Análisis etnográfico del intervencionismo en la atención perinatal / Ethnographic analysis of the perinatal care interventionism

Objetivo principal: analizar los factores culturales que determinan el intervencionismo de la atención perinatal en un área de salud de la Región de Murcia. Metodología: se desarrolló una investigación cualitativa con enfoque etnográfico. Se realizaron dos grupos de discusión a profesionales, dieciocho entrevistas etnográficas en profundidad a puérperas y observación participante en atención primaria y hospital de referencia del área de estudio. Resultados principales: los resultados se circunscribieron a las representaciones ideológicas del dolor en la gestante, la incertidumbre del riesgo del proceso perinatal, y el hospital como espacio de seguridad y eje del intervencionismo. Conclusión: la alta demanda de la analgesia epidural por las embarazadas y la oferta sistemática por los profesionales, la incertidumbre del riesgo durante el embarazo, la representación del hospital como espacio de seguridad y control durante el parto, y la endoculturación de la mujer en el circuito asistencial serán factores determinantes en el intervencionismo de la atención perinatal

Objective: To analyse the cultural facts that determine the perinatal interventionism in a Health Area of Murcia Region. Methods: A qualitative research with ethnographic approach was carried out in this research by using both focus group to professionals and eighteen in depth interviews to women who were in postpartum period. These methods were complemented by carrying out a participant observation in both primary health care and hospital. Results: Three central themes emerged from narratives: pregnant women's ideologic representations about pain, the uncertainty of the risk of the perinatal process, the hospital: security environment and axis of the interventionism. Conclusions: the determinant facts about the interventionism of the perinatal care are related to the high demand for epidural analgesia from pregnant women and its systematic offer provided by professionals, the uncertainty of the risk during the pregnancy, the hospital representation as a safe place during childbirth, and the pregnancy women's enculturation that takes place through circuit of care

Effects of a 30-mL Epidural Normal Saline Bolus on Time to Full Motor Recovery in Parturients Who Received Patient-Controlled Epidural Analgesia With 0.125% Bupivacaine With 2 µg/mL of Fentanyl.

Previous research suggests that an epidural bolus of 30 mL of normal saline after vaginal delivery may decrease the time for recovery from motor block. A double-blind, randomized controlled study was conducted in 46 parturients to determine if a 30-mL normal saline bolus or sham administered via epidural approach after delivery reduces the time to full motor recovery and the time to 2-dermatome regression. No significant difference was found in time to full motor recovery (saline group 83.18 ± 54 minutes vs control group 100.23 ± 48 minutes, P = .27) or time to 2-dermatome sensory regression (saline group 29.32 ± 16.35 minutes vs control group 36.14 ± 14.39 minutes, P = .15). Results suggest no advantage to the administration of a saline bolus after delivery to hasten the motor recovery in parturients. A post hoc power analysis suggested a sample size of 204 subjects would have been needed to show a difference for this dilute local anesthetic regimen. There were no complications to the technique, which suggests that it is safe to perform, but the difference in recovery (approximately 17 minutes) from a dilute local anesthetic dose may not be clinically significant.

The rise of remifentanil and the decline of midwifery autonomy.

Since the 1980s epidural analgesia has been considered the gold standard for pain relief in labour. Over the past decade there has been a growing trend in UK maternity units to offer remifentanil PCA as a fast, safe alternative for women where epidural analgesia is contraindicated. Increasingly more obstetric units and anaesthetists are extending the use of remifentanil and in many units it is now preferred over central neuroaxial blocks (Stocki et al 2014). It would appear that remifentanil is being hailed as the panacea for labour pain. Whilst discussion around the use and effects of remifentanil is very well documented in anaesthetic journals, there is very little midwifery research around this subject. Following a review of the current evidence, this article will explore the use of remifentanil in labour, consequences for women and neonates and implications for midwifery practice.

Functional discomfort and a shift in midwifery paradigm.

OBJECTIVE: To determine and critically examine maternity attitudes surrounding labour pain and how midwives can best facilitate women navigating intrapartum discomfort without relying on 'pain-relief' strategies or immediate recourse for analgesic assistance. APPROACH: This article examines current literature using seminal research and wider international perspectives, exploring the complex and fluctuating needs of women negotiating the composite factors of labour discomfort are investigated. FINDINGS: Factors such as birth environment, fear, midwifery presence, and self-efficacy, have a significant impact on the uptake of intrapartum analgesia. A holistic view of intrapartum discomfort is needed to shift the current paradigm of pathologising labour pain into one which situates it as a source of positive physiology and functional discomfort. CONCLUSION: Continuing to practice with a pharmacological outlook, aiming to rid the labouring body of discomfort, is reductionist for both midwives and women. Midwives must seek to employ a new lexicon with which to communicate and facilitate women within the dynamic and continually changing territory of labour. If this conceptual shift is realised, the subsequent positive sequalae of women rediscovering their innate birthing capabilities could create a situation where birth can be considered as an aesthetic peak experience, improving satisfaction on both sides of the midwife-mother diad.

A case report on the anxiolytic properties of nitrous oxide during labor.

Widely used in Europe as a labor analgesic, nitrous oxide (N2O) is making a dramatic return in the United States. Valued for its analgesic properties, N2O also has anxiolytic characteristics. Fear and anxiety in childbirth have been associated with various negative effects, and N2O may have the potential to lessen these effects for some women. Women in the United States should have the option of using N2O during labor.

