Controle tecnológico do corpo e da vida: cesariana entre mulheres usuárias do setor privado / Control tecnológico del cuerpo y la vida: cesariana entre mujeres usuarias del sector privado / Technological control of the human body and life: c-section among women private sector users

Resumo O artigo analisa os sentidos que a ideia de controle do corpo e da vida adquire nos discursos acerca da decisão sobre o parto, a partir das falas de mulheres que realizaram cirurgia cesariana em maternidades privadas da região metropolitana do Rio de Janeiro e do município de São Paulo. A abordagem teórico-metodológica é da análise das práticas discursivas e produção de sentidos. Dor, integridade corporal, controle dos riscos, estética do parto e os tempos (social e reprodutivo) são acionados como elementos contidos no ideário de controle que circunda a cesárea como uma prática de nascimento. Esse controle seria exercido em redes de interações entre mulheres, familiares, profissionais, objetos tecnológicos médicos e não médicos e instituições.

Resumen El artículo analiza los sentidos que la idea de control del cuerpo y de la vida adquiere en los discursos acerca de la decisión sobre el parto a partir de las palabras de mujeres que realizaron cirugía cesárea en maternidades privadas de la región metropolitana de Río de Janeiro y del municipio de São Paulo. El enfoque teórico-metodológico es del análisis de las prácticas discursivas y la producción de sentidos. El dolor, integridad corporal, control de los riesgos, estética del parto y los tiempos (social y reproductivo) son accionados como elementos contenidos em el ideario de control que circunda la cesárea como una práctica de nacimiento. Este control se ejerceren redes de interacción entre mujeres, familiares, profesionales, objetos tecnológicos médicos y no médicos, e instituciones.

Abstract This paper analyses the way that the idea of control of body and life gets in the discourse about the decision on childbirth from the speech of women who underwent cesarean surgery in private hospitals in the metropolitan area of Rio de Janeiro and São Paulo. The theoretical-methodological approach is the analysis of discursive practices and the production of meanings. Pain, body integrity, risk control, birth aesthetics and times (social and reproductive) are triggered as elements contained in the control idea that surrounds cesarean delivery as a birth practice.This control would be exercised in interaction networks among women, family, professional, medical and non-medical technological objects, and institutions.

Percepción del dolor durante el trabajo de parto. Una revisión de los factores involucrados / Pain perception during labor. A review of factors

The pain experimented by women during the labor is considered as one of the most important, significative and stressing events in the life of a woman. It is widely known than labour is the caused of severe pain. Our purpose is to review the aspects related to the experience of acute pain of patients in labor, related to the normal physiology in this process and to describe different variables that can modify it. From the evidence we conclude that perception of pain is subjective and variable, and it is influenced or modified for multiple factors, by past living experiences or transmitted through generations, by socio-cultural environment and individual expectative in front of this event, also by psychological, clinical, biochemical and genetic factors that predispose to experience a different perception of its severity. This information seems relevant to us for a better comprehension of pain during the labor and for developing strategies that would allowed a relief in a more effective way helping the maternal-fetal welfare and a better experience of maternity, especially during labor.

El dolor experimentado por mujeres durante el trabajo de parto es considerado uno de los eventos más importantes, significativos e intensos en la vida de una mujer. Es ampliamente conocido que el trabajo de parto es causa de un dolor severo. Nuestro propósito es revisar los aspectos relacionados a la experiencia del dolor agudo en las pacientes en trabajo de parto, en cuanto a la fisiología normal de este proceso y describir diferentes variables que pueden modificarlo. Desde la revisión bibliográfica concluimos que la percepción del dolor es subjetiva y variable, y está influenciada o modificada por múltiples factores, por las experiencias pasadas vividas o transmitidas entre generaciones, por el entorno sociocultural y las expectativas individuales ante este evento, también por factores psicológicos, clínicos, bioquímicos y genéticos que predisponen a experimentar una percepción diferente en cuanto a su severidad y significado. Esta información nos parece relevante para una mejor compresión del dolor en el parto y para desarrollar estrategias que permitan su alivio de manera más efectiva, contribuyendo al bienestar materno-fetal y a una mejor experiencia de la maternidad, especialmente durante el trabajo de parto.

Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura / Autonomía femenina en el proceso de parto y nacimiento: revisión integradora de la literatura / Womens autonomy in the process of labour and childbirth: integrative literature review

RESUMO Objetivo Identificar as evidências disponíveis na produção científica acerca das práticas de assistência à saúde que interferem no exercício da autonomia das mulheres brasileiras no processo de parto e nascimento. Método A busca dos artigos foi desenvolvida nas bases de dados LILACS, Scopus e PubMed, no período entre 1996 e 2015, tendo como eixo orientador a questão norteadora e os critérios de exclusão, sendo selecionados 22 artigos como corpus de análise. Resultados Foram evidenciadas como práticas que favorecem o exercício da autonomia feminina: práticas assistenciais extra-hospitalares; práticas assistenciais de apoio e conforto; e práticas assistenciais educativas. Em contrapartida, revelaram-se como práticas limitantes ao exercício da autonomia: práticas assistenciais autoritárias; práticas assistenciais padronizadas ou rotineiras; práticas assistenciais que intensificam a sensação dolorosa do parto; e prática assistencial impessoal e fria. Conclusão Revelou-se uma situação de alerta relativa ao grande descompasso existente entre o cotidiano assistencial e as recomendações ministeriais.

RESUMEN Objetivo Identificar la evidencia disponible en la literatura científica acerca de las prácticas de atención de salud que interfieren con el ejercicio de la autonomía de las mujeres brasileñas en el proceso de parto y el nacimiento. Método La búsqueda de artículos se desarrolló en las bases de datos LILACS, Scopus y en PubMed, en el período comprendido entre 1996 y 2015, con el principio rector de los rectores criterios de interrogación y exclusión, y seleccionó 22 artículos como un corpus de análisis. Resultados Hemos puesto de relieve las prácticas que favorecen el ejercicio de la autonomía de la mujer: las prácticas de atención ambulatoria; prácticas de apoyo y consuelo; prácticas educativas y atención. Por el contrario se han demostrado como una limitación del ejercicio práctico de la autonomía: las prácticas de atención autoritarias; prácticas de cuidados estandarizados o de rutina; cuidado prácticas que mejoran la sensación dolorosa del parto; y la práctica de la atención impersonal y fría. Conclusión Se puso de manifiesto una situación de alerta en el gran desajuste entre su vida cotidiana y recomendaciones ministeriales.

ABSTRACT Objective To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. Method The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. Results The main practices that favoured the exercise of women’s autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. Conclusion There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

Examining the nexus of labour pain and culture using an applied social science framework

Birthing women can convey a cultural response to pain. The greater the cultural distance between a woman and her midwife, the greater the chance of misinterpretation of her labour experience. This paper examines childbirth beliefs, influences and practices, which contribute to cross-cultural understandings of pain. A literature search was conducted in April 2013. Studies were included if they had pain as the primary outcome and examined non-elicited pain language from the maternal perspective. Twelve articles were included. The language findings were reported in a companion paper. The present paper reported the cultural findings using an applied social science framework to reflect upon the nexus of pain and culture within pain communication and the development of culturally sensitive practice. The studies depicted shared childbirth beliefs and practices across African, Asian, European, North American and South American cultures, which in part is attributed to common physiological factors of childbirth. Childbirth may be impacted upon by 'internal' factors: pain reactions and attitudes, religion and spirituality, pain definition and meaning, anxiety, pain acceptance and tolerance, conceptualisation of motherhood, psychology, and societal beliefs; external factors may include the environment (physical setting or context of childbirth) and the model of care. The interpretation of these beliefs may be influenced by the midwife's development of their cultural competence.Viewing cultural patterns provides a cultural lens for midwives across care models (e.g. technocratic, humanistic, and holistic) to better understand women's experiences of pain, to reflect upon cross-cultural interpretation of pain and to develop cross-cultural competence.

