Efecto del dolor perineal en las actividades de mujeres sometidas a episiotomía / Perineal pain effect on the activities of women who had an episiotomy

Objetivo principal: Este artículo discute la influencia del dolor perineal después del parto normal en las actividades diarias de las mujeres con episiotomía. Metodología: Estudio descriptivo con recolección de datos a través de entrevistas con 52 mujeres entre 20 y 48 horas después del parto, con aplicación de la escala numérica de dolor (0-10). Resultados principales: El dolor perineal estuvo presente entre 86,5% y 82,7% de las mujeres, a las 20 y 48 horas, respectivamente. Hubo un predominio del dolor leve (64,4% a 72,1%), seguido de moderado (28,9% a 18,6%). La restricción de las actividades varió entre 92,3% y 86,5% de las mujeres, 20 y 48 horas después del parto, respectivamente. Conclusión principal: Aunque de la mayoría de las mujeres después del parto atribuye nota de intensidad leve, se señaló que esto limita las actividades esenciales (AU)

Objective: This manuscript discusses the influence of the perineal pain after normal birth on daily activities of women who had an episiotomy. Methods: Descriptive study with data collected through interviews performed from 20 to 48 hours after delivery, with 52 women, applying the pain numeric scale (0-10). Results: Perineal pain was present in 86.5% and 82.7% of women, at 20 and 48 hours after delivery, respectively. There was a predominance of mild pain (64.4% to 72.1%), followed by moderate pain (28.9% to 18.6%). The restriction of the activities varied between 92.3% and 86.5% women, from 20 to 48 hours after delivery, respectively. Conclusions: Although most women had reported mild pain, it was noted that this morbidity limits the essential activities (AU)

Use of hyaluronidase to prevent perineal trauma during spontaneous births: a randomized, placebo-controlled, double-blind, clinical trial.

INTRODUCTION: The purpose of this study was to compare the frequency and severity of perineal trauma during spontaneous birth with or without perineal injections of hyaluronidase (HAase). METHODS: A randomized, placebo-controlled, double-blind clinical trial was conducted in a midwife-led, in-hospital birth center in São Paulo, Brazil. Primiparous women (N = 160) were randomly assigned to an experimental (n = 80) or control (n = 80) group. During the second stage of labor, women in the experimental group received an injection of 20.000 turbidity-reducing units of HAase in the posterior region of the perineum, and those in the control group received a placebo injection. The assessment of perineal outcome was performed by 2 independent nurse-midwives. A 1-tailed Fisher exact test was performed, and a P value < .025 was considered statistically significant. RESULTS: Perineal integrity occurred in 34.2% of the experimental group and in 32.5% of the control group, which was not a statistically significant difference (P= .477). First-degree laceration was the most common trauma in the posterior region of the perineum in women in both groups (experimental = 56%, control = 42.6%). Severe perineal trauma occurred in 28.9% of the experimental group and 38.8% of the control group, which also was not a statistically significant difference (P= .131). The depth of second-degree perineal lacerations in the experimental and control groups, measured by the Peri-Rule, was 1.9 cm and 2.3 cm, respectively. An episiotomy was performed in 11 women (experimental group = 3, control group = 8), and 4 (all in control group) had third-degree lacerations. DISCUSSION: The use of injectable HAase did not increase the proportion of intact perineum and did not reduce the proportion of severe perineal trauma in our sample.

Women's experiences of perineal pain during the immediate postnatal period: a cross-sectional study in Brazil.

OBJECTIVE: To identify the severity and prevalence of perineal pain during the post partum in-patient period and associated obstetric, maternal and newborn baby factors following birth. DESIGN: Cross-sectional study. SETTING: A postnatal ward of a hospital in São Paulo, Brazil. PARTICIPANTS: 303 Postnatal women. MEASUREMENTS: Interviews and perineal assessment were conducted to evaluate the perineal outcomes (trauma and pain). Data on maternal characteristics and infant anthropometric variables were collected. RESULTS: Among all women, 80.5% had perineal trauma (60.7% had episiotomy) and 18.5% reported perineal pain. The mean pain intensity score was 4.8 ± 1.9 on the visual analogue scale. Only maternal age (ORa = 1.08) and performance of episiotomy (ORa = 3.80) remained as independent predictors of perineal pain in the final logistic regression model. KEY CONCLUSIONS: Perineal pain in the immediate postnatal period was highly associated with older maternal age and use of episiotomy, although the overall reporting of perineal pain was low. IMPLICATIONS FOR PRACTICE: Perineal pain following vaginal birth is associated with interventions during labour as well as with maternal characteristics. Despite the negative impact on a woman's daily activities, perineal pain following birth is neglected by care givers and usually not reported by women who may consider it to be a normal outcome of giving birth. Care providers need to ensure all interventions during labour and birth are informed by evidence of benefit and that barriers to implementation of evidence are addressed. Further work is needed to obtain the views of women in Brazil on their health and well-being following birth.

