Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity / Lacerações perineais: um estudo retrospectivo em uma maternidade pública de risco habitual

Abstract Objective In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events. Methodology A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p<0.05 were considered significant. Results In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the "hands-off" method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them. Conclusion Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.

Resumo Objetivo Aproximadamente 85% dos partos vaginais cursam ou com lacerações perineais e/ou com episiotomia. Este estudo objetivou determinar a incidência de lacerações e episiotomias das parturientes de 2018 de uma maternidade pública de risco habitual, no sul do Brasil, bem como determinar os fatores de risco e proteção para tais eventos. Métodos Estudo transversal retrospectivo, no qual os dados foram obtidos dos prontuários e analisados no programa Stata. Realizaram-se regressões logísticas uni e multivariada. Foram considerados como significantes valores de p<0,05. Resultados Em 2018, aconteceram 525 partos vaginais, sendo 27,8% assistidos por médicos obstetras, 70,7%, por enfermeiros obstetras, e 1,5% evoluíram sem assistência. Ao todo, 55,2% das parturientes apresentaram algum grau de laceração. O profissional que assistiu ao parto foi uma variável que demonstrou significância: um maior número de lacerações de primeiro e segundo graus, bem como casos de maior gravidade, ocorreram em partos assistidos por enfermeiros (razão de probabilidades [RP]: 2,95; intervalo de confiança de 95% [IC 95%]: 1,74 a 5,03). Posições ao nascimento que não permitiam técnicas de proteção perineal (período expulsivo na técnica "sem mãos" [hands off, em inglês]), quando analisadas isoladamente, determinaram o risco; contudo, no modelo final de regressão, essa relação não se confirmou. Apesar de relatada na literatura, não houve associação entre a ocorrência de laceração e a idade, a cor da pele, ou o peso de nascimento. Em 24% dos partos, uma episiotomia foi realizada, tendo os médicos executado 63,5% delas. Conclusão Partos assistidos por enfermeiros resultaram em um maior risco de lacerações perineais, de variados graus. Por sua vez, os assistidos por médicos apresentaram maior ocorrência de episiotomia.

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)

Burnout, compassion fatigue, and compassion satisfaction among obstetrics and gynecology resident physicians in the Philippines: A cross-sectional study / Philippine Journal of Obstetrics and Gynecology

Introduction@#Physician burnout (BO) is an increasing global concern due to its rising prevalence and effect on patient care@*Objective@#This study determined the prevalence of BO, compassion fatigue (CF), and compassion satisfaction (CS), among residents of obstetrics and gynecology in the Philippines, and identified the factors associated with these@*Methods@#This was a cross‑sectional study, which used stratified random sampling. The strata comprised public and private hospitals that were subdivided into Luzon, Visayas, Mindanao, and National Capital Region. From these, 33 training hospitals were randomly selected, which served as clusters wherein all resident physicians of obstetrics and gynecology were invited to answer either an online or printed version of the Professional Quality of Life Scale Version 5 questionnaire@*Results@#Majority of the 311 participants included had average level of BO (n = 281, 90.4%), CF (n = 237, 76.2%), and CS (n = 213, 68.5%). CS was negatively correlated with burnout (r = −0.31, P < 0.001) and CF (r = −0.34, P < 0.001), whereas BO and CS were positively correlated (r = +0.48, P < 0.001). Type of institution, sleeping hours, and interrupted leaves were the common factors that yield significant differences in BO (P = 0.037, P < 0.001, and P < 0.001) and CF (P = 0.002, P = 0.043, and P = 0.005). Significant differences were observed in CS scores in terms of age (P = 0.016), marital status (P = 0.038), child dependents (P = 0.006), level of training (P = 0.005), and location and type of institution (P ≤ 0.001 and P = 0.003).@*Conclusion@#There is a need to develop active awareness of BO and CF among resident physicians to effect interventions at the individual and institutional level.