Mujeres que dan a luz pueden transmitir una reacción cultural al dolor. Cuanto más distancia cultural hay entre una mujer y su matrona mayores la posibilidad de una interpretación errónea de su experiencia del dolor de parto. Este artículo examina las creencias, influencias y prácticas del parto que contribuyen al entendimiento transcultural del dolor. Se realizó una búsqueda de la literatura en abril de 2013. Fueron incluidos doce estudios lo cuales tuvieron el dolor como un resultado principal y examinaron el idioma del dolor no provocado (es decir, el idioma natural que no está obtenido por la evaluación estandarizada del dolor) de la perspectiva materna. Los resultados lingüísticos fueron presentados en otro artículo anterior. En cambio, este artículo presenta los resultados culturales usando un marco de ciencia social aplicada para reflexionar sobre el nexo del dolor y la cultura dentro de la comunicación del dolor y el desarrollo de una práctica culturalmente sensible. Los estudios representaron creencias y prácticas del parto compartidos por la cultura africana, asiática, europea, norteamericana y sudamericana que está atribuido ­en parte ­a los factores fisiológicos comunes del parto. El parto puede estar impactado por los factores 'internos': las reacciones y actitudes del dolor, la religión y espiritualidad, las definiciones y significaciones del dolor, la ansiedad, la aceptación y tolerancia del dolor, la conceptualización de la maternidad, la psicología, y las creencias sociales; los factores externos pueden incluir el ambiente (entorno físico u contexto del parto) y el modelo de atención. La interpretación de estas creencias puede estar influenciada por el desarrollo de competencia cultural de la matrona. Observarlos patrones culturales ofrece a las matronas unos lentes culturales, a través, de los modelos de atención(ej. tecnocrático, humanista, holístico) para entender mejor la experiencia del dolor de la mujer, para reflexionar sobre la interpretación transcultural del dolor y para desarrollar la competencia transcultural.

As dores do parto. Reflexões psicopatológicas em torno da angústia e do narcisismo primitivo / The pains of childbirth. Psychopathological reflections around anxiety and primitive narcissism / Los dolores del parto. Reflexiones psicopatológicas en torno de la angustia y del narcisismo primitivo

Este trabalho tem como ponto de partida os enigmas suscitados pelo discurso de duas pacientes para refletir sobre as dores do parto e o pathos nele implicado. O trabalho visa aprofundar a dimensão dolorosa do nascimento, posto que nele opera um processo de disjunção. Analisa-se como a dor e o sofrimento vivenciados por Tânia e Luíza no momento do parto configuram a angústia atrelada ao inquietante e ao narcisismo primitivo. O texto também ressalta a "lavagem das dores" como possibilidade terapêutica, a qual viabiliza a passagem da angústia provocada pela disjunção para a emergência do amor materno...

This work has as starting point the enigmas raised by the speech of two patients in order to reflect about the pain of childbirth and the pathos involved in it. The paper seeks to deepen the painful dimension of childbirth, as it operates a process of disjunction. It analyzes how the pain experienced by Tânia and Luíza at the time of childbirth configures the anxiety related with the uncanny and the primitive narcissism. The text also highlights the "washing of the pains" as a therapeutic option that eases the passage of the anxiety caused by the disjunction towards the emergence of maternal love...

Este trabajo tiene como punto de partida los enigmas suscitados por el discurso de dos pacientes para reflexionar en torno de los dolores del parto y el "pathos" en el implicado. El trabajo busca profundizar en la dimensión dolorosa del nacimiento puesto que en este opera un proceso de disyunción. Se analiza como el dolor vivenciado por Tânia e Luíza en el momento del parto configura la angustia relacionada con lo inquietante y el narcisismo primitivo. El texto también resalta la "limpieza de los dolores" como posibilidad terapéutica que viabiliza el pasaje de la angustia provocada por la disyunción hacia la emergencia del amor materno...

