percent, and 82.2 percent of the women, respectively. Episiotomy rates were lower in the first two facilities, which have adopted patient-centered obstetric practices (7.2 percent at the birthing center and 14.8 percent at the award-winning hospital) as compared to 54.9 percent at the standard maternity facility. The liberal offer of epidural anesthesia at the awarding-winning hospital resulted in a higher anesthesia rate (54.4 percent) as compared to the standard facility (7.7 percent). Forceps delivery and neonatal admission rates were higher in the standard hospital, but there were no differences in mean Apgar or cesarean rates. The findings suggest resistance to selective use of interventions in all three models of obstetric care, although favoring the birthing center as a strategy for controlling interventions during labor and childbirth in low-risk pregnancies, with no resulting harm to the mothers or newborns.

Desempenho de indicadores de processo do Programa de Humanização do Pré-natal e Nascimento no Brasil: uma revisão sistemática / Evaluation of the Program for Humanization of Prenatal and Childbirth Care in Brazil: a systematic review

Em 2000 iniciou-se o Programa de Humanização do Pré-natal e do Nascimento (PHPN), com critérios quantitativos para o cuidado obstétrico, e o SISPRENATAL foi seu instrumento de informação. O presente estudo compilou os dados nacionais sobre o acompanhamento pré-natal, utilizando o SISPRENATAL ou outras fontes de informação. Trata-se de uma revisão sistemática, com busca eletrônica de artigos no MEDLINE, EMBASE e SciELO. Compilaram-se publicações a partir de 2001 que utilizaram os indicadores de processo do PHPN. Foi realizada metanálise, estimando-se a proporção média de cada indicador com seu respectivo IC95 por cento. Os indicadores de processo apresentaram incremento ao longo do período, mas o SISPRENATAL registra baixa cobertura do PHPN quando comparado com outras fontes de informação. O PHPN tem pela frente o desafio da correta documentação da informação pelo SISPRENATAL. Deve-se priorizar a conscientização da importância do registro da informação, treinamento para sua inclusão no sistema e aprimoramento de instrumentos mais acessíveis e menos burocráticos de registro de dados.

The Program for Humanization of Prenatal and Childbirth Care (PHPN) was launched in Brazil in 2000, with quantitative criteria for obstetric care and SISPRENATAL as the database. The current study pooled the national data on prenatal care using SISPRENATAL and other data sources. This was a systematic review of prenatal care with an online search of articles in MEDLINE, EMBASE, and SciELO. The study compiled publications since 2001 that used PHPN process indicators. A meta-analysis was performed, estimating the mean proportion of each process indicator with its respective 95 percentCI. Process indicators increased over the target period, but SISPRENATAL showed low coverage for PHPN as compared to other data sources. The PHPN faces the challenge of proper data recording through SISPRENATAL. Priorities should include awareness-raising on the importance of data recording, training for inclusion of data in the system, and more accessible and less cumbersome data recording tools.

Comportamiento de la mortalidad materna en Argentina, Colombia, Brasil y Costa Rica / Behavior of mortality maternal in Argentina, Colombia, Brazil and Costa Rica

La Organización Mundial de la Salud (OMS) y UNICEF estiman que cerca de 585,000 mujeres mueren cada año debido a complicaciones en el embarazo o parto. Objetivo. Caracterizar el comportamiento de la mortalidad materna en Argentina, Colombia, Brasil y Costa Rica considerando sus Determinantes, Indicadores Epidemiológicos y Políticas Sanitarias Metodología. Estudio de revisión sistemática para conocer el comportamiento de la mortalidad materna a partir de los determinantes, prevalencia y políticas sanitarias en Colombia, Argentina, Costa Rica y Brasil. Se realizo una revisión sistemática de literatura, que incluyo el periodo de 1990 – 2008. La búsqueda de los textos científicos fue realizada en las bases de datos bibliográficas de Medical Literature Analysis and Retrieval System Online (MEDLINE), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) incluida dentro de la biblioteca virtual en Salud (BVS), páginas web oficiales de los Ministerios de Salud de los países incluidos en el estudio, Organización Panamericana de la Salud y Organización Mundial de la Salud.

