Satisfacción de la mujer respecto al rol de la matrona/matrón en la atención del parto, en el contexto del modelo de atención personalizada en Chile / Chilean women’s satisfaction about the midwifery role in the context of the personalized model of care during childbirth

OBJETIVO: Describir la satisfacción de la mujer respecto al rol de la matrona/matrón en la atención del parto en una Maternidad de la ciudad de Santiago de Chile, perteneciente al Sistema de Salud Público. MÉTODO: Estudio cualitativo. Se realizaron entrevistas semiestructuradas a 14 mujeres chilenas, puérperas de parto vaginal, de entre 19 y 43 años, sin patologías asociadas. Se llevó a cabo un análisis del contenido de los datos. RESULTADOS: En el análisis de las entrevistas se valoraron cinco categorías: I) experiencia general del parto; II) la matrona/matrón: un profesional cercano y cómplice en el proceso (III) y un pilar en el manejo del dolor; IV) habilidades comunicacionales y entrega de información, y V) la matrona/matrón como ente de empoderamiento durante el parto. Con respecto al rol de la matrona/matrón, el componente relacional destaca por encima de las habilidades técnicas: el buen trato, la compañía, la contención emocional, la cercanía y la entrega de información. Las mujeres esperan empatía, amabilidad y motivación, y que la matrona/matrón contribuya a disminuir la ansiedad y el dolor, de modo que se sientan apoyadas y puedan vivir una mejor experiencia. CONCLUSIÓN: La calidad de la atención determina una buena experiencia de parto. El rol del profesional matrona/matrón es de gran relevancia en este proceso, lo que hace necesaria una formación orientada no sólo a las competencias técnicas, sino también, y fundamentalmente, a las comunicacionales y relacionales, de modo que sea posible ofrecer una atención de calidad que favorezca el estado emocional óptimo de la madre

OBJECTIVE: To describe the satisfaction of women regarding the role of the midwife in delivery care in a Maternity belonging to the public health system in Santiago de Chile. METHOD: Qualitative study using semi-structured interviews with 14 postpartum low risk women, undergoing a vaginal delivery between 19 and 43 years old. A content analysis of the data was performed. RESULTS: The analysis of these interviews revealed five categories: overall experience of childbirth, Midwife: a close professional an accomplice in the process, a fundamental pillar in pain management, communication skills and information delivery, the midwife as an entity of empowerment during childbirth. Regarding the role of the midwife, stands out the relational component far over the technical skills: good treat, company, closeness and provision of information. Women expect empathy, kindness, containment, motivation that helps reducing anxiety and pain, this allows them feeling supported and live a better experience. CONCLUSION: Quality of care determines a good birth experience The role of the midwife is of great importance during this process, requiring technical skills and training, but mainly communication and relational skills are needs, to provide a real quality care and ensure an optimal maternal emotional state

Age, menopause and hormone replacement therapy influences on cardiovascular risk factors in a cohort of middle-aged Chilean women.

OBJECTIVE: To determine the prevalence of obesity and other cardiovascular risk factors (RF) in middle-aged women, to correlate them with each other, and to describe the prevalence of such a RF and their changes with aging, menopause and Hormone Replacement Therapy (HRT) in a cohort of Chilean workers. MATERIAL AND METHOD: In 1991-1992 cardiovascular RFs were assessed in 467 women between 40 and 59 who were not taking HRT at that time. Five years later these women were re-evaluated. RESULTS: Sedentarism (87.2%), dyslipidemias (71.5%), high blood pressure (13.5%), obesity (13.1%), smoking (12.4%) and diabetes (2.8%) were the more prevalent RF. These RF become more prevalent with age. In the second control, 5 years later, hypertension (20.9%), obesity (27.3%), smoking (20.8%) and diabetes (5.9%) were observed increased. Dyslipidemia did not changed, although triglyceride levels rose from 125.9+/-56.4 to 136.8+/-63.5 mg/dl (P<0.01). Sedentarism dropped to 58.8%. Menopause did not deteriorate any of these RF. The use of HRT increased during the 5-years follow-up from 3.8 to 35%, and related to its use a decrease in LDL-cholesterol and an increase in HDL-cholesterol levels were detected. CONCLUSION: Middle-aged women included in this cohort have a high prevalence of RF; these deteriorate with age, but no with menopause. HRT improves the lipid profile.

