Improving Maternity Care Where Home Births Are Still the Norm: Establishing Local Birthing Centers in Guatemala That Incorporate Traditional Midwives.

More than half of births among Indigenous women in Guatemala are still being attended at home by providers with no formal training. We describe the incorporation of comadronas (traditional midwives) into casas maternas (birthing centers) in the rural highlands of western Guatemala. Although there was initial resistance to the casa, comadronas and clients have become increasingly enthusiastic about them. The casas provide the opportunity for comadronas to continue the cultural traditions of prayers, massages, and other practices that honor the vital spiritual dimension of childbirth close to home in a home-like environment with extended family support while at the same time providing a safer childbirth experience in which complications can be detected by trained personnel at the casa, managed locally, or promptly referred to a higher-level facility. Given the growing acceptance of this innovation in an environment in which geographical, financial, and cultural barriers to deliveries at higher-level facilities lead most women to deliver at home, casas maternas represent a feasible option for reducing the high level of maternal mortality in Guatemala.This article provides an update on the growing utilization of casas and provides new insights into the role of comadronas as birthing team members and enthusiastic promotors of casas maternas as a preferable alternative to home births. Through the end of 2023, these casas maternas had cared for 4,322 women giving birth. No maternal deaths occurred at a casa, but 4 died after referral.The Ministry of Health of Guatemala has recently adopted this approach and has begun to implement it in other rural areas where home births still predominate. This approach deserves consideration as a viable and feasible option for reducing maternal mortality throughout the world where home births are still common, while at the same time providing women with respectful and culturally appropriate care.

Health professionals' perceptions of planned home birth care within the Brazilian health system.

BACKGROUND: The American College of Obstetricians and Gynecologists, in its opinion of the Committee on Midwifery Practice, points out that planned home birth is a woman's and family's right to experience, but also to choose and be informed about, their baby's place of birth. The aim of this study was to understand obstetric nurses' perceptions of planned home childbirth care within the framework of the Brazilian obstetric model. METHOD: A qualitative study, with Snowball Sampling recruitment, totaling 20 obstetric nurses through semi-structured interviews between September 2022 and January 2023, remotely, using the Google Meet application and the recording feature. After the data had been collected, the material was transcribed in full and subjected to content analysis in the thematic modality with the support of ATLAS.ti 8.0 software. RESULTS: Obstetric care at home emerged as a counterpoint to hospital care and the biomedical model, providing care at home based on scientific evidence and humanization, bringing qualified information as a facilitator of access and financial costs as an obstacle to effective home birth. CONCLUSION: Understanding obstetric nurses' perceptions of planned home birth care in the context of the Brazilian obstetric model shows the need for progress as a public policy and for strategies to ensure quality and regulation.

Planned home births in Joinville: epidemiological profile of women and maternal and neonatal outcomes.

OBJECTIVE: To identify the epidemiological profile of women who opted for planned home birth in a city in the north of Santa Catarina and to present the main maternal and neonatal outcomes. METHOD: Quantitative, cross-sectional research, with retrospective and documentary data collection carried out in 66 medical records of women who had planned home births from January 2012 to March 2020, in Joinville. The data were organized in tables and analyzed in a descriptive way. RESULTS: The women who opted for planned home birth have a mean age of 31 years, are mostly white, married, with higher education, multiparous, planned pregnancy and performed prenatal care properly. Maternal and neonatal outcomes were positive, with low transfer rates, none being neonatal, and no cases of maternal morbidity. CONCLUSION: The evidence found proved to be satisfactory for the implementation of a new model of health care for women and children.

Professional autonomy in dealing with complications: discourse of obstetric nurses working in planned home births.

OBJECTIVE: to understand the exercise of professional autonomy by obstetric nurses in dealing with complications in planned home births. METHODS: this is a qualitative study, supported by the Discourse of the Collective Subject methodological framework, whose data collection took place from January to March 2021, through interviews guided by a semi-structured script, in which seven midwives who are members of a childbirth care collective in northeastern Brazil and who work in the home context participated. RESULTS: four central ideas emerged from the collective discourses related to the exercise of professional autonomy by obstetric nurses: shared decisions; theoretical-practical instrumentalization; professional expertise; and teamwork. FINAL CONSIDERATIONS: obstetric nurses' autonomy in the face of complications reflects the safety of planned home births and is based on collective critical thinking, reinforcing this professional' leading role in obstetrics.

Trends in facility-based childbirth and barriers to care at a birth center and community hospital in rural Chiapas, Mexico: A mixed-methods study.

