Endometriosis: «Nivel de conocimiento y expectativas de formación específica entre profesionales especialistas en medicina de familia y comunitaria y matronas en atención primaria en la isla de Gran Canaria» / Endometriosis: “Level of knowledge and expectations of specific training among primary care doctors and midwives on the island of Gran Canaria, Spain”

Objetivo: Analizar el nivel de conocimiento entre profesionales sanitarios de atención primaria sobre endometriosis e identificar sus necesidades formativas en esta materia. Diseño: Estudio descriptivo realizado en atención primaria del Área de Salud de Gran Canaria, mediante cuestionario online anónimo. Resultados: Ciento diecinueve especialistas en medicina de familia y comunitaria y 37 matronas respondieron el cuestionario. El 54,6% de profesionales médicos y el 67,6% de matronas consideran escaso su conocimiento sobre endometriosis. Menos del 50% de profesionales conoce la guía de atención a las mujeres con endometriosis en el Sistema Nacional de Salud. Los síntomas más frecuentes relacionados con endometriosis son: dismenorrea moderada/severa, dolor pélvico crónico, esterilidad. Los menos relacionados son los digestivos y las alteraciones urinarias catameniales. Un 80% de profesionales médicos señalan como menor de 10 el número anual de pacientes en las que piensan que puedan tener endometriosis y menos de 20 para el 75% de matronas. El 40% de profesionales médicos trataría a una paciente con solo dismenorrea y sin planes de gestación con anticonceptivos orales; el 8% considera que el dolor con la menstruación es algo común. El 25% de profesionales especialistas en medicina de familia y comunitaria señalan la terapia de larga duración con antiinflamatorios no esteroideos como tratamiento de primera línea. Menos del 25% de ellos derivarían al especialista en Ginecología con solo sospechar endometriosis. Mayoritariamente los profesionales manifiestan interés en mejorar su formación en endometriosis. El 94,6% de las matronas consideran que tienen un papel estratégico en el manejo de pacientes con endometriosis. Conclusión: La demora en el diagnóstico de la endometriosis se debe en parte al desconocimiento de la enfermedad. Los profesionales de atención primaria constituyen la primera línea de atención sanitaria.(AU)

Objective: To analyze the level of knowledge of endometriosis in primary care doctors and midwives and to identify their training needs in this area. Design: Descriptive study conducted in the primary care services of the Health Area of Gran Canaria, through an anonymous online questionnaire. Results: One hundred and nineteen doctors and 37 midwives completed the questionnaire; 54.6% of doctors and 67.6% of midwives considered that their knowledge about endometriosis was poor. Less than 50% of healthcare professionals knew the National System of Health's guidelines for the management of women with endometriosis. Symptoms most frequently associated to endometriosis included: moderate/severe dysmenorrhea, chronic pelvic pain and sterility. Less frequently related ones included: digestive symptoms and catamenial urinary disorders; 80% of doctors suspected endometriosis in <10 women per year; 75% of midwives suspected this condition in <20 women per year; 40% of doctors would prescribe oral contraceptives to patients with dysmenorrhea who were not planning pregnancy; 8% of doctors considered that menstruation-associated pain was common. Medical therapy was the most frequently chosen first-line treatment; 25% of doctors would choose long-term NSAIDs therapy as a first-line treatment; less than 25% of them would refer a patient to the Gynecology service only for suspected endometriosis. Most health professionals expressed their interest in improving their knowledge about endometriosis; 94.6% of midwives considered that they played a strategic role in the identification and management of patients with endometriosis. Conclusion: Delays in the diagnosis of endometriosis are partially due to ignorance of the disease. Primary care professionals constitute the first line of health care. In this context, it is essential to develop specific training strategies, which would be welcome by health professionals.(AU)

Percepciones de matronas de Atención Primaria sobre el uso de la telemedicina durante la pandemia COVID-19 en España / Primary health care midwives’ perceptions on the use of telemedicine during the COVID-19 pandemic in Spain

Objetivo: Explorar las experiencias de matronas/es de atención primaria de salud (APS) con la implementación de la telemedicina en la atención al embarazo y al puerperio durante la pandemia por COVID-19. Método: Estudio cualitativo exploratorio basado en análisis de contenido inductivo de 15 entrevistas semiestructuradas realizadas a matronas/es de APS en 2021-2022, seleccionadas intencionalmente en cuatro comunidades autónomas españolas. Resultados Se identificaron cinco categorías: 1)cambios en la modalidad de atención en el embarazo y puerperio: priorización de mujeres embarazadas, puerperio desprotegido, aumento de visitas domiciliarias y declive de los grupos de educación parental; 2)implementación de la telemedicina en un escenario cambiante: el lado positivo y negativo de la telemedicina; 3)reacción de las mujeres ante la telemedicina; 4)estrategias implementadas por las matronas para un cuidado humanizado, y 5)aprendizajes para el futuro. Conclusiones: El uso de la telemedicina por parte de matronas de atención primaria posibilitó la atención de mujeres embarazadas y puérperas durante la pandemia en España. Los aspectos positivos de la puesta en marcha de este tipo de atención plantean posibilidades de cambio hacia un formato híbrido de atención sanitaria.(AU)

