Changes in maternity care policies and practices that support breastfeeding as measured by the Ten Steps to Successful Breastfeeding - United States, 2018-2022.

BACKGROUND: Experiences during the birth hospitalization affect a family's ability to establish and maintain breastfeeding. The Ten Steps to Successful Breastfeeding (Ten Steps) describe evidence-based hospital policies and practices shown to improve breastfeeding outcomes. We aim to describe hospitals' implementation of the Ten Steps, changes over time, and hospitals' implementation of a majority (≥ 6) of the Ten Steps by hospital characteristics and state. METHODS: The biennial Maternity Practices in Infant Nutrition and Care (mPINC) survey assesses all hospitals in the United States (including the District of Columbia and territories) that routinely provide maternity care services. We analyzed data from 2018, 2020, and 2022 survey cycles to describe trends in the prevalence of hospitals implementing maternity care policies and practices that are consistent with the Ten Steps. Differences were calculated using the absolute difference in percentage-points between 2018 and 2022. RESULTS: Between 2018 and 2022, the percentage of hospitals that implemented Step 2: Staff Competency and Step 5: Support Mothers with Breastfeeding increased 12 and 8 percentage points, respectively. The percentage of hospitals that implemented Step 6: Exclusive Breastfeeding Among Breastfed Infants was 7 percentage points lower in 2022 than 2018. Implementation of the remaining seven steps did not change by more than 5 percentage points in either direction between 2018 and 2022. Nationally, the percentage of hospitals that implemented ≥ 6 of the Ten Steps increased from 44.0% in 2018 to 51.1% in 2022. Differences were seen when comparing implementation of ≥ 6 of the Ten Steps by hospital characteristics including state, hospital size, and highest level of neonatal care offered. CONCLUSIONS: Nationally, maternity care policies and practices supportive of breastfeeding continued to improve; however, certain practices lost progress. Differences in implementation of the Ten Steps were observed across states and by certain hospital characteristics, suggesting more work is needed to ensure all people receive optimal breastfeeding support during their delivery hospitalization.

Evaluation of maternal and perinatal outcomes in pregnancy with preeclampsia at Aljala Maternity Hospital

Hypertensive disorders of pregnancy (HDP) accounts for 18% of maternal deaths worldwide, with an estimated number of about 62, 000­77, 000 deaths occur each year. The current study aimed to assess maternal and perinatal outcomes of pregnancies complicated by hypertension in Aljala Maternity Hospital. A retrospective, descriptive, case series analysis for four hundred patients was done on the outcome of hypertensive disorder among pregnant women who admitted and were managed at Aljala teaching hospital with preeclampsia during the years 2019 and 2020. Demographic data involving age, parity, gestational week, clinical and laboratory findings were recorded from the medical files. Additionally, delivery route, indications of cesarean section, fetal and maternal complications were determined. The current finding reported high prevalence of perinatal and maternal mortality among pregnant women with preeclampsia. Moreover, other severe maternal and perinatal complications such as Hemolysis Elevated Liver Enzyme Platelet (HELLP) syndrome, placental abruption, eclamptic fits, as well as low birth weight were also commonly reported. The current study showed early onset of preeclampsia was associated with increased risk of developing adverse maternal-fetal/neonatal outcomes compared to lateonset after 36 weeks. Our findings call for special consideration and close surveillance of those women with early-onset diseases

Quality indicators of public maternity units in the governorate of Monastir (Tunisia).

INTRODUCTION: Increasing access to healthcare for expectant mothers is a national goal. In Monastir, Tunisia, some Peripheral Maternity Units (PMUs) required assessment. Our goals were to describe the delivery activities in MUs (maternity units) and to assess whether some of PMUs need to have their activities replaced. METHOD: We analyzed aggregate data of deliveries in Monastir from 2015 to 2020. The gouvernorate's seven public MUs were included. Only the morning activity was allotted for obstetricians and gynecologists, in RMUs 1 and 2, whereas they were not available in all PMUs. Data was gathered from the reports of the National Perinatal Program. Both the availability of Comprehensive Essential Obstetric Care (CEOC) and Basic Essential Obstetric Care (BEOC) were calculated. Trends were calculated using Joinpoint software. The Annual Percent Change (APC) was calculated. RESULTS: The number of births decreased from 2015 to 2020 (APC= -4.3%: 95%CI : -6; -2.4; p = 0.003). The largest significant decreases in APCs of deliveries were reported in PMU 2 (APC = -12.6% (95%CI : -20; -4.4; p = 0.014), in PMU 3 (APC = -29.3% (95%CI : -36.5; -21.4; p = 0.001), and in PMU 4 (APC = -32.9% (95%CI: -49.1; -11.5); p = 0.016). If PMU 3 and 4 were no longer operating as maternity facilities, BEOC and CEOC standards would still be adequat. For accessibility, both PMU 3 and PMU 2 are accessible from PMU 4 and PMU 1, respectively. CONCLUSIONS: Pregnant women prefer to give birth in obstetric services with ability to perform emergency caesarean at the expense of PMU. Nowadays, it appears that accessibility is less important than the presence of qualified human resources when a pregnant woman choose a maternity hospital.