The World Health Organization (WHO) and UNICEF estimate that about 585.000 women die each year due to complications in pregnancy or childbirth. Aim. Characterizing the behaviour of maternal mortality in Argentina, Colombia, Brazil and Costa Rica considering their determinants, epidemiological indicators and Health Policy. Methodology. Study of systematic review to know the behaviour of maternal mortality based on the determinants, prevalence and health policies in Colombia, Argentina, Costa Rica and Brazil. A systematic review of literature was carried out, which included the period 1990-2008. The search for the scientific texts was carried out in the bibliographic databases of Medical Literature Analysis and Retrieval System Online (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS) included within the Virtual Health Library (VHL), official websites of the Ministries of Health of the countries included in the study, Pan American Health Organization and World Health Organization.

Comportamiento de la mortalidad materna en la Provincia de Córdoba, periodo 2001-2009 / Maternal behavior in the Province of Córdoba, period 2001-2009

Objetivo: Conocer cual ha sido el comportamiento de MM en la Provincia de Córdoba y sus causas, en el período 2001-2009. Diseño metodológico: estudio retrospectivo, descriptivo y correlacional simple. Las variables estudiadas fueron: número de MM por año, causas, momento de ocurrencia, edades de las pacientes, residencia,prevalenciadel aborto, comparación con datos nacionales. Resultados: en el periodo 2001-2009 hubo 172 MM en Córdoba, se calcularon tasas sobre 100.000 nacidos vivos. La edad promedio fue de 30. La tasa fue de 26 en 2001 aumentando progresivamente hasta 2005 (34), disminuye en 2006 y 2007 con un franco incremento en 2008 y 2009llegando a 41 y 75. Existen variaciones importantes a nivel nacional, donde hay tasas que llegan a 197 en Formosa (2001) y a 7 el Buenos Aires (2008). En cuanto a las causas el aborto ocupó el primer lugar (26%), las causas indirectas globales llegaron al 33%, los estados hipertensivos al 15%, las infecciones el 10%, las hemorragias el 11%, otras causa directas el 5%. El aborto ocupó 50% de los óbitos en el año 2003. El incremento de las causas indirectas se relaciona con afecciones respiratorias y cardiovasculares. La distribución de acuerdo a la procedencia fue similarpara capital e interior. Discusión-Conclusiones: la MM fue alta en Córdoba posteriormente a la crisis económica nacional del 2002, con un nuevo ascenso en 2008 y 2009, probablemente dependiente de factores socio económicos y a la pobre respuesta frente a la pandemia de gripe A. Los aspectos a mejorar son la inequidad, la prevención de embarazos no deseados y aborto, la legislación. La capacidad instalada y el recurso humano capacitado deberían y derivaciones rápidas y efectivas, sonaspectos pendientes. Se debe facilitar el empoderamiento, la educación, la igualdad de oportunidades en el acceso a los servicios de salud.

Unavailability of essential obstetric care services in a local government area of south-west Nigeria.

This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal mortality in a local government area (LGA) of South-West Nigeria. The objectives were to determine the availability of essential obstetric care (EOC) services in the LGA and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. Twenty-one of 26 health facilities surveyed were public facilities, and five were privately owned. None of the facilities met the criteria for a basic EOC facility, while only one private facility met the criteria for a comprehensive EOC facility. Three facilities employed a nurse and/or a midwife, while unskilled health attendants manned 46% of the facilities. No health worker in the LGA had ever been trained in lifesaving skills. There was a widespread lack of basic EOC equipment and supplies. The study concluded that there were major deficiencies in the supply side of obstetric care services in the LGA, and EOC was almost non-existent. This result has implications for interventions for the reduction of maternal mortality in the LGA and in Nigeria.

Immediate and early postnatal care for mothers and newborns in rural Bangladesh.

The study evaluated the impact of essential newborn-care interventions at the household level in the Saving Newborn Lives project areas. Two household surveys were conducted following the 30-cluster sampling method using a structured questionnaire in 2002 (baseline) and 2004 (endline) respectively. In total, 3,325 mothers with children aged less than one year in baseline and 3,110 mothers in endline from 10 sub-districts were interviewed during each survey. The proportion of newborns dried and wrapped immediately after birth increased from 14% in 2002 to 55% in 2004; 76.2% of the newborns were put to the mother's breast within one hour of birth compared to 38.6% in baseline. Newborn check-up within 24 hours of delivery increased from 14.4% in 2002 to 27.3% in 2004. Postnatal check-up of mothers by trained providers within three days of delivery rose from 2.4% in 2002 to 27.3% in 2004. Knowledge of the mothers on at least two postnatal danger signs increased by 17.2%, i.e. from 47.1% in 2002 to 64.3% in 2004. Knowledge of mothers on at least three postnatal danger signs also showed an increase of 16%. Essential newborn-care practices, such as drying and wrapping the baby immediately after birth, initiation of breastmilk within one hour of birth, and early postnatal newborn check-up, improved in the intervention areas. Increased community awareness helped improve maternal and newborn-care practices at the household level. Lessons learnt from implementation revealed that door-to-door visits by community health workers, using community registers as job-aids, were effective in identifying pregnant women and following them through pregnancy to the postnatal periods.

