Parto domiciliar planejado no Brasil: uma revisão sistemática nacional / Planned home birth in Brazil: a systematic review

Resumo O parto domiciliar planejado (PDP) tem crescido cada vez mais no Brasil, especialmente nos grandes centros urbanos, frente à crescente insatisfação das mulheres com o sistema obstétrico hospitalar vigente. Estudos internacionais demonstram a segurança do PDP, porém a produção nacional ainda é limitada nesta área. Desta maneira, este estudo objetivou revisar a produção bibliográfica nacional acerca de parto domiciliar entre os anos de 2008 e 2018, a fim de compilar dados relacionados ao PDP no Brasil. Após levantamento, 18 estudos foram incluídos na revisão, sendo subdivididos nas seguintes categorias: "Desfechos maternos e neonatais dos PDP", "Sentimentos, motivação e perfis associados à escolha pelo PDP", "Percepção dos profissionais que atendem PDP" e "Abordagem teórica do PDP". Concluiu-se que o PDP tem crescido entre parcelas privilegiadas da população, representando importante prática de exercício da autonomia da mulher em contraponto ao modelo obstétrico vigente, apresentando-se como alternativa segura de local de parto, com alto grau de satisfação para as mulheres e famílias. Este modelo de assistência, entretanto, apresenta-se como opção limitada, uma vez que o PDP não é oferecido pelo Sistema Único de Saúde, ainda inacessível para a maioria das mulheres no país.

Abstract Planned home birth (PHB) has grown in Brazil, especially in large urban centers, in the face of women's dissatisfaction with the current obstetric system. International studies have demonstrated the security of PHB, but national production about this area is still limited. Thus, this study aimed to review the national bibliographic production about PHB between 2008 and 2018, in order to compile data related to PHB in Brazil. After survey, 18 studies were included in the review, and then subdivided into the following categories: "Maternal and neonatal outcomes of PHB", "Feelings, motivation and personal characteristics of women that choose PHB", "Perception of professionals that practice PHB" and "Theoretical approach to PHB". It was concluded that the PHB has grown between privileged portions of Brazilian population, representing the important practice of women's autonomy, presenting itself as a safe alternative place of birth, with a high degree of satisfaction of women and families. However, this model of assistance presents itself as a limited option, since the PHB is not offered by the Health System, still unaccessible to most of women in the country.

Apgar scoring system in Brazil's live births records: differences between home and hospital births / Escala de Apgar nos registros de nascidos vivos do Brasil: discordância entre parto normal hospitalar e parto domiciliar

Abstract Objective To promote informed choice for women and to compare home andhospital births in relation to the Apgar score. Methods Mother's profile and Apgar score of naturally born infants (without forceps assistance) in Brazil between 2011 and 2015, in both settings-hospital or home-were collected from live birth records provided by the Informatics Department of the Unified Health System (DATASUS, in the Portuguese acronym). For the analysis, were included only data fromlow-riskdeliveries, including gestational time between 37 and 41weeks, singleton pregnancy, at least four visits of prenatal care, infants weighing between 2,500 g, and 4,000 g, mother age between 20-40 years old, and absence of congenital anomalies. Results Home birth infants presented significantly higher risk of 0-5 Apgar scores, both in 1 minute (6.4% versus 3%, odds ratio [OR] = 2.2, confidence interval [CI] IC 2-2.4) and in 5 minutes (4.8% versus0.4%,OR = 11.5,CI 10.5-12.7). Another findingis related to recovery estimateswhen from an initially bad 1-minute Apgar (<6) to a subsequently better 5-minute Apgar (> 6). In this scenario, home infants had poorer recovery, Apgar scorewas persistently < 6 throughout the fifth minute in most cases (71% versus 10.7%, OR 20.4, CI 17-24.6). Conclusion The results show worse Apgar scores for babies born at home, compared with those born at the hospital setting. This is a pioneer and preliminary study that brings attention concerning differences in Apgar score related to home versus hospital place of birth in Brazil.