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: double-blind randomised controlled trial.

OBJECTIVE: to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery. DESIGN: double-blind, randomised-controlled trial. SETTING: a birth centre, in the city of Sao Paulo, Brazil. PARTICIPANTS: from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n=16 per treatment per group). INTERVENTIONS: an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5ml) and to suture spontaneous lacerations (1ml), followed by repeated doses (1ml) until pain was completely inhibited. MEASUREMENTS AND FINDINGS: the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1ml, 95% confidence interval (CI) 0.4-1.6) and second-degree (3.7ml, 95% CI 1.6-5.8) lacerations (p=0.002 and 0.001, respectively). A 0.3ml (95% CI 1.5-2.1) average decrease in anaesthetic volume was observed with episiotomy (p=0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1-2ml in 95% and 3-4ml in 50% of first-degree lacerations, respectively, and 1-6ml in 88% and 7-15ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15ml, regardless of anaesthetic solution used. KEY CONCLUSIONS: our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy.

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.

A comparison of "hands off" versus "hands on" techniques for decreasing perineal lacerations during birth.

Our goal was to determine the frequency, degree, and location of perineal lacerations and the neonatal outcomes associated with the use of two techniques of perineal protection--expectant ("hands off") and interventionist ("hands on")--during childbirth. We conducted a randomized controlled trial to compare the effectiveness of two techniques for perineum protection during spontaneous delivery. Study participants included 70 nulliparous expectant mothers, who were divided equally between the "hands off" and "hands on" groups (n = 35 per group). Perineal laceration occurred in 81.4% of the women. Among these, first-degree lacerations were predominant (82.5%). Lacerations in the anterior and posterior regions of the perineum occurred with similar frequencies. Laceration rates did not differ between the "hands off" and "hands on" groups (P > .05). Neonatal outcomes were similar in both groups. The use of "hands off" technique of perineal protection does not alter the frequency or degree of perineal lacerations in childbirth, relative to a "hands on" technique.

Tipo de parto: expectativas das mulheres / Childbirth types: women's expectations

Estudo descritivo e exploratório, realizado mediante entrevista com 221 puérperas que tiveram parto em maternidades públicas estaduais, localizadas no município de São Paulo. Teve como objetivos: 1. identificar o tipo de parto esperado pelas mulheres, considerando a via vaginal ou cesariana, e sua justificativa; 2. verificar a ocorrência do tipo de parto, segundo as expectativas dessas mulheres; 3. comparar a indicacão médica da cesariana com o entendimento das mulheres sobre justificativa dessa intervencão. Os dados revelam que 74,7 por cento tinham expectativa de que o parto fosse normal, e 25,3 por cento, de que fosse cesárea. O parto normal, esperado por 165 entrevistadas, ocorreu em 66,1 por cento dessas mulheres. A justificativa mais citada pelas mulheres para esperar o parto normal foi a recuperacão pós-parto mais rápida e, para a cesárea, ter tido cesárea anterior. As justificativas apresentadas por 61 mulheres para a realizacão da cesariana não era coincidente com a indicacão médica em 47,5 por cento dos casos

Realidade e expectativas do estudante de enfermagem quanto à capacitação e qualificação na área de enfermagem obstétrica / Nursing students: expectations with respect to professional activity in the field of obstetrics

Estudo realizado em São Paulo, em 1999 e 2000, com alunos de graduação em enfermagem de oito instituições públicas e privadas, e o objetivo de caracterizar o estudante quanto à experiência curricular e expectativas de atuação profissional na área obstétrica...

Escola de Enfermagem da USP e Secretaria de Estado da Saúde de Säo Paulo: parcerias na especializaçäo em enfermagem obstétrica / School of nursing at the University of Säo Paulo and Säo Paulo State Health Department: partners in the nurse-midwifery specialization program

A Escola de Enfermagem da Universidade de Säo Paulo e a Secretaria de Estado da Saúde de Säo Paulo estabeleceram uma proposta de capacitaçäo de enfermeiras, através do Curso de Especializaçäo, tendo como objetivos: analisar a problemática da assistência obstétrica à mulher, no contexto da família e do SUS, nas diversas fases do ciclo gravídico; capacitar a enfermeira para a assistência à gestante, parturiente, puérpera e neonato nas unidades de saúde, em bases clínicas, epidemiológicas e humanísticas; capacitar a enfermeira para realizaçäo do parto normal. O Curso foi concluído por 19 alunas, que realizaram uma média de 35 partos/enfermeira.

Levantamento do número de enfermeiros obstetras formados nos últimos 20 anos pelas Escolas de Enfermagem do Brasil / Obstetrical nursing: Nursing of schools

A Associaçäo Brasileira de Obstetrizes e Enfermeiros Obstetras (ABENFO) tem um papel muito importante no que tange à participaçäo do enfermeiro na assistência à mulher e ao recém-nascido, preocupando-se com a qualidade de assistência à saúde prestada a esse grupo. Em nosso País, os absurdos índices de morbimortalidade materna e perinatal continuam crescentes, apesar de todos os avanços técnico-científicos da área...

