Women's experiences of two different self-assessment methods for monitoring fetal movements in full-term pregnancy : a crossover trial

Background: Low maternal awareness of fetal movements is associated with negative birth outcomes. Knowledge regarding pregnant women's compliance with programs of systematic self-assessment of fetal movements is needed. The aim of this study was to investigate women's experiences using two different self-assessment methods for monitoring fetal movements and to determine if the women had a preference for one or the other method. Methods: Data were collected by a crossover trial; 40 healthy women with an uncomplicated full-term pregnancy counted the fetal movements according to a Count-to-ten method and assessed the character of the movements according to the Mindfetalness method. Each self-assessment was observed by a midwife and followed by a questionnaire. A total of 80 self-assessments was performed; 40 with each method. Results: Of the 40 women, only one did not find at least one method suitable. Twenty of the total of 39 reported a preference, 15 for the Mindfetalness method and five for the Count-to-ten method. All 39 said they felt calm, relaxed, mentally present and focused during the observations. Furthermore, the women described the observation of the movements as safe and reassuring and a moment for communication with their unborn baby. Conclusions: In the 80 assessments all but one of the women found one or both methods suitable for self-assessment of fetal movements and they felt comfortable during the assessments. More women preferred the Mindfetalness method compared to the count-to-ten method, than vice versa.

A parturiente: um estudo psicológico

Este trabalho teve por objetivo identificar as vivências femininas no decorrer de seu primeiro parto normal. Pressupondo-se uma abordagem baseada nos ensinamentos fenomenológicos, foi planejada uma pesquisa exploratória de campo em que 30 puérperas de parto normal, poucas horas após terem dado à luz. As entrevistas seguiram o modelo metodológico da técnica de histórias de vida e, através destas, as puérperas contribuíram com um relato acerca de seu parto. Os relatos serviram para nos dar informes a respeito de quatro aspectos básicos acerca da parturiente no processar do seu parto normal: a) vivências físicas; b) vivências emocionais; c) significado da experiência e d) percepção da conduta médica. A experiência de gerar um filho para praticamente todas as mulheres entrevistadas mostrou-se altamente importante e plena de gratificações. Apenas um pequeno número de mulheres apresentou considerações negativas à chegada da criança.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Applicability of non-pharmacological strategies for pain relief in parturient: integrative review

MORAES, Maísa Suares Teixeira; ROLIM, Lariane Thays Albuquerque; ENDERS, Bertha Cruz; FARIAS, Glaucea Maciel de; DAVIM, Rejane Marie Barbosa. Applicability of non-pharmacological strategies for pain relief in parturient: integrative review. Revista de Enfermagem UFPE on line, v.4, n.especial, p.131-136, May/June 2010. Disponivel em:< http://www.ufpe.br/revistaenfermagem/index.php/revista/>.

Avaliação da efetividade de estratégias não farmacológicas para o alívio da dor de parturientes na fase ativa do período de dilatação no trabalho de parto

This study was aim to evaluate the effectiveness of strategies non pharmacological for the relief of the intensity of the parturient pain in the phase activates of the dilation period in the labor. Is a clinic rehearse of the type therapeutic intervention before and after" with a quantitative approach, accomplished in the Humanized Unit of Childbirth of the Maternity Januário Cicco School of the Federal University of Rio Grande do Norte, in Natal/RN, whit 130 parturient, being 30 in the pre-test of the strategies and 100 in the application of the strategies non pharmacological combined (breathing exercises, muscular relaxation and lombossacral massage) and isolated (shower bath in a normal temperature). We used the visual analogical scale to evaluate the intensity of the pain of the study parturient before and after" to the application of the strategies in the phases of acceleration, maximum inclination and desaceleration in the phase activates of dilation period in the labor. The principal results showed that the majority of the study parturient was between 20 to 30 years old (60%); with incomplete fundamental teaching (85%); family income until 2 minimum wages (74%); 78% had a companion and these, 44% were the own husband. The oxytocin was administered in the parturient during the phase activates of the labor in 81% of the cases and only 15% these women didn´t reciev anything medication. We verified significant relief (ρ=0.000) of intensity of the pain of the study parturient after application of the strategies non pharmacological combined and isolated. We concluded that the strategies non pharmacological combined and isolated were effective in the relief of the pain of the study parturient in the phase activates de labor

