Decision-making on birth choices following a caesarean delivery in Taiwan

 A qualitative research aimed to explore decision-making on birth choices following a caesarean delivery in Taiwan. Safety and risk management were the major influences for both Taiwanese women’s and obstetricians’ decisions. Biased information provision regarding birth options and over-medicalisation of the birth environment contributed to women seeking repeat caesarean delivery.

Peeling the onion: understanding others' lived experience

BACKGROUND: Society and some healthcare professionals often marginalise pregnant women who take illicit substances. Likewise the midwives who care for these women are often viewed as working on the edge of society. The aim of this research was to examine the lived world of these midwives to gain insight into the world of their work.

DESIGN: A phenomenological study informed by Heidegger, Gadamer and Merleau-Ponty was chosen to frame these lived experiences of the midwives. Using face-to-face phenomenological interviews data were collected from 12 midwives whose work is only caring for women who take illicit drugs.

RESULTS: The 3 fundamental themes that emerged from the study were: making a difference, establishing partnerships: and letting go and refining practice. Conclusions and impetus for this paper: Lived experiences are unique and can be difficult for researchers to grasp. The stories told by participants are sometimes intangible and often couched in metaphor. This paper aims to discuss lived experience and suggests that like an onion, several layers have to be peeled away before meaning can be exposed; and like peeling onions, each cover reveals another layer beneath that is different from before and different from the next. Exemplars from this midwifery study are used to explain lived experiences.

Midwives experiences of establishing partnerships: working with pregnant women who use illicit drugs

OBJECTIVE: To present the interpreted experiences of midwives who choose to work with pregnant women who also use illicit drugs. DESIGN: Twelve (n=12) Australian midwives were interviewed. Each interview was audio-taped, de-identified and transcribed. The interviews were analysed using a systematic, thematic analysis approach informed by Heideggarian hermeneutic phenomenology. FINDINGS: Three themes identified from the data that encapsulate the experience were establishing partnerships, making a difference, and letting go and redefining practice. The interpretations of establishing partnerships which includes engagement, genuine regard and compassion, with a subtheme courting the system are presented in this paper. The midwives' experiences were both positive and negative, as they were rewarded and challenged by the needs of women who use illicit drugs and the systems in which they worked. CONCLUSION: The midwives in this study found that establishing partnerships was essential to their work. They appraised their experience of working with pregnant women who used illicit drugs and found strategies that attempted to meet the needs of the women, the system and themselves. The participants revealed that to support women and families who use illicit drugs in their community, partnerships must be based on deep respect and trust. Significant components engagement, genuine regard and compassion that are central to midwifery partnerships require revisiting to address the needs of this vulnerable population of women.

Hermeneutic phenomenology: a methodology of choice for midwives

Hermeneutic phenomenology has been used widely by researchers to understand lived experiences. This methodology asserts that individual people are as unique as their life stories. The practice of midwifery is underpinned by a philosophy that values women and the uniqueness of their child-bearing journey. The tenets of hermeneutics phenomenology align with those of contemporary midwifery practice, making it a useful research methodology for providing insights into issues relevant to the profession. The purpose of this paper is to unravel some foundational concepts of hermeneutic phenomenology and recommend it as a methodology of choice for midwives to apply to their application to midwifery-in-action.

Incident delirium in the acute general medical setting

 Delirium is a serious neuro‐cognitive disorder that affects many people admitted to hospital. Results of this research have contributed valuable knowledge regarding the risk factors, health outcomes and management of medical patients with who developed incident delirium during hospitalisation.

Elaboração e validação de instrumento para consulta de enfermagem à puérpera no âmbito da atenção básica

