Há décadas discute-se a importância da qualidade da interação mãe-bebê para um desenvolvimento saudável. Estudos têm demonstrado que prejuízos na interação mãe-filhote podem resultar em danos hormonais e comportamentais, além de desregulação emocional em diversos mamíferos. Estes dados sugerem adaptação evolutiva de mecanismos neurofisiológicos que mantém altos os níveis de comportamentos pró-sociais. Estudos com humanos evidenciaram que desde o nascimento, bebês apresentam habilidades que permitem a comunicação inicial por meio do olhar, voz, expressão facial, gestos e toque. O objetivo da Tese de Doutorado foi aprofundar conhecimento sobre a interação inicial por meio do estudo dos comportamentos da mãe e do recém-nascido imediatamente após o parto, em situação naturalística, e investigar a influência de procedimentos hospitalares, condições emocionais e sociais maternas, e das características físicas do bebê, além de averiguar as concentrações hormonais de cortisol e DHEA-s. Este estudo foi realizado em parceria com o Hospital Universitário da Universidade de São Paulo para a gravação de vídeos dos primeiros minutos de vida de 120 recém-nascidos e suas mães. A codificação do comportamento dos bebês considerou: choro, atividade motora, acalmar-se e permanecer de olhos abertos e, para a mãe, olhar para o bebê, falar com ele, tocá-lo de forma afetuosa e sorrir. A frequência dos comportamentos foi transformada em variáveis ordinais com base nos valores dos quartis. Regressões ordinais foram usadas com o intuito de prever a influência das variáveis de interesse na frequência dos comportamentos da díade. Adicionalmente, análises de variância foram usadas para investigar as concentrações hormonais de cortisol e DHEA-s em função das condições emocionais maternas e da frequência dos comportamentos. Os resultados apontaram contribuição importante dos procedimentos hospitalares em promover a interação inicial. Bebês nascidos de parto normal tiveram maior chance de apresentar atividade motora em comparação aos de parto fórceps e ao contrário do esperado os bebês que foram colocados em contato pele a pele com a mãe apresentaram menor chance de chorar em comparação aos que receberam este contato físico. A influência das condições emocionais maternas sobre os comportamentos justificou maior atenção e investimento no bem-estar das gestantes: piores condições emocionais foram preditores de maior frequência de choro do recém-nascido e mulheres que relataram conflito com o pai do bebê apresentaram menor chance de olhar e falar com o bebê. Os resultados apontaram diferenças relativas ao sexo, logo ao nascer: bebês do sexo masculino tiveram mais chance de chorar em relação aos de sexo feminino. As mães, por sua vez, mostraram mais chance de acariciar e falar com os bebês do sexo masculino. Maior concentração de cortisol foi observada em bebês filhos de mães em piores condições emocionais, sugerindo influência hormonal durante a gestação. Estes resultados evidenciaram o papel ativo dos indivíduos desde os primeiros momentos de vida e lançaram luz sobre as complexas interações que influenciam sua trajetória de desenvolvimento desde o nascimento, e possivelmente antes. Assistência à mãe, desde a gestação, salientou-se como ferramenta essencial para a saúde física e psicológica do indivíduo / The quality of early interaction plays a crucial role in child development. Findings from animal and human studies demonstrate hormonal, behavioral and emotional impairment as a result of an impoverished interaction. These results suggest an evolutionary adaptation of mechanisms to maintain high levels of prosocial behaviors. Babies communicate from birth, through gaze, voice, facial expression, gestures, and touch. The aim of the Ph.D. thesis was to improve knowledge of initial interaction through the study of the mother and infant behavior immediately after birth in a naturalistic situation and to investigate the influence of hospital procedures, emotional and social conditions from the mother, infant characteristics as well as average hormonal concentrations of cortisol and DHEA-s. This study was conducted in association with the University of São Paulo Hospital in order to record videos from the first minutes of life of 120 newborns with their mothers. Behaviors were coded every ten seconds focused on: a) infant: motor activity, cry, soothing and open eyes; b) mother: affectionate touch, smile, talking and looking at the baby. The frequency of each behavior was converted into quartiles. Multiple ordinal regressions were performed to predict independent variables and analyses of variances were performed to investigate mean differences of hormonal concentrations. The results pointed out an important contribution of the hospital procedures in promoting early interaction. In general, babies born by normal birth were more likely to show physical activity compared to those born by instrumental delivery, contrary to our initial hypothesis, infants that were not placed skin-to-skin on mothers chest were less likely to cry compared to those who had this skin