Performance of resident nurses in obstetrics on childbirth care

OBJETIVO: Descrever e discutir a produção científica acerca da prática de enfermeiras na assistência ao parto. MÉTODO: Foi realizada uma revisão de literatura integrativa utilizando publicações disponíveis. A busca dos artigos ocorreu nas bases de dados LILACS, BDENF, Portal de periódicos CAPES, Biblioteca Eletrônica Científica Online SCIELO no período de 2014 a 2019, sendo selecionados e analisados 14 estudos. Para pesquisa foi utilizado os descritores “saúde da mulher”, “parto humanizado”, “parto normal”, “enfermeiras obstétricas”, “humanização da assistência” com o operador booleano AND no final de cada descritor. Os critérios de inclusão utilizados foram artigos originais e de revisão, publicados na íntegra, na língua portuguesa em periódicos nacionais. RESULTADOS: Emergiram duas categorias de análise: Prática das enfermeiras acerca das boas práticas da assistência ao parto e nascimento e fatores que interferem no trabalho de parto das parturientes. CONSIDERAÇÕES FINAIS: Verificou-se uma adesão às boas práticas de atenção ao parto e nascimento, como o uso de métodos não farmacológicos no manejo da dor, presença do acompanhante, dentre outros. No entanto, também foi observado que as mulheres são colocadas em um lugar passivo e ficam expostas devido a uma estrutura inadequada e a falta de recursos materiais.

Objectives: to identify the prevalence and factors associated with obstetric interventions in parturients assisted in public maternity hospitals. Methods: a cross-sectional study with 344 puerperal women, from two public maternity hospitals, referring to childbirth by Sistema Único de Saúde (SUS) (Public Health Service System) in Londrina City, Paraná, Brazil, between January and June 2017. The medical records were the data source. The following obstetric interventions were considered: oxytocin use, artificial rupture of the membranes, instrumental childbirth and episiotomy. Multivariate Poisson regression was used to analyze associated factors, with p<5% being significant. Results: the prevalence of obstetric intervention was 55.5%, the maximum number of interventions in the same parturient woman was three. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated on maternal disease (p=0.005) and intrapartum meconium (p=0.022) independently increased, the risk of obstetric intervention, while dilation was equal to or greater than 5 cm at admission, there was a protective factor against this outcome (p=0.030). Conclusion: the prevalence of obstetric interventions was high. In the case of maternal disease and intrapartum meconium, special attention should be given to the parturient woman, in order to avoid unnecessary interventions. Thus, the maternity hospitals need to review their protocols, seeking good practices in childbirth care.

Objectives: to analyze the incidence of obstetric practices in labor and childbirth care at usual risk in a tertiary hospital. Methods: cross-sectional, descriptive study with a quantitative approach. Data were collected from 314 Monitoring Sheets of Labor and Childbirth Care of women who had their birth attended at the institution, from July 2017 to July 2018. The study was approved by the research ethics committee, with the embodied opinion number 2.822.707. Results: most women in the study were between 20 and 34 years old, coming from the city of Fortaleza, Ceará; had completed high school; and had unpaid work. The prevalence of good practices was identified: umbilical cord clamping in a timely manner (81.5%), immediate skin-to-skin contact (73.9%), breastfeeding in the childbirth room (74.2%), freedom of position and movement (72.3%), completion of the partograph (66.6%), presence of a companion (66.2%), offer of a liquid diet (65%), and non-pharmacological methods for pain relief (54.8%). As for interventional practices, we identified: venoclysis (42.4%), oxytocin infusion (29%), and amniotomy (11.1%). Conclusions: advances in the adoption of good practices based on scientific evidence are noteworthy; however, the technocratic model of childbirth care for women at normal risk persists.

To determine the level of satisfaction with childbirth and the postpartum period. This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used. A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001). The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

Knowledge, attitudes and practices of Brazilian obstetricians in relation to childbirth care.

Background and objective: In obstetrics training, there are gaps in the scientific evidence on how to teach safe practices with respect. The objective of this study was to explore from the point of view of the preceptors how the process of training obstetricians (physicians and nurses) in residency leads to the development and inculcation of the practices recommended by the national and international guidelines for assistance with natural childbirth.Methods: Qualitative, exploratory-descriptive study. Thirty-five professionals, including 21 physicians and 14 nurses, from a public institution in the Midwest of Brazil participated in the study. Data were collected through face-to-face interviews conducted from March to June 2018. They were categorized into emerging themes, supported by NVivo to natural birth ® software. Two researchers reviewed the data, and by consensus, the identified issues were confirmed.Results: Of the participants’ comments, 4 themes were codified: approach of the good practices in natural childbirth care; unnecessary practices that remain in use; norms and routines in natural childbirth care; and work processes in the obstetric residency program.Conclusions: The results highlight the necessity of reorganization of the work processes in the residency program, with continuous action directed toward the strengthening of pedagogical processes and the qualification of the actors involved in the formation and organization of childbirth care services to expand the disruptive potential of new health professionals.