Daquilo que os médicos quase não falam: transe e êxtase na cena de parto. Experiências e percepções dissidentes de saúde e de bem-estar na contemporaneidade / What doctors hardly talk about: trance and ecstasy at the scene of childbirth. Dissident experiences and perceptions of health and welfare in contemporary times

Para os grupos de mulheres adeptas de outros modos de parir que não a cesárea e o modelo tecnocrático-hospitalar, a dor do trabalho de parto parece operar em outro registro, que não o da desordem e de algo a ser evitado. Dispostas a "sentir o parto", parecem ir ao encontro das contrações, das emoções e do descontrole, dando passagem para percepções de saúde que seriam atravessadas pela sexualidade e pela espiritualidade, por noções de êxtase e de transe. Diante disso, pretende-se explorar se e de que maneiras tais experiências e percepções têm desalojado a prática médica da "biopolítica", tematizando, para tanto, suas impressões e atitudes à luz da lógica das intensidades e dos afetos, de novos modos de subjetivação e da possibilidade de outras moralidades, que não mais a da histeria e a da fragilidade dos corpos das mulheres.

For the groups of women devotees of ways of giving birth other than cesarean section and the technocratic hospital model, the pain of labor seems to operate at another register, quite different from disorder and something to be avoided. Fully prepared to "experience the birth," they seem to eagerly embrace the contractions, the emotions and lack of control, giving expression to perceptions of health that appear to be permeated by sexuality and spirituality and by elements of ecstasy and trance. Therefore, the scope of this paper is to explore whether and in what ways these experiences and perceptions have dislodged the medical practice of "biopolitics," thereby examining their impressions and attitudes in light of the logic of the intense emotions and affection, namely of new modes of subjectivity and possibility of other moralities, other than hysteria and the fragility of women's bodies.

Representações e experiências das mulheres sobre a assistência ao parto vaginal e cesárea em maternidades pública e privada / Women's representations and experiences with vaginal and cesarean delivery in public and private maternity hospitals

Este estudo analisa as diferentes representações e experiências quanto ao parto vaginal e cesárea de mulheres de diferentes estratos sócio-econômicos, bem como a natureza das relações profissionais de saúde/usuárias no contexto institucional em que estão inseridas. A pesquisa de natureza qualitativa foi desenvolvida em três maternidades do Município do Rio de Janeiro, Brasil, sendo uma pública, uma conveniada com o SUS e uma particular, com mulheres que tiveram os dois tipos de parto. Os resultados revelam que o modelo de organização dos serviços público e privado apresentam variações que produzem diferentes tipos de assistência e de relação entre os profissionais de saúde e as usuárias, dando forma a experiências distintas entre as mulheres pesquisadas. Todavia, ao empreendermos uma crítica assentada nas relações de gênero, podemos verificar que o modelo de assistência ao parto permanece submetendo quem deve ser sujeito e reproduzindo o projeto da medicalização - mesmo que este processo se manifeste de formas diferenciadas entre os grupos estudados -, o que reduz o campo da assistência e inviabiliza um lugar de poder diferenciado das usuárias.

This study analyzes the different representations and experiences of women from different social classes, including issues related to their relations with hospital staff in different institutional settings. This qualitative study focused on women who had experienced both types of delivery, in three maternity hospitals in Rio de Janeiro, Brazil (one public, one fully private, and another private under an outsourcing agreement with the public health system). The study showed that variations in public and private service models result in different types of delivery care and different relations with staff, and are reflected in different birthing experiences for the women. However, a critical gender perspective shows that in both cases, the service models reproduce the medicalization of childbirth and women's submission as objects in the birthing process. Although this is manifested in different ways in the three groups, the end result is to reduce the range of care and the possibility of women's empowerment during childbirth.