contact. Worse maternal emotional state predicted increased frequencies of infants\' cry, highlighting the need to promote well-being during pregnancy. Women who reported conflict with the childs fathers showed less chance to look and talk to the baby in the delivery room. The analyses yielded differences at birth related to sex: male infants showed a greater chance of crying than females. Mothers, in turn, showed a greater chance of caressing and talking to male babies. Infants whose mothers were in worse emotional condition showed higher concentrations of cortisol, suggesting an influence from mothers hormones on the fetus during pregnancy. These results showed the active role of individuals from the first moment of their lives, shedding light on the complex interactions that influence their developmental trajectory since their birth. Thus, assistance to the mother during her pregnancy has been emphasized as an essential tool for her physical and psychological health

Tipificado de forma autônoma pela nossa legislação, o delito de infanticídio, previsto no artigo 123 do Código Penal, trata da conduta da mãe que tira a vida do próprio filho durante ou logo após o parto. Historicamente cercado de dúvidas e pontos de conflito, a conduta infanticida passou por extremos, indo da punição absolutamente desumana à total benevolência para com o violador da norma. Analisada a figura típica do infanticídio, percebe-se uma modalidade especial do crime de homicídio que o legislador preferiu apenar mais brandamente. Em um primeiro momento, foi levado em consideração para justificar tal abrandamento o critério psicológico, baseado na honra da mãe. Posteriormente, tal critério foi substituído pelo fisiopsicológico, onde o estado puerperal passou a ser a elementar do tipo. Em conjunto com o estado puerperal, o lapso temporal em que a conduta deve ser praticada, durante ou logo após o parto, fazem do infanticídio um dos delitos que mais geram dúvidas dentro no ordenamento jurídico vigente. Considerada a genitora sujeito ativo do delito, o estado puerperal como elementar do tipo suscita questionamentos a respeito da prática do crime em concurso de agentes. Igualmente, a não previsão da modalidade culposa ao tipo caracteriza uma lacuna geradora de conflitos doutrinários em caso da morte do nascente ou neonato por imprudência ou negligência da mãe. Juntamente com toda problemática que o tipo apresenta, o julgamento do delito pelo Tribunal do Júri, com as alterações legislativas recentemente sofridas por esse instituto, faz com que o infanticídio seja, mais uma vez, objeto de dúvidas com relação ao modo como a quesitação deve ser apresentada. Útil ao estudo do tema, uma análise do crime, frente às legislações dos demais países da América Latina e alguns países da Europa, darão um quadro geral de como o delito é tratado fora de nossas fronteiras. Por fim, espera-se contribuir para que se forme uma opinião sobre a necessidade ou não da manutenção do tipo, de forma autônoma, em nosso ordenamento jurídico. / Typified autonomously by our legislation, the crime of infanticide under the article 123 of the Penal Code, deals with the behaviour of the mother who takes the life of her own son during the child-birth or soon after it. Historically surrounded by doubts and conflicts, the infanticidal conduct has gone through extremes, from totally unhumane punishment to total benevolence for the violator of the law. After analyzing the typical figure of infanticide, we can notice a special genre of homicide that the legislator chose to punish more softly. At first it was considered the psychological criterion to justify such mitigation, based on the mothers honour. After that, such criterion was replaced by the physiopsychological, where the puerperal state became the base of the type. Together with the puerperal state, the time lag in which the conduct must be practised, during the child-birth or soon after that, turns the infanticide into one of the crimes that most generates doubts inside the actual legal system. As the genitor is considered the active subject of the crime, the puerperal state as the base of the type evokes questioning about the practice of the crime in competition of agents. In the same way, the non prevision of the fault mode to the type caracterizes a gap generator of doctrinaire conflicts in case of the death of the new born because of the mothers imprudence or neglection. Together with all the set of problems that the type introduces, the judgement of the delict by the Court of Justice, with the recent legislative changes occurred in this institute, turns the infanticide, once more, the object of doubts in respect to the way the inquiry is presented. Useful for the study of the subject, the analysis of the crime facing the legislation of the other Latin American countries and some European countries will show a general view of how the delict is dealt with outside our borders. Finally, it is expected to contribute in order to form an opinion about the necessity or no necessity of the maintenance of the type autonomously in our legal system.

