Models of maternity care: a continuity of midwifery care

Pregnancy and birth are significant life events for women and their families and midwife supports a woman throughout pregnancy, birth and the postnatal period. So, the demand for services that are family friendly, women focused, safe and accessible is increasing. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. Because pregnancy and childbirth involve every part of feelings, physical and practical needs, hopes, religious and spiritual beliefs can all affect pregnancy and birth. So, model of maternity care addresses all these aspects to help give birth safely, naturally and confidently. The aim of this review is how midwives working in different model care constructed their midwifery role in order to maintain a positive work-life balance. Evidence from high income countries found such models to be a cost-efficient way to improve health outcomes, reducing medical interventions and increasing satisfaction with care.

El parto y el nacimiento en la modernidad. Una visión con perspectiva de género desde la enfermería obstétrica / Birth and birth in modernity . a gender perspective from obstetric nursing

El estudio está suscrito dentro de las líneas de investigación sobre salud sexual y reproductiva. Haciendo especial atención en los procesos reproductivos de las mujeres: parto y nacimiento, eventos que la obstetricia en manos del modelo biomédico hegemónico, ha expropiado del cuerpo de las mujeres. Para precisar la realidad requerimos develar el imaginario colectivo sobre el parto y el nacimiento construido por las enfermeras a través de su praxis hospitalaria. Enmarcamos la mirada teórica desde el feminismo como teoría y epistemología contestataria de la concepción patriarcal del mundo en torno a la mujer. Nos apropiamos de la categoría de género como metodología analítica siguiendo el camino cualitativo. El grupo sujeto de estudio, estuvo conformado por cinco enfermeras con Maestría en Ciencias de la Enfermería, más de 5 años de experiencia profesional en la sala de partos del I.V.S.S. "Dr. José María Carabaño Tosta" de la Ciudad de Maracay/Aragua. La representatividad de la investigación estuvo garantizada por la calidad de la información obtenida a través del punto de saturación del conocimiento. La construcción del análisis fue enriquecido por los testimonios recogido a través de las entrevistas enfocadas. La construcción del análisis se realizó a través de la categorización de eventos críticos, con los cuales evidenciamos la realidad del trato medicalizado, tecnocratizado y patologizador que se les dan a las mujeres en las salas de parto producto de la formación tecnocrática que reciben las enfermeras en manos del modelo biomédico hegemónico, conceptualizando a las mujeres como seres netamente reproductores.

The study is part of the research lines on sexual and reproductive health, focusing on the reproductive processes of women: labor and childbirth, events that obstetrics - in the hands of the hegemonic biomedical model - has expropriated from women's bodies. In order to clarify this fact, we need to unveil the collective imaginary about labor and childbirth, constructed by nurses through their hospital praxis. We frame the theoretical view from feminism as a theory and argumentative epistemology from the patriarchal conception of the world around the woman. We appropriate the category of gender as analytical methodology following the qualitative approach. The research group was composed of five nurses with a Master in Nursing Science, over 5 years of professional experience in the labor room at the "Dr. José María Carabaño Tosta" I.V.S.S. (Venezuelan Institute of Social Security - Government health care) in Maracay City/Aragua state.The representativeness of the research was guaranteed by the quality of the information obtained through the saturation point of knowledge. The construction of the analysis was enriched by the testimonies collected through the focused interviews. The construction of the analysis was done through the categorization of critical events, with which we showed the reality of the medicalized, technocratized and pathologizing treatment given to women in the labor rooms as a result of technocratic training received by nurses in hegemonic biomedical model, conceptualizing women as purely reproductive beings.

Pregnancy and Delivery in a Generalized Dystonia Patient Treated with Internal Globus Pallidal Deep Brain Stimulation: a Case Report

Internal globus pallidus (GPi) deep brain stimulation (DBS) has been widely accepted as an effective treatment modality of medically refractory dystonia. However, there have been few studies regarding the safety issue of pregnancy and childbirth related with DBS. This report describes a female patient who was pregnant and delivered a baby after GPi DBS surgery. A 33-year-old female patient with acquired generalized dystonia underwent bilateral GPi DBS implantation. She obtained considerable improvement in both movement and disability after DBS implantation. Four years later, she was pregnant and the obstetricians consulted us about the safety of the delivery. At 38-weeks into pregnancy, a scheduled caesarian section was carried out under general anesthesia. After induction using thiopental and succinylcholine, intubation was done quickly, followed by DBS turn off. For hemostasis, only bipolar electrocautery was used. Before awakening from the anesthesia, DBS was turned on as the same parameters previously adjusted. After delivery, she could feed her baby by herself, because the dystonia of left upper extremity and hand was improved. Until now, she has been showing continual improvement and being good at housework, carrying for children, with no trouble in daily life. This observation indicates that the patients who underwent DBS could safely be pregnant and deliver a baby.