Síndrome metabólica e fatores associados: estudo comparativo com mulheres que apresentaram pré-eclâmpsia e gravidez normal, acompanhadas cinco anos após o parto

Preeclampsia is defined as an extremely serious complication of the pregnancy-puerperium cycle with delayed emergence of cardiovascular risk factors, including metabolic syndrome. The research aimed estimate the prevalences of metabolic syndrome and associated factors in women with preeclampsia and normal pregnancy followed five years after childbirth. This is a cross-sectional observational study using a quantitative approach, conducted at a maternity school in the city of Natal in Rio Grande do Norte state. The sample was composed of 70 women with previous preeclampsia and 75 normal selected by simple random probability sampling. Subjects were analyzed for sociodemographic, obstetric, clinical, anthropometric and biochemical parameters. International Diabetes Federation criteria were adopted to diagnose metabol ic syndrome. The Kolmogorov-Smirnov, Mann-Whitney, Student s t, Pearson s chi-squared, and Fisher s exact tests, in addition to simple logistic regression, were used for data analysis, at a 5% significance level (p ≤ 0.05). Statistical tests demonstrated elevated body mass index (p = 0.001), predominance of family history of diabetes mellitus (p = 0.022) and significantly higher prevalence of metabolic syndrome in the preeclampsia group (37.1%) when compared to normal (22.7%) (p = 0.042). Intergroup comparison showed a high number of metabolic syndrome components in women with previous preeclampsia. Altered systolic and diastolic blood pressure (p < 0.001) was the most prevalent, followed by low concentrations of high-density lipoproteins (p = 0.049), and hyperglycemia (p=0.030). There was a predominance of the metabolic syndrome in women with schooling 0-9 years (42.4%) (p = 0.005), body mass index above 30Kg.m 2 (52.3%) (p < 0.001), uric acid high (62.5%) (p = 0.050 and family history of hypertension (38.5%) (p< 0.001). Multivariate analysis of the data showed that the body mass index above 30 kg.m2, education level less than 10 years of study (p < 0.001) and family history of hypertension (p = 0.002) remained associated with the metabolic syndrome after multivariate analysis of the data. It is considered Women with previous preeclampsia exhibited high prevalence of metabolic syndrome and their individual components in relation to normal, especially, altered systolic and diastolic blood pressure, low concentrations of high-density lipoproteins and hyperglycemia. The factors associated to this ou tcome were obesity, less than 10 years of schooling, and family history of hypertension. Overall, this study identified young women with a history of PE exposed to a higher cardiovascular risk than normal

Vivência de mulheres no puerpério : significado atribuído à revisão pósparto

The consultation for women during the postpartum period should occur between the seventh and tenth days, and 42 days after childbirth, to decrease the incidence of maternal and neonatal morbidity and mortality. However, the effectiveness of such assistance in primary health care has not been achieved, especially in the forty-second day of puerperium. Facing this reality, the research aimed to understand the views of women about postpartum consultation. This is an exploratory and descriptive research with qualitative approach, developed in the municipality of Lajes/RN, Brazil, with women inscribed on the four teams that make up the Family Health Strategy. Data were collected through semistructured interviews with 15 women who met the following criteria: be enrolled in ESF; have health mental preserved, have been entered in the Humanization Program of Prenatal and Birth, and that was, at maximum, 60 days postpartum. The data were organized according to the precepts of content analysis according to Bardin, generating three categories: prevention of puerperal complications, feelings related to life changes after childbirth, and postpartum care. This process of coding and categorizing a central theme emerged: the experience of women in the postpartum period. The data were analyzed according to the principles of symbolic interactionism, according to Blumer. The study revealed that the meanings attributed to the postpartum period for prevention of complications were directly related to home, to the consultation and postpartum care provided by family members and health professionals. The interviewees strictly complied with the rest under the influence of the context in which they were entered. But that has not happened with the postpartum revision because few mothers underwent this procedure. Therefore, the interaction of the interviewed people in their living standard as well as the feelings that permeated the post-partum were crucial to consider whether or not the post-partum visit as significant. According to the results, it was noted that disability guidelines and counter-references has impaired the access of women to postpartum review. Thus, further studies are needed on the subject, as well as a reorientation of health care activities in view of the consolidation of postpartum consultation in primary care