[ process of women's decision making for selection of cesarean delivery]

Although cesarean section has been considered as a way for reducing infant and mother mortality rate, it has been changed to a general dilemma, so that in Iran, cesarean rate is higher than World Health Organization standards. The aim of this study was to discover the process of decision making for selection of cesarean delivery by those who did not have indication for cesarean. Grounded theory method was used in this study. Twenty six pregnant women, experiencing the third trimester, were selected based on purposeful and theoretical sampling. For access to participants, the researcher referred to one teaching health care centers of Iran University of Medical Sciences and two private offices of gynecology in Tehran, Iran. The data were collected by semi-structured interviews. All data were audio taped and transcribed. Data collection and analysis was performed simultaneously. Constant comparative method was used to analyze data. The main categories were "fear due to not having knowledge", "being painless, and physical and spiritual peace" and "unpleasant experience of others and their encouragement", "being worry of complications", inappropriate communication of health care staff", and "the feeling of loneliness and death", "infant's health". Constant analysis of data revealed that women get through for creation balance in order to receipt the best result, process of to consider, making a lawful and to choice. Attentive to main theme that it is fear of labor and delivery is a physiology phenomenon. It is necessary to encourage methods for relieving pain and fear and for promoting self-esteem in order to make good decision by pregnant women. It is also important to encourage women for vaginal delivery

Sobre as dores e temores do parto: dimensões de uma escuta / On pains and fear in childbirth: dimensions of listening

OBJETIVOS: desenvolver algumas reflexões sobre os possíveis efeitos benéficos de uma escuta responsiva à verbalização da presença de dor, medos e seus correlatos na cena do parto tomando como base dados empíricos de pesquisa realizada em maternidade situada na cidade de São Paulo, Brasil. MÉTODOS: estudo descritivo, de metodologia qualitativa, referenciado no quadro teórico da Psicologia Social, Psicanálise e Lingüística, utilizando entrevistas semi-estruturadas com 20 parturientes e sete doulas e observação de rotinas da maternidade. RESULTADOS: a análise, apoiada em categorias estabelecidas (subjetividade auto-referida, intersubjetividade, acolhimento, apropriação da experiência) mostrou, entre outros pontos, a importância e a valorização da interlocução qualificada no processo da parturição. Processo esse referido pelas parturientes como experiência de elevado grau de estresse, com vivências de dor, medos e ansiedades, porém mitigados pelo apoio recebido. CONCLUSÕES: a análise permitiu compreender as relações interpessoais como campo de interlocução e acolhimento percebidos pelas mulheres do estudo capazes de produzir efeitos favoráveis sobre as vivências do estresse materno, configurando-se como recurso técnico, qualificado e valioso, oferecido à parturiente.

OBJECTIVES: to reflect on the possibilities raised by listening to the life-experiences related by parturient women concerning pain on delivery, using empirical data from research carried out in a Maternity ward in the city of São Paulo, Brazil. METHODS: a descriptive study, with a qualitative methodology, based on the theoretical framework of Social Psychology, Psychoanalysis and Linguistics was carried out, by means of semi-structured interviews with parturient women and midwives, in addition to observation of maternity routines. RESULTS: one of the findings of the analysis, based on established categories (self-referred subjectivity, intersubjectivity, the appropriation of experience), was the importance of accurate interlocution in the course of the parturition process. This process was mentioned by the parturient women as an experience accompanied by a high level of stress, involving pain, fear and anxiety, although these may be mitigated by the support received. CONCLUSIONS: the analysis shed light on the role of interpersonal relationships involving dialogue and physical contact experienced by these women in reducing the stress of childbirth, suggesting that these constitute a valuable and effective resource that should be offered to parturient woman.

Support from a close female relative in labour: the ideal maternity nursing intervention in Thailand.

Childbirth is a significant event in the lives of women and their families. It is a critical time in the human development that transforms women into mothers. Women remember their childbirth for the rest of their lives. Thus, the quality of support that women receive during labour and delivery is important and nurses need to be concerned. Previously, women were delivered at homes; they received emotional support from female relatives. Now women give birth in hospitals; they are separated from their families. Although nurses are adept at providing physical and emotional support, they may have to care for several other women. Nurses sometimes may give support to an individual woman a low priority because they have various clinical responsibilities and paper work. It may create womens' experience emotional loneliness and deal with labour pain and in unfamiliar environment alone. These situations can contribute negative effects on childbirth outcomes. Having a close female relative to support a woman in labour can reduce maternal stress and anxiety and improve childbirth outcomes. The present article provides guidelines for including a close female relative on the labour unit to support a woman during labour and delivery.