Registration of a pregnant woman in the maternity hospital (optimally at 36th-37th weeks) at the Olomouc University Hospital in 2022.

OBJECTIVE: The aim of the study was to analyse the results of the implementation of the new health service Registration of a pregnant woman in the maternity hospital (optimally at 36th-37th weeks) provided as part of outpatient/ambulatory health care at Olomouc University Hospital (OUH). MATERIALS AND METHODS: A prospective cohort study. In 2022, a total of 2,271 women gave birth in OUH, and 2,010 of them were Registered in the maternity hospital, defined specific risks were identified and a pregnancy termination strategy was established/determined. RESULTS: The health service was provided to 88.5% of women giving birth (2,010/2,271). The age of the mothers was 15-56 years (mean 31.3 years; median 31 years), their body mass index was 13.4-53.1 kg/m2 (mean 24.6 kg/m2; median 23.2 kg/m2). 43.6% of them (877/2,010) were Low-risk pregnancies and 56.4% (1,133/2,010) were Pregnancies with a defined specific risk. The most frequently identified risks were as follows: RhD negative blood group (18.4%), diabetes mellitus (13.9%), history of caesarean section (12.0%), hypertensive disorders (6.5%), small fetus/fetal growth restriction (6.3%), risk the development of hemolytic disease in the fetus and the newborn (2.5%), multiple pregnancy (1.6%), congenital malformation of the fetus (1.3%) and placentation disorders (0.5%). In 63.4% of them (1,275/2,010), the pregnancy termination strategy was determined by spontaneous vaginal delivery, in 18.0% (361/2,010) by pre-induction of vaginal delivery and in 14.2% (285/2,010) by caesarean section. In 4.4% (89/2,010) the health service was not implemented correctly because no strategy was established. CONCLUSION: The implementation of the new health service will make it possible to replace activity (more frequent antenatal care contacts/visits and routine antenatal cardiotocography) with efficiency (risk identification, determination of the optimal strategy for outpatient/ambulatory antenatal care and timing and mode of delivery) and thereby provide better and safer health care (from a medical, organizational, legislative and economic points of view).

The prevalence and associated factors of success of labor induction in Hargeisa maternity hospitals, Hargeisa Somaliland 2022: a hospital-based cross-sectional study.

BACKGROUND: The induction of labor is an artificial initiation of labor and has become one of the most common interventions in modern obstetrics to improve maternal and neonatal health. Understanding the prevalence and pregnancy outcomes following labor inductions is crucial in regions with high rates of maternal mortality and morbidity because of insufficient access to comprehensive emergency obstetric care. Therefore, this study aimed to assess the prevalence and associated factors of the success of induction of labor in Hargeisa maternity hospital Somaliland. METHODS: A hospital-based cross-sectional study was employed among 453 women in Hargeisa maternity hospitals, Somaliland from January 1st to March 30th, 2022. Data were entered using Epi data version 4.6 and analyzed by using SPSS version 25. Bivariable and multivariable logistic regression were used to identify the associated factors with the success of labor induction and an odds ratio with a 95% confidence interval was used to measure the strength of the association. A P-value of ≤ 0.05 was considered statistically significant in multivariate analysis. RESULTS: Of a total of 453 study participants who had undergone induction of labor, 349 (77%) of them had successful induction of labor with a 95% CI: 73%, 81%. Favorable Bishop score (AOR = 3.45, 95% CI: 1.98, 5.99), time from the start of induction to delivery < 12 h (AOR = 4.01, 95% CI: 2.16, 7.450), non-reassuring fetal heart rate pattern (AOR = 0.42, 95% CI: 0.22, 0.78) and amniotic fluid change to meconium (AOR = 0.43, 95% CI: 0.23, 0.79) were significantly associated with the success of labor induction. CONCLUSION: This study implies that three out of four women who underwent induction had successful induction of labor. Favorable bishop score, time from the start of induction to delivery < 12 h, non-reassuring fetal heart rate pattern, and amniotic fluid change to meconium were significantly associated with the success of labor induction. The hospital should establish a clear bishop scoring system and there should be a strict follow-up on the condition of the fetal heartbeat and take corrective actions as needed. The factors related to healthcare facilities and providers need to be addressed by additional prospective studies.