Resumo Objetivo Promover a escolha informada para asmulheres, comparando os resultados de partos domiciliares e hospitalares em relação à escala de Apgar. Métodos Foramcoletadas as informaçõesmaternas e a pontuação Apgar de nascidos de parto normal (pela definição, sem auxílio de fórcipe) no Brasil, de 2011 a 2015, a partir de registros de nascidos vivos disponibilizados pela plataforma do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para a análise, incluímos somente dados de partos de baixo risco ocorridos em hospitais ou residências, incluindo tempo de gestação entre 37 e 41 semanas, gestação única, pelo menos quatro consultas de pré-natal, crianças com peso entre 2.500 g e 4.000 g, e idade materna entre 20 anos e 40 anos e ausência de anomalias congênitas. Resultados Em comparação ao nascido em ambiente hospitalar, o nascido em domicílio apresentou risco significativamente maior de pontuação 0 a 5, tanto no primeiro minuto (6,4% versus 3%, razão de chance [RC] = 2,2, intervalo de confiança [IC] 2-2,4) como no quinto minuto (4,8% versus 0,4%; RC = 11,5; IC 10,5-12,7). Outro achado que merece destaque é em relação às estimativas de recuperação quando de um Apgar inicialmente ruimao primeirominuto (< 6) para um subsequentemelhor (> 6) no quinto minuto. Neste cenário, os nascidos em domicílio apresentaram menor recuperação até o quinto minuto, persistindo em Apgar < 6 na maior parte dos casos (71% versus 10,7%; OR 20,4; IC 17-24,6). Conclusão Os resultados indicam piores escalas de Apgar para bebês nascidos em ambiente domiciliar, em comparação àqueles nascidos em ambiente hospitalar. Este é um estudo pioneiro e preliminar que atenta para as diferenças na escala de Apgar em relação ao local de nascimento domiciliar versus hospitalar no Brasil.

A opção pelo parto domiciliar planejado: uma opção natural e desmedicalizada / Choosing the home planned childbirth: a natural and drug-free option / Opción para el parto hogar planificada: una elección natural y desmedicalizada

Objetivo: Analisar com base no referencial teórico de Dorothy Smith, a opção de mulheres pelo parto domiciliar planejado com fator de segurança e conforto para a mulher. Métodos: Estudo etnográfico institucional, com 17 mulheres que pariram no domicílio no período de 2008 a 2010 no município do Rio de Janeiro, aplicando entrevista semiestruturada na coleta dos dados, analisados conforme a análise temática articuladas com a teoria de Dorothy Smith. Resultados: A expressão do parto natural faz-se presente nas concepções das mulheres, expressando, em maior conforto e liberdade, uma relação de confiança com o profissional de saúde, transmitindo uma segurança para a opção do parto domiciliar. Conclusão: Concluiu-se que o encontro com o referencial ratifica a conscientização e o fortalecimento da mulher, que se empodera em defesa ao acesso da informação, e uma relação saudável com o profissional de saúde

Objective: The study's purpose has been to analyze, based on Dorothy Smith's theoretical framework, the women's choice for the home planned childbirth as a safety factor, as well as a women's comfort issue. Methods: It is an institutional ethnographic study with 17 women who gave birth at home over the period from 2008 to 2010 in Rio de Janeiro city by applying a semi-structured interview in the data collection, and then analyzed according to the thematic analysis articulated with Dorothy Smith's Theory. Results: The expression of natural childbirth is present in the women's conceptions, expressing through greater comfort and freedom a relationship of trust with the health professional, thus conveying security towards the home childbirth option. Conclusion: It was concluded that the encounter with the referential ratifies both awareness and empowerment of the women, who in turn get empowered toward the defense of access to information, and also toward a healthy relationship with the health professional

Objetivo: Analizar basa en el marco teórico de Dorothy Smith, la elección de las mujeres para el factor de parto en casa planeado de seguridad y comodidad para la mujer. Métodos: Estudio etnográfico Institucional com 17 mujeres que dieron a luz en el hogar en el período de 2008 a 2010 em la ciudad de Río de Janeiro la aplicación de entrevistas semiestructuradas para recopilar datos, y analizados de acuerdo con el análisis temático articulado con la teoría de Dorothy Smith. Resultados: La expresión de parto natural está presente en las concepciones de la mujer, que expresa uma mayor comodidad y libertad, una relación de confianza con el profesional de la salud, transmitiendo una seguridad para la opción de parto en casa. Conclusión: Se concluye que la reunión con el punto de referencia confirma la sensibilización y capacitación de las mujeres, que faculta, en defensa de acceso a la información, y una relación sana con el profesional de la salud

Características y Prevalencia de Partos Domiciliarios en un distrito Rural de la Sierra del Perú, 2015-2016 / Characteristics and prevalence of home births in a rural district of the Sierra of the Peru, 2015-2016