[ effect of massage on intensity of pain during first stage of labor]

Labor and birth are two important aspects of human life. At the same time, labor pain is a serious concern for every pregnant woman, Massage as a non pharmacological techniques is a way to overcome this difficulty. Research findings demonstrate that massage has especially positive effects in reducing not only pain, but also stress. Our study has been conducted to determine the effects of massage on intensity of pain during the first stage of labor in primiparous women who have attended Isfahan Shahid Beheshti hospital in 2005. In this randomize clinical trial, a total of 75 primiparous women in 38-42 week of low risk pregnancy were randomly divided in 3 groups. First group received 20 minutes of back effleurage massage at the periods of 4-5 cm, 6-7 cm, 8-10 cm, cervical dilation. An emotional support was offered for second group in the same duration of time and the same cervical dilation. Third group just received routine care during labor. In all groups, pregnant women were asked to evaluate their severity of pain before and after intervention. Data being obtained through the visual analogue scale, check list and inspection form. Study result demonstrated that intensity of pain was significantly lower in massage group [p< 0.001]. Intensity of pain in supported group was consistent during 4-5 cm dilatation period and 8-10 cm but during 6-7 cm period there was an increase in severity of pain. In routine care group severity of pain increased in every stage. Receiving back massage is more effective than supporting and routine care for relieving labor pain

O trabalho do PSF no incentivo ao parto normal através do uso de um método psicossomático de alívio da dor: relato de caso / The work of the PSF in the incentive to the normal Childbirth through the use of a psychosomatic method of relief of pain - case story / El trabajo del PSF en el estímulo al parto normal por médio del uso de un método psicosomático de alivio del dolor - relato de caso

Trata-se de relato de caso de três gestantes pertencentes a uma equipe do Programa Saúde da Família (PSF), acompanhadas durante o pré-natal, o trabalho de parto e o parto com um método psicossomático de alívio da dor. O método utilizado foi o de Lamaze. Propõem-se algumas modificações com o objetivo de aliviar a dor durante o trabalho de parto, empregando as técnicas de respiração, relaxamento e educação. O curso para a preparação das gestantes iniciou-se em torno da 20ª semana de gestação e constou de seis encontros individuais. Fez-se o acompanhamento durante o trabalho de parto e o parto, bem como uma entrevista com a mulher oito dias depois do parto.

This is a case history of three pregnant women cared for by a team of the Family Health Program. They were monitored during prenatal care, labor and delivery and the Lamaze psychosomatic pain relief method was used. Some modifications are proposed in order to relieve pain during labor, using breathing techniques, relaxation and education. The course to prepare the pregnant women began in the 20th week of gestation and included 6 individual meetings. The monitoring was carried out during labor and delivery, and the women were interview eight days after delivery.

Se trata de un relato de tres embarazadas de un equipo del Programa Salud de la Familia, con seguimiento durante el prenatal, trabajo de parto y parto empleando un método psicosomático para aliviar el dolor. El método utilizado es el de Lamaze, con algunas modificaciones, cuyo objeto es aliviar el dolor durante el trabajo de parto utilizando técnicas de respiración, relajación y educación. El curso de preparación de las mujeres empezó alrededor de la 20ª semana de embarazo y constó de seis encuentros individuales. El seguimiento se llevó a cabo durante el trabajo de parto y en el parto y ocho días después se realizó una entrevista con la mujer.