This study is an exploratory study, descriptive in nature and investigates the familiarity and practices of midwives and women with regard to complementary therapies during pregnancy and labour. The study was conducted in four major hospitals in Western Sydney, namely Nepean, Jamieson, Blue Mountains Anzac Memorial and Hawkesbury hospitals. The findings showed that in the main the midwives and women were familiar and made use of four therapies, ie. aromatherapy, massage, music and hydrotherapy. The midwives practiced without any significant training in these therapies. Hospital policies were almost non existant in relation to the practice of complementary therapies and nurses often felt frustrated at not being able to implement complementary therapies. The main issues that emerged from the study were the need for education for the midwives related to specific complementary therapies, hospital policies conducive to the practice of complementary therapies and research into the efficacy of the different complementary therapies. The women need further exposure to complementary therapies and education in the respective therapies if they are to feel empowered in dealing with the stress of their daily lives / Master of Nursing (Hons)

Quantile regression, a method used to estimate conditional quantiles of a set of data ( X, Y ), was popularized by Koenker and Bassett (1978). For a particular quantile q , the q th quantile estimate of Y given X = x can be found using an asymmetrically-weighted, absolute-loss criteria. This form of regression is considered to be robust, in that it is less affected by outliers in the data set than least-squares regression. However, like standard L 1 regression, this form of quantile regression can still be affected by multiple outliers. In this thesis, we propose a method for improving robustness in quantile regression through an application of Scott's L 2 Estimation (2001). Theoretic and asymptotic results are presented and used to estimate properties of our method. Along with simple linear regression, semiparametric extensions are examined. To verify our method and its extensions, simulated results are considered. Real data sets are also considered, including estimating the effect of various factors on the conditional quantiles of child birth weight, using semiparametric quantile regression to analyze the relationship between age and personal income, and assessing the value distributions of Major League Baseball players.

A presente pesquisa traça uma cartografia do movimento social pela humanização do parto e nascimento no Brasil, que surge por volta de 1970 e ganha ampla adesão das mulheres usuárias de sistemas de saúde duas décadas depois, em um processo intimamente relacionado à democratização da internet e mais especificamente do ciberespaço. Após retomar os processos históricos do movimento, a dissertação ocupa-se de acompanhar especialmente os fluxos de luta estabelecidos pelas mulheres no ciberambiente, abordando as diferentes produções que nele emergem e seus desdobramentos na sociedade. A partir do aporte conceitual da esquizoanálise, buscou-se compreender como se articulam fluxos individuais e coletivos de luta e busca pelo parto humanizado, e de que modo estes vêm incidindo no cenário da assistência obstétrica no País. Concluiu-se que os itinerários individuais e coletivos se produzem em um plano comum e têm incidido na ampliação do diálogo sobre a assistência à parturiente no País. Tais fluxos parecem abrigar muitas potências, dentre as quais, se evidencia a contribuição à modificação do modelo de atenção ao parto vigente, além do fortalecimento do próprio movimento de humanização do parto. / This research draws a map of the social movement for the humanization of childbirth in Brazil, which arises around 1970 and gains broad support of women health system users two decades later, in a process closely related to the democratization of the Internet and more specifically, of cyberspace. After exposing the historical movement processes, the dissertation deals with follow especially the fight fluxes established by women in cyberspace, addressing the different productions that emerge in it and its consequences in society. We tried to understand how are articulated individual and collective fluxes of struggle and search for humanized birth, and how they affect the scene of obstetric care in the country. It was concluded that the individual and collective itineraries are produced in a common plan, and have affected on expanding the dialogue on assistance to the woman in labor in the country. Such fluxes seem to harbor many powers, among which highlights the contribution to the modification of the attention to current child-birth model besides the strengthen of the childbirth humanization movement itself.

