Background Midwifery units (MUs) provide midwife-led care for women at low risk of complications. They may be located on the same site as an obstetric unit (OU), in a hospital without obstetric services or separate from any hospital. In MUs, if unforeseen complications arise, transfer to an OU may be necessary. Aim To provide evidence to contribute to the improvement of the transfer process, help make transfer safer and less distressing for women, thereby improving the care and experience of women planning to give birth in MUs. Methods A structured literature review of existing evidence was followed by three integrated component studies using different methods. The content and quality of local NHS transfer guidelines were evaluated. Data from the Birthplace national prospective cohort study were analysed to estimate transfer rates, describe the transfer process and identify factors associated with transfer. The experiences of women transferred were explored in qualitative interviews. Findings Transfer is a common event, affecting around 25% of women planning birth in MUs, although rates in different units vary. Primiparous women are more likely to be transferred than women having a second or subsequent baby. The risk of transfer for primiparous women increases with increasing age; around 50% of women having their first baby aged 40 years or over are transferred. Local NHS transfer guidelines are generally of poor quality and pay little attention to women’s experience. Women interviewed after transfer report feeling unprepared for transfer. Sensitive care and clear communication from midwives during labour facilitate feelings of control in women and help women accept transfer as the right decision and not a 'negative' event. Transfer that is perceived by women as “too late” can have potentially serious and long-lasting negative effects. Women’s experience of the transfer journey could be improved by the offer of choice in a number of areas which would help women feel 'cared for' rather than 'transported'. Having the MU midwife continue to care for the woman after transfer should be considered 'best practice'; where this is not possible a good handover is essential. Women who have experienced transfer should be offered the opportunity to talk to a midwife about their experience.

Este estudo aborda o processo de trabalho na assistência ao parto e nascimento na Maternidade Leila Diniz e a contribuição do assistente social. Sua finalidade foi desvelar as particularidades deste processo de trabalho e de que forma o assistente social nele se insere. Trata-se de uma pesquisa com enfoque descritivo-analítico realizada através de pesquisa documental, observação participante e entrevista com vários sujeitos: profissionais e gestores. Utilizou-se as categorias processo de trabalho, fragmentação do trabalho e cooperação como forma de apreender a lógica de organização dessa assistência no município. Pode-se apreender que a contribuição do assistente social encontra-se vinculada à sua competência teórico - metodológica e ética-política para desvendar as contradições do SUS e dos processos de trabalho. Apresenta-se como uma das categorias profissionais que vem se colocando na defesa dos princípios do SUS. Sua contribuição encontra-se respalda no projeto ético-político da categoria e em consonância com as iniciativas da SMS/RJ, na busca de um novo modelo de atenção ao parto e nascimento, que assegure a saúde como um direito social. / This study addressed the process of labor in childbirth and birth in the Leila Diniz Maternity and contribution of the social worker. Its purpose was to reveal the particularities of this work and how the social worker it fits process. This is a survey of descriptive and analytical approach performed through archival research, participant observation and interviews with several subjects: professional and managers. Used the categories of work process , fragmentation of labor and cooperation as a way to grasp the logic of organization of such assistance in the municipality. We can learn that the contribution one of the social worker is bound to its theoretical competence - methodological and ethical -political to unravel the contradictions of the NHS and work processes. Presents itself as one the professional categories that has been putting in the defense of the principles of the SUS. Your contribution supports lies in the ethical- political project category and in line with the initiatives of SMS / RJ, in search of a new model of care during labor and birth, to ensure health as a social right.

Este estudo aborda o processo de trabalho na assistência ao parto e nascimento na Maternidade Leila Diniz e a contribuição do assistente social. Sua finalidade foi desvelar as particularidades deste processo de trabalho e de que forma o assistente social nele se insere. Trata-se de uma pesquisa com enfoque descritivo-analítico realizada através de pesquisa documental, observação participante e entrevista com vários sujeitos: profissionais e gestores. Utilizou-se as categorias processo de trabalho, fragmentação do trabalho e cooperação como forma de apreender a lógica de organização dessa assistência no município. Pode-se apreender que a contribuição do assistente social encontra-se vinculada à sua competência teórico - metodológica e ética-política para desvendar as contradições do SUS e dos processos de trabalho. Apresenta-se como uma das categorias profissionais que vem se colocando na defesa dos princípios do SUS. Sua contribuição encontra-se respalda no projeto ético-político da categoria e em consonância com as iniciativas da SMS/RJ, na busca de um novo modelo de atenção ao parto e nascimento, que assegure a saúde como um direito social. / This study addressed the process of labor in childbirth and birth in the Leila Diniz Maternity and contribution of the social worker. Its purpose was to reveal the particularities of this work and how the social worker it fits process. This is a survey of descriptive and analytical approach performed through archival research, participant observation and interviews with several subjects: professional and managers. Used the categories of work process , fragmentation of labor and cooperation as a way to grasp the logic of organization of such assistance in the municipality. We can learn that the contribution one of the social worker is bound to its theoretical competence - methodological and ethical -political to unravel the contradictions of the NHS and work processes. Presents itself as one the professional categories that has been putting in the defense of the principles of the SUS. Your contribution supports lies in the ethical- political project category and in line with the initiatives of SMS / RJ, in search of a new model of care during labor and birth, to ensure health as a social right.