OBJECTIVE: To assess trends in childbirth at a hospital-birth center among women living in Compañeros En Salud (CES)-affiliated communities in Chiapas, Mexico and explore barriers to childbirth care. Our hypothesis was that despite interventions to support and incentivize childbirth at the hospital-birth center, the proportion of births at the hospital-birth center among women from Compañeros En Salud-affiliated communities has not significantly changed after two years. We suspected that this may be due to structural factors impacting access to care and/or perceptions of care impacting desire to deliver at the birth center. DESIGN: This explanatory mixed-methods study included a retrospective Compañeros En Salud maternal health census review followed by quantitative surveys and semi-structured qualitative interviews. PARTICIPANTS AND SETTING: Participants were women living in municipalities in the mountainous Sierra Madre region of Chiapas, Mexico who received prenatal care in one of 10 community clinics served by Compañeros En Salud. Participants were recruited if they gave birth anywhere other than the primary-level rural hospital and adjacent birth center supported by Compañeros En Salud, either at home or at other facilities. MEASUREMENTS: We compared rates of birth at the hospital-birth center, other health facilities, and at home from 2017-2018. We conducted surveys and interviews with women who gave birth between January 2017-July 2018 at home or at facilities other than the hospital-birth center to understand perceptions of care and decision-making surrounding childbirth location. FINDINGS: We found no significant difference in rates of overall number of women birthing at the hospital-birth center from Compañeros En Salud-affiliated communities between 2017 and 2018 (p=0.36). Analysis of 158 surveys revealed distance (30.4%), time (27.8%), and costs (25.9%) as reasons for not birthing at the hospital-birth center. From 27 interviews, negative perceptions and experiences of the hospital included low-quality and disrespectful care, low threshold for medical interventions, and harm and suffering. Partners or family members influenced most decisions about childbirth location. KEY CONCLUSIONS: Interventions to minimize logistical barriers may not be sufficient to overcome distance and perceptions of low-quality, disrespectful care. IMPLICATIONS FOR PRACTICE: Better understanding of complex decision-making around childbirth will guide Compañeros En Salud in developing interventions to further meet the needs and preferences of birthing women in rural Chiapas.

Motivações para escolha do parto domiciliar planejado / Motivos para elegir el parto a domicilio previsto / Motivations for choosing planned home birth

Objetivo: compreender as motivações das mulheres na escolha do parto domiciliar planejado e as percepções dessa vivência. Método: estudo descritivo, exploratório e qualitativo, desenvolvido com 14 mulheres que vivenciaram um parto domiciliar planejado entre janeiro de 2019 e dezembro de 2020. As entrevistas foram realizadas entre março e maio de 2021, transcritas na íntegra e submetidas à análise de conteúdo. Resultados: a análise possibilitou compreender que as motivações para escolha do parto domiciliar planejado estiveram relacionadas ao sentimento de medo das práticas obstétricas hospitalares. A segurança no ambiente domiciliar, a garantia da autonomia e a possibilidade da presença dos filhos foram tanto motivações como percepções positivas dessa vivência. A resistência por parte da sociedade foi frequentemente vivenciada. Conclusão: o modelo obstétrico vigente precisa ser repensado e readequado, com vistas à oferta assistência ao parto segura e respeitosa, seja em âmbito domiciliar ou hospitalar.

Objetivo: comprender las motivaciones de las mujeres en la elección del parto domiciliario planeado y las percepciones de esa vivencia. Método: estudio descriptivo, exploratorio y cualitativo, desarrollado con 14 mujeres que experimentaron un parto domiciliario planeado entre enero de 2019 y diciembre de 2020. Las entrevistas se realizaron entre marzo y mayo de 2021, transcritas en su totalidad y sometidas al análisis de contenido. Resultados: el análisis permitió comprender que las motivaciones para la elección del parto domiciliar planeado estuvieron relacionadas con el sentimiento de miedo de las prácticas obstétricas hospitalarias. La seguridad en el ambiente domiciliario, la garantía de la autonomía y la posibilidad de la presencia de los hijos fueron tanto motivaciones como percepciones positivas de esa vivencia. La resistencia por parte de la sociedad fue frecuentemente experimentada. Conclusión: el modelo obstétrico vigente necesita ser repensado y readequado, con vistas a la oferta asistencia al parto segura y respetuosa, sea en ámbito domiciliar u hospitalario.

Objective to understand the motivations of women in choosing the planned home birth and the perceptions of this experience. Method: descriptive, exploratory and qualitative study, developed with 14 women who experienced a planned home birth between January 2019 and December 2020. The interviews were conducted between March and May 2021, transcribed in full and submitted to content analysis. Results: the allowed understanding that the motivations for choosing planned home birth were related to the feeling of fear of hospital obstetric practices. Safety in the home environment, the guarantee of autonomy and the possibility of the presence of children were both motivations and positive perceptions of this experience. Resistance on the part of society was often experienced. Conclusion: the current obstetric model needs to be rethought and readjusted, in order to provide safe and respectful birth, whether at home or in the hospital.

Experiências de partos não planejados fora do ambiente hospitalar / Experiences of unplanned deliveries outside the hospital environment

Objetivo: identificar as experiências das mães em partos não planejados fora do ambiente hospitalar. Metodologia: Foi realizada revisão integrativa nas bases de dados Medline e SciVerse Scopus. Foram incluídas publicações em inglês e em português, no período entre 2000 e 2021. A amostra final foi composta de quatro artigos. Resultados: As experiências vividas se mostram ambíguas, com relatos de vulnerabilidade, estresse e culpa, mas, também, sensações de sorte, alívio e orgulho após o nascimento. Ainda, o tempo de deslocamento até uma instituição de saúde é determinante na realização de partos fora do ambiente hospitalar. Outros fatores que influenciam na ocorrência dizem respeito às mães solo, baixa escolaridade e falta de assistência pré-natal. Conclusões: O nível de desenvolvimento socioeconômico do país é um fator decisivo, no qual mães procedentes de países desenvolvidos sentiam-se mais seguras com a experiência do que as mães de países em desenvolvi-mento. Além disso, a educação médica baseada em um atendimento humanizado potencializou a promoção de uma vivência positiva em relação ao parto não planejado fora do ambiente hospitalar para as mulheres. (AU)