RESUMEN Introducción y objetivos: En el Perú, un país en vías de desarrollo, las cifras de partos domiciliarios en zonas rurales incrementan las tasas de mortalidad materna y neonatal, por tal razón el objetivo del trabajo fue: Determinar la prevalencia y características de los partos domiciliarios en la provincia de Ocongate, zona rural del departamento de Cusco en la sierra del Perú, 2015-2016. Materiales y Métodos: Se realizó un estudio observacional, de diseño de casos y controles, donde se incluyó 46 casos, de mujeres con parto domiciliario y 100 controles con partos institucionales registrados en los años 2015 y 2016, se exploraron resultados descriptivos de características sociodemográficas y Gineco-Obstétricas. Realizando análisis bivariado con la prueba estadística del chi cuadrado, calculando los Odds Ratio e intervalos de confianza al 95% (IC95%) con Regresión Logística Múltiple. Resultados: De 558 partos registrados 49 (8,7%) fueron partos domiciliarios, donde la edad promedio fue de 25,3 ± 6,4 años; en el análisis multivariado encontró que: no tener ningún control prenatal [OR=12,2; IC95% 4,6-64,9]; tener antecedente de parto domiciliario [OR=4,5; IC95% 1,01-20,5]; vivir a una distancia > de 90 minutos [OR=3,2; IC95% 1,08-10,2]; y tener una captación tardía de a gestante, ser factores de riesgo para tener un parto domiciliario. Conclusiones: En la mayoría de mujeres que tuvieron partos domiciliarios influyó negativamente la captación tardía de la gestante, un mayor tiempo de viaje al centro de salud, antecedente de parto domiciliario, y no tener ningún control prenatal, siendo necesario diseñar estrategias para disminuir los partos domiciliarios en zonas rurales del Perú.

ABSTRACT Introduction and objectives: In Perú, Maternal and neonatal mortality rates are increased by the non-institutional births in rural areas. This is why the study's objective was to determine the prevalence and characteristics of non-institutional births in the province of Ocongate, a rural area located in Cusco, in the highland of Peru, 2015-2016 Methods and materials: An observational case-control study was conducted, which included 46 cases of noninstitutional births and 100 controls of institutional births between 2015 and 2016. Gynecological, Obstetric and sociodemographic characteristics are described and analyzed by a bivariate analysis, which was performed with chi square statistical test calculating the Odds Ratio and 95% confidence intervals (95% CI) with Multiple Logistic Regression. Results: Forty-nine (8.7%) of the total registered deliveries were non-institutional births. The average age was 25.3 ± 6.4 years. In the multivariate analysis, it was found that: not having any prenatal control [OR = 12.2; 95% CI 4.6-64.9]; having a history of home birth [OR = 4.5; 95% CI 1.01-20.5]; living at a distance of> 90 minutes [OR = 3.2; 95% CI 1.08-10.2]; and having a late uptake of a pregnant woman, are all risk factors for having a noninstitutional birth. Conclusions: The majority of women who had non-institutional births was negatively affected by the late pregnancy uptake, a longer travel time to the nearest health center, a previous non-institutional birth and no prenatal control. It is necessary to design strategies to reduce non-institutional births in rural areas of Perú.

Determinants of infant mortality in the Jequitinhonha Valley and in the North and Northeast regions of Brazil / Determinantes do óbito infantil no Vale do Jequitinhonha e nas regiões Norte e Nordeste do Brasil

ABSTRACT OBJECTIVE This study aims to identify the social and demographic determinants, in addition to the determinants of reproductive health and use of health services, associated with infant mortality in small and medium-sized cities of the North, Northeast and Southeast regions of Brazil. METHODS This is a case-control study with 803 cases of death of children under one year and 1,969 live births (controls), whose mothers lived in the selected cities in 2008. The lists of the names of cases and controls were extracted from the Sistema de Informação sobre Mortalidade (SIM – Mortality Information System) and the Sistema de Informação sobre Nascidos Vivos (SINASC – Live Birth Information System) and supplemented by data obtained by the research of “active search of death and birth”. Data was collected in the household using a semi-structured questionnaire, and the analysis was carried out using multiple logistic regression. RESULTS The final model indicates that the following items are positively and significantly associated with infant mortality: family working in agriculture, mother having a history of fetal and infant losses, no prenatal or inadequate prenatal, and not being associated to the maternity hospital during the prenatal period. We have observed significant interactions to explain the occurrence of infant mortality between race and socioeconomic score and between high-risk pregnancy and pilgrimage for childbirth. CONCLUSIONS The excessive number of home deliveries and pilgrimage for childbirth indicates flaws in the line of maternity care and a lack of collaboration between the levels of outpatient and hospital care. The study reinforces the need for an integrated management of the health care networks, leveraging the capabilities of cities in meeting the needs of pregnancy, delivery and birth with quality.