Objective: To explore the experiences of primary healthcare (PHC) midwives with the implementation of telemedicine in pregnancy and puerperium care during the COVID-19 pandemic. Method: Exploratory qualitative study based on an inductive content analysis of 15 semi-structured interviews with intentionally selected PHC midwives in four Spanish Autonomous Regions, during 2021-2022. Results: Five categories were identified: (1)changes in the modality of care in pregnancy and puerperium: prioritization of pregnant women, unprotected puerperium, an increase of home visits and decline of parental education groups; (2)implementation of telemedicine in a changing scenario: the positive and negative side of telemedicine; (3)reaction of women to telemedicine; (4)strategies implemented by midwives for a humanized care, and (5)learning for the future. Conclusions: The use of telemedicine by primary healthcare midwives enabled the care of pregnant and postpartum women during the pandemic in Spain. The positive aspects of the implementation of this type of care raise possibilities for change towards a hybrid format of healthcare.(AU)

Primary health care midwives' perceptions on the use of telemedicine during the COVID-19 pandemic in Spain.

OBJECTIVE: To explore the experiences of primary healthcare (PHC) midwives with the implementation of telemedicine in pregnancy and puerperium care during the Covid-19 pandemic. METHOD: Exploratory qualitative study based on an inductive content analysis of 15 semi-structured interviews with intentionally selected PHC midwives in four Spanish Autonomous Regions, during 2021-22. RESULTS: Five categories were identified: (1) changes in the modality of care in pregnancy and puerperium: prioritization of pregnant women, unprotected puerperium, an increase of home visits and decline of parental education groups, (2) implementation of telemedicine in a changing scenario: the positive and negative side of telemedicine (3) reaction of women to telemedicine (4) strategies implemented by midwives for a humanized care, (5) learning for the future. CONCLUSIONS: The use of telemedicine by primary healthcare midwives enabled the care of pregnant and postpartum women during the pandemic in Spain. The positive aspects of the implementation of this type of care raise possibilities for change towards a hybrid format of healthcare.

Attitudes, capacities and perceived barriers in research of nurses of the Canary Health Service.

OBJECTIVE: To evaluate the attitudes, capacities and perceived barriers associated with research among nurses and midwives of the Canary Health Service (SCS). METHODS: Descriptive observational cross-sectional study with an analytical component carried out in the different SCS departments by means of an online survey in which sociodemographic and specific variables, the Spanish version of the Attitudes towards Research and Development within Nursing Questionnaire (ATRDNQ-e) instrument and the BARRIERS scale were collected. Authorisation was obtained from the two provincial ethics committees. A descriptive and inferential analysis (Mann-Whitney U test and Kruskal-Wallis test, post hoc contrast by Dwass-Steel-Critchlow-Fligne test) was performed with JAMOVI® v.2.3.24 software. RESULTS: A total of 512 nurses and midwives with a mean age of 41.82 years participated in the study. Regarding the scores with the ATRDNQ-e instrument, the dimension with the lowest score was «Language of research¼ (mean = 3.55/SD = 0.84) and the highest «Assessment of nursing research and development of the nursing discipline¼ (mean = 4.54/SD = 0.52). The total mean score with the BARRIERS scale was 54.33 (SD = 16.52), with «Organizational characteristics¼ being the highest scoring subscale (mean = 17.25/SD = 5.90). The two highest perceived barriers were «Not enough time at work to implement new ideas¼ (mean = 2.55/SD = 1.11) and «Nursing does not have time to read research¼ (mean = 2.46/ SD = 1.11). CONCLUSIONS: SCS nurses have a positive attitude towards research, although there are some barriers where improvement actions for nursing research should be implemented.