Objective: This study aims to identify the experiences of mothers that gave an unplanned out-of-hospital birth. Design: An integrative review was performed in Medline and SciVerse Scopus databases. Publications in English and Portuguese, covering the period between 2000 and 2021, were included. The final selection consisted of four articles. Results: The experiences are ambiguous, showing vulnerability, stress, and guilt, but also feelings of good fortune, relief, and pride after labor. Furthermore, the time spent traveling to a health institution is a determinant of births out of the hospital. Other factors influencing the occurrence are related to single mothers, insufficient education, and lack of prenatal care. Conclusion: It is acknowledged that the country's socio-economic develop-ment level is a decisive factor, in which mothers from developed countries felt more secure with the experience than mothers from developing countries. In addition, medical education based on humanized care has enhanced the promotion of a positive experience concerning unplanned childbirth in an out-of-hospital environment for women. (AU)

A vivência da mulher no parto domiciliar planejado: uma jornada transpessoal / The experience of women in planned home birth: a transpersonal journey

Resumo: Algumas mulheres brasileiras vêm, ao longo das últimas décadas, buscando locais e modos alternativos ao hospital de parir e nascer, buscando também a assistência de enfermeiras obstetras. O cuidado prestado por estas profissionais deve unir conhecimentos técnico-científicos e saberes que contemplem as diversas dimensões da existência humana (físicas, emocionais, psíquicas, sociais e espirituais), razão pela qual o presente estudo fundamenta-se no referencial teórico do Cuidado Transpessoal, proposto pela Ciência do Cuidado Unitário de Jean Watson. Para fomentar a reflexão sobre os impactos multidimensionais do Parto Domiciliar Planejado na individualidade e na sociedade, questionou-se "como as mulheres vivenciam seus partos domiciliares planejados?". Da conclusão desta tese foi possível interpretar a vivência de mulheres que tiveram o Parto Domiciliar Planejado, elaborar uma teoria substantiva que explicitasse esta vivência e, por fim, propor contribuições para a prática profissional que fomentem o cuidado e vivências transpessoais no parto e nascimento. A presente tese tratou-se de uma pesquisa qualitativa, do tipo interpretativista, que utilizou como referencial metodológico a Teoria Fundamentada nos Dados. O estudo ocorreu entre dezembro de 2018 a dezembro 2022, sendo a coleta de dados, do grupo-piloto ao quarto grupo amostral, realizada entre outubro de 2020 a março de 2022. Por amostragem teórica, foram entrevistadas vinte e seis mulheres que tiveram seus partos em domicílio, de forma planejada, entre os anos de 2007 a 2021. Como recurso de fonte de dados, utilizaram-se entrevistas audiogravadas, a partir de roteiro semiestruturado composto por questões abertas e orientadoras, além de produções estéticas, recurso inspirado no método criativo sensível e na pesquisa baseada em artes, produzidas pelas mulheres, referentes às suas vivências. Para a análise, foi utilizada a corrente glaseriana, que envolveu codificações substantivas e teóricas, apoiadas pelo uso de memos, diagramas, e do software NVivo® para a organização dos dados. A partir da análise, elaborou-se a teoria substantiva "A vivência da mulher no Parto Domiciliar Planejado: uma jornada transpessoal", composta por um conceito central, três conceitos, seis subconceitos e vinte e cinco unidades de sustentação, que foi validada por pesquisadores experts e mulheres com vivência em parto domiciliar planejado. A partir dessa teoria substantiva, publicaram-se dois ensaios teóricos em periódico científico, e propõe-se sua inclusão na formação profissional obstétrica fundamentada no cuidado transpessoal, bem como utilizá-la como um guia para mulheres que estão iniciando na jornada. Acredita-se que essas contribuições para a prática, quando implementadas, serão capazes de favorecer a melhoria da qualidade prestada e mudança do cuidado ao parto e nascimento, tanto no âmbito institucional como no domiciliar, impactando positivamente pessoas e sociedade por meio das transformações oportunizadas pela vivência de um parto domiciliar planejado.

