Una experiencia de acompañamiento con doula a adolescentes en trabajo de parto / Doula support during labor: experience in a sample of pregnant teenagers

Objetivo: Comparar la percepción del dolor-temor durante el trabajo de parto y parto, y el grado de dificultad-satisfacción con la experiencia de parto, en un grupo de adolescentes acompañadas por doula y otro con atención habitual. Método: El grupo estudio comprendió 80 adolescentes del "Programa Emprende Mamá" que controlaron sus embarazos en centros de salud de la comuna de La Florida y con parto en el hospital Dr. Sótero del Río, acompañadas por una mujer familiar o amiga, elegida por la joven, con capacitación previa de 2 horas. El grupo control estuvo formado por 80 adolescentes no participantes del programa, que controlaron sus embarazos en los mismos centros de salud, con parto en el mismo período. Resultados: El grupo estudio refirió menor percepción de dolor durante el trabajo de parto y parto, menor temor durante el parto y lo percibió como más fácil. No se encontraron diferencias significativas en el nivel de satisfacción respecto de la experiencia total. Sin embargo, las adolescentes con doula señalaron estar satisfechas por aspectos positivos de la vivencia, mientras que el grupo control centra su satisfacción en la ausencia de expectativas negativas temidas. Conclusión: El acompañamiento por doula en el parto de la embarazada adolescente, es una intervención de bajo costo que permite mejorar cualitativamente su vivencia de parto.

Objective: To compare the effects of continuous doula support and standard hospital care on pain and fear perception, during labor and delivery, as well as perception of difficulty and satisfaction with the birth experience, in a sample of pregnant teenagers. Method: The study group was conformed by eighty pregnant teenagers participants in "Emprende Mama Program" attended in the outpatient clinics of La Florida county for their prenatal care and delivery at a public hospital. They received emotional support during labor by a 2 hour trained female relative or friend, previously chosen by them. The control group was conformed by eighty non participants teenagers attended at the same outpatient clinics and delivery in the same period. Results: Teenagers with doula support reported less pain and fear during labor and delivery and perceived their birth experience as less difficult. No significant differences were reported in relation to satisfaction with birth experience. Although teenagers with doula support reported satisfaction due to positive aspects with birth experience, meanwhile the control group felt mostly satisfied due the absence of negative feared expectations. Conclusion: Labor support given by doula, is a low cost intervention which improves quality perception of birth experience in the adolescent pregnant.

Exposición crónica a plomo ambiental en lactantes chilenos II: efectos en el desarrollo psicomotor / Effects of chronic lead exposure on neurobehavioral development of Chilean lactating children

Background: Lactating children are specially susceptible to lead toxicity due to their underdeveloped nervous system, lower body mass, higher intestinal absorption and lower elimination rates. Aim: To determine the effects of lead exposure, comparing Chilean lactating children residing in rural areas with low lead exposure, and in urban areas with high lead exposure. Material and methods: Newborns from public maternity hospitals of the rural locality of San Felipe and from Metropolitan Santiago, were recruited for the study. On admission to the study, umbilical cord and maternal blood samples were obtained and an inquiry about perinatal, sociohereditary and lead exposure history was done. Children were followed every 6 months until 24 months of age, measuring blood parameters and neurobehavioral development using Bayley scales. Results: Three hundred twelve children from Santiago and 113 from San Felipe were studied. Maternal and children blood lead levels were higher in Santiago, but lower than those reported in other international studies. At 24 months of age, 4.5 percent of children from Santiago and 0.7 percent of children from San Felipe had levels over 10 µg/dl. No differences in neurobehavioral development were observed between children of both cities. At 24 months, scores of MDI scales were 91 in Santiago and 97 in San Felipe. The figures for PDI scale were 93 in Santiago and 93 in San Felipe. Main risk factors for a retarded neurobehavioral development were socioeconomic level with a mean Odds ratio of 3.5 (0.99-12.4), male sex with an Odds ratio of 2.3 (1.09-5.07) and stimulation at home with an Odds ratio of 0.7 (0.53-0.82. Conclusions: In this cohort of children, no effect of lead levels on neurobehavioral development was found

Impacto del apoyo emocional durante el parto en la disminución de cesáreas y gratificación del proceso / Emotional support impact during labor in cesarian decreasing and gratefulling the process

Se evaluó el efecto del apoyo durante el parto, mediante una acompañante elegida antes del parto, por la propia embarazada, sobre la incidencia de cesáreas, proceso de parto y satisfacción del mismo. La investigación clínica se ralizó en la maternidad del Hospital J.J. Aguirre (1997-1999). El estudio aleatorizado incluyó un grupo de intervención con acompañante (217 gestantes) y otro control (218). La muestra consideró 40 por ciento incidencia de cesáreas, 30 por ciento reducción, alfa, 0,05 beta 80 por ciento. El análisis calculó riesgo relativo con intervalo de confianza 95 por ciento. Los grupos fueron semejantes. Las embarazadas sintieron menos el temor al parto cuando hubo acompañante (RR 0,79 IC 0,63-0,99). No hubo diferencias en incidencia de cesáreas ni otros resultados maternos y neonatales. Los beneficios restringidos podrían explicarse por: capacitación simplificada de acompañante, o profesionales asumiendo ese papel y limitaciones impuestas por rutinas médicas independientes

Exposición crónica a plomo ambiental en lactantes chilenos / Chronic exposure to environmental lead in Chilean nursing infants

Background: in Chile, there are several sources of environmental lead exposure. However, the few studies about lead levels in Chilean infants, do not allow to establish the prevalence of high lead in this population. Aim: to measure blood lead levels in nursing infants, living in rural and urban areas, from birth until two years of age. Subjects and methods: newborns from public maternity hospitals in Santiago and a rural area were selected for the study. An umbilical cord blood sample was obtained at bird and venous blood samples thereafter, every 6 months until the age of 24 months. Lead levels were measured by atomic absorption spectrophotometry atmospheric lead was measured simultaneously every week in Santiago and the rural area. Results: three hundred twelve children from Santiago and 113 from the rural area completed the 24 months follow-up. The mean lead exposure for infants living in Santiago and in the rural area was 1.23 ñ 0.66 and 0.19 ñ 0.15 µg/m3 respective (p < 0.001). Mean blood levels were always higher in infants from Santiago, compared to those from the rural area. At 24 months, 4,5 percent of children from Santiago and 0,7 percent of children from the rural area had blood lead levels over 10 µg/dl. Significant risk factors for high lead levels were recent paining of the house where the infant lives, eating soil bitting banisters and familiar labor exposure to lead. Conclusions: infants living in an urban area and exposed to increased atmospheric lead levels have higher blood lead levels than infants living in a rural area