Manejo de la hemorragia posparto por parte de las matronas en centros sanitarios del estado de Ekiti: estudio cualitativo exploratorio / Management of postpartum hemorrhage by midwives in healthcare facilities in Ekiti state: An exploratory qualitative study

Objetivos: La mortalidad materna continúa planteando un desafío crítico en la práctica obstétrica, siendo la hemorragia posparto (HPP) una de las principales causas. El objetivo de este estudio fue explorar las experiencias vividas de matronas en relación con el manejo de la HPP. Métodos: El estudio empleó un enfoque fenomenológico cualitativo. Los participantes fueron seleccionados utilizando la técnica de muestreo intencional, reclutándose un total de 15 participantes para el estudio. La recopilación de datos se realizó utilizando una entrevista guiada semiestructurada para entrevistas en profundidad. Las entrevistas fueron grabadas en audio, y el análisis de datos se realizó mediante análisis temático. Resultados: Dos temas emergieron del análisis: 1) prácticas de manejo adoptadas contra la HPP y 2) protocolo hospitalario para el manejo de la HPP. Las principales prácticas de manejo adoptadas por las matronas fueron el uso de uterotónicos, especialmente la oxitocina junto con otras prácticas de manejo como el uso de prendas antichoque, estimulación de las contracciones por frotamiento del útero, evaluación de la causa del sangrado y sutura de laceraciones. También se dedujo que los diferentes centros sanitarios tienen su propia política para el manejo de la HPP. Las barreras que afectan el manejo efectivo de la HPP incluyen la falta de personal, la falta de disponibilidad de instalaciones y equipos adecuados, las restricciones de las enfermeras/parteras en el manejo de la HPP, la política hospitalaria desfavorable y la falta de comunicación entre el equipo de atención sanitaria. Conclusión: Las experiencias de los participantes sugieren que están algo satisfechos con el manejo de la HPP en sus centros. Sin embargo, deben abordarse las barreras como la falta de personal, la falta de disponibilidad de equipos, la mala comunicación entre los equipos...(AU)

Objectives: Maternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum hemorrhage (PPH). Methods: The study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis. Results: Two themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum hemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team. Conclusion: The participants’ experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives’ experiences in PPH management.(AU)

La COVID-19 y sus consecuencias en la salud física, psicológica y social de obstetras

Introducción: La pandemia por la COVID-19 ha tenido efectos en la salud de los trabajadores sanitarios, dentro de ellos, los obstetras, pero se desconocen las consecuencias en este grupo ocupacional. Objetivo: Determinar las consecuencias de la COVID-19 en la salud física, psicológica y social de obstetras del Perú. Métodos: Estudio observacional, descriptivo, transversal, realizado a 511 obstetras asistenciales, en la primera línea de atención. Se aplicó un cuestionario en línea, previamente validado y confiable para medir las variables: características generales y de exposición a la COVID-19, salud física, salud psicológica y salud social. Los datos fueron analizados mediante estadística descriptiva. Resultados: 468 (91,6 %) obstetras son mujeres, 287 (56,2 %) de 40-59 años, 213 (41,7 %) casadas, 292 (57,1 %) laborando en el primer nivel de atención; 216 (42,3 %) se infectaron de la COVID-19, 165 (32,3 %) tuvieron cefalea, 127 (24,9 %) dolor de garganta y 121 (23,7 %) fatiga; 167 (77,3 %) requirieron tratamiento ambulatorio y 3 (1,3 %) cuidados intensivos. La obesidad reportada por 102 (20,0 %) obstetras fue la principal comorbilidad, seguida de hipertensión con 38 (7,4 %) y diabetes con 14 (2,7 %); 263 (51,5 %) reportaron síntomas depresivos y 464 (90,8 %) estrés; 238 (46,6 %) sintieron discriminación y 118 (23,1 %) llevaban la carga laboral del hogar en solitario. Conclusiones: La salud física, psicológica y social de los obstetras se afecta por la pandemia; genera trastornos de sobrepeso/ obesidad, depresión, estrés; así como discriminación y sobrecarga laboral en el hogar.

Introduction: The COVID-19 pandemic has had effects on the health of health workers, including obstetricians, but the consequences in this occupational group are unknown. Objective: Determine the consequences of COVID-19 on the physical, psychological and social health of obstetricians in Peru. Methods: Observational, descriptive, cross-sectional study, carried out on 511 attending obstetricians, in the first line of care. An online questionnaire, previously validated and reliable, was applied to measure the variables: general characteristics and exposure to COVID-19, physical health, psychological health, and social health. Data were analyzed using descriptive statistics. Results: 468 (91.6%) obstetricians are women, 287 (56.2%) aged 40-59 years, 213 (41.7%) married, 292 (57.1%) working at the first level of care; 216 (42.3%) were infected with COVID-19, 165 (32.3%) had headache, 127 (24.9%) sore throat and 121 (23.7%) fatigue; 167 (77.3%) required outpatient treatment and 3 (1.3%) intensive care. Obesity reported by 102 (20.0%) obstetricians was the main comorbidity, followed by hypertension with 38 (7.4%) and diabetes with 14 (2.7%); 263 (51.5%) reported depressive symptoms and 464 (90.8%) stress; 238 (46.6%) felt discrimination and 118 (23.1%) carried the workload of the home alone. Conclusions: The physical, psychological and social health of obstetricians is affected by the pandemic; generates disorders of overweight/obesity, depression, stress; as well as discrimination and work overload at home.