Bereaved parents involvement in maternity hospital perinatal death review processes: 'Nobody even thought to ask us anything'.

INTRODUCTION: The death of a baby is devastating for parents, families and staff involved. Involving bereaved parents in their baby's care and in the maternity hospital perinatal death review can help parents manage their bereavement and plan for the future. In Ireland, bereaved parents generally have not been involved in this review process. The aim of our study was to assess parents' perception of how they may be appropriately involved in the maternity hospital perinatal death review in ways that benefit them and the review process itself. METHODS: Bereaved parents (n = 20) in Ireland were invited to take part in semistructured interviews. Thematic analysis was carried out on the interview transcripts. RESULTS: Four main themes were identified based on the participants' views and opinions on how they experienced the review process and how they feel this process may be improved. The themes reflect the journey of the parents through the different stages of the review process: Throughout process; On leaving the hospital; Interaction with the hospital 'waiting in limbo'; Review itself. Identified subthemes highlighted essential aspects of this process and care provided to parents. For the parents, open, honest communication with staff, as well as having a key hospital contact was essential. Parents wished to provide feedback on their experience and wanted to be included in the review of their baby's death, in a way that was sensitive to their needs and the hospital's schedule. CONCLUSION: A respectful, flexible system that allows bereaved parents' involvement in their baby's perinatal death review and is tailored to their needs is essential. A collaborative process between staff and parents can highlight clinical areas in need of change, enhance lessons learned, improve bereavement services and may prevent future perinatal deaths. PUBLIC CONTRIBUTION: Bereaved parents were interviewed for this study.

A (im)possibilidade de ser mulher e mãe com deficiência: uma revisão integrativa / La (im)possibilidad de ser mujer y madre con deficiencia: una revisíon integradora / The (im)possibility of being a woman and a mother with disabilities: an integrative review

Objetivo: Integrar e analisar os estudos empíricos acerca do conhecimento produzido sobre a vivência da sexualidade e da maternidade de mulheres com deficiência. Método: Revisão Integrativa de Literatura realizada com 17 artigos levantados nas bases de dados Literature and Retrivial System on Line, Directory of Open Access Journals, Scopus e Cinahl, sendo utilizada a análise de conteúdo temática. Resultados: Identificaram-se sentimentos de exclusão e estigma diante da sexualidade e maternidade; falta de educação sexual e reprodutiva à mulher com deficiência, decorrente da imagem social destas mulheres; poucos profissionais de saúde capacitados para orientar e acolher essas mulheres diante da maternidade, durante e após o processo gravídico puerperal. Considerações finais: A sexualidade e a maternidade das mulheres com deficiência são influenciadas pelo seu reconhecimento social e profissional como pessoas produtivas, capazes de exercer sua autonomia, além da importância de profissionais de saúde capacitados para lidar com as diferenças individuais.

Objetivo: Integrar y analizar los estudios empíricos acerca del conocimiento producido sobre la vivencia de la sexualidad y de la maternidad de mujeres con deficiencia. Método: Revisión integradora de la literatura realizada con 17 artículos buscados en las bases de datos Literature and Retrieval System on Line, Directory of Open Access Journal, Scopus y Cinahl, siendo utilizada el análisis de contenido temático. Resultados: se han identificado sentimientos de exclusión y estigma delante de la sexualidad y maternidad; falta de educación sexual y reproductiva para mujeres con deficiencia que decorre de la imagen social de estas mujeres; pocos profesionales de salud capacitados para orientar y acoger estas mujeres delante de la maternidad, mientras y después del ciclo gravídico-puerperal. Consideraciones finales: La sexualidad y la maternidad de las mujeres con deficiencia son influenciadas por su reconocimiento social y profesional como personas productivas, capaces de ejercer su autonomía, además de la importancia de los profesionales de salud capacitados para manejar las diferencias individuales.