Birth-preparedness for maternal health: findings from Koupéla District, Burkina Faso.

Maternal mortality is a global burden, with more than 500,000 women dying each year due to pregnancy and childbirth-related complications. Birth-preparedness and complication readiness is a comprehensive strategy to improve the use of skilled providers at birth, the key intervention to decrease maternal mortality. Birth-preparedness and complication readiness include many elements, including: (a) knowledge of danger signs; (b) plan for where to give birth; (c) plan for a birth attendant; (d) plan for transportation; and (e) plan for saving money. The 2003 Burkina Faso Demographic and Health Survey indicated that only 38.5% of women gave birth with the assistance of a skilled provider. The Maternal and Neonatal Health Program of JHPIEGO implemented a district-based model service-delivery system in Koupéla, Burkina Faso, during 2001-2004, to increase the use of skilled providers during pregnancy and childbirth. In 2004, a cross-sectional survey with a random sample of respondents was conducted to measure the impact of birth-preparedness and complication readiness on the use of skilled providers at birth. Of the 180 women who had given birth within 12 months of the survey, 46.1% had a plan for transportation, and 83.3% had a plan to save money. Women with these plans were more likely to give birth with the assistance of a skilled provider (p=0.07 and p=0.03 respectively). Controlling for education, parity, average distance to health facility, and the number of antenatal care visits, planning to save money was associated with giving birth with the assistance of a skilled provider (p=0.05). Qualitative interviews with women who had given birth within 12 months of the survey (n=30) support these findings. Most women saved money for delivery, but had less concrete plans for transportation. These findings highlight how birth-preparedness and complication readiness may be useful in increasing the use of skilled providers at birth, especially for women with a plan for saving money during pregnancy.

Maternal and newborn-care practices during pregnancy, childbirth, and the postnatal period: a comparison in three rural districts in Bangladesh.

The aim of this study was to examine the prevalence of maternal and newborn-care practices among women reporting a birth in the previous year in three districts in different divisions of Bangladesh. In 2003, 6,785 women, who had delivered a newborn infant in the previous year, across three districts in Bangladesh, were interviewed. Overall, less than half of the women received any antenatal care, and 11% received a minimum of four check-ups. Only 18% took iron tablets for at least four months during pregnancy. Over 90% of the 6,785 deliveries took place at home, and only 11% were attended either by a doctor or by a nurse. The mothers reported three key hygienic practices in 54% of deliveries: attendants washing their hands with soap and boiling cord-tie and blade for cutting the cord. Forty-four percent of the 6,785 infants were bathed immediately after delivery, and 42% were given colostrum as their first food. The results suggest that maternal and newborn-care remains a cause of concern in rural Bangladesh. Short-term policies to promote healthy behaviour in the home are needed, in addition to the long-term goal of skilled birth attendance.

Review of domiciliary newborn-care practices in Bangladesh.

In Bangladesh, high proportions of infant deaths (two-thirds) and deaths among children aged less than five years (38%) occur in the neonatal period. Although most of these deaths occur at home due to preventable causes, little is known about routine domiciliary newborn-care practices and care-seeking for neonatal illness. As an initial step in strategic planning for the implementation of interventions in Bangladesh to improve neonatal outcomes, a review of the literature of antenatal, intrapartum, and postpartum care practices for mothers and newborns in Bangladeshi communities and homes was conducted. A dearth of information was found and summarized, and priority areas for future formative research were identified. The information gained from this review was used for informing development of a guide to formative research on maternal and neonatal care practices in developing-country communities and forms a cornerstone for formulation of behaviour change-communication strategies and messages to advance neonatal health and survival in Bangladesh.

Are birth-preparedness programmes effective? Results from a field trial in Siraha district, Nepal.