Abstract: Over the last decades, some Brazilian women have been searching for places and alternative ways, rather than a hospital, to labor and delivery, also seeking for the obstetric nurses' assistance. The care provided by these professionals must join technical-scientific knowledge, as well as knowledge that contemplates the various dimensions of human existence (physical, emotional, psychological, social, and spiritual), which is why the present study is based on the theoretical framework of the Transpersonal Care, proposed in Jean Watson's Unitary Caring Science. To encourage reflection on the multidimensional impacts of Planned Homebirth on individuals and society, the question asked was "how do women experience their planned home births?". From the conclusion of this thesis, it was possible to interpret the experience of women who had Planned Homebirth, to elaborate a substantive theory that explained this experience and, finally, to propose contributions to professional practice that promote care and transpersonal experiences in labor and delivery. This thesis was an interpretive qualitative research, which used the Grounded Theory as a methodological framework. The study took place between December 2018 and December 2022, and data collection, from the pilot group to the fourth sample group, was carried out between October 2020 and March 2022. By theoretical sampling, twenty-six women were interviewed, who had planned home births between 2007 and 2021. As a data source, audio-recorded interviews were used, by means of a semi-structured questionnaire with open, guiding questions, and art productions, a resource inspired by the sensitive creative method and art-based research, performed by the women, regarding their lived experiences. For the analysis, the Glaserian approach was used, which comprised substantive and theoretical coding, supported by memos, diagrams, and the NVivo® software for data organization. Based on the analysis, the substantive theory "Women's experience in Planned Home birth: a transpersonal journey" was elaborated, entailing one core concept, three concepts, six subconcepts and twenty-five supporting units, which was validated by expert researchers and women with experience in planned home birth. Based on this substantive theory, two theoretical essays were published in a scientific journal, and its inclusion in a professional obstetric training course grounded in the transpersonal care has been proposed. Its use has also been proposed as a guide for women who are starting their labor and delivery journey. It is believed that these contributions to practice, when implemented, will be able to favor the improvement of the quality provided and change of care during labor and birth, both institutional and home settings, positively impacting on people and society through the transformations provided by the experience of a planned home birth.

[Geographies for a good birth: a geo(corpo)graphic approach to home birth in Chile]. / Geografías para un buen nacer: una aproximación geo(corpo)gráfica del parto en domicilio en Chile.

Home birth has added a layer of complexity to the epistemology of birth, raising questions about its institutional aspects. From this standpoint, this article stems from an interest in the narratives that Chilean women ascribe to the scenario of home birth. Thirty women were interviewed between October 2018 and January 2019 using elements of body mapping. A central category emerged in thematic analysis: geo(corpo)graphies of home birth, which involves the deployment of the material/symbolic body in a manner that allows birth to occur. Three subcategories also emerged: creating the ideal setting for childbirth, which has to do with imagining and defining the ideal space for childbirth; the best place to give birth letting instincts flow, which is constructed by feeling and listening to the body; and resignifying the ideal scenario, which implies attributing a new meaning to the home in order to give birth. These geo(corpo)graphic narratives of home birth recognize corporality and its disposition in space, allowing birth to be collectively socialized, blurring the boundaries between the public and the private.

El parto en domicilio ha complejizado la epistemología del nacimiento cuestionando la institucionalidad. Así surge el interés por conocer las narrativas que las mujeres chilenas le otorgan al escenario del parto en domicilio. Entre octubre de 2018 y enero de 2019, se entrevistó a 30 mujeres utilizando elementos de los mapeos corporales. Mediante el análisis temático emergió la categoría central geo(corpo)grafías del parto en domicilio, que implica un despliegue del cuerpo material/simbólico que permite que el nacimiento suceda; y tres subcategorías: crear el escenario ideal para el parto, que responde a imaginar y concretar el espacio ideal del nacimiento; el mejor lugar para parir dejando fluir los instintos, que se construye a partir de sentir y escuchar el cuerpo; y resignificar el escenario ideal, que implica otorgar un nuevo significado al domicilio para dar a luz. Las narrativas geo(corpo)gráficas del parto en domicilio reconocen la corporalidad y la disposición de este en el espacio, y permiten socializar el nacimiento y difuminar la barrera entre lo público y lo privado.

Safe birth in cultural safety in southern Mexico: a pragmatic non-inferiority cluster-randomised controlled trial.

BACKGROUND: Available research on the contribution of traditional midwifery to safe motherhood focuses on retraining and redefining traditional midwives, assuming cultural prominence of Western ways. Our objective was to test if supporting traditional midwives on their own terms increases cultural safety (respect of Indigenous traditions) without worsening maternal health outcomes. METHODS: Pragmatic parallel-group cluster-randomised controlled non-inferiority trial in four municipalities in Guerrero State, southern Mexico, with Nahua, Na savi, Me'phaa and Nancue ñomndaa Indigenous groups. The study included all pregnant women in 80 communities and 30 traditional midwives in 40 intervention communities. Between July 2015 and April 2017, traditional midwives and their apprentices received a monthly stipend and support from a trained intercultural broker, and local official health personnel attended a workshop for improving attitudes towards traditional midwifery. Forty communities in two control municipalities continued with usual health services. Trained Indigenous female interviewers administered a baseline and follow-up household survey, interviewing all women who reported pregnancy or childbirth in all involved municipalities since January 2016. Primary outcomes included childbirth and neonatal complications, perinatal deaths, and postnatal complications, and secondary outcomes were traditional childbirth (at home, in vertical position, with traditional midwife and family), access and experience in Western healthcare, food intake, reduction of heavy work, and cost of health care. RESULTS: Among 872 completed pregnancies, women in intervention communities had lower rates of primary outcomes (perinatal deaths or childbirth or neonatal complications) (RD -0.06 95%CI - 0.09 to - 0.02) and reported more traditional childbirths (RD 0.10 95%CI 0.02 to 0.18). Among institutional childbirths, women from intervention communities reported more traditional management of placenta (RD 0.34 95%CI 0.21 to 0.48) but also more non-traditional cold-water baths (RD 0.10 95%CI 0.02 to 0.19). Among home-based childbirths, women from intervention communities had fewer postpartum complications (RD -0.12 95%CI - 0.27 to 0.01). CONCLUSIONS: Supporting traditional midwifery increased culturally safe childbirth without worsening health outcomes. The fixed population size restricted our confidence for inference of non-inferiority for mortality outcomes. Traditional midwifery could contribute to safer birth among Indigenous communities if, instead of attempting to replace traditional practices, health authorities promoted intercultural dialogue. TRIAL REGISTRATION: Retrospectively registered ISRCTN12397283 . Trial status: concluded.