Objective: To integrate and analyze empirical studies on the knowledge produced about the sexuality and motherhood experiences of women with disabilities. Method: An Integrative Literature Review carried out with 17 articles collected in the Literature and Retrieval System on Line, Directory of Open Access Journals, Scopus and CINAHL databases, using thematic content analysis. Results: Feelings of exclusion and stigma towards sexuality and motherhood were identified; as well as lack of sexual and reproductive education for women with disabilities, resulting from their social image; and scarcity of health professionals duly trained to guide and welcome women in the face of motherhood, both during and after the pregnancy-puerperal process. Final considerations: The sexuality and motherhood of women with disabilities are influenced by their social and professional recognition as productive people, capable of exercising their autonomy, in addition to the importance of health professionals duly trained to deal with individual differences.

Avaliação psicológica hospitalar: experiência de parametrização de intervenções assistenciais em maternidade-escola de alto risco / Hospital psychological assessment: experience of parameterisation of maternity-high-risk school care interventions / Evaluación psicológica hospitalaria: experiencia de la parametrización de las intervenciones de asistencia en maternidad escolar de alto riesgo

Objetivo: Apresentar a experiência de parametrização de intervenções de avaliação psicológica hospitalar de gestantes e puérperas internadas em situação de alto risco. Relato de experiencia: A atividade foi empreendida em Maternidade-Escola pública de alta complexidade, referência em alto risco, em Teresina, Piauí, de abril a junho de 2023, circunscrita ao Estágio Supervisionado Profissionalizante em Psicologia da Saúde. A partir da imersão no campo para articulação ensino-serviço, com supervisão teórico- prática semanal in loco (presencial) e mediante reuniões síncronas (Google Meet), realizou-se debates sobre as experiências de ensino-aprendizagem e para confecção de uma proposta de roteiro de exame e avaliação psicológica, com o intuito de nortear a atuação dos estagiários, bem como de contribuir com o robustecimento da instrumentalização e orientação das intervenções assistenciais de psicologia na instituição hospitalar. A proposta de instrumento orientador desenvolvido possui doze partes: identificação; motivo da hospitalização; situação de saúde; situação de crise; exame psíquico; sono; sintomas psicossomáticos emergentes; sentido da vida; maternagem e cuidado ao bebê; estratégias de coping; síntese; hipótese diagnóstica. Considerações finais: O roteiro de exame e avaliação psicológica robustece a parametrização de intervenções de psicologia em saúde nos hospitais; vivifica o desenvolvimento e fortalecimento de competências e habilidades para conduzir a avaliação psicológica hospitalar de maneira eficiente, técnica, ética, que dignifique o cuidado perinatal materno sob a égide da integralidade e baseado em evidências.

Objective: To present the experience of parameterisation of hospital psychological evaluation interventions of pregnant women and those who have recently given birth in a high risk situation. Experience report: The activity was undertaken in Maternity-High complexity public school, reference in high risk, in Teresina, Piauí, from April to June 2023, circumscribed to the Supervised Professional Internship in Health Psychology. From immersion in the field for teaching-service articulation, with weekly theoretical-practical supervision in loco (in person) and through synchronous meetings (Google Meet), debates were held on teaching-learning experiences and to prepare a proposal for a roadmap for psychological examination and evaluation, with the aim of guiding the work of trainees, as well as contributing to the strengthening of the instrumentalisation and orientation of psychological assistance interventions in the hospital institution. The proposed guiding instrument developed has twelve parts: identification; reason for hospitalisation; health situation; crisis situation; psychic examination; sleep; emerging psychosomatic symptoms; sense of life; maternity and baby care; coping strategies; synthesis; diagnostic hypothesis. Concluding considerations: The psychological examination and assessment roadmap strengthens the parametrisation of health psychology interventions in hospitals; it vivifies the development and strengthening of competencies and skills to conduct hospital psychological assessment in an efficient, technical, ethical manner, that dignifies maternal perinatal care under the aegis of completeness and evidence-based.

