Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2017-07-12T12:13:54Z No. of bitstreams: 2 Dissertação - Mayara Guimarães Santos -2017.pdf: 7875810 bytes, checksum: 702355209b8273e7260c8b8f339a6555 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Rejected by Luciana Ferreira (lucgeral@gmail.com), reason: Substituir arquivo. on 2017-07-13T10:38:11Z (GMT) / Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2017-07-19T14:30:58Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação - Mayara Guimarães Santos - 2017.pdf: 7875396 bytes, checksum: 4d4cbfc2152054b4e06255f0d81cd064 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-07-20T10:58:16Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação - Mayara Guimarães Santos - 2017.pdf: 7875396 bytes, checksum: 4d4cbfc2152054b4e06255f0d81cd064 (MD5) / Made available in DSpace on 2017-07-20T10:58:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertação - Mayara Guimarães Santos - 2017.pdf: 7875396 bytes, checksum: 4d4cbfc2152054b4e06255f0d81cd064 (MD5) Previous issue date: 2017-06-14 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Obstetric violence is a worldwide public health issue. It refers to all kind of violence originated during the assistance to pregnancy and puerperal cycle or abortion, perpetrated by health professionals in heath care institutions. The main objective of this research is to identify and to analyze the meanings of obstetric violence by physicians and obstetric nurses workers in public institutions for delivery care assistance. This is a qualitative approach of social and strategic research. The data were collected by semi-structured interviews with 13 professionals of two public institutions on delivery-care assistance in Goiânia, Goiás. The data from these interviews was analyzed by the Meaning Interpretation Method, which generated three theme categories. The first one, “Humanization of parturient assistance” the professionals reported the meaning and practices of the delivery care assistance humanization. In the second, “Living the obstetric violence”, are presented meanings of violence, its’ showings, being the care unworthy, body abuse, non-confidential care and discrimination the most expressive facts for these actions. The third category, “Knowledge about the pregnancy and puerperal cycle”, the interview participants reported a lack of knowledge of parturients about gestation, childbirth and puerperium, besides prenatal inefficiency to prepare pregnant women to childbirth. This research contributed for a better comprehension of meanings attributed to obstetric violence and provided subsidies for concrete actions related to this matter may be considered during public policy making, in order to face this phenomena and improve the quality of parturient assistance. / A violência obstétrica é um problema de Saúde Pública no âmbito nacional e internacional. Refere-se a todas as formas de violência originadas durante a assistência ao ciclo gravídico-puerperal ou abortamento, perpetradas por profissionais de saúde em instituições de atendimento. O objetivo desta pesquisa foi identificar e analisar os significados atribuídos à violência obstétrica por médicos e enfermeiros obstetras com vínculos de trabalho na rede pública de assistência ao parto. Pesquisa social do tipo estratégica, de natureza qualitativa. Os dados foram coletados por meio de entrevistas semiestruturadas com 13 profissionais de duas instituições públicas de atenção ao parto em Goiânia, Goiás. O material proveniente das entrevistas foi analisado por meio do Método de Interpretação de Sentidos, gerando três categorias temáticas. A primeira, “Humanização da assistência à parturiente”, os profissionais relataram o significado e as práticas de humanização da assistência ao parto. A segunda, “Vivências da violência obstétrica”, diz respeito aos significados da violência, suas manifestações, sendo o cuidado indigno, abuso físico, cuidado não confidencial e a discriminação os mais expressivos para a ocorrência desses atos. A terceira, “Conhecimento sobre o período gravídico-puerperal”, os participantes relataram a falta de conhecimento das parturientes sobre a gestação, parto e puerpério, além da ineficácia do pré-natal para preparar as gestantes para o parto. O estudo contribuiu para uma melhor compreensão dos significados atribuídos à violência obstétrica e forneceu subsídios para que ações concretas relacionadas a essa questão possam ser consideradas na elaboração de políticas públicas para enfrentamento deste fenômeno e melhoria da qualidade da assistência à parturiente.