Made available in DSpace on 2014-12-17T14:20:34Z (GMT). No. of bitstreams: 1 LiaHL_TESE.pdf: 1636368 bytes, checksum: 7b3aa7dddd721306b5b5e69a1cde3942 (MD5) Previous issue date: 2014-05-29 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The birth models of care are discussed, in the light of classical and contemporary social science theoretical background, emphasizing the humanistic model. The double spiral of the sociology of absences and the sociology of emergences is detailed, being based, on one hand, on the translation of experiences of knowledge, and, on the other, on the translation of experiences of information and communication, by revealing the movement articulated by Brazilian women on blogs that defend and bring into light initiatives aiming to recover natural and humanized birth. A cartography of the thematic ideas in birth literature is produced, resulting in the elaboration of a synthetic map on obstetric models of care in contemporaneity, pointing out the consequences of the obstetric model that has become hegemonic in contemporary societies, and comparing that model to others that work more efficaciously to mothers and babies. A symbolic cartography of the activism for humanizing birth on the Brazilian blogosphere is configured by the elaboration of an analytical map synthetizing the main mottos defended by the movement: Normal humanized birth; Against obstetrical violence; and Planned home birth. The superposition of the obstetric models of care s map and the rebirth of birth s analytical map indicates it is necessary to reinforce three main measures in order to make a paradigmatic turn in contemporary birth models of care possible: pave the way for the humanistic care of assistance in normal birth, by defending and highlighting practices and professionals that act in compliance with evidence based medicine, respecting the physiology of birth; denaturalize obstetric violence, by showing how routine procedures and interventions can be means of aggression, jeopardizing the autonomy, the protagonism and the respect towards women; and motivate initiatives of planned home birth, the best place for the occurrence of holistic experiences of birth. It is concluded that Internet tools have allowed a pioneer mobilization in respecting women s reproductive rights in Brazil and that the potential of the crowd s biopower that resides on the blogosphere can turn blogs into a hegemonic alternative way to reach more democratic forms of social organization. In that condition of being virtually hegemonic in contesting the established power, these blogs can be understood, therefore, as potentially great contra-hegemonic channels for the rebirth of birth and for the reinvention of social emancipation, as their author s articulate and organize themselves to strive against the waste of experience, trying to create reciprocal intelligibility amongst different experiences of world / Discute-se, ? luz de referenciais te?ricos cl?ssicos e contempor?neos das ci?ncias sociais, os modelos de assist?ncia ao parto, pondo em relevo o parto humanizado. Particularizam-se os referentes da dupla espiral da sociologia das aus?ncias e da sociologia das emerg?ncias, assente, de um lado, na tradu??o de experi?ncias de conhecimentos, e de outro, na tradu??o de experi?ncias de comunica??o e informa??o, ao mostrar o movimento que se articula entre mulheres brasileiras em blogs que defendem e d?o visibilidade a iniciativas de recupera??o do parto natural e humanizado. Realiza-se uma cartografia das ideias tem?ticas presentes na literatura sobre o parto, resultando na elabora??o de mapa s?ntese dos modelos de assist?ncia obst?trica na contemporaneidade, apontando-se as consequ?ncias do modelo que se tornou hegem?nico nas sociedades contempor?neas e contrapondo-o a outras abordagens de aten??o ao nascimento que funcionam mais eficazmente para m?es e beb?s. Configura-se uma cartografia simb?lica do ativismo pela humaniza??o do parto na blogosfera brasileira, mediante elabora??o de mapa anal?tico com s?ntese das principais bandeiras defendidas pelo movimento: Parto normal humanizado; Contra a viol?ncia obst?trica; e Parto Domiciliar Planejado (PDP). A sobreposi??o do mapa com os modelos de assist?ncia obst?trica e do mapa anal?tico do renascimento do parto aponta ser necess?rio refor?ar tr?s medidas principais para possibilitar uma virada paradigm?tica na assist?ncia ao parto na contemporaneidade: pavimentar o caminho para a assist?ncia humanizada ao parto normal, ao defender e dar visibilidade a pr?ticas e a profissionais que atuam de acordo com a medicina baseada em evid?ncias, respeitando a fisiologia do parto; desnaturalizar a viol?ncia obst?trica, ao mostrar como procedimentos e interven??es de rotina s?o formas de agress?es que colocam em xeque a autonomia, o protagonismo e o respeito ? mulher; e incentivar iniciativas de parto domiciliar planejado, local mais vi?vel para ocorr?ncia das experi?ncias hol?sticas de nascimento. Conclui-se que as ferramentas da Internet t?m permitido uma mobiliza??o in?dita em prol do respeito aos direitos reprodutivos das mulheres no Brasil e que o potencial de biopot?ncia da multid?o que reside na blogosfera pode tornar tais canais em hegem?nicos enquanto vias alternativas para alcan?ar formas mais democr?ticas de organiza??o social. Nessa condi??o de virtualmente hegem?nicos na contesta??o do poder estabelecido, os blogs configuram-se, assim, em canais com grande potencial contra-hegem?nico para o renascimento do parto e a reinven??o da emancipa??o social, na medida em que suas autoras se articulam e se organizam para combater o desperd?cio das experi?ncias, buscando criar inteligibilidade rec?proca entre diferentes experi?ncias de mundo