A presente pesquisa traça uma cartografia do movimento social pela humanização do parto e nascimento no Brasil, que surge por volta de 1970 e ganha ampla adesão das mulheres usuárias de sistemas de saúde duas décadas depois, em um processo intimamente relacionado à democratização da internet e mais especificamente do ciberespaço. Após retomar os processos históricos do movimento, a dissertação ocupa-se de acompanhar especialmente os fluxos de luta estabelecidos pelas mulheres no ciberambiente, abordando as diferentes produções que nele emergem e seus desdobramentos na sociedade. A partir do aporte conceitual da esquizoanálise, buscou-se compreender como se articulam fluxos individuais e coletivos de luta e busca pelo parto humanizado, e de que modo estes vêm incidindo no cenário da assistência obstétrica no País. Concluiu-se que os itinerários individuais e coletivos se produzem em um plano comum e têm incidido na ampliação do diálogo sobre a assistência à parturiente no País. Tais fluxos parecem abrigar muitas potências, dentre as quais, se evidencia a contribuição à modificação do modelo de atenção ao parto vigente, além do fortalecimento do próprio movimento de humanização do parto. / This research draws a map of the social movement for the humanization of childbirth in Brazil, which arises around 1970 and gains broad support of women health system users two decades later, in a process closely related to the democratization of the Internet and more specifically, of cyberspace. After exposing the historical movement processes, the dissertation deals with follow especially the fight fluxes established by women in cyberspace, addressing the different productions that emerge in it and its consequences in society. We tried to understand how are articulated individual and collective fluxes of struggle and search for humanized birth, and how they affect the scene of obstetric care in the country. It was concluded that the individual and collective itineraries are produced in a common plan, and have affected on expanding the dialogue on assistance to the woman in labor in the country. Such fluxes seem to harbor many powers, among which highlights the contribution to the modification of the attention to current child-birth model besides the strengthen of the childbirth humanization movement itself.

abstract: Postpartum depression has been described as one of the most common complications related to childbirth (Beck, 2008). To understand better the theoretical underpinnings of the disorder, the current study used a vulnerability-stress conceptualization to develop a theoretical model of postpartum depression. The predictive model was tested on 144 mothers with infants under 12-months of age using structural equation modeling. Four alternative models were also tested. A variation of the original theoretical model was found to have the best fit. Consistent with past research, this model indicated that need for approval, relationship conflict, and maternal-efficacy directly predicted postpartum depressive symptoms. Need for approval also moderated the relation between maternal-efficacy and postpartum depressive symptoms, so that this relation was stronger for mothers with high need of approval than for mothers with low need for approval. The role of these risk factors, particularly negative maternal perceptions and cognitions, is highlighted in relation to developing clinical interventions to treat postpartum depression. Limitations of this study are discussed and suggestions are made for future models to be tested through empirical research. / Dissertation/Thesis / Ph.D. Psychology 2014

A presente pesquisa traça uma cartografia do movimento social pela humanização do parto e nascimento no Brasil, que surge por volta de 1970 e ganha ampla adesão das mulheres usuárias de sistemas de saúde duas décadas depois, em um processo intimamente relacionado à democratização da internet e mais especificamente do ciberespaço. Após retomar os processos históricos do movimento, a dissertação ocupa-se de acompanhar especialmente os fluxos de luta estabelecidos pelas mulheres no ciberambiente, abordando as diferentes produções que nele emergem e seus desdobramentos na sociedade. A partir do aporte conceitual da esquizoanálise, buscou-se compreender como se articulam fluxos individuais e coletivos de luta e busca pelo parto humanizado, e de que modo estes vêm incidindo no cenário da assistência obstétrica no País. Concluiu-se que os itinerários individuais e coletivos se produzem em um plano comum e têm incidido na ampliação do diálogo sobre a assistência à parturiente no País. Tais fluxos parecem abrigar muitas potências, dentre as quais, se evidencia a contribuição à modificação do modelo de atenção ao parto vigente, além do fortalecimento do próprio movimento de humanização do parto. / This research draws a map of the social movement for the humanization of childbirth in Brazil, which arises around 1970 and gains broad support of women health system users two decades later, in a process