A scheme of combined oral contraceptives for women more than 40 years old.

OBJECTIVE: To study whether the addition of estrogen to the 7 hormone-free days of a combined oral contraceptive (OC) cycle improves the symptomatology in perimenopausal women with climacteric complaints. DESIGN: A total of 56 women in their forties presenting with mood disorders and/or hot flashes were included in this randomized double-blind study. Symptoms were evaluated using the Greene test. Subjects were allocated into two groups: 23 women received an OC containing 20 microg of ethinyl-estradiol and 150 mg of desogestrel for 21 days and then 7 placebo tablets (placebo group); the other 33 women received 21 tablets with the same hormone combination, followed by 2 placebo tablets and 5 ethinyl-estradiol tablets of 10 microg each (estrogen group). After three cycles, symptoms were reassessed. RESULTS: Symptoms were similar in the two groups at the start of the study. Three months later, vasomotor symptoms in the placebo group dropped from 3.3 +/- 1.7 to 1.7 +/- 1.8, and in the estrogen group, from 3.0 +/- 1.7 to 0.7 +/- 0.9 (p < 0.04). Similarly, symptoms of depression fell from 8.8 +/- 4.0 to 6.7 +/- 3.9 in the placebo group and from 10.3 +/- 3.5 to 3.8 +/- 2.9 in the estrogen group (p < 0.002). Somatic symptoms fell with placebo from 10.9 +/- 5.3 to 7.4 +/- 5.4, and with estrogen, from 9.7 +/- 4.9 to 4.0 +/- 2.5 (p < 0.03). Sexual dysfunction as measured by the Greene Scale (loss of sexual interest) also improved more in women who received additional estrogen: 2.0 +/- 0.9 to 0.5 +/- 0.9 vs. 1.8 +/- 1.2 to 1.2 +/- 1.2, p < 0.03. Anxiety symptoms improved in both groups but without any significant difference between them. CONCLUSIONS: Adding 5 days of estrogen to the classic contraceptive scheme improves the climacteric symptoms of perimenopausal women who use OCs.

Quality of life after the menopause: a population study.

OBJECTIVE: To assess the impact of menopause and some sociodemographic variables on quality of life (QoL). MATERIALS AND METHODS: Four hundred and eighty-one women aged 40-59 years attending the Southern Metropolitan Health Service in Santiago de Chile were studied using the Specific Quality of Life Questionnaire for Menopause from Toronto University. RESULTS: Univariate analysis showed that menopausal women have worse QoL scores than women conserving cycles in the four areas of the questionnaire: They show a 10.6-fold higher risk for suffering vasomotor disorders affecting QoL, a 3.5-fold higher risk for psychosocial impairment, a 5.7-fold higher risk for physical disorders, and a 3.2-fold higher risk for sexual disorders (P < 0.0001). Regarding the influence of social markers (age, marital status, school years, work, number of children and sexual activity), housewives were found to have higher, worse, scores than working women in all test components (vasomotor, 3.11+/-1.90 versus 2.57+/-1.71, P < 0.003; psychosocial, 3.44+/-1.59 versus 2.92+/-1.45, P < 0.0007; physical, 3.45+/-1.36 versus 2.96+/-1.20, P < 0.0001; sexual, 3.63+/-2.23 versus 2.49+/-1.95, P < 0.0001). However, logistic regression demonstrated that the only variable found to cause a significant impairment in QoL was menopause. CONCLUSION: Menopause causes a decrease in quality of life, which is independent from age and other sociodemographic variables.