Objective: to analyze practices in childbirth and postpartum hospital care. Methods: cross-sectional study, conducted with 335 mothers in a reference maternity hospital. A form was used based on the indicators of the Bologna index and guidelines for childbirth and puerperium assistance. Data were analyzed using descriptive and inferential statistics (chi-square, binomial and Clopper-Pearson tests), with p&lt;0.05 being significant. Results: it was observed that 77.9% of the puerperal women considered professional assistance satisfactory. The presence of the doula (p=0.037) and breastfeeding in the first hour of life (p=0.032) had a significant relation with the evaluation of women. The Bologna index evaluation obtained an average of 2.6. Conclusion: there was a higher frequency of intermediate and inadequate practices in childbirth and postpartum care.

Objective: to describe the actions recommended by the Carioca Stork Program for assistance to pregnant women and identifywhether the implementation of this program had repercussions on the assistance from the perspective of the nursingteam. Methods: descriptive study with a qualitative approach, conducted in a public maternity hospital. Semi-structuredinterviews were conducted with four obstetric nurses and seven nursing auxiliaries who work at the obstetric center of thismaternity hospital. We used the technique of thematic content analysis. Results: the study categories were: Qualification ofthe hospital obstetric care, care and professional repercussions from the Carioca Stork Program. Conclusion: the nursingstaff considered that the implementation of the program brought improvements in childbirth care, favored women’s rightsand the performance of obstetric nursing in the municipal health network.

Objective: to describe the actions recommended by the Carioca Stork Program for assistance to pregnant women and identifywhether the implementation of this program had repercussions on the assistance from the perspective of the nursingteam. Methods: descriptive study with a qualitative approach, conducted in a public maternity hospital. Semi-structuredinterviews were conducted with four obstetric nurses and seven nursing auxiliaries who work at the obstetric center of thismaternity hospital. We used the technique of thematic content analysis. Results: the study categories were: Qualification ofthe hospital obstetric care, care and professional repercussions from the Carioca Stork Program. Conclusion: the nursingstaff considered that the implementation of the program brought improvements in childbirth care, favored women’s rightsand the performance of obstetric nursing in the municipal health network.

Introduction: The experience of motherhood for primiparous women is a moment of passage and concerns physical and emotional changes. This experience needs to be welcomed by health teams from primary care to medium and high complexity. Therefore, in the usual risk prenatal care, the generalist nurse and the obstetrician nurse must be in the care teams, maintaining the quality of prenatal, childbirth and postpartum care. The attention to women in a humanized way can contribute to the experience of a more satisfactory postpartum period. Objectives: to recognize the perceptions of puerperal women in the care actions given by nurses in a School Hospital. Methods: qualitative, exploratory study, carried out in a Federal School Hospital, linked to a public university. The group in this study was composed of 13 primiparous women, who gave birth to their children through normal delivery or cesarean section in the second half of 2021. An interview was carried out using the Google Meet platform between the 30th and 45th day postpartum with the following question: What does it mean to me to be a woman and a puerperal for the first time? The analysis was performed using the Iramuteq software (Interface R pous les Analyses Multidimensionnelles de Textes et de Questionnaires – Version 0.7 alpha 2) Results: the corpus of the 13 interviews generated 308 Elementary Context Units (ECU). The Descending Hierarchical Classification (CHD) retained 254 UCE, with an 82.47% success rate and five classes; the most frequent lexicon was nurse (a), with a frequency of 23 citations in the text segments. Conclusions: it was possible to recognize the nurse as a professional promoter of humanized practices in childbirth care, by the participants' reports about the reception received at the time of childbirth and the immediate postpartum period.

Objective: to analyze the prevalence of practices in childbirth care, obstetric and neonatal adverse events and their association with care models in three public health services. Method: this is a prospective cohort study carried out with 548 dyads, postpartum women and their newborns, whose pregnancy was of usual risk and vaginal birth, admitted to hospital in three public services, one with an exclusive care model by nurse-midwives (service A), one with a collaborative model involving obstetric doctors and nurses (service B) and one with an exclusive medical care model (service C). Initially, an interview was carried out with participants, and a second contact was carried out 42 days after birth to complement the collection of the adverse event outcome. Results: in service A, no woman underwent the Kristeller maneuver, episiotomy, directed pushing or more than one vaginal examination per hour. Meanwhile, in service C, 19.3%, 39.9%, 77.1% and 26.3% of women underwent these interventions, respectively. Adverse events occurred in 19.2% of the dyads. Occurrence of adverse events was associated with not using partograph (p=0.001; OR: 11.03; CI: 2.64-45.99) and episiotomy (p=0.042; OR: 1.72; CI: 1. 02-2.91). The mean probability of experiencing an adverse event was 5% in service A, 21% in service B and 24% in service C. Conclusion: adverse events had a lower mean probability of occurrence in the service exclusively operated by nurse-midwives, in which greater application of recommendations for labor and birth care was identified.