Body privacy in gynecology obstetrics / Privacidad del cuerpo en obstetricia ginecológica / Privacidade corporal em ginecologia e obstetrícia

Abstract This study aimed to develop a scale to ethically evaluate the privacy of the body in gynecology and obstetrics. It was carried out in a university research and application hospital and in a private hospital in Turkey. A stratified sample was adopted with a total of 2,159 participants, including physicians, nurses, and midwives, OB/GYN patients, surgical patients, internal medicine patients, and healthy individuals. The Lawshe method was used. The results showed that physical space is important in protecting privacy; the participants perceived privacy as a right; women, married people, primary school graduates, older people and those closest to rural culture are more sensitive to privacy than others; Among healthcare providers, physicians are more privacy conscious than nurses and midwives; no participant had in-depth knowledge of patient rights and relevant legislation. The body privacy scale in gynecology and obstetrics proved to be a valid and reliable scale. With it, the privacy of the body in obstetrics and gynecology can be evaluated in future research, as well as the perceptions of body privacy of those who receive and provide medical care. By applying this scale, the privacy of gynecological and obstetric patients can be protected and the results reflected in clinical practice. This scale can also be used in education and in improving ethical sensitivity in physicians.

Resumen Este estudio tuvo como objetivo desarrollar una escala para evaluar éticamente la privacidad del cuerpo en ginecología y obstetricia. Se realizó en un hospital universitario de investigación y aplicación y en un hospital privado en Turquía. Se adoptó un muestreo estratificado con un total de 2.159 participantes, incluidos médicos, enfermeras y parteras, pacientes de ginecología y obstetricia, pacientes quirúrgicos, pacientes de medicina interna e individuos sanos. Se usó el método Lawshe. Los resultados mostraron que el espacio físico es importante en la protección de la privacidad; los participantes percibieron la privacidad como un derecho; las mujeres, las personas casadas, los titulados de la escuela primaria, personas mayores y los más cercanas a la cultura rural son más sensibles a la privacidad que otros; entre los proveedores de atención médica, los médicos tienen mayor conciencia de la privacidad que enfermeras y parteras; ningún participante tenía un conocimiento profundo de los derechos de los pacientes y de la legislación pertinente. La escala de la privacidad corporal en ginecología y obstetricia mostró ser una escala válida y confiable. Con ella, la privacidad del cuerpo en ginecología y obstetricia se puede evaluar en futuras investigaciones, así como las percepciones de privacidad corporal de aquellos que reciben y proporcionan atención médica. Aplicando esta escala, se puede proteger la privacidad de pacientes ginecológicos y obstétricos y reflejar los resultados en la práctica clínica. Esta escala también se puede utilizar en educación y en mejorar la sensibilidad ética en los médicos.

Resumo Esse estudo objetiva desenvolver uma escala para avaliar eticamente a privacidade do corpo em ginecologia e obstetrícia. Ele foi conduzido em um hospital universitário e em hospital privado na Turquia. Uma amostra estratificada foi adotada com um total de 2159 participantes, incluindo médicos, enfermeiras e parteiras, pacientes de obstetrícia, ginecologia, cirúrgicos e de medicina interna, e indivíduos saudáveis. O método Lawshe foi utilizado. Os resultados mostraram que o espaço físico é importante para proteger a privacidade; os participantes consideraram a privacidade como um direito; mulheres, pessoas casadas, com escolaridade primária completa, pessoas mais velhas e aquelas mais próximas da cultura rural são mais sensíveis à privacidade que outras; entre os profissionais de saúde, médicos são mais conscientes da privacidade que enfermeiras e parteiras; nenhum participante tinha conhecimento aprofundado dos direitos de pacientes e da legislação relevante. A escala de privacidade corporal em ginecologia e obstetrícia provou ser uma escala válida e confiável. Com ela, a privacidade do corpo em obstetrícia e ginecologia pode ser avaliada em pesquisas futuras bem como as percepções de privacidade corporal daqueles que recebem e fornecem cuidados médicos. Aplicando essa escala, a privacidade de pacientes ginecológicos e obstétricos pode ser protegida e os resultados refletidos na prática clínica. Essa escala pode também ser usada em educação e em melhorar a sensibilidade ética de médicos.

Trastornos mentales y consumo de drogas en mujeres embarazadas con alto riesgo obstétrico

Introducción: El consumo de sustancias psicoactivas en el embarazo puede desencadenar patologías, como cuadro psiquiátrico agudo, síndrome de abstinencia y algunos riesgos relacionados con las conductas asociadas al consumo. Objetivo: Describir la prevalencia de trastornos mentales y consumo de drogas en mujeres embarazadas con alto riesgo obstétrico. Materiales y métodos: Estudio observacional, descriptivo transversal en 220 mujeres embarazadas con alto riesgo obstétrico. Se calcularon prevalencias de trastornos mentales y de consumo de drogas. Resultados: El trastorno mental con mayor prevalencia fue el episodio depresivo mayor (10,0 %). Las sustancias con mayor prevalencia de consumo en el último año fueron: alcohol (58,3 %), bebidas energéticas (36,4 %), cigarrillo (10,9 %) y marihuana (6,4 %). Conclusiones: Es necesario incluir en los protocolos de atención de la mujer gestante, la exploración de estos aspectos, incluido el tamizaje de drogas en orina, dadas las implicaciones que para la salud pública tiene el consumo de sustancias psicoactivas y la presencia de trastornos mentales durante el embarazo.

