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The humanizing in delivery: the bibliographyc study  [cached]
Karla de Abreu Peixoto Moreira,Michell ?ngelo Marques Araújo,Maria Veraci Oliveira Queiroz,Maria Salete Bessa Jorge
Online Brazilian Journal of Nursing , 2006,
Abstract: This is a bibliographic study in papers of nursing of 2000 to 2005 which objective was to analysis the scientific production in nursing about humanization in delivery. It was researched seven brazilian magazines in nursing with international classification using the descriptors humanization in delivery and pain in delivery. Overall were found 16 articles which were submitted to content analysis. We highlight the core of senses that were grouped forming the categories: the rescue of historicity of delivery; the medicalization and use of technologies in delivery; humanization in delivery and methods of care to woman. The studies shown convergence of opinions about the institution of delivery and technologic interventions that get far of humanized conducts. Thus, the reversion of this phenomena occurs with respect to privacity and woman autonomy. There is need to new studies about the theme, deeming the complexity of aspects that involves the humanization in delivery.
Humanizing delivery: progress and difficulties for its implementation
Samira Maria Oliveira Almeida, Maria de Fátima de Araújo Silveira
Revista de Enfermagem UFPE On Line , 2009,
Abstract: Objective: to identify the advances and difficulties in implementation and practice of humanization of parturition. Methodology: the study was conducted in a qualitative approach, and its sample was composed of 13 professionals directly involved with the care. Data were collected through semi-structured interview guide and observation from the participants. Processing of data, using the content analysis ― themes analysis. Results: advances in the process of humanization are considered least in comparison to the difficulties raised by the interviewees. The study has been approved by the Committee of Ethics in Research of the University of Paraiba State (CAAE 0724.0.000.133-06). The resistance of professionals, the limited of the vacancies, high demand, accompanied by the small number of professionals, are the factors considered most difficult in the practice of humanization. Conclusion: the results show that the factors related to the difficulties and advances in humanization depend largely on professionalism and ethics on the attitude of managers and health professionals involved with care delivery, so that together can overcome the obstacles that put forward to humanized care in all its dimensions
Determinants of skilled birth attendants for delivery in Nepal  [PDF]
Y R Baral,K Lyons,J Skinner,E R van Teijlingen
Kathmandu University Medical Journal , 2010, DOI: 10.3126/kumj.v8i3.6223
Abstract: This review is to explore the factors affecting the uptake of skilled birth attendants for delivery and the issues associated with women’s role and choices of maternal health care service for delivery in Nepal. Literature was reviewed across the globe and discussed in a Nepalese context. Delivery by Skilled Birth Attendance serves as an indicator of progress towards reducing maternal mortality worldwide, the fifth Millennium Development Goal. Nepal has committed to reducing its maternal mortality by 75% by 2015 through ensuring accessibility to the availability and utilisation of skilled care at every birth. The literature suggests that several socio-economic, cultural and religious factors play a significant role in the use of Skilled Birth Attendance for delivery in Nepal. Availability of transportation and distance to the health facility; poor infrastructure and lack of services; availability and accessibility of the services; cost and convenience; staff shortages and attitudes; gender inequality; status of women in society; women’s involvement in decision making; and women’s autonomy and place of residence are significant contributing factors for uptake of Skilled Birth Attendance for delivery in Nepal. The review found more quantitative research studies exploring the determinants of utilisation of the maternal health services during pregnancy in Nepal than qualitative studies. Findings of quantitative research show that different social demographic, economic, socio-cultural and religious factors are responsible for the utilisation of maternal health services but very few studies discussed how and why these factors are responsible for utilisation of skilled birth attendants in pregnancy. It is suggested that there is need for more qualitative research to explore the women’s role and choice regarding use of skilled birth attendants services and to find out how and why these factors are responsible for utilisation of skilled birth attendants for delivery. Qualitative research will help further exploration of the issues and contribute to improvement of maternal health services. DOI: http://dx.doi.org/10.3126/kumj.v8i3.6223 Kathmandu Univ Med J 2010;8(3):325-32 ?