In many Indigenous communities, traditional midwives support mothers during pregnancy, childbirth, and some days afterwards. Research involving traditional midwives has focused on training them in Western techniques and redefining their role to support Western care. In Guerrero state, Mexico, Indigenous mothers continue to trust traditional midwives. Almost half of these mothers still prefer traditional childbirths, at home, in the company of their families and following traditional practices. We worked with 30 traditional midwives to see if supporting their practice allowed traditional childbirth without worsening mothers' health. Each traditional midwife received an inexpensive stipend, a scholarship for an apprentice and support from an intercultural broker. The official health personnel participated in a workshop to improve their attitudes towards traditional midwives. We compared 40 communities in two municipalities that received support for traditional midwifery with 40 communities in two municipalities that continued to receive usual services. We interviewed 872 women with childbirth between 2016 and 2017. Mothers in intervention communities suffered fewer complications during childbirth and had fewer complications or deaths of their babies. They had more traditional childbirths and fewer perineal tears or infections across home-based childbirths. Among those who went to Western care, mothers in intervention communities had more traditional management of the placenta but more non-traditional cold-water baths. Supporting traditional midwifery increased traditional childbirth without worsening health outcomes. The small size of participating populations limited our confidence about the size of this difference. Health authorities could promote better health outcomes if they worked with traditional midwives instead of replacing them.

Parto domiciliar planejado assistido por enfermeira obstétrica: significados, experiências e motivação para essa escolha / Parto domiciliario planificado asistido por enfermera obstétrica: significados, experiencias y motivación para esta elección / Planned home birth assisted by a midwife nurse: meanings, experiences and motivation for this choice

RESUMO Objetivo: compreender os significados e experiências de mulheres que vivenciaram o parto domiciliar planejado assistido por enfermeira obstétrica e a motivação (das mulheres) para essa escolha. Metodologia: estudo qualitativo, exploratório e descritivo, com 16 mulheres, realizado por meio de entrevista semiestruturada e analisado pelos pressupostos da análise temática de conteúdo. Resultados: as mulheres vivenciaram o parto com tranquilidade, autonomia e respeito, escolheram as posições e as pessoas de sua preferência. O parto teve significado de vitória e de libertação, cuja experiência foi descrita como inesquecível, fantástica, intensa e protagonizada pela mulher. O descontentamento com o modelo de assistência vigente, a participação em grupo de gestantes, o acesso a informações e a vivência de violência obstétrica anterior motivaram as mulheres a optarem pelo parto domiciliar. Considerações finais: as experiências das mulheres convergem para o exercício da autonomia e respeito à individualidade. Evidencia-se o protagonismo das mulheres que vivenciaram um parto natural e livre de intervenções. A assistência obstétrica foi centrada nas necessidades da parturiente, proporcionou confiança, segurança, tranquilidade e respeito às suas escolhas. Aponta-se a necessidade de ampliar a assistência ao parto por enfermeiras obstétricas às mulheres que desejam o parto domiciliar planejado. Políticas públicas de assistência ao parto podem viabilizar isso.

RESUMEN Objetivo: comprender los significados y las experiencias de las mujeres que vivieron el parto domiciliario planificado asistido por enfermera obstétrica y la motivación (de las mujeres) para esta elección. Metodología: estudio cualitativo, exploratorio y descriptivo, con 16 mujeres, realizado a través de entrevista semiestructurada y analizado por los supuestos del análisis de contenido temático. Resultados: las mujeres experimentaron el parto con tranquilidad, autonomía y respeto, eligieron las posiciones y las personas de su preferencia. El parto tuvo un significado de victoria y liberación, cuya experiencia se describió como inolvidable, fantástica, intensa y protagonizada por la mujer. La insatisfacción con el modelo de atención actual, la participación en grupo de mujeres embarazadas, el acceso a informaciones y la experiencia de violencia obstétrica anterior motivaron a las mujeres a optar por el parto domiciliario. Consideraciones finales: las experiencias de las mujeres convergen para el ejercicio de la autonomía y respeto a la individualidad. Se evidencia el protagonismo de las mujeres que experimentaron un parto natural y libre de intervenciones. La atención obstétrica se centró en las necesidades de la parturienta, proporcionó confianza, seguridad, tranquilidad y respeto con sus elecciones. Se señala la necesidad de ampliar la atención al parto por enfermeras obstétricas a las mujeres que desean el parto domiciliario planificado. Las políticas públicas de atención al parto pueden hacer esto posible.