The birth-preparedness package (BPP) promotes active preparation and decision-making for births, including pregnancy/postpartum periods, by pregnant women and their families. This paper describes a district-wide field trial of the BPP implemented through the government health system in Siraha, Nepal, during 2003-2004. The aim of the field trial was to determine the effectiveness of the BPP to positively influence planning for births, household-level behaviours that affect the health of pregnant and postpartum women and their newborns, and their use of selected health services for maternal and newborn care. Community health workers promoted desired behaviours through inter-personal counselling with individuals and groups. Content of messages included maternal and newborn-danger signs and encouraged the use of healthcare services and preparation for emergencies. Thirty-cluster baseline and endline household surveys of mothers of infants aged less than one year were used for estimating the change in key outcome indicators. Fifty-four percent of respondents (n=162) were directly exposed to BPP materials while pregnant. A composite index of seven indicators that measure knowledge of respondents, use of health services, and preparation for emergencies increased from 33% at baseline to 54% at endline (p=0.001). Five key newborn practices increased by 19 to 29 percentage points from baseline to endline (p values ranged from 0.000 to 0.06). Certain key maternal health indicators, such as skilled birth attendance and use of emergency obstetric care, did not change. The BPP can positively influence knowledge and intermediate health outcomes, such as household practices and use of some health services. The BPP can be implemented by government health services with minimal outside assistance but should be comprehensively integrated into the safe motherhood programme rather than implemented as a separate intervention.

Comparative study of knowledge about different Child Survival and Safe Motherhood intervention in two groups of mothers.

A cross-sectional study was conducted in an urban field practice slum area served by Urban Health Centre (UHC) attached to the Dept. of Preventive and Social Medicine, T. N. Medical College and Nair Hospital, Mumbai, to compare the knowledge about different Child Survival and Safe Motherhood interventions in two groups of mothers. 152 mother who regularly attended antenatal check-up in UHC constituted study group and 153 mothers selected by individual matching constituted the control group. Significant differences in the knowledge of study and control groups of mothers were observed about some interventions like time of initiation of breast feeding, duration of exclusive breast feeding, age of starting weaning and number of OPV and DPT doses to be given till 1 year of age.

Viabilidade da reduçäo de cesáreas em maternidade universitária pública no município de Säo Paulo / Reduction possibility of cesarean in a public university maternity in Säo Paulo city, Säo Paulo state, Brazil

Com o objetivo de verificar a possibilidade de reduçäo da taxa de cesáreas em maternidade pública universitária da cidade de Säo Paulo, foi conduzido, durante o ano de 1997, um projeto de auditoria interna, através de uma adequaçäo das indicaçöes de cesáreas a parâmetros estabelecidos em conjunto pela equipe obstétrica e neonatal. Um dos instrumentos utilizados foi exigir maior precisäo nos diagnósticos de cada uma das indicaçöes de cesáreas. Após um ano de intervençäo, foi possível obter uma queda significativa da taxa de cesáreas de 31,3 por cento para 28,4 por cento, sem criar danos à saúde do recém-nascido nem aumentar a morbidade materna. A reduçäo da taxa de cesáreas foi possível graças à revisäo do conceito e dos parâmetros que caracterizavam sofrimento fetal agudo. A queda ocorreu em todas as categorias de origem das pacientes, ordenadas segundo a sua procedência regional, que utilizam os serviços do Hospital Universitário da Universidade de Säo Paulo. Ficou evidenciado que dentro do contingente de cesáreas, uma parte delas era desnecessária, ainda que nem sempre evitável. Este estudo demonstrou que o recurso de intervençäo, basseado na avaliaçäo crítica de cada cesárea, dentro de uma dada instituiçäo, é um instrumento válido e suscetível de trazer bons resultdos. Iniciativas desta natureza, cuja eficácia já foi demonstrada por outros autores, poderiam ser adotadas em instituiçöes interessadas em conter o avanço e reduzir as taxas de cesárea no Brasil

Primer borrador: políticas de maternidad segura / First draft: policies for safe motherhood

Proporciona el borrador de las políticas de maternidad segura, el que constituye una iniciativa que consta de diez pasos para realizar una adecuada atención médica con calidad y calidez de la atención a la mujer durante el período de embarazo, parto, puerperio y al recién nacido, esto con el fin de disminuir la mortalidad materna y perinatal