Mode of delivery and cord blood cytokines: a birth cohort study
Ngoc P Ly, Bego?a Ruiz-Pérez, Andrew B Onderdonk, Arthur O Tzianabos, Augusto A Litonjua, Catherine Liang, Daniel Laskey, Mary L Delaney, Andrea M DuBois, Hara Levy, Diane R Gold, Louise M Ryan, Scott T Weiss, Juan C Celedón
Clinical and Molecular Allergy , 2006, DOI: 10.1186/1476-7961-4-13
Abstract: To examine whether cesarean section results in neonatal secretion of cytokines that are associated with increased risk of atopy and/or asthma in childhood. To examine whether the association between mode of delivery and neonatal immune responses is explained by exposure to the maternal gut flora (a marker of the vaginal flora).CBMCs were isolated from 37 neonates at delivery, and secretion of IL-13, IFN-γ, and IL-10 (at baseline and after stimulation with antigens [dust mite and cat dander allergens, phytohemagglutinin, and lipopolysaccharide]) was quantified by ELISA. Total and specific microbes were quantified in maternal stool. The relation between mode of delivery and cord blood cytokines was examined by linear regression. The relation between maternal stool microbes and cord blood cytokines was examined by Spearman's correlation coefficients.Cesarean section was associated with increased levels of IL-13 and IFN-γ. In multivariate analyses, cesarean section was associated with an increment of 79.4 pg/ml in secretion of IL-13 by CBMCs after stimulation with dust mite allergen (P < 0.001). Among children born by vaginal delivery, gram-positive anaerobes and total anaerobes in maternal stool were positively correlated with levels of IL-10, and gram-negative aerobic bacteria in maternal stool were negatively correlated with levels of IL-13 and IFN-γ.Cesarean section is associated with increased levels of IL-13 and IFN-γ, perhaps because of lack of labor and/or reduced exposure to specific microbes (e.g., gram-positive anaerobes) at birth.According to the Centers for Disease Control and Prevention's National Center for Health Statistics, the rate of cesarean section rose to 29.1% in 2004 in the United States (a > 40% rate increase since 1996) [1]. Because cesarean section has been associated with increased risks of asthma [2-5] and atopy [6-8], further understanding of the relationship between mode of delivery and immune system ontogeny is needed.Several studies have
Changing trends on the place of delivery: why do Nepali women give birth at home?  [cached]
Shrestha Saraswoti,Banu Bilkis,Khanom Khursida,Ali Liaquat
Reproductive Health , 2012, DOI: 10.1186/1742-4755-9-25
Abstract: Background Home delivery in unhygienic environment is common in Nepal. This study aimed to identify whether practice of delivery is changing over time and to explore the factors contributing to women’s decision for choice of place of delivery. Methods A community based cross sectional study was conducted among 732 married women of reproductive age (MWRA) in Kavrepalanchok district of Nepal in 2011. Study wards were selected randomly and all MWRA residing in the selected wards were interviewed. Data were collected through pre-tested interviewer administered questionnaire. Chi-square and multivariate analysis was used to examine the association between socio-demographic factors and place of delivery. Results The study shows that there was almost 50% increasement in institutional delivery over the past ten years. The percentage of last birth delivered in health institution has increased from 33.7% before 10 years to 63.8% in the past 5 years. However, the place of delivery varied according to residence. In urban area, most women 72.3% delivered in health institutions while only 35% women in rural and 17.5% in remote parts delivered in health institutions. The key socio-demographic factors influencing choice of place of delivery included multi parity, teen-age pregnancy, less or no antenatal visits. Having a distant health center, difficult geographical terrain, lack of transportation, financial constraints and dominance of the mothers- in-law were the other main reasons for choosing a home delivery. Psychological vulnerability and insecurity of rural women also led to home delivery, as women were shy and embarrassed in visiting the health center. Conclusion The trend of delivery at health institution was remarkably increased but there were strong differentials in urban–rural residency and low social status of women. Shyness, dominance of mothers in law and ignorance was one of the main reasons contributing to home delivery.