RESUMO OBJETIVO Identificar os determinantes sociais, demográficos, da saúde reprodutiva e de utilização dos serviços de saúde associados ao óbito infantil em municípios de pequeno e médio porte das regiões Norte, Nordeste e Sudeste do Brasil. MÉTODOS Trata-se de um estudo caso-controle com 803 casos de óbito de menores de um ano e 1.969 nascidos vivos (controles), cujas mães residiam em 2008 nos municípios selecionados. As listas nominais dos casos e do controles foram extraídas do Sistema de Informação sobre Mortalidade e do Sistema de Informação sobre Nascidos Vivos e completadas por dados obtidos pela pesquisa de “busca ativa de óbito e nascimento”. A coleta de dados foi realizada em domicílio por meio de questionário semiestruturado, e a análise, por meio de regressão logística múltipla. RESULTADOS O modelo final indicou que estão associadas positivamente e significativamente ao óbito infantil: a família trabalhar na agricultura, a mãe ter tido história de perdas fetais e infantis, não ter feito pré-natal ou ter tido um pré-natal inadequado e não estar vinculada à maternidade durante o pré-natal. Foram observadas interações significativas para explicar a ocorrência do óbito infantil entre cor de pele e escore socioeconômico e entre gestação classificada como de risco e peregrinação para o parto. CONCLUSÕES O número excessivo de partos domiciliares e de peregrinação para o parto indica falhas na linha de cuidado da gestante e desarticulação entre os níveis de atenção ambulatorial e hospitalar. O estudo reforça a necessidade de uma gestão integrada das redes de atenção à saúde, potencializando as capacidades municipais em atender, com qualidade, à gestação, ao parto e ao nascimento.

Parto acidental não-hospitalar como indicador de risco para a mortalidade infantil / Accidental non-hospital birth as an indicator of risk of infant mortality

Analisar diferenças na mortalidade infantil, segundo local do parto, no Estado de São Paulo (2009). Métodos: coorte de 252.201 nascidos vivos (NV) por parto vaginal, vinculados a 3289 óbitos infantis, por técnica determinística, divididos em: nascidos em hospitais (250.850) e em domicílio/outro local (1351). Foram calculadas probabilidades de morte e os riscos relativos (RR) e para avaliar o efeito de covariáveis sobre o óbito, utilizou-se modelo de regressão logística multinomial. Resultados: 0,5 por cento NV ocorreram em domicílio/outro local e apresentaram maior probabilidade de morte (45,2 por mil NV) do que os nascidos em hospitais (12,9). A mortalidade foi maior para os nascimentos fora do hospital em todos os componentes da mortalidade infantil: neonatal precoce (RR=3,9), neonatal tardio (RR=2,6) e pós-neonatal (RR=3,4). A probabilidade de morte diminuiu conforme aumentou o peso ao nascer, porém o risco de morte dos NV ≥2500 g em domicílio/outro local foi duas vezes maior que nos partos hospitalares. Após ajuste, nascer fora do hospital permaneceu como risco apenas para a mortalidade pós-neonatal. Conclusões: embora reduzidos, os partos fora do hospital apresentam maior risco de morte, inclusive no período pós-neonatal, sugerindo que há barreiras de acesso não só durante o pré-natal e parto, mas que estas persistem na atenção à criança no primeiro ano de vida...