Ações de profissionais relativas ao banco de leite humano : uma perspectiva de mudança

This is an exploratory and descriptive study that aimed to investigate the actions of professionals in the context of breastfeeding, on the assumption that the actions taken by employees working together to postpartum and newborn are not competing to effect the distribution of pasteurized human milk so that it meets the needs of infants who depend on it. Thus, the study aimed to analyze the actions of medical and nursing staff of the distribution of pasteurized human milk to the newly born. The investigation was developed by action research in a federal hospital, located in the capital the state of Rio Grande do Norte, Brazil, reference assistance to women during pregnancy, childbirth and postpartum high risk in 2010. Study participants were fifty-five professionals chosen from the following inclusion criteria: to act in the NICU or rooming, being a pediatrician and / or neonatologists, nurses and technical nursing. According to the methodology of action research a questionnaire was applied, techniques in focus groups and courses were developed, and, finally, action evaluation. The project was submitted to the Ethics Committee at the Federal University of Rio Grande do Norte and approved with no protocol 448/2009. The problems identified in the responses issued by the social research were grouped into categories according to the similarity between them. The answer to the question of the survey - How is the need for pasteurized human milk for the newborns in neonatal intensive care unit and rooming identified? - Brought subsidies for action planning and implementation of strategies for change in the practice of professionals working in rooming and ICU. Thus, the study has relevance in social care and, when at the local level, will compete for the distribution pasteurized human milk to take effect as best as possible, as recommended by the Ministry of Health. It is also conceived that, in a macro view of society, it could contribute to minimizing the health problem that involves the child population

Do útero à adoção: a experiência de mulheres férteis que adotaram uma criança

Even with all changes and ruptures related to the social roles that woman had performed, the literature had confirmed that the motherhood still configures it like one of the main roles that she hopes to play in some moment of her life. When the woman did not get pregnant or take ahead a pregnancy, some women find in adoption an alternative to play this role. This research aimed to understand the experience of being mother for adoption in the case of fertile women, but whose partner is infertile. Supported by existential-phenomenological theory, used it the narrative, how methodological instrument. Participated five women, whose adoption process followed the legal ways in the Youngness and Infancy Judgeship of Natal/RN. The results showed that in the selfish training, the woman to see herself how whose role principal is to generate children, although, she think that is natural her participation in others activities go out home too. In male infertile case is a tendency that the woman strikes the infertile status too. The adoption is an alternative to fulfill her desire of being a mother and, meanwhile, please her husband and guarantee the continuity of her love relationship. Through motherly care, the woman discover herself as a mother, what brings a new meaning for her live, independent of to generate a child. Though, exit frustration, sometimes, in association with suffering, on account of the pregnancy and childbirth absence. The end of the research suggests reflections that to become fulfilled herself as mother, the woman does not need, necessarily, to generate a child, being the maternity one of the uncountable possibilities that are shown, and that she can choose, or not, accomplish it