Birth defects in newborns and stillborns: an example of the Brazilian reality
Camila Oliveira, Antonio Richieri-Costa, Valéria Carvalho Ferrarese, Denise Móz Vaz, Agnes Fett-Conte
BMC Research Notes , 2011, DOI: 10.1186/1756-0500-4-343
Abstract: For all infants we carried out physical assessment, photographic records, analysis of medical records and collection of additional information with the family, besides the karyotypic analysis or molecular tests in indicated cases.The incidence of birth defects was 2.8%. Among them, the etiology was identified in 73.6% (ci95%: 64.4-81.6%). Etiology involving the participation of genetic factors single or associated with environmental factors) was more frequent 94.5%, ci95%: 88.5-98.0%) than those caused exclusively by environmental factors (alcohol in and gestational diabetes mellitus). The conclusive or presumed diagnosis was possible in 85% of the cases. Among them, the isolated congenital heart disease (9.5%) and Down syndrome (9.5%) were the most common, followed by gastroschisis (8.4%), neural tube defects (7.4%) and clubfoot (5.3%). Maternal age, parental consanguinity, exposure to teratogenic agents and family susceptibility were some of the identified risk factors. The most common observed consequences were prolonged hospital stays and death.The current incidence of birth defects among newborns and stillbirths of in our population is similar to those obtained by other studies performed in Brazil and in other underdeveloped countries. Birth defects are one of the major causes leading to lost years of potential life. The study of birth defects in underdeveloped countries should continue. The identification of incidence, risk factors and consequences are essential for planning preventive measures and effective treatments.Birth defects (BD) or congenital anomalies include all structural and functional alterations in embryonic or fetal development resulting from genetic, environmental or unknown causes, which result in physical and/or mental impairment. There may be single or multiple alterations with major or minor clinical significance [1,2]. The incidence of BD is 3 to 5% among newborn babies [3]. BD comprise a complex and heterogeneous group of embryonic and/o
Maternal hematocrite level and risk of low birth weight and preterm delivery
A. Garshasbi,N. Fallah
Tehran University Medical Journal , 2006,
Abstract: Background: The aim of the study was to investigate associations between maternal characteristics, with emphasis on hematological status, and risk of low birth weight and preterm delivery among pregnant women Methods: In a cohort study, 1,500 pregnant women attending Hazrat Zaynab Hospital for prenatal care and delivery in the period 2000-2001, without any risk factors for preterm delivery and low birth weight were included. Maternal characteristics including hematocrit values were recorded at the first antenatal visit. Main outcome measures included birth weight and gestation at delivery. Linear and logistic regression models were used to analyze data. Results: Severe anemia (hematocrit 40%) did not increase the risk of low birth weight and preterm delivery. Teenagers, women with short height or low body mass index had significantly higher risk of delivering low birth weight infants. Conclusion.: Severe maternal anemia, particularly in the first trimester, was significantly associated with adverse pregnancy outcome. Low maternal age, height or body mass index also increased the risk of low birth weight. Improved nutritional status of young women could contribute to improved health among their infant.