Management of postpartum hemorrhage by midwives in selected healthcare facilities in Ekiti State: An exploratory qualitative study.

OBJECTIVES: Maternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum haemorrhage (PPH). METHODS: The study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis. RESULTS: Two themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum haemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team. CONCLUSION: The participants' experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives' experiences in PPH management.

Píldoras formativas para mejorar la educación enfermera sobre programación temprana / Educational pills to improve nursing education on early programming

Introducción: La obesidad infantil ha sido declarada la epidemia del siglo XXI. La programación temprana es un elemento esencial que debe utilizarse para prevenir enfermedades no transmisibles. Las enfermeras están en una posición única para aplicar este concepto, pero no está incluido en su educación. Objetivos: El desarrollo, implementación y evaluación del uso de píldoras educativas que se ofrecen a los estudiantes de enfermería para mejorar su conocimiento sobre la programación temprana. Metodología: Se trata de una investigación cuasi-experimental. Es un estudio pre/post con seguimiento longitudinal. Para la recolección de datos, se diseñaron tres cuestionarios de desarrollo propio para medir el nivel de conocimiento, la intención de actuar y la satisfacción con la metodología. El nivel de conocimiento y la intención de actuar se midieron antes y después de la intervención para ver el efecto de la intervención. Se midió la satisfacción con la metodología y los recursos utilizados después de la intervención. La población incluida en este estudio son los estudiantes de enfermería de primer y segundo año matriculados en dos asignaturas diferentes en el curso 2019/2020. Se estima que el tamaño de la población es de 200 estudiantes. Se ha organizado el proceso en tres etapas definidas: etapa inicial, etapa de elaboración y etapa de implementación. Resultados: Se han observado diferencias significativas en todos los parámetros medidos. Conclusiones: La intervención ha mejorado el conocimiento de las futuras enfermeras sobre la programación temprana, ha aumentado la intención de actuar y los estudiantes encuentran esta metodología adecuada para su formación. (AU)

Background: Childhood obesity has been declared the epidemic of the 21st century. Early programming is an essential element that should be used to prevent non-communicable diseases. Nurses are uniquely positioned to apply this concept, but it is not included in their education. Objectives: The development, implementation and evaluation of the use of educational pills offered to nurse students to improve their knowledge of early programming. Methodology: This is quasi-experimental research. It is a pre/post study with a longitudinal follow-up. For data collection, three self-developed questionnaires were designed to measure the level of knowledge, intention to act and satisfaction with the methodology. The level of knowledge and the intention to act were measured before and after the intervention to see the intervention's effect. Satisfaction with the methodology and resources used was measured after the intervention. The population included in this study is the first-year and second-year nursing students enrolled in two different subjects in the academic year 2019/2020. The population size is estimated to be 200 students. We have organised the process into three defined stages: the initial stage, elaboration stage and implementation stage. Results: Significant differences have been observed in all the measured parameters. Conclusions: The intervention has improved the knowledge of future nurses about early programming and has increased the intention of nurses to act. Students find this methodology suiTable for their training. (AU)

Satisfaction of Quechua-speaking women in climacteric stage with the care provided by midwives.

OBJECTIVE: To determine the satisfaction of Quechua-speaking women in climacteric stage of a rural Peruvian area with respect to primary health care provided by midwives. METHOD: Descriptive cross-sectional observational study, with a total of 690 Quechua-speaking women in climacteric stage from the rural community of Macashca (3,384 masl), Huaraz province, Ancash-Peru, whose primary health care was carried out by midwives. A questionnaire was applied between October 2019 and February 2020. The information was processed using the IBM SPSS version 22.0® statistical package, applying a descriptive statistical analysis. RESULTS: 72.1% of the women were totally satisfied with the health care provided by midwives, highlighting the interest shown in the health status of the users (71.3%), use of the Quechua language (75.4%), treatment received (74.3%), resolution of doubts (69.5%), information on the relief of climacteric symptoms (67.1%) and home follow-up (74.9%). CONCLUSIONS: The majority of Quechua-speaking women in climacteric stage stated that they were fully satisfied with the primary health care provided by midwives, where the most highly valued aspects were the use of the Quechua language, home follow-up, treatment received, and interest shown in the health status of the women; being able to consider improvements with respect to the information on the relief of climacteric symptoms and the resolution of doubts.