Introduction: Psychoactive substances use during pregnancy could produce some pathologies as an acute psychiatric disorder, abstinence syndrome, and some risks related to drug use behavior. Objective: To describe the prevalence of mental disorders and drug use in pregnant women with high obstetrician risk. Materials and methods: Observational and transversal descriptive study in 220 pregnant women with high obstetrician risk. The prevalence of mental disorders and drug use were calculated. Results: The most frequent mental illness is the major depressive episode (10,0%). The most used substances, in the last year, were alcohol (58,3%), energetics drinks (36,4%), cigarettes (10,9%), and marihuana (6,4%). Conclusions: It is necessary to include, in the expectant woman attention protocol, the exploration of those aspects, including urine drug screen, because of the implications of psychoactive substances use and mental disorders in the public health.

A study of impact of stress: examinations on menstrual cycle among medical students

Background: Premenstrual Syndrome (PMS), a common problem among adolescent girls, is associated with various physical, mental and behavioral symptoms that lead to social and occupational impairment. Stress has also been hypothesized to be an important etiologic factor. Examination stress may also be responsible for affecting the premenstrual symptoms. The objectives of this study was to study the impact of exam stress on the menstrual cycle and the relationship of perceived stress with the severity of premenstrual symptoms. Methods: This was a cross-sectional observational study conducted among female medical students of final MBBS, who were candidate of upcoming exams. They were assessed on semi structured socio-demographic and menstrual history proforma, ACOG guidelines, DSM-5 criteria, Perceived Stress Scale (PSS) and Premenstrual Symptom Screening Tool (PSST).Results: As per ACOG guidelines, 66% participants had PMS and 6% participants had PMDD according to DSM-5 criteria. On PSST total 88% participants had premenstrual symptoms and out of them 58% had mild/no PMS while 30% had moderate to severe PMS. 5% participants also fulfilled criteria for PMDD on PSST. Stress was found to be mild in 26% and moderate in 74% participants on PSS. PMS was found in 93.75% participants who had painful menstruation (dysmenorrhea) and this association was statistically significant. Data wise 73.1% participants having mild stress had PMS, while 93.2% participants having moderate stress, had PMS and this association was found to be statistically significant.  Surprisingly not a single participant consulted to any health care provider for their menstruation related problems.Conclusions: Premenstrual Syndrome is common in adolescent girls and exam stress is an important etiological factor. PMS/PMDD was found significantly higher in participants who had dysmenorrhea and moderate stress. A positive and highly significant correlation was also found between the severity of stress and severity of premenstrual symptoms.

Establishment and evaluation of a standardization management model for pregnant women after caesarean sections / 中国实用护理杂志

Objective To establish a midwife-obstetrician collaboration-based management model for pregnant women after caesarean sections and to evaluate its effectiveness on women′s childbirth outcomes. Methods A panel of experts including obstetricians and midwives was established. A revised management scheme for women after cesarean sections was finally formed through multiple expert consultation method. A historical control method was implemented in our study. Women giving birth before the implementation of collaboration-based management scheme between 2011 and 2013 were recruited in the control group;and women giving birth afterwards between 2014 and 2016 were recruited in the intervention group. Childbirth outcomes such as the mode of delivery, rate of trial of labor after cesarean sections, and vaginal birth rate after cesareans were compared between the two groups. Results A total of 3326 women in intervention group, of those women 281 (8.4%) under trial of labor after cesarean, of the women who under trial of labor 264(94.0%) had successful vaginal birth. A total of 1625 women in control group, of those women 28(1.7%) under trial of labor after cesarean, of the women who under trial of labor 22(78.6%) had successful vaginal birth. The trial of labor after cesarean sections rate and the vaginal birth rate after cesareans rate was significantly higher in intervention group than that in control group (P<0.01). Conclusions The midwife-obstetrician collaboration-based management model can promote vaginal birth for women after cesarean sections, and has no adverse effect on other childbirth outcomes, which is worthy of being implemented more widely in China.