Significando a dor no parto: expressão feminina da vivência do parto vaginal / Expressing the pain in labor: the female manifestation about vaginal delivery experience

Estudo qualitativo. Teve como objetivos Identificar os significados atribuídos à dor por mulheres que vivenciaram o parto vaginal, Analisar a vivência da dor segundo a percepção de mulheres que pariram por via vaginal e Discutir as estratégias vivenciadas pelas mulheres para aliviar a dor durante o trabalho de parto e parto vaginal. Os dados foram coletados no Alojamento Conjunto da maternidade da Unidade Integrada de Saúde Herculano Pinheiro com puérperas que passaram algum tempo dos seus trabalhos de parto na instituição. O instrumento para coleta de dados foi a entrevista semi-estruturada. As entrevistas foram gravadas, transcritas e os dados tratados com a técnica de Análise temática de Conteúdo. Para análise dos dados foi utilizado um referencial teórico pertinente aos diversos modelos assistenciais ao parto no Brasil. Vimos que as mulheres significam a dor no parto como sofrimento e/ou prazer e esse sofrimento tem a dimensão redentora influenciada pela Igreja, a dimensão heróica influenciada pela cultura e a dimensão inútil influenciada pela medicalização que retira os significados da dor. Elas significam a dor também com o prazer quando a relaciona com o bebê e com a saúde. As depoentes viveram a dor no parto sentindo uma sensação intensa e até violenta ou fisiológica que tem características próprias e são pertinentes ao processo de parturição. Algumas mulheres não focaram sua atenção na dor. Ela valorizaram mais as respostas psicoemocionais. As depoentes sentiram mais dor quando estavam dentro do hospital sofrendo as intervenções do seu modelo assistencial. Perante a dor no parto elas estrategicamente seguem os conselhos medicalizadas e comportam-se de forma civilizada. Outras mulheres utilizam estratégias instintivas para lidar com a dor no parto. Todas as estratégias utilizadas parecem ter por finalidade a finalização do processo parturitivo.

Qualitative study. Its object was to identity the meanings attributed to the pain by women who experienced vaginal childbearing, analyze the experience of the pain according to the perception of women who gave birth through vaginal delivery and discuss the strategies experienced by women to alleviate the pain during labor and delivery. The data was collected at the “Unidade Integrada de Saúde Herculano Pinheiro” with women in their immediate puerperium who had their childbearing labor at that institution. The data was collected through a semi-structured interview. The interviews were recorded, transcribed and the data treated through the technique of Thematic Content Analysis. For the data analysis, a theoretical standpoint was adopted pertaining to the various models of childbearing assistance in Brazil. We discovered that women see the pain in labor as suffering and/or pleasure and that suffering carries the redeeming aspect as influenced by the Church, the heroic aspect as influenced by culture and the useless aspect as influenced by the medicalization which removes all the significance of pain. They also see the pain as pleasure when they associate it to the child and health. The interviewed women experienced the pain in labor as an intense sensation, sometimes even violent or physiological, which bears its own characteristic relating to the delivery process. Some women did not focus on the pain. They valued the psycho-emtional response more. The interviewed women felt more pain while inside the hospital enduring the interventions of their assistential model. When facing the pain in labor, those women strategically follow the medicalized advice and behave in a civilized manner. Other women employ instinctive strategies to deal with the pain in labor. All the strategies used seem to aim to complete the delivery process.

Assessment of the fear of delivery among women at labor

To assess the fear of laboring women regarding the delivery on themselves and their newborns. A descriptive study was conducted on [100] pregnant women who where admitted to labor room in Al-Yarmock Teaching Hospital/Maternity Units, Fatima Al-Zahra and Ibn-Al Baladi Maternity and Pediatric Hospital. The questionnaire was consisted of pregnant women, socio-demographic data, reproductive data and fear items of labor. Data were collected by using a questionnaire format, through interview technique and reviewing pregnant records. descriptive and inferential statistical procedure were used to analyze the data. The main results of the study revealed a high mean of scores with moderate [RS] in women's fear regarding labor on her self [labor difficulties, dying during labor, labor pain related to uterine contractions, prolonged labor, fear of being left alone, fear of episiotomy, and exposure to infection]. And on their newborn in [delivery of unhealthy or abnormal newborn, newborn death during or after delivery, head dystocia, fetal asphyxia, and exposure to cold and infection]. The findings also presented significant differences between women's fear regarding labor on themselves and socio demographic and reproductive variables in [age, education, residency, socioeconomic status, history of abortion, pregnancy and delivery complications], and on their newborn in [age, education, type of family, gravidity, parity, history of abortion, and pregnancy complications]. Educational program can be designed to orient the pregnant women toward physiological and psychological changes during pregnancy, labor and delivery process and Initiation of prenatal education classes in primary health care centers