Implementación de un programa de corta estancia hospitalaria maternoinfantil / Early post-partum discharge program in a maternity unit

Objetivo: El objetivo del estudio fue analizar el perfil sociodemográfico y obstétrico, así como la incidencia de consultas y reingresos, de las mujeres acogidas a un programa de corta estancia puerperal en el hospital del estudio. Metodología: Se realizó un estudio descriptivo de las variables relativas al perfil sociodemográfico, el embarazo, el parto y el puerperio de las mujeres con parto vaginal y alta precoz antes de 48 horas en el Hospital del Mar (Barcelona), desde junio de 2017 a junio de 2019. Resultados: 188 mujeres (un 8,2% del total de partos vaginales) se acogieron a la corta estancia hospitalaria durante el periodo de estudio. El 53,7% (n= 101) eran de nacionalidad española, y el resto eran de 32 nacionalidades distintas más. El 74,5% (n= 140) habían tenido uno o más partos previos, y el 84,6% (159) eran gestantes sin riesgo. El 95,7% de las mujeres (n= 180) tuvieron partos eutócicos. Un 7% (n= 13) de mujeres tuvieron que consultar en el hospital durante la primera semana después del alta por diferentes motivos. Tuvieron que consultar e ingresar un 2,1% (n= 4) de los neonatos con alta precoz, todos ellos por ictericia. No hubo ningún reingreso materno. Conclusiones: El perfil de mujeres que se acogen al programa de alta precoz en el centro del estudio son gestantes de bajo riesgo y presentan menos complicaciones en el parto que el resto de la población. No hubo más complicaciones o readmisiones hospitalarias en las mujeres con alta precoz respecto al global de los partos del centro del estudio. La implementación de un programa de corta estancia puerperal en nuestra institución es un procedimiento seguro, pero aceptado por un perfil de mujeres específico. (AU)

Objective: The objective of the study is to analyze the different mothers and newborns profiles who attend this program, and to analyze the different readmission rates comparing to the overall population that come for the usual childbirth in the hospital. Methodology: A descriptive study was performed, analyzing socio-demographic, obstetrical and partum and post-partum outcomes in women who attended to an early post-partum discharge before 48h after a vaginal delivery in Hospital del Mar (Barcelona), from June 2017 to June 2019. Results: 188 women (8.2% of total of vaginal deliveries) had the early post-partum discharge, 53.7% (n= 101) were Spanish women, 74.5% (n= 140) of women had already children, and 84.6% (n= 159) had no obstetrical risk factors. 95.7% (n= 180) women had eutocic deliveries, 7% (n= 13) of mother had to readmission to the hospital after the early discharge during the first week. There was only a 2.1% (n= 4) of newborns with early discharge that need to readmission; all of them because of neonatal hyperbilirubinemia. Conclusions: Most of women who attend to an early post-partum discharge are low risk pregnancies and deliveries. There are no higher mother readmission rates respect to the overall population. The implementation of an early post-partum discharge in the maternity unit in the institution is a safe process, but still accepted by a specific maternal profile of women. (AU)

Experiencia del embarazo y parto en casa durante la pandemia de Covid-19 / Experience of pregnancy and home birth during the Covid-19 pandemic

En los últimos años, se ha mostrado un creciente interés por dar a luz en entornos seguros, aunque menos medicalizados, como son las salas de atención al "parto natural" que ya funcionan en algunos hospitales. Sin embargo, la opción de parir en casa, en caso de embarazo de bajo riesgo, no está contemplada en el sistema sanitario público de salud. A raíz de la pandemia del Covid, ha aumentado la demanda de parto en casa y en Cataluña se ha triplicado. Con la intención de profundizar en la decisión del lugar donde dar a luz, se entrevista en profundidad a una mujer primípara durante el confinamiento. El relato sigue un hilo conductor: inicio de la gestación, vivencias durante el embarazo, aparición de la pandemia y el final del parto. Conclusión: la elección de parir en casa, en el caso que nos ocupa, se forja a partir de constatar la imposibilidad de cumplir con su deseo de un parto natural dada la situación generada por la Pandemia de COVID-19. La información facilitada por las matronas ha sido clave en el empoderamiento para la toma de esta decisión. (AU)

In recent years, there has been a growing interest in giving birth in safe environments, although less medicalized, such as the "natural delivery" rooms that already operate in some hospitals. However, the option of giving birth at home is not contemplated within the public health system for low-risk pregnancies. As a result of the Covid pandemic, the demand for home birth has increased and in Catalonia it has tripled. With the intention of deepening the decision of where to give birth, a primiparous woman is interviewed in depth during confinement. The story follows a common thread: the beginning of pregnancy, experiences during pregnancy, the onset of the pandemic and the end of childbirth. Conclusion: the choice to give birth at home, in the present case, it is forged after verifying the impossibility of fulfilling her desire for a natural childbirth due the situation generated by the COVID-19 Pandemic. The information provided by midwives has been a key in empowering she in order to make this decision. (AU)