closely related to the democratization of the Internet and more specifically, of cyberspace. After exposing the historical movement processes, the dissertation deals with follow especially the fight fluxes established by women in cyberspace, addressing the different productions that emerge in it and its consequences in society. We tried to understand how are articulated individual and collective fluxes of struggle and search for humanized birth, and how they affect the scene of obstetric care in the country. It was concluded that the individual and collective itineraries are produced in a common plan, and have affected on expanding the dialogue on assistance to the woman in labor in the country. Such fluxes seem to harbor many powers, among which highlights the contribution to the modification of the attention to current child-birth model besides the strengthen of the childbirth humanization movement itself.

Tipificado de forma autônoma pela nossa legislação, o delito de infanticídio, previsto no artigo 123 do Código Penal, trata da conduta da mãe que tira a vida do próprio filho durante ou logo após o parto. Historicamente cercado de dúvidas e pontos de conflito, a conduta infanticida passou por extremos, indo da punição absolutamente desumana à total benevolência para com o violador da norma. Analisada a figura típica do infanticídio, percebe-se uma modalidade especial do crime de homicídio que o legislador preferiu apenar mais brandamente. Em um primeiro momento, foi levado em consideração para justificar tal abrandamento o critério psicológico, baseado na honra da mãe. Posteriormente, tal critério foi substituído pelo fisiopsicológico, onde o estado puerperal passou a ser a elementar do tipo. Em conjunto com o estado puerperal, o lapso temporal em que a conduta deve ser praticada, durante ou logo após o parto, fazem do infanticídio um dos delitos que mais geram dúvidas dentro no ordenamento jurídico vigente. Considerada a genitora sujeito ativo do delito, o estado puerperal como elementar do tipo suscita questionamentos a respeito da prática do crime em concurso de agentes. Igualmente, a não previsão da modalidade culposa ao tipo caracteriza uma lacuna geradora de conflitos doutrinários em caso da morte do nascente ou neonato por imprudência ou negligência da mãe. Juntamente com toda problemática que o tipo apresenta, o julgamento do delito pelo Tribunal do Júri, com as alterações legislativas recentemente sofridas por esse instituto, faz com que o infanticídio seja, mais uma vez, objeto de dúvidas com relação ao modo como a quesitação deve ser apresentada. Útil ao estudo do tema, uma análise do crime, frente às legislações dos demais países da América Latina e alguns países da Europa, darão um quadro geral de como o delito é tratado fora de nossas fronteiras. Por fim, espera-se contribuir para que se forme uma opinião sobre a necessidade ou não da manutenção do tipo, de forma autônoma, em nosso ordenamento jurídico. / Typified autonomously by our legislation, the crime of infanticide under the article 123 of the Penal Code, deals with the behaviour of the mother who takes the life of her own son during the child-birth or soon after it. Historically surrounded by doubts and conflicts, the infanticidal conduct has gone through extremes, from totally unhumane punishment to total benevolence for the violator of the law. After analyzing the typical figure of infanticide, we can notice a special genre of homicide that the legislator chose to punish more softly. At first it was considered the psychological criterion to justify such mitigation, based on the mothers honour. After that, such criterion was replaced by the physiopsychological, where the puerperal state became the base of the type. Together with the puerperal state, the time lag in which the conduct must be practised, during the child-birth or soon after that, turns the infanticide into one of the crimes that most generates doubts inside the actual legal system. As the genitor is considered the active subject of the crime, the puerperal state as the base of the type evokes questioning about the practice of the crime in competition of agents. In the same way, the non prevision of the fault mode to the type caracterizes a gap generator of doctrinaire conflicts in case of the death of the new born because of the mothers imprudence or neglection. Together with all the set of problems that the type introduces, the judgement of the delict by the Court of Justice, with the recent legislative changes occurred in this institute, turns the infanticide, once more, the object of doubts in respect to the way the inquiry is presented. Useful for the study of the subject, the analysis of the crime facing the legislation of the other Latin American countries and some European countries will show a general view of how the delict is dealt with outside our borders. Finally, it is expected to contribute in order to form an opinion about the necessity or no necessity of the maintenance of the type autonomously in our legal system.