Establishment and evaluation of a standardization management model for pregnant women after caesarean sections / 中国实用护理杂志

Objective To establish a midwife-obstetrician collaboration-based management model for pregnant women after caesarean sections and to evaluate its effectiveness on women′s childbirth outcomes. Methods A panel of experts including obstetricians and midwives was established. A revised management scheme for women after cesarean sections was finally formed through multiple expert consultation method. A historical control method was implemented in our study. Women giving birth before the implementation of collaboration-based management scheme between 2011 and 2013 were recruited in the control group;and women giving birth afterwards between 2014 and 2016 were recruited in the intervention group. Childbirth outcomes such as the mode of delivery, rate of trial of labor after cesarean sections, and vaginal birth rate after cesareans were compared between the two groups. Results A total of 3326 women in intervention group, of those women 281 (8.4%) under trial of labor after cesarean, of the women who under trial of labor 264(94.0%) had successful vaginal birth. A total of 1625 women in control group, of those women 28(1.7%) under trial of labor after cesarean, of the women who under trial of labor 22(78.6%) had successful vaginal birth. The trial of labor after cesarean sections rate and the vaginal birth rate after cesareans rate was significantly higher in intervention group than that in control group (P<0.01). Conclusions The midwife-obstetrician collaboration-based management model can promote vaginal birth for women after cesarean sections, and has no adverse effect on other childbirth outcomes, which is worthy of being implemented more widely in China.

Reflection on the Cultivation of Humanistic Practice Ability of Obstetricians and Gynecologists / 中国医学伦理学

Obstetrics and gynecology is concerned with the gestation,birth and healthy development of human life and related to the happiness and joy of all families.Physicians need to have good medical humanistic practice ability.This paper analyzed the connotation of the physician's humanistic practice ability,investigated the current status of humanistic practice ability of obstetricians and gynecologists through in-depth interviews,and put forward the countermeasures of cultivating the humanistic practice ability of obstetricians and gynecologists,including strengthening the foundation of medical humanistic knowledge,carrying out the training of the humanities skills of obstetricians and gynecologists,integrating the evaluation of humanistic practice ability into the work of medical ethics,and integrating the new medical humanistic view into the construction of hospital culture.

Knowledge and practices of rural family physicians and obstetricians towards gestational diabetes mellitus.

Background: The Gestational Diabetes Mellitus (GDM) offers an important opportunity for prevention of type 2 diabetes (T2DM). The prevalence of GDM is increasing even in rural parts of India. Family Physicians (FPs) and obstetricians working in rural areas need to be well equipped to manage this disease. This study aimed at assessing the knowledge ant practices amongst these rural doctors. Methods: Validated, self-completion questionnaire administered to family physicians and obstetricians after taking the written consent for participation. The questionnaire was divided in to two sections. First section was to assess the knowledge and the second section was to assess the practices adopted by participants towards GDM. Results: The participants were the 18 FPs and 12 obstetricians working in rural areas and managing pregnancies. About 89% (16) of FPs and 50% (6) Obstetricians exactly knew the definition. More than 55% (10) FPs and 66.7% (8) obstetricians knew the approximate prevalence of GDM. Only 22% (4) FPs and 58.3% (7) obstetricians were practicing universal screening for GDM. Only 38.9% (7) FPs were using insulin for the treatment of GDM where as 75% (9) obstetricians using insulin. Only 17% (3) FPs and 50% (6) obstetricians were practicing at least once weekly blood glucose monitoring for GDM. Conclusions: There are gap in knowledge and practices both amongst FPs and obstetricians towards the management of GDM. Future research focusing on education strategy is required which may involve novel tools like internet and mobile devices.

Dr. Alfredo Rodríguez Pérez. Médico al servicio de la Revolución / Doctor Alfredo Rodríguez Perez. A revolution´s serve doctor

Es un necesidad que las nuevas generaciones de profesionales de la salud cubanos cuenten, como legado imperecedero, con el conocimiento, la admiración y el respeto por la vida, trayectoria, obra y huella de una generación de médicos formados con la Revolución, y que han brindado, con hermosos gestos y consagración, lo mejor de sí. Es el caso del Dr. Alfredo Rodríguez Pérez, Profesor Consultante en Obstetricia y Ginecología de la Facultad de Ciencias Médicas "Finlay-Albarrán". Con ese propósito, apoyados en su testimonio, la revisión de documentos y su obra escrita, se logró reconocer su trayectoria como estudiante, soldado, médico, profesor, internacionalista, asesor, en fin como un hombre cuya única gloria verdadera ha estado en los servicios prestados a la Revolución.