La violencia obstétrica desde la perspectiva de las matronas de atención primaria y hospitalaria en Barcelona. Un análisis desde la antropología / Obstetric violence from the perspective of midwives in primary and hospital care in Barcelona. An analysis from anthropology

Objetivo: Conocer las percepciones de las matronas barcelonesas, que trabajan tanto en atención primaria como en el ámbito hospitalario, acerca de la violencia obstétrica. Metodología: Se trata de un estudio cualitativo de corte etnográfico llevado a cabo en Barcelona en 2019. Se realizaron entrevistas a 8 matronas con un análisis del discurso posterior. Para la selección de la muestra se ha utilizado un muestreo intencional con informantes clave. El análisis cualitativo posterior ha sido triangulado con una extensa revisión teórica de textos que proceden tanto de las ciencias sociales como de la biomedicina. Resultados: La mayor parte de las matronas entrevistadas consideran que la violencia obstétrica existe, y que se produce y reproduce en su ámbito de trabajo a través de diversas prácticas. Otras matronas consideran que el concepto como tal es erróneo porque en ningún momento hay intención lesiva por parte de los profesionales de la salud implicados. Para muchas de las informantes, dicho fenómeno está relacionado con el enfoque de riesgo de la biomedicina, la patologización de los procesos reproductivos y las jerarquías hospitalarias. Conclusiones: La investigación invita a la reflexión acerca de las implicaciones que tiene la violencia obstétrica también para los profesionales de la salud. Además, sería conveniente iniciar un diálogo para definir qué prácticas son consideradas por profesionales y usuarias como violencia obstétrica, y cómo media la biomedicina en ellas. (AU)

Objective: To explore Barcelona midwives’ perceptions about obstetric violence working at primary care and hospital settings. Methodology: The methodology is an ethnographic qualitative research design carried out in Barcelona in 2019. Eight midwifes were interviewed and were selected using an intentional sampling among key informants interested in the subject. The qualitative analysis is focus on the discourse and has been triangulated with an extensive theoretical revision of texts that come from both the social sciences and biomedicine. Results: Most of the interviewed midwives considered that obstetric violence exists and is produced and replicated in their working place through various practices. Others consider the concept is wrong because there isn’t any harmful intent on the part of the health care professionals involved. For many informants this phenomenon is related to the biomedi -cine risk approach, its ability to pathologize reproductive processes andhospital hierarchies.Conclusions: The research invites reflection on the obstetric violence implications also for health professionals. In addition, it would be convenient to begin a conversation to define what practices are considered for professionals and women as obstetric violence and what role plays the biomedicine on it. (AU)

Mortalidad materna y su relación con la distribución de matronas en las regiones de Perú: un estudio ecológico / Maternal mortality and its relationship with the distribution of midwives in the regions of Peru: an ecological study

Objetivo: Determinar la relación entre la distribución de matronas en las regiones de Perú y la mortalidad materna. Metodología: Estudio de diseño ecológico, en el que se obtuvieron, por cada región, la distribución de matronas por cada 1.000 gestantes y la tasa de mortalidad materna. Se usó como fuente de datos los informes del Ministerio de Salud de Perú hasta el año 2015, por la completitud que presentaban. Se evaluó la relación entre las variables mediante una correlación de Spearman, debido a la distribución no normal de las variables, con un intervalo de confianza del 95%. Se utilizó el software QGIS para evaluar la distribución geográfica de las variables. Resultados: La mediana de la tasa de mortalidad materna en Perú fue de 72,9 muertes por cada 100.000 nacidos vivos, mientras que el número de matronas por 1.000 gestantes fue de 22,6. El análisis mostró una relación negativa, que llegó a ser significativa (Rho= –0,397; p= 0,049). Asimismo, se halló que el número de matronas se ha incrementado en un 62,2% y que el número de muertes se ha reducido en un 9,2% durante el periodo 2010-2015. Conclusiones: Existe una relación inversa significativa entre la mortalidad materna y la distribución de matronas en las regiones de Perú. (AU)