ABSTRACT Objective: to understand the meanings and experiences of women who dealt with planned home birth assisted by a nurse midwife and the motivation (of these women) for this choice. Methodology: qualitative, exploratory and descriptive study, with 16 women, performed by means of semi-structured interviews and analyzed by the assumptions of thematic content analysis. Results: the women experienced childbirth with tranquility, autonomy and respect, and they chose the positions and people of their preference. Childbirth had a meaning of victory and liberation, whose experience was described as unforgettable, fantastic, intense and carried out by the woman. The dissatisfaction with the current model of care, the participation in a group for pregnant women, the access to information and the experience of previous obstetric violence motivated women to choose home birth. Final considerations: the women's experiences converge towards the exercise of autonomy and respect for individuality. The leading role of women who experienced a natural birth and free of interventions, should be highlighted. Obstetric care was focused on the parturient woman's needs, provided confidence, security, tranquility and respect for her choices. There is a need to expand childbirth care provided by nurse midwives to women who wish to have a planned home birth. Public policies for childbirth care can make this possible.

Desejando parir naturalmente: perspectiva de mulheres sobre o parto domiciliar planejado com uma enfermeira obstétrica / Wanting to give birth naturally: women's perspective on planned homebirth with a nurse midwife / Deseando parir naturalmente: perspectiva de mujeres sobre el parto domiciliario planificado con una enfermera obstétrica

Objetivo: descrever a escolha do parto domiciliar planejado acompanhado por enfermeira obstétrica em um centro urbano de grande porte, na perspectiva de mulheres brasileiras. Métodos: estudo qualitativo guiado pela Grounded Theory. Foram entrevistadas dez mulheres com idade entre 20 e 41 anos que tiveram parto domiciliar planejado acompanhadas por enfermeiras obstétricas. As participantes foram recrutadas por meio de rede social, acessando um grupo de mulheres que escreveram sobre seu parto domiciliar. Resultados: Emergiram duas categorias: Não vendo possibilidade de parir naturalmente no ambiente hospitalar e Pensando na segurança do parto domiciliar planejado. O hospital representou vários aspectos desfavoráveis como intervenções desnecessárias e solidão. As mulheres consideravam o lar um lugar seguro para parir, conectado aos cuidados de enfermeiras obstétricas. Conclusão: há mulheres que não desejam parir no hospital, preferindo parir em casa e do ponto de vista dos direitos humanos e dos cuidados desmedicalizados, as enfermeiras obstétricas devem apoiar as mulheres nessa sua decisão.

Objective: to describe the choice of planned homebirth attended by a nurse midwife in a large urban centre, from the perspective of Brazilian women. Methods: in this Grounded Theory study, ten women aged 20 to 41 years, who had a planned homebirth accompanied by a nurse midwife, were interviewed. Participants were recruited through a social network by accessing a group of women who wrote about their homebirth. Results: two categories emerged: seeing no possibility of giving birth naturally in the hospital environment; and thinking about the safety of a planned homebirth. Hospital represented several unfavourable aspects, such as unnecessary interventions and loneliness. Women thought of home as a safe place to give birth, connected with nurse midwife care. Conclusion: there are women who do not wish to give birth in hospital, but prefer to give birth at home and, from the point of view of human rights and de-medicalized care, nurse midwives should support women in their decision.

Objetivo: describir la elección del parto domiciliario planificado con enfermera obstétrica en un gran centro urbano, desde la perspectiva de mujeres brasileñas. Métodos: estudio cualitativo guiado por la Grounded Theory. Se entrevistó a diez mujeres entre 20 y 41 años que tuvieron parto domiciliario planificado, siendo acompañadas de enfermeras obstétricas. Las participantes fueron reclutadas a través de red social, accediendo a un grupo de mujeres que escribieron sobre su parto en domicilio. Resultados: surgieron dos categorías: las que no veían posibilidad de dar a luz naturalmente en el hospital y las que pensaron en la seguridad del parto domiciliario planificado. El hospital representó varios aspectos desfavorables como intervenciones innecesarias y soledad. Las mujeres consideraban que el hogar era un ambiente seguro para dar a luz, vinculado al cuidado de enfermeras obstétricas. Conclusión: hay mujeres que no desean dar a luz en el hospital, prefieren hacerlo en casa y, desde el punto de vista de los derechos humanos y de los cuidados sin la intervención de un médico, las enfermeras obstétricas deben apoyarlas en esa decisión.

Cuidados domiciliares de parteiras tradicionais na assistência ao parto / Home care by traditional midwives in childbirth care / Cuidados domiciliarios de parteras tradicionales en la atención del parto

Objetivo: descrever os cuidados domiciliares prestados por parteiras tradicionais durante a assistência ao parto. Método: estudo qualitativo conduzido por meio do método da História Oral Temática, realizado com 16 parteiras em nove municípios do Cariri cearense. A coleta de dados ocorreu entre julho e dezembro de 2015 por meio de entrevista semiestruturada, os relatos foram transcritos, textualizados e transcriados. Resultados: as parteiras prestavam cuidados familiares, assistência ao parto vaginal, cuidados com o recém-nascido e no puerpério imediato. Usavam chás e orações como adjuvantes do seu ofício. Conclusão: o cuidado das parteiras na assistência ao parto centralizava-se nas necessidades da mulher e da família, sendo, em alguns casos, extensivo à casa. As parteiras conheciam os sinais e sintomas do trabalho de parto e agiam nas possíveis intercorrências.