Propósito: Proporcionar la experiencia de parametrización de las intervenciones de evaluación psicológica hospitalaria de las mujeres embarazadas y las personas que adoptan a temprana edad en situaciones de alto riesgo. Informe de la experiencia: La actividad se realizó en la Escuela Maternidad-Pública de alta complejidad, una referencia de alto riesgo en Teresina, Piauí, de abril a junio de 2023, limitada a la Etapa altamente profesional supervisada en Psicología de la Salud. A raíz de la inmersión en el ámbito de la vinculación entre la educación y los servicios, con la supervisión teórico-práctica in loco (asistencia) y mediante reuniones sincrónicas (Google Meet), se celebraron debates sobre las experiencias de enseñanza-aprendizaje y una propuesta de hoja de ruta para el examen y la evaluación psicológicos, con el fin de orientar la labor de los pasantes y contribuir a fortalecer la instrumentalización y orientación de las intervenciones de asistencia psicológica en el hospital. La propuesta de un instrumento de orientación desarrollada consta de doce partes: identificación; motivo de hospitalización; situación de salud; situación de crisis; examen psicológico; sueño; síntomas psicosomáticos emergentes; sentido de la vida; maternidad y cuidado del bebé; estrategias de afrontamiento; síntesis; hipótesis diagnósticas. Consideraciones finales: La hoja de ruta para el examen y la evaluación psicológicos fortalece la parametrización de las intervenciones de psicología sanitaria en los hospitales; ilustra el desarrollo y el fortalecimiento de las aptitudes y capacidades para llevar a cabo una evaluación psicológica hospitalaria de manera eficiente, técnica y ética que dignifica la atención perinatal materna bajo los auspicios de la exhaustividad y basada en pruebas.

[Reorganization of a third-level maternity ward during the COVID-19 pandemic: maternity ward experience at the University Hospital of Marrakech]. / Expérience de réorganisation d'une maternité de troisième niveau face à la pandémie de la COVID-19: étude du cas de la maternité de l´hôpital universitaire de Marrakech.

Introduction: COVID-19 pandemic has put unprecedented pressures on obstetrics and gynecology care services. Maternity hospitals have needed to rapidly prepare to provide quality care while preventing the transmission of the infection. The purpose of this study is to describe the key elements of the response to COVID-19 within the maternity ward of the Mohammed VI University Hospital in Marrakech. Methods: a case study was conducted. Data were collected using various administrative documents related to activities in the maternity ward of the Mohammed VI University Hospital during the COVID-19 pandemic. We also conducted semi-structured interviews with professionals at the maternity ward. Qualitative thematic analysis approach was used for the analysis of transcribed data and triangulation, with the analysis of documentary data. Results: the study highlighted phases of design and organization of two maternity ward access circuits. A new circuit for suspicious or confirmed cases of COVID-19 ensured access to quality care for patients, by guaranteeing isolation measures. The access circuit that was commonly used remained functional to consolidate the right of access to tertiary obstetrics and gynecology care while applying protective measures against COVID-19. Conclusion: this study highlights the necessity to draw on the experience of other health facilities, to contextualize local activities and to anticipate work organization in the face of health crises.

Complementary bottles during the first month and risk of cow's milk allergy in breastfed infants.

AIM: To assess the impact of complementary feeding bottles given at maternity hospital and/or over the first month after discharge from the maternity ward on cow's milk allergy (CMA) risk in breastfed infants. METHODS: Case-control study involving infants aged 6-9 months and who were breastfed for at least 1 month. RESULTS: In 554 cases with a diagnosis of CMA and 211 controls, feeding bottles at maternity hospital, feeding bottles during the first month of life, avoidance of dairy products during pregnancy or breastfeeding, family history of allergy, intake of antibiotics and consumption of proton-pump inhibitors or antacids by the infant during the first month of life were associated with increased risk of CMA in a univariate model. In a multivariate model, only feeding bottle at maternity hospital (OR = 1.81 [1.27; 2.59]), family history of allergy (OR = 2.83 [2.01; 3.99]) and avoidance of dairy products during pregnancy or breastfeeding (OR = 5.62 [1.99; 15.87]) were independent risk factors of CMA. CONCLUSION: Complementary bottles given at maternity hospital to newborns who will be exclusively breastfed increases the later risk of CMA. Similarly, avoidance of dairy products during pregnancy or breastfeeding should be discouraged.

Alexandra General Hospital in Athens: Historical Connections to the Greek Royal Family.

