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Portuguese / English: www.scielo.br/reeusp RESUMO O objetivo foi descrever os resultados maternos e perinatais da assistência no Centro de Parto Normal Casa de Maria (CPN-CM), na cidade de São Paulo. A amostra probabilística foi de 991 parturientes e seus recém-nascidos, assistidos entre 2003 e 2006. Os resultados mostraram que 92,2% das parturientes tiveram um acompanhante de sua escolha e as práticas mais utilizadas no parto foram banho de aspersão ou imersão (92,9%), amniotomia (62,6%), deambulação (47,6%), massagem de conforto (29,8%) e episiotomia (25,7%). Com relação aos recém-nascidos, 99,9% apresentaram índice de Apgar = 7 no quinto minuto; 9,3% receberam aspiração das vias aé-reas superiores; nenhum necessitou ser entubado; e 1,4% foram removidos para o hospital. O modelo de assistência praticado no CPN-CM apresenta resultados maternos e perinatais esperados para mulheres com baixo risco obstétrico, sendo alternativa segura e menos intervencionista no parto normal. DESCRITORES

Objectives: To characterize the use of the Swiss ball for the care of laboring women in obstetric care services linked to the Unified Health System in São Paulo, and to identify the characteristics of its use in assisting laboring women by nurse-midwives. Methods: A descriptive study based on structured interviews with 35 nurses who were providing assistance to laboring women. Results: We found that 100% of Normal Birthing Centers and 40.9% of obstetric centers owned the Swiss ball. The indications for the use of Swiss ball were: promoting fetal descent (32.4%), relaxation (19.7%), progression of labor (17.1%), exercise of the perineum (14.5%), pain relief (11.8%), psychological benefits and maternal movement. Nearly all of the institutions visited (96.8%) had no protocol for its use. Conclusion: The study found that nurses ascribe benefits to using the Swiss ball during labor. Clinical trials are needed to evaluate its effects and support the development of guidelines for its use. Keywords: Obstetrical nursing; Exercise therapy; Natural childbirth RESUMO Objetivos: Caracterizar o uso da bola suíça na assistência à parturiente em serviços de atenção obstétrica vinculado ao Sistema Único de Saúde no Município de São Paulo e identificar as características de seu emprego na assistência à parturiente por enfermeira obstétricas. Métodos: Estudo descritivo com base em entrevistas estruturadas com 35 enfermeiras que prestavam assistência às parturientes. Resultados: Constatou-se que 100% dos Centros de Parto Normal e 40,9% dos Centros Obstétricos possuiam bola suíça. As indicações do uso da bola suíça foram: promover a descida da apresentação fetal (32,4%), relaxamento (19,7%), progressão do parto (17,1%), exercício do períneo (14,5%), alívio da dor (11,8%), benefícios psicológicos e movimentação materna. A quase totalidade das instituições visitadas (96,8%) não possuia protocolo para sua utilização. Conclusão: O estudo apontou que as enfermeiras atribuem benefícios ao uso da bola suíça no trabalho de parto. Ensaios clínicos são necessários para avaliar seus efeitos e subsidiar a elaboração de orientações para seu uso. Descritores: Enfermagem obstétrica; Terapia por exercício; Parto normal RESUMEN Objetivos: Caracterizar el uso de la pelota suiza en la asistencia a la parturienta en servicios de atención obstétrica vinculado al Sistema Único de Salud en el Municipio de Sao Paulo e identificar las características de su empleo en la asistencia de la parturienta por enfermeras obstétricas. Métodos: Estudio descriptivo a partir de entrevistas estructuradas realizadas a 35 enfermeras que prestaban asistencia a las parturientas. Resultados: Se constató que el 100% de los Centros de Parto Normal y 40,9% de los Centros Obstétricos poseían la pelota suiza. Las indicaciones del uso de la pelota suiza fueron: promover el descenso de la presentación fetal (32,4%), relajamiento (19,7%), progresión del parto (17,1%), ejercicio del periné (14,5%), alivio del dolor (11,8%), beneficios psicológicos y movimiento materno. La casi...

The use of ice packs for 20 minutes was effective for perineal pain relief after vaginal birth.

Birth centers are maternal care models that use appropriate technology when providing care to birthing women. This descriptive study aimed to characterize intrapartum care in a freestanding birth center, in light of the practices recommended by the World Health Organization (WHO), with 1,079 assisted births from 2006 to 2009 in the Sapopemba Birth Center, São Paulo, Brazil. Results included the use of intermittent auscultation (mean=7 controls); maternal positions during delivery: semi-sitting (82.3%), side-lying (16.0%), other positions (1.7%), oral intake (95.6%); companionship (93.3%); exposure to up to three vaginal examinations (85.4%), shower bathing (84.0%), walking (68.0%), massage (60.1%), exercising with a Swiss ball (51.7%); amniotomy (53.4%), oxytocin use during the first (31.0%) and second stages of labor (25.8%), bath immersion (29.3%) and episiotomy (14.1%). In this birth center, care providers used practices recommended by the WHO, although some practices might have been applied less frequently.

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.

OBJECTIVE To examine maternal and obstetric factors influencing births by cesarean section according to health care funding.METHODS A cross-sectional study with data from Southeastern Brazil. Caesarean section births from February 2011 to July 2012 were included. Data were obtained from interviews with women whose care was publicly or privately funded, and from their obstetric and neonatal records. Univariate and multivariate analyses were conducted to generate crude and adjusted odds ratios (OR) with 95% confidence intervals (95%CI) for caesarean section births.RESULTS The overall caesarean section rate was 53% among 9,828 women for whom data were available, with the highest rates among women whose maternity care was privately funded. Reasons for performing a c-section were infrequently documented in women’s maternity records. The variables that increased the likelihood of c-section regardless of health care funding were the following: paid employment, previous c-section, primiparity, antenatal and labor complications. Older maternal age, university education, and higher socioeconomic status were only associated with c-section in the public system.CONCLUSIONS Higher maternal socioeconomic status was associated with greater likelihood of a caesarean section birth in publicly funded settings, but not in the private sector, where funding source alone determined the mode of birth rather than maternal or obstetric characteristics. Maternal socioeconomic status and private healthcare funding continue to drive high rates of caesarean section births in Brazil, with women who have a higher socioeconomic status more likely to have a caesarean section birth in all birth settings.

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