Social inequalities and women's satisfaction with childbirth care in Brazil: a national hospital-based surveyDesigualdades sociais e satisfação das mulheres com o atendimento ao parto no Brasil: estudo nacional de base hospitalar Diferencias sociales y satisfacción de las mujeres con la atención al parto en Brasil: estudio nacional de base hospitalaria

Background: To evaluate the effectiveness and safety of the support given to women by a companion of their choice during labor and delivery.

OBJECTIVETo analyze if the presence of a companion favors the use of best practices in the delivery care in the South region of Brazil.METHODSThis is a cross-sectional analysis of the longitudinal study Nascer no Brasil. We analyzed data from 2,070 women from the South region of Brazil who went into labor. The data were collected between February and August 2011, by interviews and medical records. We performed a bivariate and multivariate analysis, calculating the crude and adjusted prevalence ratios using Poisson regression with robust variance estimation. The level of significance adopted was 5%.RESULTSMost women had a companion during labor (51.7%), but few remained during delivery (39.4%) or cesarean section (34.8%). Less than half of the women had access to several recommended practices, while non-recommended practices continue to be performed. In the model adjusted for age, education level, source of payment for the delivery, parity, and score of the Brazilian Association of Market Research Institutes, the presence of a companion was statistically associated with a greater supply of liquids and food (aPR = 1.34), dietary prescription (aPR = 1.34), use of non-pharmacological methods for pain relief (aPR = 1.37), amniotomy (aPR = 1.10), epidural or spinal analgesia (aPR = 1.84), adoption of non-lithotomy position in the delivery (aPR = 1.77), stay in the same room during labor, delivery, and postpartum (aPR = 1.62), skin-to-skin contact in the delivery (aPR = 1.81) and cesarean section (PR = 2.43), as well as reduced use of the Kristeller maneuver (aPR = 0.67), trichotomy (aPR = 0.59), and enema (aPR = 0.49).CONCLUSIONSIn the South region of Brazil, most women do not have access to the best practices in addition to undergoing several unnecessary interventions. The presence of a companion is associated with several beneficial practices and the reduction in some interventions, although other interventions are not impacted.

Health providers considered positive the support provided by a labor companion and had no problems in managing laboring women in the presence of their companions. Labor companions were pleased and happy with this experience. There was no conflicting opinions.

BackgroundThe participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections.MethodsBirth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births.Results16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower.ConclusionsThe results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0236-7) contains supplementary material, which is available to authorized users.

The effects of support for women during labor and delivery provided by health professionals, lay women, and doulas on the maternal and neonatal outcomes have been evaluated through randomized clinical trials, meta-analyses, and systematic reviews. This article presents a review of these studies, focusing on the principal characteristics, support provider, simultaneous presence of the woman's spouse and/or family members during labor and delivery and the outcomes. The analysis included studies published from 1980 to 2004 which explicitly approached these aspects. In general, the results of such support were favorable, highlighting a reduction in the cesarean rate, analgesia/ medication for pain relief, duration of labor, and utilization of oxytocin and an increase in maternal satisfaction with the experience. The benefits were greater when the support provider was not a health professional. The available studies did not evaluate the specific companion chosen by the woman as a support provider, which constitutes a gap in the knowledge that should be filled by future research.

Foi realizada uma revisão integrativa com o objetivo de identificar a contribuição das pesquisas desenvolvidas, em âmbito nacional e internacional, sobre a percepção do parto normal e cesáreo pelas mulheres que os vivenciaram. A busca dos artigos ocorreu nas bases de dados MEDLINE, LILACS, BDENF, CINAHL e INDEXPSI, no período de 2000 a 2009, sendo selecionados e analisados 17 estudos. Os estudos apresentam percepções positivas e negativas das mulheres sobre os dois tipos de parto, tais como o protagonismo da mulher e a melhor recuperação no parto normal, a ausência de dor na cesárea, a insatisfação com a assistência recebida; assim como recomendações para a prática obstétrica e sugestão de novas pesquisas. Os resultados apontam aspectos assistenciais que podem contribuir para a satisfação das mulheres e a necessidade de outras investigações para compreender melhor a multidimensionalidade do processo de parto, seja normal ou cesáreo.

resuMo: Revisão sistemática que objetivou avaliar os resultados maternos e neonatais decorrentes da utilização de métodos não farmacológicos para alívio da dor no trabalho de parto, classificados como tecnologia leve-dura. Foi realizada uma pesquisa nas bases de dados CINAHL, MEDLINE, LILACS, SciELO, SCOPUS e Isi Web of Science. Incluiu-se 12 ensaios clínicos randomizados elegíveis, publicados entre 1980 e 2009, que avaliaram o banho de imersão, a massagem e a aromaterapia. Os resultados mostraram que o banho de imersão deve ser iniciado após 3 cm de dilatação, para não prolongar o trabalho de parto e prejudicar os resultados neonatais. A massagem é eficaz no alívio da ansiedade, dor e estresse, sendo mais efetiva para reduzir a dor, quando utilizada no começo da fase latente. A aromaterapia diminui a ansiedade e o medo. É necessário estabelecer parâmetros de aplicação de cada método para que os resultados maternos e neonatais sejam positivos e contribuam para a satisfação da mulher. non-pharMacological approach to pain relief during labor as hard-light care technology: a systeMatic review abstract: The objective of this systematic review was to evaluate the maternal and neo-natal results generated from the utilization of non-pharmacological methods for pain alleviation concerning the strains of delivery, classified as light-to-hard technology. Research was carried out in the following databases: CINAHL, MEDLINE, LILACS, SciELO, SCOPUS, and Isi Web of Science. This study is composed of 12 randomized eligible clinical tests published between 1980 and 2009 which evaluated immersion baths, massages, and aromatherapy. Results show that the immersion bath should be initiated after 3 cm of dilation in order not to prolong the strains of delivery and harm neo-natal results. Massage is efficient in alleviating anxiety, pain, and stress, being most effective in reducing pain when utilized in the beginning of the latent phase. Aromatherapy diminishes anxiety and fear. It is necessary to establish parameters for the application of each method in order that maternal and neonatal results are positive and contribute to the woman's satisfaction. los Métodos no farMacológicos para aliviar el dolor durante el parto: una revision sisteMática resuMen: Se trata de una revisión sistemática con el objetivo de evaluar los resultados maternos y neonatales de la utilización de métodos no farmacológicos para aliviar el dolor durante el parto, que son clasificados como tecnología blanda y dura. Se realizó una búsqueda en las bases de datos CINAHL, MEDLINE, LILACS, SciELO, SCOPUS y el ISI Web of Science. Se incluyeron 12 ensayos clínicos aleatorios elegibles, publicados entre 1980 y 2009, en los que se evaluaron: el baño de inmersión, el masaje y la aromaterapia. Los resultados mostraron que baño de inmersión debe ser iniciado después de 3 cm de dilatación para no prolongar el trabajo de parto y afectar el resultado neonatal. El masaje es efectivo para aliviar la ansiedad, el dolor y el estrés, siendo más eficaz en la reducción del dolor c...