It is a necessity that the new generations of cuban professionals of health have, as a permanent legacy, the knowledge, admiration and respect, for the life and results of the professional development of a generation of doctors in medicine formed by the Revolution, that have given with beautiful acts and consagration the gest of themselves, which is the case of Dr. Alfredo Rodríguez Pérez, Consultant Professor in Obstetric and Gynecology, of the Faculty of Medical Science "Finlay-Albarrán". With that purpose and supported on his testimony and documents of his written work, it was possible to recognize his trajectory as student, soldier, doctor in medicine, professor, internationalist, adviser, in conclusion, a man that his only really glory has been the services to the Revolution.

Honrar, Honra. Panel en Homenaje al Aniversario 85 del natalicio del Ministro Dr. Sergio del Valle Jiménez / To honour does one's honour. Panel paying Homage to Dr. Minister Sergio Del Valle Jiménez on occasion of his 85th birthday Anniversary

En homenaje al General de División y Héroe de la República de Cuba, Dr. Sergio del Valle Jiménez, excelente médico obstetra; militante del Movimiento 26 de Julio; combatiente de la Sierra Maestra; Jefe de la Fuerza Aérea al triunfo revolucionario; Jefe del Estado Mayor General de las FAR, cuando el ataque mercenario a Playa Girón y la Crisis de Octubre, momentos difíciles que compartiera con el Comandante en Jefe Fidel Castro Ruz; Ministro del Interior (1968-1979) y Ministro de Salud Pública (1979-1985), se realizó un Coloquio en el Museo de la Revolución _gracias al apoyo solidario de su Director y equipo de especialistas y trabajadores- en vísperas del 85 Aniversario de su natalicio, el 15 de abril. El Panel estuvo integrado por compañeros, quienes compartieron distintas etapas de su vida estudiantil, laboral, de la clandestinidad y la Sierra Maestra, y las responsabilidades asumidas después del triunfo revolucionario. Una nutrida asistencia demostró su interés por conocer más del hombre excepcional a quien se recordaba en ese día. Todos los panelistas coincidieron en que las principales virtudes que destacaron a este admirado médico revolucionario son la honestidad, nobleza, modestia, firmeza revolucionaria, sentido de justicia, decisión y coraje. Dos interesantes intervenciones del público asistente, así lo corroboraban. La Moderadora, en las conclusiones, leyó dos juicios de valor emitidos por el máximo líder de la Revolución Cubana acerca del extraordinario hombre a quien se le rendía tributo, y agradeció a todos su asistencia, especialmente a las decenas de personas, quienes se mantuvieron de pie durante las dos horas del coloquio.

It was carried out a colloquy at the museum of the Revolution to do homage to General of Division and hero of the Republic of Cuba Dr. Sergio del Valle Jiménez, militant of "26 de Julio" movement, combatant at Sierra Maestra mountains, Commander of the Air Force at the Revolutionary triumph in 1959 and General chief of the revolutionary armed forces(FAR) when the mercenary attack in Playa Giron and the so called "October Crisis", these last two difficult moments that he shared with Commander in chief Fidel Castro Ruz, He was also in charge of the Cuban "Ministerio del Interior"during the period 1968 - 1979 and Minister of Public Health for six years (1979 - 1985). We would like to thanks the jointly support of the director of the museum as well as all the specialists and workers of this institution who made possible this activity on the eves of the 85th anniversary of his birthday on April 15th. The panelists of the activity were comrades of Dr.Sergio del Valle who shared different stages of his life as a student, worker, fighter at Sierra Maestra mountains and in charge of different responsabilities he assumed after the revolutionary victory in 1959. All the panelists had total coincidence when expressing the main virtues of this admired revolutionary doctor. Those virtues were honesty, modesty, sense of justice, decision and courage. At the end of the activity the moderator read two important considerations made by the leader of the Cuban revolution about Dr. Sergio del Valle and thanked all the persons who attended the colloquy specially those who remained standing for the two hours the activity lasted.