Efeito da via de parto sobre a força muscular do assoalho pélvico

OBJETIVO: analisar a influência da via de parto sobre a força muscular do assoalho pélvico (FM-AP). MÉTODOS: estudo clínico de corte transversal, para avaliar a FM-AP pelo teste da avaliação da força do assoalho pélvico (AFA) e uso do perineômetro em primíparas, entre 20-30 anos de idade, 4-6 meses pós-parto. A contração, medida pelos dois testes, foi classificada em: zero - ausência, um - leve, dois - moderada e três - normal, sustentada por 6 segundos. Avaliaram-se 94 mulheres, entre 20 e 30 anos, divididas em três grupos: pós-parto vaginal (n=32); pós-cesárea (n=32) e nulíparas (n=30). A variável independente foi a via de parto e a dependente, a FM-AP. A comparação entre os graus de contração foi realizada pelo teste de Kruskal-Wallis e o teste de Dunn para comparações múltiplas; a influência da via de parto pelo teste chi2, o risco relativo (RR) para alteração da FM-AP e o coeficiente kappa para avaliar equivalência entre os testes. RESULTADOS: a mediana e 1º e 3º quartil da FM-AP foram menores (p=0,01) pós-parto vaginal (2,0;1-2) e intermediários pós-cesárea (2,0; 2-3) em relação às nulíparas (3,0;2-3), tanto analisadas pelo AFA como pelo perineômetro. Aumentou o RR de exame alterado pós-parto vaginal (RR=2,5; IC 95%: 1,3-5,0; p=0,002); (RR=2,3; IC 95%: 1,2-4,3; p=0,005) e pós-cesárea (RR=1,5; IC 95%: 0,94-2,57; p=0,12); (RR=1,3; IC 95%: 0,85-2,23; p=0,29) pelo PFSE e perineômetro, respectivamente. CONCLUSÕES: o parto vaginal diminuiu a força muscular do AP de primíparas quando comparado com os casos submetidos à cesárea e com as nulíparas.

Medical students' personal choice for mode of delivery in Santa Catarina, Brazil: a cross-sectional, quantitative study

Background: The increase in overall rates of cesarean sections (CS) in Brazil causes concern and it appears that multiple factors are involved in this fact. In 2009, undergraduate students in the first and final years of medical school at the University of Santa Catarina answered questionnaires regarding their choice of mode of delivery. The aim of the study was to evaluate whether the education process affects decision-making regarding the waay of childbirth preferred by medical students.Methods: A cross-sectional, quantitative study was conducted based on data obtained from questionnaires applied to medical students. The questions addressed four different scenarios in childbirth, as follows: under an uneventful pregnancy; the mode of delivery for a pregnant woman under their care; the best choice as a healthcare manager and lastly, choosing the birth of their own child. For each circumstance, there was an open question to explain their choice.Results: A total of 189 students answered the questionnaires. For any uneventful pregnancy and for a pregnant woman under their care, 8.46% of the students would opt for CS. As a healthcare manager, only 2.64% of the students would recommend CS. For these three scenarios, the answers of the students in the first year did not differ from those given by students in the sixth year. In the case of the student's own or a partner's pregnancy, 41.4% of those in the sixth year and 16.8% of those in the first year would choose a CS. A positive association was found between being a sixth year student and a personal preference for CS according to logistic regression (OR = 2.91; 95%CI: 1.03-8.30). Pain associated with vaginal delivery was usually the reason for choosing a CS.Conclusions: A higher number of sixth year students preferred a CS for their own pregnancy (or their partner's) compared to first year students. Pain associated with vaginal delivery was the most common reason given for haven chosen a CS. The students' preference for childbirth changed over time during their graduation in favor of cesarean sections. This finding deserves considerable attention when structuring medical education in Obstetrics.

Menstrual irregularity: a possible clinical marker of metabolic dysfunction in women with class III obesity

Purpose. To evaluate whether menstrual irregularity in morbidly obese women is indicative of metabolic dysfunction.Patients and Methods. Fifty-seven women with morbid obesity were evaluated. They were divided into two groups: one comprising women without menstrual dysfunctions or hirsutism (Group 1), and another obese women showing menstrual dysfunction with or without hirsutism (Group 2). The following were evaluated: age, colour, childbirth, marital status, profession, socio-economic level, education, age at menarche, body weight, height, body mass index, presence of hirsutism (Ferriman Gallwey Index), abdominal circumference, hip circumference, waist-to-hip ratio, menstrual cycle, blood pressure, presence of acanthosis nigricans, insulin resistance (IR), fasting glycaemia, total cholesterol, HDL-C, LDL-C, triglycerides, thyroid-stimulating hormone, free T4, luteinising hormone (LH), follicle-stimulating hormone, prolactin, total testosterone, dehydroepiandrosterone sulfate, insulin and the Homeostasis Model Assessment (HOMA test).Results. Clinical and epidemiological aspects did not present statistical differences. Clinical and laboratory parameters did not show statistically significant alterations; however, HOMA test values for Group 2 were significantly higher than those for Group 1.Conclusions. The presence of IR in class III obese women can cause menstrual dysfunctions such as amenorrhoea or oligomenorrhoea even in the absence of hyperandrogenism, suggesting that IR plays an important role in the ovarian mechanisms involved in the menstrual cycle control.