To examine diferences in infant mortality rates by place of birth, in the State of São Paulo (2009). Methods: a cohort of all 252,201 live vaginal births, with 3,289 infant deaths, was obtained from a deterministic linkage and divided into those born in hospital (250,850) and those born at home or else-where (1351). The probability of death and relative risk (RR) were calculated and a multinomial logistic regression model was used to assess the effect of co-variables on mortality. Results: 0.5 percent live births occurred in the home or elsewhere outside the hospital and presented a greater likelihood of mortality (45.2 per thousand live births) compared with those born in hospital (12.9). Mortality was higher for births outside of hospital for all types of infant mortality: early neonatal (RR=3.9), late neonatal (RR=2.6) and post-neonatal (RR=3.4). The likelihood of death diminished as birth weight increased, although the risk of death for live births ≥2500 g in the home or elsewhere was twice as high as for hospital births. After adjustment, being born outside of hospital continued to be a risk factor for post-neonatal mortality. Conclusions: although few in number, births outside of hospital present a greater risk of death, including post-neonatal mortality, suggesting that there are barriers to access not only during the prenatal period and delivery, but also throughout the first year of life...

Perfil de casais que optam pelo parto domiciliar assistido por enfermeiras obstétricas / Profile of couples who opt for home birth assisted by obstetric nurses

Esta pesquisa exploratório-descritiva foi desenvolvida com o objetivo de identificar as características sociodemográficas de casais que optam pelo domicílio como local para a ocorrência do parto. Participaram 25 casais que elegeram os serviços de uma equipe de enfermeiras obstétricas que assiste a partos domiciliares, em Florianópolis-SC. As informações foram obtidas por meio dos registros em prontuários dos atendimentos prestados pelas enfermeiras e de entrevistas semiestruturadas com os casais praticantes do parto domiciliar planejado, tendo sido realizada análise descritiva do perfil obtido. Identificou-se que a maioria dos casais era de pessoas com formação superior, relacionamento estável, que residiam em casa própria e tinham estabilidade profissional. Grande parte dos participantes não era natural de Florianópolis e alguns casais vieram de outras cidades para que o parto ocorresse nesta cidade. Foi possível concluir que a opção pelo parto em casa está atrelada à revalorização do ambiente doméstico, e não a um resgate do passado.

Resultado de partos domiciliares atendidos por enfermeiras de 2005 a 2009 em Florianópolis, SC / Outcomes of planned home birth assisted by nurses, from 2005 to 2009, in Florianópolis, Brazil

Estudo transversal sobre resultados obstétricos e neonatais dos partos domiciliares planejados assistidos por enfermeiras obstétricas em Florianópolis, SC. Dados coletados nos prontuários de 100 parturientes assistidas de 2005 a 2009 apontam 11 transferências hospitalares, sendo nove submetidas a cesariana. A maioria das que pariram no domicílio apresentou batimentos cardíacos fetais (94,0%) e evolução no partograma normais (61,0%), adotou posição vertical na água, no período expulsivo (71,9%), e os recém-nascidos receberam Apgar do 5° minuto > 7 (98,9%). A frequência de episiotomia foi 1,0%, 49,4% não necessitaram sutura perineal. Os resultados indicam que o parto domiciliar é seguro.

A cross-sectional study was performed to analyze obstetric and neonatal results of planned home births assisted by obstetric nurses in the city of Florianópolis, Southern Brazil. Data collected from the medical records of 100 parturient women cared for between 2005 and 2009 indicated 11 hospital transfers, nine of which underwent a Cesarean section. The majority of women who had a home birth showed normal fetal heart beat (94.0%) and progress on the partogram (61.0%), vertical water delivery was the position most frequently chosen (71.9%), newborns had an Apgar score > 7 at five minutes (98.9%), episiotomy was performed in 1.0%, and 49.4% did not need perineal suturing. Outcomes indicated that planned home birth is safe.

Parto e nascimento domiciliar assistidos por parteiras tradicionais: o programa trabalhando com parteiras tradicionais e experiências exemplares / Labor and birth at home assisted by traditional midwives: the program working with TBAs and exemplary experiences

O Ministério da Saúde tem como uma de suas prioridades a atenção integral à saúde da mulher e da criança. No que se relaciona particularmente à melhoria da assistência obstétrica – com vistas à redução da morbimortalidade materna e neonatal e à ampliação do acesso, da qualificação e da humanização da atenção pré-natal, ao parto, ao nascimento, ao puerpério, ao recém-nascido e à situação de abortamento – o Ministério vem desenvolvendo um conjunto de estratégias, incluindo-se entre elas a melhoria da atençãoao parto e nascimento domiciliar assistidos por parteiras tradicionais.

A study on delivery and newborn care practices in a rural block of West Bengal.