Objective: to describe home care provided by traditional midwives during childbirth care. Method: this qualitative study, using the Thematic Oral History method, was conducted with 16 midwives from nine municipalities in Cariri, Ceará. Data were collected from July to December 2015 through semi-structured interviews, the reports were transcribed, textualized and transcreated. Results: midwives provided family care, vaginal delivery care, newborn care and immediate postpartum care. They used teas and prayers as an adjuncts to their craft. Conclusion: childbirth care by midwives centered on the women's and families' needs and, in some cases, extended to the home. Midwives knew the signs and symptoms of labor and acted on possible complications.

Objetivo: describir los cuidados domiciliarios brindados por parteras tradicionales durante la atención al parto. Método: estudio cualitativo conducido mediante el método de Historia Oral Temática, realizado con 16 parteras en nueve municipios de Cariri en Ceará. La recolección de datos se realizó entre julio y diciembre de 2015 a través de entrevistas semiestructuradas; los relatos fueron transcritos, textualizados y transcreados. Resultados: las parteras brindaron atención familiar, asistencia en el parto vaginal, cuidados al recién nacido y en el puerperio inmediato. Usaban tés y oraciones como complemento de su oficio. Conclusión: el cuidado de las parteras en la atención al parto se centraba en las necesidades de la mujer y de la familia, extendiéndose, en algunos casos, al hogar. Las parteras conocían los signos y síntomas del trabajo de parto y actuaban sobre las posibles complicaciones.

Planned home birth assistance: challenges during the COVID-19 pandemic.

OBJECTIVE: To understand the challenges faced by urban midwives in assisting planned home births during the COVID-19 pandemic. METHODS: Qualitative study, based on the Collective Subject Discourse methodological framework, carried out with eight professionals, members of a birth care collective from the northeast region of Brazil. Data was collected between September and October of 2020 using the focus group technique. RESULTS: The collective discourses revealed five central ideas: Changing assistance strategy; Dealing with frustration; Facing the fear of contamination; Avoiding exposure to the virus; and Keeping distance during the care process. FINAL CONSIDERATIONS: The challenging condition the pandemic brings to the care of planned home births is made evident, being marked by the need for collective protection and the pressure of following health recommendations. The study also points out the need for official protocols and good quality information based on scientific evidence and humanizing principles to guide health care.

Exploring women's decisions of where to give birth in the Peruvian Amazon; why do women continue to give birth at home? A qualitative study.

BACKGROUND: Despite improvements in maternal mortality globally, hundreds of women continue to die daily. The World Health Organisation therefore advises all women in low-and-middle income countries to give birth in healthcare facilities. Barriers to seeking intrapartum care have been described in Thaddeus and Maine's Three Delays Model, however these decisions are complex and often unique to different settings. Loreto, a rural province in Peru has one of the highest homebirth rates in the country at 31.8%. The aim of this study was to explore facilitators and barriers to facility births and explore women's experiences of intrapartum care in Amazonian Peru. METHODS: Through purposive sampling, postnatal women were recruited for semi-structured interviews (n = 25). Interviews were transcribed verbatim and thematically analysed. A combination of deductive and inductive coding was used. Analytical triangulation was undertaken, and data saturation was used to determine when no further interviews were necessary. RESULTS: Five themes were generated from the data: 1) Financial barriers; 2) Accessing care; 3) Fear of healthcare facilities; 4) Importance of seeking care and 5) Comfort and traditions of home. Generally, participants realised the importance of seeking skilled care however barriers persisted, across all areas of the Three Delays Model. Barriers identified included fear of healthcare facilities and interventions, direct and indirect costs, continuation of daily activities, distance and availability of transport. Women who delivered in healthcare facilities had mixed experiences, many reporting good attention, however a selection experienced poor treatment including abusive behaviour. CONCLUSION: Despite free care, women continue to face barriers seeking obstetric care in Amazonian Peru, including fear of hospitals, cost and availability of transport. However, women accessing care do not always receive positive care experiences highlighting implications for changes in accessibility and provision of care. Minimising these barriers is critical to improve maternal and neonatal outcomes in rural Peru.

Information that (de)motivate women's decision making on Planned Home Birth.

OBJECTIVE: To understand how information about Planned Home Birth motivates or discourages women's decisions on this location of birth. METHOD: Descriptive exploratory study, qualitative approach. Data collection carried out from February to April 2019, through semi-structured interviews with 14 women and documentary sources. The data were analyzed using Bardin's content analysis process, with the help of ATLAS.ti 8.0. RESULTS: The motivations for choosing Planned Home Birth are: respect for the autonomy and natural process of childbirth and delivery, support from a partner and trust in professionals. Aspects that discourage this choice are fear of complications, the need for a hospital medical structure, opinions that value risk. CONCLUSION: Women's choices are based not only on information, but also on how that information is processed. This study demonstrated that the perception pertaining to the safety of Planned Home Birth is essential for making this decision.

