RESUMO
BACKGROUND: The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women's participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women's autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women's and midwives' experiences, values, and preferences regarding water immersion during childbirth. METHODS: A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. RESULTS: Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. CONCLUSIONS: The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.
Assuntos
Tocologia , Água , Gravidez , Feminino , Humanos , Imersão , Parto , Parto Obstétrico , Tocologia/métodos , Pesquisa QualitativaRESUMO
Objetivo: Evaluar los resultados de la implantación y el grado de cumplimientode una vía clínica de atención al parto basada en la evidenciacientífica.Material y métodos: Estudio observacional descriptivo. Se estudiaronlos 943 partos de las mujeres atendidas en el Hospital do Salnésdurante los periodos analizados (abril-diciembre de 2007 y abril-diciembrede 2008), divididos en dos grupos similares: uno prospectivo alque se aplicó la vía clínica en 2008 (n= 500) y otro grupo control, histórico,retrospectivo, formado por mujeres que dieron a luz en 2007 (n=443). Se compararon variables perinatales para evaluar la eficacia de lavía clínica. En una segunda etapa, se evaluó el grado de cumplimientode indicadores y estándares de calidad, incluida una encuesta de satisfacción.La comparación estadística se realizó aplicando la prueba de laji al cuadrado.Resultados: Mediante la aplicación de la vía clínica, se redujo la tasade cesáreas, el número de partos estimulados con oxitocina, y el uso dela anestesia epidural y de la episiotomía en los partos vaginales. Aumentaronlos partos eutócicos, los partos vaginales tras cesárea y el númerode recién nacidos con pH venoso umbilical <7,20. En la evaluacióndel cumplimiento, se alcanzaron los estándares en la postura delparto eutócico, número de partos en vertical, consumo de líquidos duranteel trabajo de parto y tasa de desgarros de tercer y cuarto grado.No se logró cumplir la tasa de lactancia materna exclusiva al alta, laentrega del plan de parto y el uso de bañera.Conclusiones: Esta evaluación permite afirmar que la implantaciónde la vía clínica mejoró la calidad de la atención, acercándola a las recomendacionesde la OMS (AU)
Objective: To evaluate the results of implantation and the level ofcompliance of a clinical route in the delivery attention based on scientificevidence.Material and methods: Observational descriptive study. A total of943 deliveries have been studied of women assisted at the Hospital doSalnés during the analyzed periods, divided in two similar groups. Oneprospective group to which a clinical route has been applied in 2008(n=500), versus a control group, historical, retrospective made up ofwomen who gave birth in 2007 (n=443). Perinatal variables have beencompared in order to evaluate the efficacy of the clinical route. In a secondstage, the compliance level of quality indicators and standards areevaluated, included a satisfaction survey. The statistical comparison wasperformed applying the chi-square test.Results: With the application of the clinical route, the rate of caesarean,deliveries stimulated with oxytocin, the use of epidural anaesthesiaand the episiotomy in vaginal deliveries has been reduced. The eutocicdeliveries have increased as well as the vaginal deliveries after caesareanand the number of newborns with umbilical venous pH <7.20. Inthe compliance evaluation, the standards have been reached as regardsto the eutocic delivery position, number of vertical deliveries, intake ofliquids during the labor and tear rate of 3°-4° degrees. It has not beenachieved the compliance of the exclusive mother lactation rate at discharge,the submission of delivery plan and the use of the bath tub.Conclusions: This evaluation allows us to assert that the implantationof the clinical route improved the attention quality, approaching it to therecommendations of the WHO (AU)