A cross-sectional study was conducted in a rural block of the State of West Bengal to generate area specific data on the proportion of home deliveries and certain newborn care practices prevalent in that area. The study was done through house-to-house survey among 165 mothers who delivered in last six months. 83.6% deliveries were conducted at home and untrained persons attended 36.3% deliveries. Bath within 24 hours of delivery was given to 17.58% newborns. Birthweight was not recorded in 38.18%. High proportion of newborns, 78.5%, was given prelacteal feeding. The health system should urgently address the deficiencies in the delivery and newborn care practices in the study area.

Barriers to hospital births: why do many Bolivian women give birth at home? / Barreras al parto hospitalario: ¿por qué muchas bolivianas dan a luz en casa?

OBJECTIVES: This study investigated the low rates of hospital/health center births recorded in Yapacaní, Bolivia, that persist despite the national maternal-infant insurance program designed to ensure equitable access to free center-based health care services for pregnant women. The purpose of this study was to identify the multilevel factors inhibiting access to and utilization of public health centers for labor and delivery. METHODS: Qualitative research methods were used, including participant observation, semistructured interviews of 62 community members, and key informant interviews with eight regional experts. Data were coded and analyzed using the grounded theory approach. RESULTS: From the semistructured interview data, five reasons for the low rate of institutional births and their frequency were identified: (1) fear or embarrassment related to receiving care at a public health care center (37 percent); (2) poor quality of care available at the health care centers (22 percent); (3) distance from or other geographic issues preventing timely travel to health care services (21 percent); (4) economic constraints preventing travel to or utilization of health care services (14 percent); and (5) the perception that health care services are not necessary due to the experience of "easy birth" (6 percent). CONCLUSIONS: The reasons for the low rate of births in public health centers exist within the context of deficient resources, politics, and cultural differences that all influence the experience of women and their partners at the time of birth. These large scale, contextual issues must be taken into account to improve access to quality health care services for all Bolivian women at the time of birth. Resources at the national level must be carefully targeted to ensure that governmental services will successfully instill confidence in Bolivian women and facilitate their overcoming the cultural, geographic, economic, and logistical barriers...

OBJETIVOS: Se investigó la baja tasa de partos en hospitales y centros de salud de Yapacaní, Bolivia, que persiste a pesar del programa nacional de seguro materno-infantil diseñado para garantizar el acceso equitativo a centros gratuitos de atención sanitaria para embarazadas. El objetivo de este estudio fue identificar los factores que a diversos niveles inhiben el acceso a centros públicos de salud para partos y su utilización. MÉTODOS: Se emplearon métodos cualitativos, entre ellos la observación participante, entrevistas semiestructuradas a 62 miembros de la comunidad y entrevistas a informantes clave con ocho expertos regionales. Los datos se codificaron y analizaron mediante el enfoque de teoría fundamentada. RESULTADOS: A partir de las entrevistas semiestructuradas se identificaron cinco razones para la baja tasa de partos institucionales y se establecieron sus frecuencias: 1) miedo o vergüenza a atenderse en un centro público de salud (37 por ciento); 2) baja calidad de la atención en los centros de salud (22 por ciento); 3) lejanía u otras barreras geográficas que impedían llegar oportunamente a los centros de salud (21 por ciento); 4) limitaciones económicas que impedían hacer el viaje o utilizar los servicios (14 por ciento); y 5) la percepción de que la atención sanitaria no era necesaria debido a la experiencia de "partos fáciles" (6 por ciento). CONCLUSIONES: Las razones de la baja tasa de partos observada en los centros públicos de salud estudiados se insertan en un contexto de escasos recursos, políticas deficientes y diferencias culturales que influyen en la experiencia de las mujeres y sus parejas en el momento del parto. Para mejorar el acceso a una atención sanitaria de calidad para todas las mujeres bolivianas en el momento del parto se deben tomar en cuenta estos problemas generalizados y contextuales. A nivel nacional, los recursos deben asignarse con cuidado para garantizar que los servicios gubernamentales logren...

Factors associated with home deliveries in Thampalakamam, Trincomalee.