Uso da anestesia local para episiotomia e reparo do trauma perineal no parto normal: práticas de enfermeiras e médicos / Local anesthesia use to episiotomy and care of perineal trauma in spontaneous vaginal delivery: nurses and physicians practice

Estudo descritivo, quantitativo, com o objetivo identificar a técnica e os anestésicos usados para anestesia local no parto normal e conhecer a prática de obstetrizes, enfermeiras e médicos sobre sua eficácia, vantagens e desvantagens. As técnicas utilizadas são bloqueio e infiltração perineal, com lidocaína. As vantagens são a recuperação mais rápida da mulher, a promoção de analgesia ou relaxamento pélvico. As desvantagens são a dor que a mulher continua sentindo e o edema vulvar. Os profissionais reconhecem manifestações freqüentes de dor durante a sutura, mas nem sempre complementam a anestesia.

Re-significando a dor e superando a solidão: experiências do parto entre adolescentes de classes populares atendidas em uma maternidade pública de Salvador, Bahia, Brasil / Re-signifying pain, overcoming loneliness: childbirth experiences among working-class adolescents in a public maternity hospital in Salvador, Bahia, Brazil

Este artigo examina o parto em uma maternidade pública de Salvador, Bahia, Brasil, com base na perspectiva de mulheres jovens e adolescentes, a maioria das quais negras e de classes populares. O estudo, de caráter antropológico, baseia-se na análise de entrevistas e na etnografia do hospital, particularmente do centro obstétrico. As mulheres descrevem o trabalho de parto como dominado pelo medo, solidão e dor, sensações que se transformam em amor com o nascimento da criança. Enfocando o parto como um processo biossocial, o trabalho mostra como as jovens produzem significados durante o processo de parturição, enquanto se encontram envolvidas nas interações sociais próprias ao parto hospitalar, particularmente com os profissionais de saúde. Do ponto de vista simbólico, as parturientes experienciam o parto como um rito de passagem que legitima a maternidade, em um contexto social e institucional que, ao contrário, deslegitima a reprodução sexual de mulheres negras, jovens e de baixa renda e estigmatiza a maternidade na adolescência.

Effect of massage on reducing pain and anxiety during labour

Labour pain is one of the most severe forms of pain that each women may experience during her life. Severe pain makes stress response with harmful effects on both mother, and her fetus. This study was carried out to evaluate the effect of massage therapy on relieving pain and its harmful sequel such as anxiety during labour. This clinical trial was performed on sixty nulliparous women selected randomly who were expected to have a normal childbirth in the Jiroft city hospital. Cases were randomly assigned to experimental [n=30] and control [n=30] groups. The experimental group received massage intervention. The nurse-rated Present Behavioral Intensity [PBI] was used as a measure of labour pain. Anxiety was measured by the Visual Analogue Scale for Anxiety [VASA]. The intensity of pain and anxiety between these two groups were compared in the latent phase [cervix dilated 3-4cm], active phase [cervix dilated 5-7cm] and transitional phase [cervix dilated 8-10cm] of labour. In both groups, there was an increase in pain intensity and anxiety level as labor progressed. Results of T-test analysis demonstrated that the experiment group had significantly lower pain reaction in all three phases [Phase1 P=0.000, Phase2 P=0.002, Phase3 P=0.000] and anxiety levels were significantly different between two groups only in latent phase [P=0.00]. Eighty seven percent [n=26] of cases in experimental group expressed that massage was helpful, provided pain relief and psychological support during labour [P<0.40]. Our findings suggest that massage is a cost effective nursing intervention that can decrease pain and anxiety during labour and nurses intervention to perform massage could have positive effect on delivery experience. It is suggested that massage be used for decreasing pain and anxiety during labour