Centros de parto normal (CPN) têm como finalidade a assistência à mulher no parto normal sem complicações. Podem ter localização intra-hospitalar, peri-hospitalar ou extra-hospitalar (autônomo). Os objetivos foram: identificar os fatores de risco para transferência materna de um CPN para o hospital; elaborar um modelo de risco para transferência intraparto baseado nos fatores identificados e analisar os desfechos maternos e neonatais das transferências. Estudo do tipo caso-controle, com coleta de dados retrospectiva, em um centro de parto extra-hospitalar (Casa do Parto de Sapopemba - CPS) e no Hospital Estadual de Vila Alpina (HEVA), na cidade de São Paulo. Os casos foram todas as mulheres transferidas da CPS para o HEVA, de março de 2002 a dezembro de 2009. Os controles foram mulheres não transferidas que deram à luz na CPS no mesmo período, selecionadas aleatoriamente, sendo quatro controles para cada caso. Os fatores de risco para transferências maternas intraparto foram analisados primeiro pelo teste Qui-Quadrado. Na análise múltipla, incluíram-se as variáveis com p<0,20. Elaborou-se a seguir o modelo de regressão logística múltiplo pelo processo stepwise forward selection; variáveis com p<0,05 foram fatores independentes associados às transferências maternas. Transferências maternas pós-parto tiveram análise descritiva, em razão do reduzido número (13). Variáveis identificadas como fatores de risco independentes para transferência intraparto: nuliparidade (OR 5,6; IC 95% 2,9-10,9), idade materna 35 anos (OR 5,0; IC 95% 2,0-12,7), não ter companheiro (OR 2,7; IC 95% 1,4-5,1), ser admitida na CPS com cervicodilatação 3 cm (OR 2,0; IC 95% 1,1-3,4), realizar 5-12 consultas na CPS (OR 3,3; IC 95% 1,6-6,7) e peso do RN de 4.000-4.600 g (OR 3,5; IC 95% 1,1-11,2). Adequação entre altura uterina e idade gestacional baixa (OR 0,3; IC 95% 0,2-0,6) foi fator de proteção para a transferência. Apresentou-se modelo de risco para transferência intraparto, com probabilidade de transferência estimada de acordo com as variáveis identificadas como fatores de risco. Nos desfechos das transferências maternas: taxa de transferência intraparto: 4,1%; pós-parto: 0,5%; não houve óbitos entre as mulheres que deram à luz na CPS ou no HEVA e entre os RN da CPS; houve óbito de dois RN do HEVA (taxa de mortalidade perinatal: 0,73/1.000 nascidos vivos). Causas de transferência intraparto: maternas (57,6% falha no progresso do trabalho de parto); fetais (28% líquido amniótico meconial e traçado cardiotocográfico alterado); outras (14,4%); via de parto das mulheres transferidas: 49,5% parto normal; 44,1% cesariana; 4,5% fórceps e 1,8% vácuo extrator. Entre os RN de mães transferidas: 25,2% e 4,5% tiveram Apgar <7 nos 1º e 5º minutos, respectivamente; unidade de internação: 10,8% na UTI neonatal, 9,0% unidade de cuidados intermediários, 0,9% setor de observação e 79,3% alojamento conjunto. Causas de transferência no pós-parto: retenção placentária (38,5%); outros problemas (30,8%); sangramento vaginal aumentado (15,4%) e febre materna (15,4%); 46,1% necessitaram de curetagem e 38,4% de transfusão sanguínea. Concluiu-se que identificar os fatores de risco para transferência materna contribui para refinar os critérios de admissão de mulheres atendidas em CPN, ao auxiliar na identificação de casos que podem resultar em complicações. / Birth centers (BC) aim to provide care to women in normal birth without complications. They may have in-hospital, alongside or freestanding (autonomous) locations. The objectives were to identify risk factors for maternal transfer from a BC to the hospital, to develop a risk model for intrapartum transfers using the identified factors and to analyze the maternal and neonatal outcomes of transfers. It was a case-control study, with retrospective data collection in a freestanding birth center (Sapopemba Birth Center - SBP) and the State Hospital Vila Alpina (HEVA), in São Paulo. The cases were all women transferred from SBP to HEVA, from March 2002 to December 2009. The controls were not transferred women who gave birth in CPS in the same period, randomly selected, four controls for each case. Risk factors for maternal intrapartum transfers were primarily analized by the Chi-square test. In the multivariate analysis, the variables with p <0.20 were included. The multiple logistic regression model was build by stepwise forward selection process; variables with p <0.05 were factors independently associated with maternal transfers. Postpartum maternal transfers had descriptive analysis, due to the small number (13). Variables identified as independent risk factors for intrapartum transfer: nulliparity (OR 5.6, 95% CI 2.9 to 10.9), maternal age 35 years (OR 5.0, 95% CI 2.0 to 12. 