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

Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care.

OBJECTIVES: To describe the differences in obstetrical results and women's childbirth satisfaction across 2 different models of maternity care (biomedical model and humanised birth). SETTING: 2 university hospitals in south-eastern Spain from April to October 2013. DESIGN: A correlational descriptive study. PARTICIPANTS: A convenience sample of 406 women participated in the study, 204 of the biomedical model and 202 of the humanised model. RESULTS: The differences in obstetrical results were (biomedical model/humanised model): onset of labour (spontaneous 66/137, augmentation 70/1, p=0.0005), pain relief (epidural 172/132, no pain relief 9/40, p=0.0005), mode of delivery (normal vaginal 140/165, instrumental 48/23, p=0.004), length of labour (0-4 hours 69/93, >4 hours 133/108, p=0.011), condition of perineum (intact perineum or tear 94/178, episiotomy 100/24, p=0.0005). The total questionnaire score (100) gave a mean (M) of 78.33 and SD of 8.46 in the biomedical model of care and an M of 82.01 and SD of 7.97 in the humanised model of care (p=0.0005). In the analysis of the results per items, statistical differences were found in 8 of the 9 subscales. The highest scores were reached in the humanised model of maternity care. CONCLUSIONS: The humanised model of maternity care offers better obstetrical outcomes and women's satisfaction scores during the labour, birth and immediate postnatal period than does the biomedical model.

Episiotomy and its relationship to various clinical variables that influence its performance.

OBJECTIVE: to understand the episiotomy rate and its relationship with various clinical variables. METHOD: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. VARIABLES: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. RESULTS: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. CONCLUSIONS: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure.

Influencia del género en la formación de las matronas en el siglo XX / Influence of gender on midwifery training in the Twentieth Century

Objetivo principal: analizar la influencia del género en la formación de las matronas durante el siglo XX. El punto de inflexión será el Decreto de 18 de enero de 1957. Metodología: este trabajo es un estudio cualitativo con enfoque fenomenológico. Realizamos entrevistas en profundidad a 13 matronas y el análisis de textos legislativos. Resultados principales: el Decreto de 1957 que estableció la especialización de matronas para las Ayudantes Técnicos Sanitarios femeninas supuso un cambio, ampliando las enseñanzas de estas profesionales y exigiéndoles un mayor esfuerzo en sus vidas. La capacitación percibida por las matronas no fue suficiente para que se les reconociera como profesión autónoma hasta el siglo XXI. Conclusión principal: el género será determinante en la formación de las matronas. Como mujeres inmersas en una profesión femenina se les ha exigido una serie de requisitos legislativos desiguales a otros profesionales

Objective: analyze the influence of gender in midwifery training in Twentieth Century. The turning point is the Decree of January 18, 1957. Methods: this work is a qualitative study using a phenomenological approach. Thirteen in-depth interviews were conducted to midwives and some laws were analyzed. Results: the 1957 decree that established the specialization of midwives for female Sanitary Technical Assistant will be a change, will expand the learnings of these professionals and will require more effort in their lives. Although midwives felt themselves well-trained it was not enough to be recognized as an autonomous profession until the XXI century. Conclusion: gender will be decisive in midwives training. Women immersed in a female profession have been demanded unequal legislative requirements to other professionals

Los manuales escritos por matronas europeas (1609-1710); el origen de cuidados humanizados en el embarazo / The manuals written by european midwives (1609-1710); origin humanized care in pregnancy

Objetivo principal: Analizar los cuidados administrados por matronas a mujeres en su embarazo en el siglo XVII transmitidos a través de los manuales escritos por las mismas parteras. Metodología: Metodología cualitativa, desde la hermenéutica y la historia cultural a través de técnicas etnográfico-narrativas mediante la lectura de cinco manuales (1609-1710), categorizando los textos siguiendo el modelo dialéctico de construcción-deconstrucción. Resultados principales: Obtuvimos como resultados la identificación de cuidados impregnados en creencias populares y el modo en que estos evolucionaron hacia la ciencia a través del diagnóstico, consejos higiénico-dietéticos, controles antenatales y atención a patologías. Conclusión principal: Concluimos que las matronas del siglo XVII se cohesionaron gracias al elemento estructural de los manuales en torno a valores de respeto a la fisiología de las mujeres y serán germen de una partería humanizada que les otorga identidad como colectivo profesional

Objective: Analyze managed care by midwives in pregnancy in the seventeenth Century and transmitted through the manual written by the same midwives. Methods: Qualitative methodology from hermeneutics and cultural history through ethnographic techniques and the reading of five manuals (1609-1710) and categorizing the texts with the dialectical model construction-deconstruction. Results: Our results were the identification of care impregnated popular beliefs and how they evolved toward science through diagnosis, hygiene and dietary advice, antenatal checks and attention to pathologies. Conclusions: We conclude that midwives of seventeenth-Century cohered through to the structural element of the manuals around values of respect for women's physiology and will be seed for a humanized midwifery and give them identity as a professional group