Efeito de técnicas fisioterápicas sobre os desconfortos músculo-esqueléticos da gestação

OBJETIVO: estudar os efeitos de técnicas fisioterápicas sobre os desconfortos músculo-esqueléticos na gestação. MÉTODOS: estudo coorte prospectivo, com 71 gestantes nulíparas, de baixo risco, distribuídas conforme a participação (estudo; n=38) ou não (controle; n=33). O Programa Multidisciplinar de Preparo para o Parto e Maternidade constou de 10 encontros (da 18ª à 38ª semana), com atividades educativas, fisioterápicas e de interação. Compararam-se, por questionário específico, no início e final do programa, a ocorrência (presença ou ausência), as características (local, tipo, intensidade, freqüência e duração) e a evolução dos desconfortos músculo-esqueléticos. As médias aferidas na avaliação inicial foram comparadas pela análise de variância (ANOVA) seguida pelo teste do F. Para o estudo entre as proporções, verificadas no início e no final do programa, utilizou-se o teste do c². A significância estatística foi definida pelo limite de 5% (p<0,05). RESULTADOS: no início do programa, 63,6% das gestantes do grupo controle e 84,2% do Estudo relataram sintomas músculo-esqueléticos (p=0,05), caracterizados por dor na região lombossacra. No grupo controle predominaram a intensidade leve (18,2%) e grave (18,4%), e no grupo estudo, a grave (36,8%) e isolada ou associada (31,6%). No final, o grupo controle tinha sintomas de intensidade grave (60,6%), com freqüência diária (42,4%) e duração maior que três horas (69,7%) (p<0,05). O grupo estudo referia intensidade leve (57,9%) e freqüência quinzenal (50,0%) com duração máxima de uma hora (55,3%) (p<0,05). A evolução dos sintomas foi diferenciada, confirmando-se piora em 63,6% das gestantes do Controle e melhora em 65,8% das participantes do Programa (p<0,05). CONCLUSÕES: as técnicas fisioterápicas do Programa Multidisciplinar de Preparo para o Parto e Maternidade se relacionaram à diminuição da intensidade, freqüência e duração e à melhor evolução dos desconfortos músculo-esqueléticos na gestação.

Intervenções benéficas durante o parto para a prevenção da mortalidade materna

O caráter multifatorial das complicações e da mortalidade materna torna difícil e demorada a tarefa de seu controle a longo prazo. A atenção profissional à mulher gestante e/ou parturiente representa seguramente elemento chave para a obtenção de bons resultados, tanto maternos quanto perinatais. Partindo-se do pressuposto de que atenção médica profissional ao parto de maneira adequada tem a capacidade de diminuir a ocorrência de complicações associadas à morbidade e mortalidade materna, são apresentadas resumidamente as evidências sobre algumas intervenções incluídas nesta atenção. São enfocadas as evidências derivadas de estudos realizados com extremo rigor metodológico e científico, os ensaios controlados randomizados, sobre intervenções capazes de reduzir as complicações e a mortalidade materna. Estas principais intervenções referem-se basicamente a: atenção institucional ao parto, atendimento profissional capacitado, utilização de parteiras tradicionais em determinados contextos, uso de tecnologias apropriadas incluindo o partograma, local do parto, posição para o parto, uso de episiotomia, tipo de parto, uso de ocitócicos na fase ativa do parto, realização de esforços de puxo no período expulsivo, manejo da dequitação e profilaxia da hemorragia puerperal. Ainda que o efeito de prevenir mortes seja difícil de ser avaliado pela baixa freqüência, sua utilização de forma racional e padronizada, por meio de manuais e normatizações de condutas de serviços, tem um efeito positivo sobre a qualidade da atenção ao nascimento. Isso faz parte do contexto técnico e humano do direito que toda mulher tem ao melhor atendimento possível nesse momento tão especial de sua vida.