Que parteira é essa? / What midwife is this?

A finalidade do estudo foi oferecer elementos para a formulação de propostas de capacitação de profissionais não-médicos - parteiras, enfermeiras obstétricas, obstetrizes ou outros - para assistência ao parto. Para tanto, teve como objetivos identificar quem é a parteira a que se referem os profissionais da área da saúde, quando defendem sua existência, e desvelar os pressupostos ideológicos que buscam justificar a formação dessa profissional. Foi utilizado o método qualitativo, adotando-se a dialética materialista e histórica como referencial teórico- metodológico. Os conceitos de ideologia, gênero, profissão e mercado de trabalho foram incorporados como categorias de análise. A coleta de dados foi realizada por meio de entrevistas com nove diferentes profissionais de saúde, responsáveis pela formação e absorção de recursos humanos da área. A análise de discurso foi a técnica escolhida para tratar o material empírico, tomando-se a dialética-hermenêutica como um caminho interpretativo. Pelo processo de análise e interpretação dos dados foi possível apreender duas categorias empíricas, denominadas "Situação da Assistência ao Parto no Brasil" e "A Parteira que Queremos (ou Devemos) e a Parteira que Podemos", que, ao serem colocadas em relação com as categorias de análise possibilitaram atingir os objetivos propostos. Assim, a parteira ideal - aquela que queremos e devemos - foi revelada nos discursos sob duas perspectivas: de um lado, é a parteiratransitória, que substitui o médico diante da carência de recursos; de outro, é sua antítese, ou seja, a parteira de sempre, aquela que sempre existiu e existirá. A partir da superação dialética da parteira ideal definida nos discursos, pode emergir a parteira possível, que é a parteira em construção, representando o projeto utópico, contra-hegemônico, capaz de romper com a taxinomia da profissão e com a visão ideologizada e desgenerificada da mulher frente aos seus ) direitos reprodutivos

The purpose of this study was to give support of the proposals for the training of no-physician professionals - midwives, nurse-midwives and others - to attend the chlidbirth. The aim of this study was to identify who is the midwife referred by the health professionals, when they defend her existence, and to unveil the ideological assumptions that justify the education of this professional. It was used the qualitative method and adopted the mateiralistic-historical dialectic as theoretic methodological referential. The concepts of ideology, gender, profession and labour market were incorporated as analysis categories. Data collection was accomplished by interview with nine different professionals of health, responsible for the education and employment of human resources in the area. This discourse analysis was used to analyse the empirical material, with the dialectic-hermeneutics as an interpretative way. Through the analysis and data interpretation, it was possible to aprehend two empirical categories denominated "Situation of Attendance to the Childbith in Brazil" and "The Midwife that We Want (or Owed) and the Midwife that We Can". These categories, when put in relationship with the analysis categories permitted to reach the aims. Thus, the ideal midwife - the one we want and we owed - was revealed in the discourses under two perspectives on one side, she is a transitory midwife, who substitutes the physician in the face of the lack of resources; on theother side, she is her antithesis, that is, the midwife of ever, the one who always existed and will exist. Starting from the dialectic transposing of the ideal midwife defined in the discourses, the possible midwife can emerge: she is the midwife in construction, representing the utopian project, against-hegemonic, that is capable to break the profession taxonomy and the ideological and ungendered vision of the woman front to her reproductive rights

Preparo da gestante para o parto na formação da enfermeira obstetra / Preparation of pregnant women for childbirth in the training of obstetric nurses

Estudo de caso sobre o ensino-aprendizagem do preparo da gestante para o parto durante o programa de habilitacao em enfermagem obstetrica da ee/usp, desenvolvido com as nove alunas de 1991. Teve como objetivo descrever a experiencia de participacao no preparo de gestantes para o parto na formacao da enfermeira obstetra. Para a coleta dos dados foi utilizada a entrevista semi-estruturada, segundo os pressupostos que orientaram o ensino teorico-pratico. E apresentado o plano de ensino e feita a discussao das categorias trabalho em grupo, vinculo, clientela, tematica e experiencia na formacao profissional, de cuja sintese destacam-se os seguintes aspectos centrais: conscientizacao da importancia de dominar os conteudos educativos da enfermagem obstetrica; reconhecimento da orientacao a gestante como uma atividade assistencial da enfermeira obstetra; valorizacao do trabalho em grupo para desenvolver atividades de educacao para a saude; respeito pelo conhecimento e experiencia pessoal das gestantes, e redefinicao da postura profissional em face da assimilacao da visao da clientela; identificacao da relevancia das condicoes emocionais e afetivas na gestacao e suas implicacoes para a assistencia de enfermagem; caracterizacao do vinculo na relacao enfermeira-gestante ou enfermeira-familia, como condicao para o exercicio e a identidade profissional da enfermeira obstetra.