La pelota de parto. Redescubriendo un recurso no farmacológico de gran importancia en el proceso del parto / The birthing ball: rediscovering a non pharmacological resource of great importance in the birth process

Los avances acontecidos en los últimos años en el mundo de la obstetricia evidencian que el movimiento libre de la pelvis en el parto disminuye el dolor y facilita el nacimiento del recién nacido. Hoy en día, disponemos de múltiples técnicas no farmacológicas eficaces para el alivio del dolor de parto. La pelota de parto (PDP) es una de ellas; este útil se encuentra íntimamente ligado a la libertad de movimientos, al balanceo pélvico y a la posición vertical materna, ha demostrado una disminución de la ansiedad y del dolor durante el proceso de parto y un aumento del índice de partos eutócicos. La PDP no sustituye a otros elementos no farmacológicos para el alivio del dolor de parto presentes durante el periodo de dilatación, pero sí los puede complementar y potenciar su eficacia. No se ha demostrado ningún efecto perjudicial asociado al uso de la PDP tanto para la madre como para el recién nacido. Como agentes de cuidados, debemos conocer el modo de uso y los beneficios que se asocian a la PDP, para poder ofertarla como un método eficaz en el alivio del dolor de parto disponible a nuestro alcance, y evitar así el uso de técnicas farmacológicas como única alternativa (AU)

Advances occurred in recent years in obstetrics show that the free movement of the pelvis during labour decreases pain and facilitates the birth of the newborn. Nowadays, many techniques have effective non pharmacological relief in pain during labour. The birthing ball (BB) is one of them, closely linked to freedom of movement, the pelvic tilt and vertical feeding; it has shown a decrease in anxiety and pain during the birthing process and increased rate of normal deliveries. The BB does not replace other non-pharmacological techniques during the period of expansion, but can complement it, thereby improving their effectiveness. Not shown any harmful effects associated with the use of the BB both the mother and the newborn. As health professionals, we must know how to use and the benefits that are associated with the BB, to offer it as an effective method of pain relief in labour available to us (AU)

[Causes of pain in obstetrics]. / Etiologie des douleurs en obstétrique.

For women, the childbearing period is a source of pain related to dysmenorrhoea, childbirth, abortion, gynaecological diseases, etc. Physiologically, female sex hormones influence pain modulation. Whatever its cause, appropriate evaluation and treatment should be offered to relieve these women.

Non-axial administration of fentanyl in childbirth: a review of the efficacy and safety of fentanyl for mother and neonate.

OBJECTIVE: to investigate the use of fentanyl for pain relief during childbirth administered by routes other than epidural or spinal (non-axial). In particular, aspects relating to the efficacy and safety of fentanyl for mother and neonate are explored. BACKGROUND: currently, pethidine is the most widely used intramuscular opioid for the relief of labour pain but has been shown to have numerous side-effects on the mother and neonate. An alternative opioid, fentanyl, has been shown to have fewer side-effects on both mother and neonate than pethidine. Therefore, its use during childbirth was examined in this literature review. REVIEW METHODS: a search of articles relating to the administration of fentanyl via non-axial routes was conducted using electronic databases, key journals and reference lists of selected research papers and reviews. RESULTS: only studies of IV administration were identified from the literature findings from showed that IV administered fentanyl appeared to be a safe, efficacious opioid when administered for pain relief in childbirth. Fentanyl is a short-acting analgesic causing less sedation and nausea in adults than pethidine. In addition, no long-term fetal or neonatal effects of fentanyl were identified, with normal neonatal neurological and adaptive capacities at two hours and 24 hours after birth supporting its safe use in childbirth. KEY CONCLUSION: in the studies identified, fentanyl was found to be efficacious, providing prompt analgesia with minimal side-effects to both mother and infant when administered intravenously (IV) during childbirth. In addition, no long-term fetal effects were found. RECOMMENDATIONS FOR FURTHER RESEARCH: there is a paucity of research relating to the maternal, fetal and neonatal effects of non-axial administered fentanyl other than that of IV. Further research should explore alternate routes of administration such as subcutaneous, sublingual and nasal which are less invasive and can be administered by midwives. IMPLICATION FOR PRACTICE: in confirming the safe use of non-axial administration of fentanyl during childbirth, benefits include midwives being able to offer women an alternative option for pain relief. Alternative routes, such as subcutaneous, can be managed by midwives through a standing order, potentially reducing the need for additional resources. In particular, this will benefit midwifery practice in rural and remote settings where resources and access to specialised services are limited.

The epidural trip: why are so many women taking dangerous drugs during labor?

Two million American women will take an epidural trip this year during childbirth. In most cases, they'll be ill­informed as to possible side effects or alternate methods of pain relief. In many ways, epidurals are the drug trip of the current generation. Similar to street drug pushers, most anesthesiologists in the delivery rooms maintain a low profile, avoid making eye contact and threaten to walk out if they don't get total cooperation. Women get epidurals for one of the main reasons so many women smoked pot in the 1970s­their friends are doing it. This article examines why so many women in the Western world are compelled to take powerful drugs during their labor and exposes the risks epidurals pose to both mother and baby.