Princess Alexandra of Greece (1870-1891), the eldest daughter of King George I of Greece (1845-1913), was known as the "beloved daughter of the Athenians". Her death at the age of 21 in 1891 due to a pregnancy complication caused nationwide grief. To honour her, the Alexandra Maternity Hospital in Athens was named in her memory. Affiliated with the University of Athens, Alexandra Maternity Hospital researches pregnancy and newborn care, including complications and maternal mortality. Today, the hospital contains various clinical and laboratory departments providing patients with exceptional health care.

[Adaptation of Health Care Organization in a level III Maternity Hospital during the COVID-19 pandemic]. / Adaptation de l'organisation des soins d'une maternité de type 3 durant l'épidémie due à la COVID-19.

The COVID-19 pandemic required a rapid adaptation of health care organization. The objective was to ensure the care of patients avoiding contamination at the time of delivery and for the nursing staff. The establishment of parent-child essential links beyond the pandemic was also taken into account. The reorganization of care first relied upon the constitution of a multidisciplinary operational team which allowed for efficient responsiveness. Then, the activities were refocused on the epidemic situation with the deprogramming of non-urgent activities and the articulation with the ambulatory network. A reorganization of the schedules and a specific training in dressing were carried out. The supply of surgical masks, disinfectant gels and wipes has been provided. A triage of admissions was set up with a special circuit and dedicated staff. A specific delivery room and operating theater equipped with strictly essential materials have been associated with a specific neonatal resuscitation station. In neonatology, two sectors where positive pressure has been suspended have been dedicated to families at risk. Wearing a mask and washing hands with disinfection with hydroalcoholic gel was required for all patients. The children were left at their mothers' bedside in a private room. An incentive for breastfeeding was made. Early discharge from 48 hours was systematically organized with relay by midwife at home. In conclusion, this adaptation of the organization of care has made it possible to respond satisfactorily to the specific situation of this pandemic.

Culture That Facilitates Change: A Mixed Methods Study of Hospitals Engaged in Reducing Cesarean Deliveries.

PURPOSE: Large-scale efforts to reduce cesarean deliveries have shown varied levels of impact; yet understanding factors that contribute to hospitals' success are lacking. We aimed to characterize unit culture differences at hospitals that successfully reduced their cesarean rates compared with those that did not. METHODS: A mixed methods study of California hospitals participating in a statewide initiative to reduce cesarean delivery. Participants included nurses, obstetricians, family physicians, midwives, and anesthesiologists practicing at participating hospitals. Hospitals' net change in nulliparous, term, singleton, and vertex cesarean delivery rates classified them as successful if they achieved either a minimum 5 percentage point reduction or rate of fewer than 24%. The Labor Culture Survey was used to quantify differences in unit culture. Key informant interviews were used to explore quantitative findings and characterize additional cultural barriers and facilitators. RESULTS: Out of 55 hospitals, 37 (n = 840 clinicians) meeting inclusion criteria participated in the Labor Culture Survey. Physicians' individual attitudes differed by hospital success on 5 scales: best practices (P = .003), fear (P = .001), cesarean safety (P = .014), physician oversight (P <.001), and microculture (P = .044) scales. Patient ability to make informed decisions showed poor agreement across all hospitals, but was higher at successful hospitals (38% vs 29%, P = .01). Important qualitative themes included: ease of access to shared resources on best practices, fear of bad outcomes, personal resistance to change, collaborative practice and effective communication, leadership engagement, and cultural flexibility. CONCLUSIONS: Successful hospitals' culture and context was measurably different from nonresponders. Leveraging these contextual factors may facilitate success.

Avaliação da atenção ao parto e nascimento nas maternidades da Rede Cegonha: os caminhos metodológicos / Assessment of delivery and childbirth care in the maternity units of Rede Cegonha: the methodological paths

Resumo Este artigo descreve o método utilizado na avaliação de práticas de cuidado ao parto e nascimento em maternidades da Rede Cegonha. Apresenta os critérios de seleção das maternidades, as diretrizes avaliadas, seus dispositivos e itens de verificação, o método utilizado para coleta das informações e o tratamento dos dados para obtenção dos resultados. Dialoga a respeito das diretrizes escolhidas e da estratégia de devolutiva dos resultados aos gestores e serviços, e discute seu potencial para fomentar processos de qualificação da gestão e atenção obstétrica e neonatal. Trata-se de estudo das práticas de atenção ao parto e nascimento de 606 maternidades selecionadas para o segundo ciclo avaliativo da Rede Cegonha. Os caminhos metodológicos primaram pela construção de corresponsabilidade tripartite para com o processo e os resultados da avaliação, com ênfase na sua utilidade para os tomadores de decisão e instituições hospitalares envolvidas.