Objective: Determine the relationship between the distribution of midwives in the regions of Peru and the maternal mortality. Methodology: Ecological design study where, for each region, the distribution of midwives per thousand pregnant women and the maternal mortality ratio were obtained. The reports of the Ministry of Health of Peru until 2015 were taken as a source of data, due to the completeness that they presented. The relationship between the variables was evaluated using a Spearman correlation, due to the non-normal distribution of the variables, with a confidence level of 95%. The QGIS software was used to evaluate the geographical distribution of the variables. Results: The median maternal mortality ratio in Peru was 72.9 deaths per 100,000 live births, while the number of midwives per 1,000 pregnant women was 22.6. The analysis showed a negative relationship that became significant (Rho= –0.397; p= 0.049). Likewise, it was found that the number of obstetricians has increased by 62.2% and the number of deaths has been reduced by 9.2% during the period from 2010 to 2015. Conclusions: There is a significant inverse relationship between maternal mortality and the distribution of midwives in the regions of Peru. (AU)

Satisfaction of Quechua-speaking women in climacteric stage with the care provided by midwives. / Satisfacción de mujeres quechuahablantes en etapa climatérica con la atención brindada por matronas.

OBJECTIVE: To determine the satisfaction of Quechua-speaking women in climacteric stage of a rural Peruvian area with respect to primary health care provided by midwives. METHOD: Descriptive cross-sectional observational study, with a total of 690 Quechua-speaking women in climacteric stage from the rural community of Macashca (3,384 masl), Huaraz province, Ancash-Peru, whose primary health care was carried out by midwives. A questionnaire was applied between October 2019 and February 2020. The information was processed using the IBM SPSS version 22.0® statistical package, applying a descriptive statistical analysis. RESULTS: 72.1% of the women were totally satisfied with the health care provided by midwives, highlighting the interest shown in the health status of the users (71.3%), use of the Quechua language (75.4%), treatment received (74.3%), resolution of doubts (69.5%), information on the relief of climacteric symptoms (67.1%) and home follow-up (74.9%). CONCLUSIONS: The majority of Quechua-speaking women in climacteric stage stated that they were fully satisfied with the primary health care provided by midwives, where the most highly valued aspects were the use of the Quechua language, home follow-up, treatment received, and interest shown in the health status of the women; being able to consider improvements with respect to the information on the relief of climacteric symptoms and the resolution of doubts.

The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study. / El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo.

AIM: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. METHOD: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). RESULTS: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. CONCLUSIONS: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record.

The midwife as a guide for the application of the Kangaroo mother care method. A case report. / La matrona como guía para la aplicación del método madre canguro. A propósito de un caso.

We present a clinical case of a premature birth from a mother of 33+5 weeks gestation where the newborn was admitted to the neonatal unit due to her low weight, chest retraction and prematurity, despite an Apgar score of 8/9/10 and birth weight of 1.300 g. The team of midwives that attended the woman from her arrival performed an assessment according to Virginia Henderson's Needs. Nursing diagnoses for the mother of Situational low self- esteem and Deficient Knowledge were established, and of Ineffective thermoregulation for the newborn infant. The care plan was based in great measure on the Kangaroo-mother care method which was started in the neonatal unit, and adapted to the needs and care required by the newborn infant. The method enabled the parents to cope with the situation in a better way and the vital signs of the infant to be maintained.

Percepción de embarazadas y matronas acerca de los consejos nutricionales durante la gestación.

Introducción: el estado nutricional previo de la embarazada, la adecuada ganancia de peso y la ingesta de ciertos nutrientes pueden tener una influencia importante tanto para la madre como para el recién nacido, a corto y largo plazo. Las recomendaciones de la Organización Mundial de la Salud son transmitidas durante el control del embarazo por la matrona.Objetivos: analizar los principales estudios sobre la percepción de las embarazadas acerca de los consejos nutricionales recibidos e identificar las estrategias utilizadas por las matronas para su implementación.Metodología: búsqueda bibliográfica sobre embarazadas de bajo riesgo controladas por matronas y que reciben consejos nutricionales realizada en WOS, CINHAL y PubMed. Se utilizaron los descriptores: pregnancy, pregnant, midwife, counselling, nutritiony sus diferentes combinaciones. Los criterios de inclusión fueron artículos originales y revisiones en inglés, español o portugués de los últimos diez años y disponibles en texto completo.Resultados: se encontraron 184 referencias. Solo 11 tratan el tema abordado. Existen múltiples artículos con consejos nutricionales en el embarazo, pero muy pocos que incluyan estrategias educativas implementadas por las matronas que aborden recomendaciones dietético-nutricionales y su utilidad.Conclusión: existen escasos estudios que investiguen los conocimientos que las matronas tienen sobre nutrición en el embarazo y los consejos que aportan sobre el tema. Igualmente sucede con los trabajos que estudian la percepción que tienen las gestantes sobre los consejos nutricionales recibidos.