INTRODUCTION: In Sri Lanka, more than 95% of women deliver in hospital. There is regional variation in the rate of home deliveries, and in some areas a significant number of mothers deliver at home. OBJECTIVE: The objective of the present study was to identify the factors associated with home deliveries in Thampalakamam, Trincomalee. METHODOLOGY: Ours was a community based, exploratory type of case control study. Cases were home deliveries during the period from Jan 1, 2000 to Dec 31, 2002 in Thampalakamam Divisonal Director of Health Services (DDHS) area. Controls were institutional deliveries among women residing in Thampalakamam DDHS area during the same period. A total of 139 cases and 278 controls were identified for this study. Data was collected at the household level using an interviewer-administered questionnaire. RESULTS: The following factors were found to have strong association with home deliveries: being a Muslim (OR = 33.0, 95% CI 16.8-64.8), low (< grade 5) maternal education (OR = 3.5, 95% CI 1.8-6.6), parity more than 3 (OR = 3.2, 95% CI 1.5-6.6) not being visited by a public health midwife (OR = 2.4, 95% CI 0.8-6.9), not being seen by a medical officer during the antenatal period (OR = 7.0, 95% CI 0.6-83.3). Lack of transport (35.5%) was mentioned as main reason for home deliveries by the women. Of the home deliveries 95% were assisted by a traditional birth attendant. CONCLUSIONS: Poor education of women and deficiencies in the delivery of antenatal care were found to be important risk factors for home deliveries.

A study on intranatal care practices in a district of West Bengal.

A study was conducted at Birbhum district of West Bengal among mothers who delivered in last one year to generate area-specific community-based data on the proportion of home deliveries, assistance during conduction of delivery and the intranatal care practices followed in the district. A multistage 40 cluster sampling method was used to study 320 mothers in the district. 37.81% deliveries were conducted at home. About 25% deliveries were conducted by untrained birth attendants, unqualified practitioners or relatives and friends. In 85.13% of home deliveries, DDK was not used. 68.6% home deliveries were conducted on the floor without any clean covering sheet. Though a clean instrument was used to cut the cord in 86.78% of home deliveries, a clean cord tie was used in only 24.89% cases. In 36.36% home deliveries, something was applied on the cord stump. High proportion of deliveries assisted by untrained persons and high magnitude of faulty intranatal care practices observed in the study require urgent and appropriate intervention.

Situation of antenatal care and delivery practices.

OBJECTIVES: The study aims to assess the situation of antenatal care usage and delivery practices in the study area. (i) To study the coverage rate for ANC and hospital delivery in different age group, parity, educational status and economic status. (ii)To study the relation of ANC visit and hospital delivery. MATERIALS AND METHOD: The study design is descriptive cross sectional study. The study was carried out in ward no. 9 of Mahankal VDC, Kathmandu. 50 women of reproductive age group who had delivered live birth five years preceding the survey were selected. A semi-structured questionnaire was administered through informal interview. For the women with more than one child, the information was gathered for the last birth. The data were analyzed through the SPSS software. RESULTS: Antenatal visit was a success story. Seventy eight percent of women were using the services. More notable fact was that the 62% of the respondents made antenatal visits for four or more than four times. Seventy two percent of the respondents y received the tetanus toxoid shots. Sixty six percent of the deliveries were hospital deliveries assisted by the doctors. However, 34% of deliveries occurred at home. The difference in ANC visit in different age groups and parity was not much obvious. The educational effect was clear as nearly double women who attained SLC or above, made four or more ANC visit as compared to illiterates. ANC seen as pathway to the institutional deliveries, once again proved its potential. Around 90% of women who made four or more ANC visits delivered in hospital as compared to 18.18% of women who never made any ANC visit. CONCLUSION: The rate of antenatal care use and hospital deliveries in the study area is found good in percentage. The rapid urbanization is taking place in nearby VDCs of Kathmandu. The hospitals in the Kathmandu are accessible to these VDCs. This could be the reason behind increased antenatal care usage and hospital delivery in the study area.

Prevalence of home deliveries and antenatal care coverage in some selected villages.

A cross sectional study was conducted in 14 selected villages of Gazipur Thana with the aim to find the prevalence of home deliveries and ante natal care coverage. All those females who delivered in the recent past (within last three months) from the selected villages were the study population Data were collected by two trained interviewers with a semi-structured interview schedule. Study result shows that 83% of the respondents received ante natal check-up throughout their last pregnancy. Most of this group (88.5%) received this care from "Health Assistant or 'Family Welfare visitor's while only 3.1% received care from graduate doctors. Out of 505 respondents 91.3% of the respondents was found to have delivered at home while only 8.7% at institutions. Study findings also suggested that there was association of place of delivery with level of education and family income of the respondents. Also there was associations of utilisation of antenatal care with level of education and family income of the respondents.