A pesquisa teve como objetivo elaborar e validar um instrumento para sistematizar a assistência de enfermagem à puérpera no âmbito da atenção básica. O documento foi construído com base na Teoria das Necessidades Humanas Básicas de Horta, na Padronização de um Conjunto Internacional de Dados Essenciais em Enfermagem e na Nomenclatura de diagnósticos e intervenções de enfermagem desenvolvida a partir dos resultados da Classificação Internacional para as Práticas de Enfermagem. Trata-se de um estudo do tipo metodológico desenvolvido em cinco etapas: identificação dos indicadores empíricos relativos à puérpera mediante revisão integrativa da literatura; avaliação dos indicadores empíricos e sua relação com as necessidades humanas básicas por grupo focal com cinco enfermeiras especialistas; estruturação do instrumento mediante a categorização dos indicadores; validação de forma e conteúdo do instrumento pelos especialistas, por meio da técnica Delphi; e aplicação e desenvolvimento das afirmativas de diagnóstico e intervenções de enfermagem. A coleta de dados da primeira etapa ocorreu nos meses de janeiro a março de 2013 nas bases de dados Scopus, Cinahl, Pubmed, Cochrane, e no periódico Journal of Midwifery and Women s Health. A segunda, terceira e quarta etapas se realizaram nos meses de maio a outubro de 2013. Participaram doze e sete especialistas na primeira e segunda rodada de avaliação respectivamente. A seleção dos especialistas ocorreu pela Plataforma Lattes mediante os seguintes critérios de inclusão: ser enfermeiro (a) docente e especialista em enfermagem obstétrica. A consulta a estes profissionais se deu via email e, ao aceitarem participar da pesquisa, assinaram um Termo de Consentimento Livre e Esclarecido. A pesquisa obteve aprovação da Comissão de Ética em Pesquisa da Universidade Federal do Rio Grande do Norte, sob o protocolo nº 184.241 e Certificado de Apresentação para Apreciação Ética nº 11674112.3.0000.5537. Para análise dos dados da primeira etapa, utilizou-se a estatística descritiva e os resultados apresentados em forma de tabelas. Nesta etapa, identificou-se 97 indicadores empíricos e, quando relacionados com as necessidades humanas básicas, 46 desses encontravam-se nas necessidades psicobiológicas, 51 nas psicossociais e 01 nas necessidades psicoespirituais. Com relação à segunda e terceira etapas, os dados passaram por um processo de categorização e análise pelo Índice de Validade de Conteúdo. Os indicadores obtiveram um índice de validação de 100%. Na parte de avaliação da puérpera, os itens não validados foram excluídos do instrumento. Os demais itens obtiveram índice acima de 70%, sendo, portanto, o instrumento validado. O instrumento para a consulta de enfermagem é constituído de dados de identificação da puérpera, dados de avaliação das necessidades humanas da puérpera e itens do cuidado de enfermagem. Na versão final foram selecionados 73 Diagnósticos de Enfermagem e 155 Intervenções de Enfermagem a partir da categorização dos indicadores empíricos validados na segunda e terceira etapas do estudo. Com a conclusão do estudo, o enfermeiro disporá de um instrumento para sistematização da assistência à puérpera na atenção básica. Além disso, o documento servirá como ferramenta para o ensino e a pesquisa em enfermagem obstétrica

A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: A pilot study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Time analysis for temporary gravitational capture: Satellites of Uranus

We study the problem of gravitational capture in the framework of the Sun-Uranus-particle system. Part of the space of initial conditions is systematically explored, and the duration of temporary gravitational capture is measured. The location and size of different capture-time regions are given in terms of diagrams of initial semimajor axis versus eccentricity. The other initial orbital elements - inclination (i), longitude of the node (Ω), argument of pericenter (ω), and time of pericenter passage (τ) - are first taken to be zero. Then we investigate the cases with ω = 90°, 180°, and 270°. We also present a sample of results for Ω = 90°, considering the cases i = 60°, 120°, 150°, and 180°. Special attention is given to the influence of the initial orbital inclination, taking orbits initially in opposition at pericenter. In this case, the initial inclination is varied from 0° to 180° in steps of 10°. The success of the final stage of the capture problem, which involves the transformation of temporary captures into permanent ones, is highly dependent on the initial conditions associated with the longest capture times. The largest regions of the initial-conditions space with the longest capture times occur at inclinations of 60°-70° and 160°. The regions of possible stability as a function of initial inclination are also delimited. These regions include not only a known set of retrograde orbits, but also a new sort of prograde orbit with inclinations greater than zero.

Entre o parto e a benção: memórias e saberes de mulheres que partejam

O presente trabalho buscou fazer uma reflexão sobre o saber-fazer de mulheres que partejam a partir da narrativa de vida de uma parteira da cidade de Bragança-(PA). Para tanto, foi utilizado o conceito de memória e identidade em Halbawchas (2006) e Bosi (1994). Compreendendo esse ofício inserido na lógica da cultura popular, foram utilizados os conceitos de Cultura em Burke (1989) e Cuche (1999) e Cultura Popular em Bosi (1992), sempre na perspectiva da heterogeneidade. A problematização dessa temática só foi possível mediante um olhar mais sensível e aproximado desses sujeitos, assim, a etnografia ofereceu os subsídios necessários nessa relação, apoiado nas fomentações de Clifford (2002) e Laplantine (1995). E por ser um conhecimento tácito a História Oral foi a base metodológica que sustentou toda a pesquisa, sendo constantemente aplicadas as orientações metodológicas proposta por Thompson (1992) e Delgado (2006). A pesquisa possibilitou compreender que existe uma representação feita por essas mulheres e pela sociedade sobre o trabalho de partejar, e que o mesmo se constitui um dom, ou um aprendizado adquirido através do contato com os mais antigos. A importância deste estudo se dá no fato de que existem diversos sujeitos sociais, que cotidianamente constroem seus saberes, mas que em função da forma hierárquica como foi concebida a sociedade, foram deixados de lado. Igualmente, é que em virtude do processo da Política de Humanização do Parto, tem-se percebido que diversos profissionais ligados à saúde da mulher tem se autodenominado parteiras, o que denota uma tentativa de apropriação e homogeneização de um saber que é específico.