The domestic participation in birth assistance in the mid-twentieth century / A participação doméstica na assistência ao parto em meados do século XX / La participación de lo doméstico en la atención del parto a mediados del siglo XX

Abstract Objective: to describe how the progressive creation of the Social Security (providing widespread health care) affected the birth assistance in Spain from the 1940s to the 1970s in a rural area. Method: historical ethnography. Twenty-seven people who lived at that time were selected and interviewed guided by a semistructured script. Based on their testimonies, a chart was built with the functional elements involved in birth assistance in this region. Results: three agents performed such care: traditional midwives, women of the family/neighbors and health workers. Conclusion: although birth assistance had been transferred to the hands of the health workers from the forties in this region, women in labor continued to count on the domestic resources until the early seventies, when births were compulsorily transferred to hospitals. This research brings to light the names and recognizes the work performed by these female characters of the popular sphere, who helped women in labor of that community to give birth, for at least three decades.

Resumo Objetivo: descrever como a criação progressiva da Seguridade Social (oferecendo assistência médica ampla) afetou a assistência ao parto na Espanha durante as décadas de 1940 a 1970, em uma região rural. Método: etnografia histórica. Foram selecionadas 27 pessoas que viveram nessa época, as quais foram entrevistadas com o auxílio de um roteiro semiestruturado. Através dos seus depoimentos, construiu-se um quadro com os elementos funcionais envolvidos na assistência ao nascimento nessa região. Resultado: três agentes desempenhavam tal assistência: parteiras tradicionais, mulheres da família/vizinhas e profissionais da saúde. Conclusão: apesar da assistência durante o parto ter sido transferida para a responsabilidade dos profissionais da saúde a partir dos anos quarenta, nesta região as parturientes continuaram utilizando os recursos domésticos até o início dos anos setenta, quando os partos foram obrigatoriamente transferidos para os hospitais. Esta pesquisa traz à tona os nomes e reconhece o trabalho de personagens femininas da classe popular, que ajudaram mulheres em trabalho de parto dessa comunidade a dar à luz, durante pelo menos três décadas.

Resumen Objetivo: describir cómo incidió la creación progresiva de la Seguridad Social (ofreciendo asistencia sanitaria generalizada) en la atención al parto en España durante las décadas de 1940 a 1970, en una zona rural. Método: etnografía histórica. Se seleccionaron 27 personas que habían vivido en esos años, y se las entrevistó apoyadas por un guión semiestructurado. A través de sus testimonios se construyó un mapa con los elementos funcionales implicados en los cuidados en el nacimiento en ese territorio. Resultado: tres actores desempeñaban dicha atención: parteras tradicionales, mujeres familiares/vecinas y personal sanitario. Conclusión: a pesar de que la asistencia en el momento del parto pasó a estar en manos de los sanitarios a partir de los años cuarenta, en esta zona las parturientas siguieron haciendo uso de los recursos domésticos hasta bien entradas los setenta, cuando los partos obligatoriamente fueron desplazados a los hospitales. Esta investigación saca a la luz el nombre y reconoce la labor de personajes femeninos que, desde la esfera popular, ayudaron a dar a luz a parturientas de esa comunidad durante, al menos, tres décadas.

Trends in health facility deliveries and caesarean sections by wealth quintile in Morocco between 1987 and 2012.

OBJECTIVES: To examine trends in the utilisation of facility-based delivery care and caesareans in Morocco between 1987 and 2012, particularly among the poor, and to assess whether uptake increased at the time of introduction of policies or programmes aimed at improving access to intrapartum care. METHODS: Using data from nationally representative household surveys and routine statistics, our analysis focused on whether women delivered within a facility, and whether the delivery was by caesarean; analyses were stratified by relative wealth quintile and public/private sector where possible. A segmented Poisson regression model was used to assess whether trends changed at key events. RESULTS: Uptake of facility-based deliveries and caesareans in Morocco has risen considerably over the past two decades, particularly among the poor. The rate of increase in facility deliveries was much faster in the poorest quintile (annual increase RR: 1.09; 95% CI: 1.07-1.11) than the richest quintile (annual increase RR: 1.01; 95% CI: 1.02-1.02). A similar pattern was observed for caesareans (annual increase among poorest RR: 1.13; 95% CI: 1.07-1.19 vs. annual increase among richest RR: 1.08; 95% CI: 1.06-1.10). We found no significant acceleration in trend coinciding with any of the events investigated. CONCLUSIONS: Morocco's success in improving uptake of facility deliveries and caesareans is likely to be the result of the synergistic effects of comprehensive demand and supply-side strategies, including a major investment in human resources and free delivery care. Equity still needs to be improved; however, the overall trend is positive.