Abstract This article describes the methodology used to evaluate delivery and childbirth care practices in maternity hospitals that belong to the Rede Cegonha, according to scientific evidence and rights guarantee. It shows the maternity selection criteria, the evaluated guidelines, their devices and check items, the method used to collect information and the treatment of data to obtain the results. It discusses the chosen guidelines and the strategy of returning results to managers and services and discusses their potential to foster management qualification processes and obstetric and neonatal care. This is a study of delivery and childbirth care practices of 606 maternity hospitals selected for the second evaluation cycle of the Rede Cegonha. The methodological paths stood out for the construction of tripartite co-responsibility for the process and the evaluation results, with an emphasis on its usefulness for the decision-makers and the hospital institutions involved.

Combined pro-breastfeeding practices are advantageous in facilities providing maternity and newborn services.

This study aimed to evaluate the association between a set of pro-breastfeeding practices in facilities providing maternity and newborn services and the prevalence of exclusive breastfeeding at 30 days postpartum, considering the contribution of each practice. A cross-sectional study nested within a cohort study was conducted with 287 women who delivered healthy term infants in two hospitals in southern Brazil. They were interviewed at home at 30 days postpartum. The following practices were evaluated: skin-to-skin contact soon after birth, breastfeeding in the first hour, uninterrupted rooming-in, professional support with breastfeeding, breastfeeding guidance, encouragement to breastfeed on demand, no supplementation with infant formula, and no pacifier use. A score of pro-breastfeeding practices was calculated using a logistic model, which allowed each practice to have its discriminatory capacity and difficulty estimated individually. Poisson regression was used to estimate the association between exclusive breastfeeding at 30 days and the pro-breastfeeding practice score. The prevalence of exclusive breastfeeding at 30 days was 61.7%. The practices with greatest discriminatory capacity, that is, those that contributed most to the score estimates, were professional support with breastfeeding, breastfeeding guidance, and encouragement to breastfeed on demand. The most difficult ones were breastfeeding in the first hour, encouragement to breastfeed on demand, and non-utilization of infant formula. For each unit (standard deviation) of increase in the score, there was an increase of 20% in the prevalence of exclusive breastfeeding at 30 days. We conclude that the set of pro-breastfeeding practices assessed here increased the effect of these practices on exclusive breastfeeding rates at 30 days.

External evaluation and self-monitoring of the Baby-friendly Hospital Initiative's maternity hospitals in Brazil.

Background: In Brazil, the Baby-Friendly Hospital Initiative (BFHI) proposes following the criteria, the "Ten Steps to Successful Breastfeeding", International Code of Marketing of Breast-milk Substitutes and Good birth and delivery practices. Brazilian Baby-Friendly Hospitals are reassessed triennially by external evaluators and annually by self-monitoring. This study aimed to verify if the self-monitoring system fulfills its role of enabling accredited hospitals to assess and improve their compliance with the BFHI criteria. In this sense, we will analyze the self-monitoring evaluation results and compare them with those of the external reassessment. Methods: This descriptive evaluation study of the compliance with the BFHI criteria by the Brazilian Baby-Friendly Hospitals by self-monitoring evaluators from 2010 to 2015 and by external evaluators in 2015. Results: Self-monitoring was performed in all years from 2010 to 2015 by 143 BFHI accredited hospitals. The trend of the levels of compliance with BFHI's criteria according to self-monitoring evaluations was stable over the assessed period. Most criteria presented compliance above 70%, except Step 4 (skin-to-skin contact and breastfeeding in the first hour of life), with mean compliance of 67%. Steps 1 (written policy), 7 (rooming-in) and 9 (give no artificial teats) showed mean compliance above 90%. Regarding the external evaluation carried out in 2015, the criteria with lowest compliance were Step 4 and Woman-Friendly care, both below 50%. Steps 9 and 10 (refer mothers to breastfeeding support groups) reached levels of compliance above 90%. For 2015, self-monitoring provided significant higher compliance levels than those from external evaluations in most criteria, except Step 3 (prenatal information on breastfeeding) and Step 10. There was a difference of more than 30% points between evaluations of Steps 1 (written policy), 2 (training), 5 (show mothers how to breastfeed), Woman-Friendly Care and father or mother stay with their newborn. Conclusions: The self-monitoring system fulfilled partially its role of allowing accredited hospitals to self-assess and improve rates of compliance with BFHI criteria. Future trainings of hospital managers need to address difficulties and identify solutions to improve implementation of Steps 4 and 6.