Excessive interventions during labor in Brazil have been reported as disrespect and abuse and contribute to neonatal and maternal morbidity and mortality. The Senses of Birth exhibition aims to encourage normal birth to promote health and improve the experience of childbirth in the country. This article describes the characteristics of 555 women who visited the exhibition during pregnancy and their perception of obstetric violence in childbirth. Obstetric violence was reported by 12.6% of the women, mostly low-income and unmarried. It was associated to lithotomic position and Kristeller maneuver during childbirth and non-immediate skin-to-skin contact with the baby. The main categories of obstetric violence reported were: not accepted interventions /accepted interventions on the basis of partial information (36.9%), undignified care / verbal abuse (33.0%); physical abuse (13.6%); non-confidential / non-privative care (2.9%) and discrimination (2.9%). Visiting the exhibition significantly increased pregnant women's knowledge about obstetric violence. However, recognition of obsolete or harmful practices as obstetric violence was still low. Initiatives such as Senses of Birth may contribute to increase knowledge and social mobilization to disseminate good practices in childbirth care.

Background: The skills of midwives in childbirth care competence are still inadequate. This problem is influenced by limitation experience of midwifery students of childbirth care in the field of practice area. That condition related to the proportion of midwifery students and case of childbirth woman was an imbalance. Midwifery students must prepare this competence in an education with childbirth care experience from practice in the laboratory and in the field of practice. Reflective learning is an appropriate learning method that uses experience as the basis of learning to improve childbirth care competence of midwifery students. Objective: This study is to analyze the effect of reflective learning implementation in childbirth care practice to improve students’ competence. Method: This research uses quasi-experimental design with non-equivalent control group design. The respondents were midwifery students in the fourth semester who had experienced the theory of childbirth care. There were totally 64 samples, 34 samples for treatment group and 30 samples for control group. Data were analyzed by using unpaired t test, Mann Whitney U and linear regression. Results: The respondents were homogeny in motivation and grade point of average (GPA). The improvement of childbirth care competency is influenced by treatment of 19.064 with R2 = 57.7%. Conclusion: The implementation of reflective learning in childbirth care practice affected the improvement of students’ competence.

BackgroundIn Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The National Supplementary Health Agency proposed the Adequate Childbirth Project (PPA), a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. The objective of this study is to assess how the participation of women in the process of improving quality childbirth care occurred in two hospitals participating in the PPA.MethodQualitative study, based on interviews with 102 women attended at two hospitals that took part in the first and second stages of the “Healthy Birth”, an evaluative hospital-based research, conducted in 2017–2018, that assessed the degree of implementation and the effects of PPA. After thematic content analysis, supported by MaxQda software, three categories emerged: (1) how women gathered knowledge about the PPA, (2) how women perceived it, and (3) which are their suggestions for the PPA improvement.ResultsThe PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the “new” model of care. Visits to the maternity hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women have expectations of a relationship with maternity that is not limited to the moment of delivery. The listening channels established between hospitals and women are fragile and not systematized. By increasing the supply of listening spaces, one can also increase the request to leave their suggestions and contributions, and thus gain more allies in improving the project. Women are not yet included as PPA agents and their voices are silenced.ConclusionsWomen’s participation to improve childbirth care is relevant and necessary. The women’s voice in the PPA is still incipient, and maternity hospitals and health plan operators should create strategies to insert and engage them. Women’s voices should be listened to not only during but also before and after childbirth.

As a part of the process of implementing Early Essential Newborn Care (EENC) in China, which are evidence-based interventions recommended by the World Health Organization (WHO), we sought to understand whether current hospital policies are consistent with WHO-recommended standards and what factors influence their use. Data from the study will help inform policy changes needed to support the introduction of evidence-based childbirth and early newborn care practices effectively and to inform further scale up of EENC nationwide. Ten randomly selected hospitals in 4 early-introducing provinces participated in the study. We collected data from 20 simulated delivery scenario observations and focus group discussions and individual interviews with 10 hospital management staff. Policies, protocols, and guidelines related to childbirth and newborn care practice were also collected and reviewed at each hospital. Additionally, a survey was emailed to 15 childbirth and newborn experts from the 4 selected provinces and completed by 13. Data were compared with WHO EENC evidence-based standards to calculate the agreement rates. Barriers to introducing evidence-based guidelines were identified in focus groups and key informant interviews, then combined into common categories. Hospital policies were not consistent with WHO recommendations in 10 (59%) of the 17 delivery and early newborn care practices. Delayed cord clamping was recommended by 30% of hospital protocols and prolonged skin-to-skin contact by 13%, neither of which were observed in the delivery simulations. Kangaroo mother care (KMC) for stable preterm babies was required in only 17% of the hospitals; no preterm babies had KMC initiated, with all immediately separated from their mothers and admitted to neonatal intensive care units. Newborn resuscitation equipment was required to be placed within 2 meters of the delivery bed in 84% of hospital protocols, but was prepared in only 40% of cases. Immediate drying after birth was required in 48% of hospital protocols, but was initiated in only 20% of observed cases. Current childbirth and early newborn care policy and practice in China is not aligned with WHO recommendations for some major interventions. To make it easier and safer for hospital workers to practice EENC, expert working groups and national policies must be established to address inconsistencies and cultural beliefs and provide a strong, evidence-based set of guidelines for hospitals and health workers to follow.