Risk factors for birth-related perineal trauma: a cross-sectional study in a birth centre

Aim and objectives. To identify maternal, newborn and obstetric factors associated with birth-related perineal trauma in one independent birth centre. Background. Risk factors for birth-related perineal trauma include episiotomy, maternal age, ethnicity, parity and interventions during labour including use of oxytocin, maternal position at time of birth and infant birth weight. Understanding more about these factors could support the management of vaginal birth to prevent spontaneous perineal trauma, in line with initiatives to reduce routine use of episiotomy. Design. Cross-sectional study. Methods. Data were retrospectively collected from one independent birth centre in Brazil, during 20062009. The dependent variable (perineal trauma) was classified as: (1) intact perineum or first-degree laceration, (2) second-degree laceration and (3) episiotomy (right mediolateral or median). Results. There were 1079 births during the study period. Parity, use of oxytocin during labour, position at time of giving birth and infant birth weight were associated with second-degree lacerations and episiotomies. After adjusting for parity, oxytocin, maternal position at the expulsive stage of labour and infant birth weight influenced perineal outcomes among primiparae only. Conclusions. Although the overall rate of episiotomies in this study was low compared with national data, it was observed that younger women were most vulnerable to this intervention. In this age group in particular, the use of oxytocin as well as semi-upright positions at the time of birth was associated with second-degree lacerations and episiotomies. Relevance to clinical practice. The use of upright alternative positions for birth and avoidance of use of oxytocin could reduce the risk of perineal trauma from lacerations and need to perform episiotomy.

Childbirth experience according to a group of Brazilian primiparas

Objective: to understand the meaning of the childbirth experience for Brazilian primiparas in the postpartum period. Design: a qualitative approach using semi-structured interviews. Content analysis was used to derive the two themes that emerged from the discourses. Setting: participants were recruited at four primary-level health-care units in Ribeirao Preto, Brazil. After providing written informed consent, an appointment was made for an interview at the participants' homes. Participants: 20 primiparas in the postpartum period, aged 15-26 years old, who attended the health-care units to vaccinate their infants and test for phenylketonuria. Findings: two thematic categories emerged from the interviews: the meaning attributed to childbirth (with four subcategories) and perceptions of care. Among the participants, the childbirth experience was marked by the 'fear of death' and 'losing the child'. The pain of giving birth was expected, and the moment of childbirth was associated with pain of high intensity. Key conclusions: childbirth is considered synonymous with physical and emotional suffering, pain, fear and risk of death. Implications for practice: this research indicates the need to break the current mechanistic model of care on which health professionals' actions are based. Care during childbirth must be guided by the foundation that women are the subjects of childbirth actions, in an attempt to emphasise actions that grant them with the autonomy and empowerment needed to experience the situation. (C) 2011 Elsevier Ltd. All rights reserved.

Factors associated with maternal intrapartum transfers from a freestanding birth centre in Sao Paulo, Brazil: A case control study

Objectives: to identify factors associated with maternal intrapartum transfer from a freestanding birth centre to hospital. Design: case-control study with retrospective data collection. Participants and settings: cases included all 111 women transferred from a freestanding birth centre in Sao Paulo to the referral hospital, from March 2002 to December 2009. The controls were 456 women who gave birth in the birth centre during the same period who were not transferred, randomly selected with four controls for each case. Methods: data were obtained from maternal records. Factors associated with maternal intrapartum transfers were initially analysed using a chi(2) test of association. Variables with p < 0.20 were then included in multivariate analyses. A multiple logistic regression model was built using stepwise forward selection; variables which reached statistical significance at p < 0.05 were considered to be independently associated with maternal transfer. Findings: during the study data collection period, 111(4%) of 2,736 women admitted to the centre were transferred intrapartum. Variables identified as independently associated factors for intrapartum transfer included nulliparity (OR 5.1, 95% CI 2.7-9.8), maternal age >= 35 years (OR 5.4, 95% CI 2.1-13.4), not having a partner (OR 2.8, 95% CI 1.5-5.3), cervical dilation <= 3 cm on admission to the birth centre (OR 1.9, 95% CI 1.1-3.2) and between 5 and 12 antenatal appointments at the birth centre (OR 3.8, 95% CI 1.9-7.5). In contrast, a low correlation between fundal height and pregnancy gestation (OR 0.3, 95% CI 0.2-0.6) appeared to be protective against transfer. Conclusions and implications for practice: identifying factors associated with maternal intrapartum transfer could support decision making by women considering options for place of birth, and support the content of appropriate information about criteria for admission to a birth centre. Findings add to the evidence base to support identification of women in early labour who may experience later complications and could support timely implementation of appropriate interventions associated with reducing transfer rates. (C) 2012 Elsevier Ltd. All rights reserved.