Midwifery practice and maternity services: A multisite descriptive study in Latin America and the Caribbean.

OBJECTIVE: over the past three decades there has been a social movement in Latin American countries (LAC) to support humanised, physiologic birth. Rates of caesarean section overall in Latin America are approximately 35%, increasing up to 85% in some cases. There are many factors related to poor outcomes with regard to maternal and newborn/infant health in LAC countries. Maternal and perinatal outcome data within and between countries is scarce and inaccurate. The aims of this study were to: i) describe selected obstetric and neonatal outcomes of women who received midwifery care, ii) identify the level of maternal well-being after experiencing midwifery care in 6 Latin America countries. DESIGN: this was a cross sectional and descriptive study, conducted in selected maternity units in Argentina, Brazil, Chile, the Dominican Republic, Peru, and Uruguay. Quantitative methods were used to measure midwifery processes of care and maternal perceptions of well-being in labour and childbirth through a validated survey of maternal well-being and an adapted version of the American College of Nurse-Midwives (ACNM) standardized antepartum and intrapartum data set. SETTING: Maternity units from 6 Latin American countries. PARTICIPANTS: the final sample was a convenience sample, and the total participants for all sites in the six countries was 3009 low risk women. FINDINGS: for the countries reporting, overall, 82% of these low risk women had spontaneous vaginal deliveries. The rate of caesarean section was 16%; the Dominican Republic had the highest rate of Caesarean sections (30%) and Peru had the lowest rate (4%). The use of oxytocin in labour was widely variable, although overall there was a high proportion of women whose labour was augmented or induced. Ambulation was common, with the lowest proportion (48%) of women ambulating in labour in Chile, Uruguay (50%), Peru (65%), Brazil (85%). The presence of continuous support was highest in Uruguay (93%), Chile (75%) and Argentina (55%), and Peru had the lowest (22%). Episiotomies are still prevalent in all countries, the lowest rate was reported in the Dominican Republic (22%), and the highest rates were 52 and 53% (Chile and Peru, respectively). The Optimal Maternal well-being score had a prevalence of 43.5%, adequate score was 30.8%; 25% of the total sample of women rated their well-being during labour and childbirth as poor. KEY CONCLUSIONS: despite evidence-based guidelines and recommendations, birth is not managed accordingly in most cases. Women feel that care is adequate, although some women report mistreatment. IMPLICATIONS FOR PRACTICE: More research is needed to understand why such high levels of intervention exist and to test the implementation of evidence-based practices in local settings.

Measuring the energy spent by parturient women in fasting and in ingesting caloric replacement (Honey).

This research aims to measure the energy spending in parturient women of low gestation risk. Participants were selected randomly and submitted to fasting (n=15; Group I) or honey ingestion (n=15; Group II). Data were collected by means of capillary blood values and heart frequency monitoring. The paired t-test with a 5% significance level and Tukey's method were used in statistical analysis. The results showed that honey ingestion did not promote an overload in the mother's glucose; the lactate response demonstrated that the substrate offered was well used; the cardiorespiratory rate demonstrated good performance for both groups; the total energy spent during labor demonstrated that carbohydrate ingestion exerts significant influence, improving maternal anaerobic performance; the group which remained in fasting presented, immediately after labor, higher levels of lactate, showing the organism's efforts to compensate for the energy spent.