Philosophiae Doctor - PhD / Background: Satisfaction with the care mothers receive during child-birth is known to have a very strong influence on their future use of facility-based care during child-birth. Women and children continue to die from complications associated with pregnancy and child-birth and the majority of the causes that lead to mortality are related to labour and delivery. For this reason it is imperative for mothers to access facility-based child-birth care to receive skilled birth care. Mothers report dissatisfaction with facility-based child-birth care as one of the reasons for home births without skilled attendants. The presence of the skilled birth attendants is known to reduce maternal and neonatal mortality rates because of their ability to diagnose any early complications, and to intervene appropriately. Aim: The aim of the current study was to develop an in-service training programme for midwives to provide patient-centred child-birth care that would increase client satisfaction with child-birth care. Method and findings: The intervention research model by Rothman and Thomas (1994) – Design and development (D & D) – was used as the research framework. Only the first four of the six phases of the D & D model were applied in this study. In the first phase, a situational analysis was done using a qualitative study. The expectations, experiences, and satisfaction with child-birth care of antenatal and postnatal mothers, were explored. The research was conducted in four health institutions within the Kumasi Metropolis. Between 12 and 15 participants were purposively sampled in each hospital. Data were collected by means of individual in-depth interviews using an interview guide and data were analysed using content analysis. The study found that mothers expected to receive respectful care and safe care. Mothers had encouraging experiences and discouraging experiences during their child-birth care. The discouraging experiences did not align with their expectations of care, leading to dissatisfaction with child-birth care. In the second phase of the study an integrative literature review was conducted to identify evidence-based best practices to deal with client dissatisfaction with health care. The integrative literature review indicated that in-service training was commonly used as best-practice to improve health professionals' knowledge, skills and attitudes towards work and consequently to improve health outcomes for patients, including client satisfaction. In the third phase of the study, the in-service training programme to enhance patient-centred care was developed using Chinn and Kramer (2005) guidelines for programme development and steps to programme development by Management Sciences for Health (2012). The fourth phase entailed an assessment of feasibility and usability of the in-service training programme using 6 midwives in a district Hospital. The procedure was guided by the I-Tech Technical Implementation guide (2010). The outcomes of the assessment was used to refine and revise the developed in-service training programme. Conclusion: This study sought to develop an intervention to increase client satisfaction with child-birth care service by engaging the following processes in phases: • Assessing the expectations and experiences of mothers about child-birth care services. • An integrative literature review for evidence-based best practice to tackle client dissatisfaction with health care. • Designing a patient-centred care in-service training programme together with experts in the field of maternal and child health. • As assessment of feasibility and usability of the in-service training programme by means of a pilot test to refine the programme. Recommendations: It was recommended among others that, the study is carried out on a national scale to cover all administrative regions of Ghana. It is further recommended that the study findings and the programme developed form part of the continuous professional assessment course requirement for nurses and midwives.