The influence of the type of birth and the mother´s diet on the breastfeeding period / La influencia del tipo de nacimiento y dieta materna en el período de lactancia

The prenatal aspects may influence the duration of breastfeeding of newborns, which when reduced harm to their development brings cranio-orofacial. Correlate the type of delivery and maternal diet with breastfeeding period. This was a descriptive study based on the records of the medical records of 820 dyads of mothers and newborns participating in the University Extension Baby Clinic. The results were analyzed, considering a significance level of 5 percent. The absence of complications during pregnancy was a positive factor for the occurrence of vaginal delivery in 94 percent of the sample (p< 0.001). It was found a high percentage of cesarean delivery (43 percent). The number of caesarean sections in women with cariogenic diet was higher than in women with non-cariogenic diet. The women who have a cariogenic diet does not have a tendency to breastfeed their children for more than 6 months (p<0.01). Also there was an association between vaginal delivery and longer period of 6 months of breastfeeding (p<0.001). The collected sample mode of delivery and maternal diet influence the duration of breastfeeding.

Los aspectos prenatales pueden influir en la duración de la lactancia materna de los recién nacidos y cuando ésta se reduce puede alterar el desarrollo cráneo- orofacial. El objetivo de esta investigación fue correlacionar el tipo de parto y la dieta materna con el tiempo de duración de la lactancia materna. Se realizó un estudio descriptivo sobre la base de los registros de las historias clínicas de 820 binomios madres-recién nacidos asistentes a la Clínica del Bebé de Extensión Universitaria. Se analizaron los resultados, considerando un nivel de significación del 5 por ciento La ausencia de complicaciones durante el embarazo fue un punto positivo para la ocurrencia de parto vaginal en el 94 por ciento de la muestra (p < 0,001). Se encontró un alto porcentaje de partos por cesárea (43 por ciento). El número de cesáreas en mujeres con dieta cariogénica fue mayor que en las mujeres con la dieta no cariogénica. Las mujeres que tienen una dieta no cariogénica tenían una tendencia a amamantar a sus hijos durante más de 6 meses (p<0,01). También hubo una asociación entre el parto vaginal y mayor período de 6 meses de lactancia materna (p<0,001). En la muestra analizada el tipo de parto y la dieta materna influencian la duración de la lactancia materna.

Home delivery in Southern Lao PDR: Challenges to achieving MDG 4 and 5 targets

@#<p style="text-align: justify;">This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.</p> <p style="text-align: justify;">A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.</p> <p style="text-align: justify;">The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.</p> <p style="text-align: justify;">Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.</p>

Alterações na rede social de apoio durante a gestação e o nascimento de filhos / Changes in mothers' social support network during pregnancy and childbirth

A rede social de apoio tem sido enfatizada como um dos aspectos mais importantes para o bem-estar materno durante a gestação e o nascimento dos filhos. Este estudo teve como objetivo verificar as alterações no apoio prestado por familiares e não familiares durante esse período, na perspectiva de 45 mulheres grávidas e de 42 com bebês de até seis meses. A coleta de dados consistiu na aplicação de um questionário de caracterização do sistema familiar e de uma entrevista semiestruturada, visando obter informações sobre a estrutura e o funcionamento da família e de sua rede social durante a gestação e o nascimento dos filhos. Os resultados apontaram mudanças na vida familiar, durante essa transição, quanto ao contato social e ao suporte emocional e material. Os dados sugerem a importância da elaboração de programas de educação familiar para a manutenção do equilíbrio familiar, nesse período.

The social support network has been highlighted as one of the most important factors in maintaining the welfare of mothers during pregnancy and childbirth. The aim of this study is to ascertain the changes in support from family and others during this period, according to 45 pregnant women and 42 women with children under six months old. Data was collected by administering a family questionnaire and a semi-structured interview, focusing on information about the characterization of the family and the social support network during pregnancy and childbirth. The results show that the main changes occurred with social contact and psychological and material support. We suggest that family educational programs are fundamental in helping families during this period of transition.

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...