Delivery type not associated with global methylation at birth
Shama Virani, Dana C Dolinoy, Sindhu Halubai, Tamara R Jones, Steve E Domino, Laura S Rozek, Muna S Nahar, Vasantha Padmanabhan
Clinical Epigenetics , 2012, DOI: 10.1186/1868-7083-4-8
Abstract: DNA was isolated from cord blood collected from the University of Michigan Women’s & Children Hospital and bisulfite-converted. The Luminometric Methylation Assay (LUMA) and LINE-1 methylation assay were run on all samples in duplicate.Global methylation data at CCGG sites throughout the genome, as measured by LUMA, were available from 392 births (52% male; 65% CD), and quantitative methylation levels at LINE-1 repetitive elements were available for 407 births (52% male; 64% CD). LUMA and LINE-1 methylation measurements were negatively correlated in this population (Spearman’s r?=??0.13, p =0.01). LUMA measurements were significantly lower for total CD and planned CD, but not emergency CD when compared to VD (median VD?=?74.8, median total CD?=?74.4, p?=?0.03; median planned CD?=?74.2, p?=?0.02; median emergency CD?=?75.3, p?=?0.39). However, this association did not persist when adjusting for maternal age, maternal smoking and infant gender. Furthermore, total CD deliveries, planned CD and emergency CD deliveries were not associated with LINE-1 measurements as compared to VD (median VD?=?82.2, median total CD?=?81.9, p?=?0.19; median planned CD?=?81.9, p?=?0.19; median emergency CD?=?82.1, p?=?0.52). This lack of association held when adjusting for maternal age, maternal smoking and infant gender in a multivariable model.Type of delivery was not associated with global methylation in our population, even after adjustment for maternal age, maternal smoking, and infant gender. While type of birth may be associated with later health outcomes, our data suggest that it does not do so through changes in global genomic methylation.Infant stress during labor is advantageous in preparation for extrauterine life; however, the stress encountered by infants varies vastly between delivery types. The progression of labor involves a surge in stress hormones, including catecholamines and cortisol, in the infant to promote lung maturity for gas exchange, increase blood flow, activat
Birth delivery assisted by nurse-midwife: perspectives and controversies  [PDF]
Selma Aparecida Lagrosa Garcia,Umberto Gazi Lippi,Sidney Antonio Lagrosa Garcia
Revista Brasileira em Promo??o da Saúde , 2010,
Abstract: Objectives: To present the conflicts in birth deliveries assisted by nurse midwife and propose ways to minimize them. Methods: We researched the historical evolution of childbirth and the actions that were necessary for the training of professionals. Codes of Ethics of Nursing and Medicine, the current law, basic books of obstetrics and gynecology, articles from medical and nursing journals, with Lilacs and Medline as data sources; laic texts and others from non-governmental organizations (NGO) were surveyed. Conflicts were identified in birth deliveries by nurse midwife, for which we propose ways of acting. Results: The analysis of research material shows that the time of delivery, initially at home and afterwards in institutions, brought interventionism in this activity; that social and human aspects of birth and delivery were minimized and birth delivery changed into medical act. We found a strong link between the focus in humanization at child delivery and its assistance by nurses. Conclusions: We conclude that even with legal and ethical support the delivery care by nurse midwife is a source of conflict between the health team, particularly with regard to the limits of performance of the nurse and doctor. Such conflicts must be identified and discussed in the institutions and they should invest in teamwork and have clear protocols defining boundaries of responsibility.
The Delivery Methods and the Factors Affecting Among Giving Birth in Hospitals in Yozgat, Turkey
Mahmut Kili?
International Journal of Caring Sciences , 2012,
Abstract: Background: The most of pregnant women can have normal vaginal birth. Recently, caesarean section rates are graduallyincreasing both worldwide, and in my country.Objectives: The aim of this study was to establish the delivery preferences among women giving birth in hospitals, and thefactors affecting this preference.Methodology: This cross-sectional study was performed in state (n=674) and private (n=148) hospitals. Data were gatheredby a questionnaire applied by an interviewer. 822 women who had given live birth and gave verbal consent to participate,were included into the study. The data were analyzed by binary logistic regression analysis.Results: Two-thirds of the live births were by caesarean section. According to the binary logistic regression analysis, thepossibility of undergoing caesarean section increased when; mothers’ age increased, they were short, they gave birth in aprivate hospital, they had social security, they were primigravida, they had a previous miscarriage/ curettage/ stillbirth, andthe major factor was found to be, having had a previous delivery by caesarean section. Variables such as; pregnancy week,babies’ weight, mothers’ educational and occupational status, fathers’ educational status, family type, residential area,economical status were found to be insignificant.Conclusion: The facts that 2/3 rds. of the deliveries were by caesarean section, and that all of those who had undergone aprevious caesarean delivery had a consequent caesarean delivery, and that most of the primigravida (60.5%) that gave birthby caesarean section were due to doctor’s medical indication, make us think that doctors prefer caesarean delivery.
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