Características sociodemográficas e gestacionais de mulheres em partos de ocorrência em domicílio / Sociodemographic and gestational characteristics of women in home births

Resumo: O Parto domiciliar planejado é aquele que ocorre em casa com o apoio de uma equipe técnica, de forma planejada. O objetivo deste estudo caracterizar o perfil das parturientes e dos partos domiciliares nas Regionais de Saúde do estado do Paraná no período compreendido entre 2014 e 2019. O presente estudo refere-se à necessidade de caracterizar o perfil dos partos domiciliares nas Regionais de Saúde (RS) do estado do Paraná no período compreendido entre 2014 e 2019. Um estudo quantitativo, transversal, com coleta retrospectiva de dados. Para estabelecer o perfil das mulheres que tiveram seus filhos em parto domiciliar, foi realizada em março de 2021, na base de dados do Sistema de Informação sobre Nascidos Vivos sobre as informações referentes às Declarações de Nascido Vivo, a coleta dos dados. Os dados foram organizados em uma tabela de Excel e selecionados 1.954 nascimentos de ocorrência em domicílio, analisados mediante análise descritiva simples por meio da apresentação de frequência, média e mediana. As fichas foram divididas em três grupos: possível parto domiciliar planejado (n=432), possível parto domiciliar acidental a termo (n=1.278) e possível parto domiciliar acidental pré-termo (n=244). A ocorrência maior de nascimentos domiciliares foi na macrorregião Leste, com 61,51% dos nascimentos. Os grupos de possível parto domiciliar apresentou média de idade, 29 anos, idade essa maior que dos outros dois grupos. Considerando a totalidade geral dos grupos (n= 1.954), o percentual de mães adolescentes (idade inferior a 20 anos) é de 9,06% (n=177). A idade paterna teve uma completude dos dados de 67,96% (n= 1328). Em relação à adequação do pré-natal, mais da metade, 51,23% (n=125) das mulheres que tiveram um parto prematuro em casa não fizeram o pré-natal ou o fizeram de forma inadequada. Em relação às semanas de gestação em que a mulher estava quando ocorreu o parto, Mais de 70% (n=1.375) das gestações ocorreram entre a 38 e 40 semanas gestacionais, com pico de ocorrência de 37% (n= 723) na 39 semana gestacional, nos grupos a termo. Os resultados do estudo evidenciaram diferenças no perfil das mulheres de parto domiciliar: um grupo que apresenta maior nível de escolaridade, situação conjugal casada ou coabita com companheiro, jovens adultas, menor número de filhos e maior adequação do pré-natal, essas, inseridas no grupo e possível parto domiciliar planejado. No outro perfil, as mulheres apresentam menor nível de escolaridade, solteiras, maior prole, menor adequação do pré-natal, pertenciam ao grupo de possível parto domiciliar acidental. Este estudo aponta a necessidade de criação de uma subcategoria nas fichas de Declaração de Nascido Vivo específica para o nascimento domiciliar, permitindo maior visibilidade desta modalidade de assistência, sendo possível um melhor acompanhamento dos indicadores e desfechos maternos e neonatais. Como contribuições para área, os resultados permitem enxergar o parto domiciliar planejado como uma opção na escolha da mulher pelo local de nascimento, de forma planejada e segura.

Abstract: Planned home birth is one that takes place at home with the support of a technical team, in a planned manner. The aim of this study is to characterize the profile of parturient women and home births in the Regional Health Departments of the state of Paraná in the period between 2014 and 2019. This study refers to the need to characterize the profile of home births in the Regional Health Department (RS). ) of the state of Paraná in the period between 2014 and 2019. A quantitative, cross-sectional study with retrospective data collection. To establish the profile of women who gave birth at home, data collection was carried out in March 2021, in the Live Birth Information System database, on information related to Live Birth Certificates. Data were organized in an Excel table and 1,954 births occurring at home were selected, analyzed using simple descriptive analysis through the presentation of frequency, mean and median. The forms were divided into three groups: possible planned home birth (n=432), possible accidental home birth at term (n=1,278) and possible accidental preterm home birth (n=244). The highest occurrence of home births was in the East macro-region, with 61.51% of births. The groups of possible home births had a mean age of 29 years, which was higher than the other two groups. Considering the overall totality of groups (n=1,954), the percentage of adolescent mothers (under 20 years of age) is 9.06% (n=177). Paternal age had a completeness of data of 67.96% (n= 1328). Regarding the adequacy of prenatal care, more than half, 51.23% (n=125) of the women who had a premature birth at home did not have prenatal care or did it inappropriately. Regarding the gestational weeks the woman was at when the childbirth occurred, More than 70% (n=1,375) of pregnancies occurred between the 38th and 40th gestational weeks, with a peak of 37% (n=723) in the 39th gestational week, in the term groups. The results of the study showed differences in the profile of home birth women: a group with a higher level of education, marital status, married or cohabiting with a partner, young adults, fewer children and greater adequacy of prenatal care, these, inserted in the group and possible planned home birth. In the other profile, women have a lower level of education, single, more offspring, less adequate prenatal care, belonged to the group of possible accidental home births. This study points out the need to create a subcategory in the Live Birth Declaration forms specific for home birth, allowing for greater visibility of this type of care, enabling better monitoring of maternal and neonatal indicators and outcomes. As contributions to the area, the results allow seeing the planned home birth as an option in the woman's choice of place of birth, in a planned and safe way.