[The evolution of places of birth]. / L'évolution des lieux de naissance.

Since the beginning of the 19th century, medical advances have drastically cut the number of deaths at birth, ensuring a maximum level of safety of childbirth today. However, there is increasing demand for alternative forms of childbirth which take into account more the expectations of the future parents as well as the psychological and relational dimensions. The current experimentation involving birth centres could lead the way for the development of such possibilities from 2018.

Prevalence and Trends in Donor Milk Use in the Well-Baby Nursery: A Survey of Northeast United States Birth Hospitals.

BACKGROUND AND OBJECTIVES: Pasteurized donor human milk ("donor milk") is an alternative to formula for supplementation of breastfed infants. We conducted a survey to determine (1) prevalence, trends, and hospital-level correlates of donor milk use for healthy newborns in the northeast United States and (2) clinician knowledge and opinions regarding this practice. METHODS: We conducted parallel surveys of clinicians (88% nurse and/or lactation consultant) at (1) all birth hospitals in Massachusetts (MA) and (2) all birth hospitals served by a northeast United States milk bank. We asked about hospital use of donor milk for newborns ≥35 weeks' gestation and receiving Level I care in well nursery, hospital-related factors we hypothesized would be associated with this practice, and clinician knowledge and opinions about donor milk use. RESULTS: 35/46 (76%) of MA birth hospitals and 51/69 (74%) of hospitals served by the milk bank responded; 71 unique hospitals were included. Twenty-nine percent of MA birth hospitals and 43% of hospitals served by the milk bank reported using donor milk for healthy newborns. Hospitals that used donor milk for healthy newborns had higher exclusive breastfeeding at hospital discharge than hospitals that did not (77% versus 56%, p = 0.02). Eighty-three percent of respondents agreed or strongly agreed that using donor milk is an effective way to increase the hospital's exclusive breastfeeding rate. CONCLUSIONS: Many northeast United States birth hospitals currently use donor milk for healthy newborns. This practice is associated with higher exclusive breastfeeding at hospital discharge. Relationships with breastfeeding after discharge and related outcomes are unknown.

Maternity services for rural and remote Australia: barriers to operationalising national policy.

INTRODUCTION: In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. METHODS: Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. RESULTS: We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. CONCLUSIONS: Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.

In-Hospital Formula Supplementation of Healthy Newborns: Practices, Reasons, and Their Medical Justification.

INTRODUCTION: In-hospital formula supplementation is a common practice and has been shown to be a strong determinant of shorter exclusive and any breastfeeding. OBJECTIVE: To investigate the reasons for and circumstances in which in-hospital formula supplementation occurs and whether the stated reasons are medically acceptable. MATERIALS AND METHODS: This prospective cohort study was conducted among 342 mother-infant pairs from April to July 2011 at the Department of Obstetrics and Gynecology, University Hospital of Split, Croatia. Data were collected based on "every feed" charts and WHO/UNICEF "Questionnaire for Monitoring Baby-Friendly Hospitals". We used WHO/UNICEF Baby-Friendly Hospital Initiative and Academy of Breastfeeding Medicine documents on indications for supplemental feeding. RESULTS: During the first 48 hours and entire hospital stay, 49.5% and 62.8% of infants, respectively, received supplements, given on average 16.68 ± 18.6 hours after delivery. In 94.1% of supplemented infants, healthy newborns were given artificial milk, of which 5.9% of mothers had not been notified. The most common maternal reasons for supplementing were "lack of milk" (49.8%), a "crying baby" (35.5%), "cesarean section" (11.5%), newborn weight loss (10.6%), and sore nipples (10.1%). Of all the given reasons, 24.6% were categorized as being medically acceptable. Primiparas were 1.3 times more likely to supplement in hospital, whereas multiparas were 1.3 times more likely to exclusively breastfeed. CONCLUSION: In our study, most reasons for formula supplementation of healthy term newborns were not standard acceptable medical reasons, indicating a need for improved maternal support, revision of hospital policies, and training of hospital staff.