Las parteras, patrimonio de la humanidad / Midwives, part of the human race’s cultural heritage

Objetivo: presentar el origen etimológico del término partera. Describir las parteras que han hecho aportes a la obstetricia a través de la historia. Hacer una reflexión . sobre el desempeño actual de las parteras en la salud Materiales y métodos: se presentan las parteras más famosas o que hicieron aportes a la tocología o la salud pública a través de los siglos. Se describe el papel de las parteras hoy día en las diferentes regiones del mundo.Conclusión: las parteras continúan jugando un importante papel en la salud materna en varios países del mundo, dado que tienen amplia aceptación en las comunidades, reciben capacitación en buenas prácticas y pueden detectar las alteraciones tempranas del embarazo y el parto; sin embargo, en otros países este oficio se halla prácticamente en el ocaso, está reducido a zonas marginales y no cuentan con apoyo de los organismos de salud...

Objective: looking at the etymological origin of the term “midwife”. Describing midwives who have made contributions to obstetrics throughout history. Reflecting on midwives’ current performance regarding public health in different parts of the world. Materials and methods: a description of the most famous midwives or those who have made contributions to tocology or public health throughout the centuries is presented. The role of midwives today related to their work in different parts of the world is described. Conclusion: midwives continue playing an important role in maternal health in several countries around the world, given that they are widely accepted in communities. Their performance can be enhanced by means training in how to detect early alterations during pregnancy and in the delivery and using good clinical practices to prevent infection. However, this job is practically in decline in other countries; it has become reduced to marginal areas and is supplanted by healthcare organizations...

O pai acompanhante no processo de nascimento e parto: narrativas sobre a experiência / The companion father in the birth and delivery process: narratives about their experiences

Este estudo teve como objetivo conhecer e descrever as representações de pais a respeito de suas experiências como acompanhantes do processo de nascimento e parto. O método de pesquisa utilizado foi a análise da narrativa, composta das seguintes etapas: ouvir, contar, transcrever, analisar e ler a experiência. Os pais acompanhantes de parturientes foram entrevistados em uma maternidade privada localizada na Cidade de São Paulo. As narrativas foram analisadas de forma indutiva e interpretativa, o que possibilitou constatar que a experiência do acompanhamento do nascimento e parto é constituída por diferentes elementos; e incluiu o envolvimento das distintas fases do ciclo gravídico e puerperal, a assistência recebida nesse período, as várias abordagens relativas à paternidade, as vivências anteriores próprias e compartilhadas e as expectativas futuras relacionadas ao tema em estudo. Estas distintas maneiras de representar a experiência devem ser conhecidas e consideradas pelos membros da equipe de saúde que prestam assistência ao nascimento e parto com o envolvimento dos pais.

This study has had the objective of knowing and describes fathers' representations in regards to their experiences as companions in the process of birth and delivery. The method of research used was the narrative analysis, composed by the following stages: listen, tell, transcribe, analyse and read the experience. The companions' fathers were interviewed in a private maternity localized in the city of São Paulo. The narratives were analyzed in a inductive and interpretative way, what has enable us to verify that the experience of the accompanying of birth and delivery is constituted by different elements; and has included the involvement of the distinct phases of the pregnancy cycle, assistance received during this period, the several approaches of paternity, own and shared previous experiences and future expectations related to the theme of the study. These different ways must be known and considered by the members of the healthy team that support birth and delivery within the fathers' involvement.

Counselling-A necessary task for the obstetrician when a fetus suffers from a congenital malformation

Counselling for women during pregnancy is an important part of the obstetrician's tasks. When the patient is a pregnant woman whose fetus is found through ultrasound scanning to suffer from a congenital malformation, counselling becomes even more important. Objective: The objectives of this article are to explore women's perceptions of the ultrasound scanning and their satisfaction with the doctor's advice and investigate the factors affectted to the quality of counseling. Method: The research was conducted in Hanoi Obstetric Hosital, using participant observation and in-depth interviews with women pregnant with an anomalous fetus. Result: The research documents that women are not always satisfied with the counselling provided. Several factors affect the quality of counseling, notably the lack of trained health staff and the overload of work at the hospital. Conclusion: The article concludes that the counselling provided does not live up to women's expectations and that this has to do with the qualifications of health staff and the organization of hospital services. On the basis of the research, some recommendations are proposed in order to improve the quality of counselling, diagnosis and decision-making when a fetal malformation occurs