Informe Trimestral del Departamento de Atención Integral de la Mujer Nicaragua 2001:: Evaluación trimestral de salud materna / Quarterly report of the department of comprehensive care to women, Nicaragua 2001: Assessment of maternal health quarterly

El Ministerio de Salud de Nicaragua a través del Departamento de Atención a la mujer presenta el porcentaje de captación temprana durante el primer trimestre del año 2001 en el país que es del 47%, registrandose un aumento del 2% en comparación al año2000 siendo lo normado un 60%. Los Silais de Chinandega, Masaya, Managua y Madriz donde se registra un mayor porcentaje en este período. Los Silais con mas bajas captaciones tempranas fueron: RAAN, Chontales y Jinotega, los que demandan mas esfuerzos en la atención temprana a la mujer embarazada para disminuir el riesgo ya que es una zona de limitado acceso geográfico. Se incluyen las estadisticas de la morbilidad relacionada con el embarazo por diferentes patologías; se menciona el porcentaje de la cobertura del parto intitucional y domiciliar ; las cesareas por Silais, cobertura de control puerperal ; los abortos segun grupos etareos , asi como las vigilancia de la mortalidad materna; causas obstetricas, procedencia de las muertes entre enero a marzo dle 2001.Al final se presenta la evaluación de los servicios de planificacion familiar; los servicios de detección precoz del Cancer cervico uterino y de mamas, se concluye con el número de defunciones por cancer del aparato reproductor femenino

Breast feeding patterns in an urban resettlement colony of Delhi.

Studies on duration and patterns of breast feeding based on recall may lead to a bias about the exact feeding status. The present study was designed to overcome this bias using the 'current status analysis method'. Mothers of 650 infants from 0 to 12 months of age attending a Health Centre were interviewed about the current feeding patterns of the infants and other socioeconomic variables. Month-wise prevalence of feeding patterns was determined. It was observed that breast feeding was maintained at a high level (more than 90%) throughout infancy while exclusive breast feeding showed a rapid decline. At 1 month, 74% and at 4 months, 46% of infants were exclusively breast-fed. The median duration of exclusive breast feeding was 3.83 months. Mothers with lesser education and lower family income were more likely to exclusively breast feed (p < 0.05). The time interval between birth and first breast feed was 24-48 hours in most (48.9%) of the infants. Majority (76.9%) of the infants received pre-lacteal feeds. Hospital-born infants received their first feed earlier and were less likely to receive pre-lacteal feeds as compared to those born at home (p < 0.001). Thus, the practice of exclusive breast feeding has to be promoted amongst pregnant and lactating mothers by health personnel. Also knowledge regarding infant feeding has to be imparted in schools and colleges.

Neonatal morbidity and mortality in Nigeria.

A retrospective analysis of neonatal morbidity and mortality was conducted over a ten-year period (1981-1990) at a tertiary hospital in Ilesa, Nigeria, to determine the trends in neonatal morbidity and mortality in relation to places of delivery. 7,225 babies were admitted into the neonatal unit during the period wherein 3,232 (44.7%) were inborns and 3,993 (55.3%) outborns. Places of delivery of outborn babies were government hospitals/maternity centres (44.1%), home (28.5%), private hospitals/clinics (18.8%), and mission houses (8.7%). Major indications for admission among inborns were neonatal jaundice (45.6%), low birthweight (18.6%), birth asphyxia (14.2%), and neonatal infections (9.3%), while those for outborns were neonatal jaundice (39.5%), low birthweight (23.2%), neonatal infections (18.0%), neonatal tetanus (5.7%), birth asphyxia (4.8%). Overall mortality rate was 13.0%. It was higher in outborns than inborns (p < 0.001). Mortality was lowest in 1983 and peaked in 1987 and 1988. It was higher in outborns than inborns during the period (p < 0.001). Major causes of death were low birth weight (42.8%), neonatal jaundice (14.1%), neonatal tetanus (12.8%), infections (12.4%), and birth asphyxia (11.6%). In almost all cases, case fatality rates were higher among the outborns (p < 0.001). Similarly, mortality was higher in outborns than inborns in almost all the weight range. Among the outborns, mortality was highest in babies delivered at home and private hospitals. Improved access to neonatal medical and antenatal care will significantly reduce neonatal morbidity and mortality in Nigeria.