7), no partner (OR 2.7, 95% CI 1.4 to 5.1), admission to the CPS with cervical dilation 3 cm (OR 2.0, 95% CI 1.1-3.4), number of appointments on SBC 5-12 CPS (OR 3.3, 95% CI 1.6 to 6.7) and newborn weight 4000-4600 g (OR 3.5, 95% CI 1.1 to 11.2). The low result for fitting uterine height and gestational age (OR 0.3, 95% CI 0.2-0.6) was a protective factor for transfer. A model of risk for intrapartum transfer was presented, to estimate the probability of transfer according to the variables identified as risk factors. The outcomes of maternal transfers were: intrapartum transfer rate: 4.1%; postpartum transfer rate: 0.5%; there were no deaths among women who gave birth in SBC or HEVA or between the newborns who were born on SBC; there were two deaths of newborns born in HEVA (perinatal mortality rate: 0.73 / 1,000 live births). Causes of intrapartum transfer: maternal (57.6% failure to progress in labor), fetal (28% meconium stained amniotic fluid and cardiotocographic trace changes), others (14.4%); mode of delivery of the transferred women: 49, 5% normal delivery, cesarean section 44.1%, 4.5% forceps and 1.8% vacuum extractor. Among infants of mothers transferred: 25.2% and 4.5% had Apgar score <7 at 1st and 5th minutes, respectively; unit admission of newborns: 10.8% in the neonatal intensive care unity, 9.0% intermediate care unit, 0, 9% observation rooms and 79.3% rooming-in unity. Causes of postpartum transfer: retained placenta (38.5%), other problems (30.8%), increased vaginal bleeding (15.4%) and maternal fever (15.4%); 46.1% required curettage and 38.4% blood transfusion. It was concluded that identifying risk factors for maternal transfer contributes to refine the criteria for admission of women attending BC, as it can be useful in identifying cases that may lead to complications.

Introdução: A mortalidade materna é aquela resultante de complicações diretas e indiretas da gravidez, parto ou puerpério, e um indicador de saúde da mulher bem como do desempenho dos sistemas de atenção à saúde. O Planejamento Familiar é considerado fundamental na diminuição das taxas de mortalidade materna. A implantação de estratégias efetivas de planejamento familiar no pós-parto (PFPP) poderia contribuir na diminuição das taxas de morbidade e mortalidade materna e infantil, bem como do número de gestações não planejadas e abortos inseguros. O uso de Tecnologias de Informação e Comunicação (TIC) em uma intervenção educativa em saúde de PFPP poderia ser considerado uma ferramenta complementar útil na atenção pós-natal. Objetivo: Determinar se o envio de mensagens de texto via Short Message Service (SMS) sobre PFPP, é um complemento útil para o acompanhamento pós-natal, incentivando o uso de anticoncepcional no pós-parto e o retorno à consulta de puerpério. Métodos: Ensaio clínico aleatorizado controlado por grupo . Realizado entre fevereiro de 2015 e junho de 2016 em Ribeirão Preto. Com 420 mulheres, 326 mulheres do grupo de controle e 94 mulheres do grupo com intervenção, cada grupo estava composto por 10 Unidades Básicas e Distritais de Saúde. Mulheres do grupo com intervenção, com idade igual ou superior a 18 anos e com idade gestacional inferior a 20 semanas, foram convidadas a cadastrar-se no programa, após o aceite de participação, foi enviado o primeiro grupo de mensagens com informações referentes ao parto e gravidez, este envio terminava após o parto. Dentro das primeiras 48 horas pós-parto a mulher era entrevistada na maternidade, sendo coletados dados sociodemográficos, e do histórico sexual e reprodutivo, quatro dias após o parto as mulheres do grupo com intervenção que aceitaram receber as mensagens após o parto, receberam o segundo grupo de mensagens durante oito semanas com informações sobre contracepção no pós-parto. No terceiro mês após o parto foram entrevistadas as 420 no domicílio, o uso de anticoncepcional no pós-parto e assistência à consulta puerperal foram avaliados como desfechos principais. Todas as mulheres assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: A taxa total de uso de anticoncepcional foi de 92% no terceiro mês após o parto, 89% foram anticoncepcionais hormonais. Em relação á consulta puerperal, 76% das mulheres compareceram à consulta. 7 Conclusões: Não houve diferencia estatisticamente significante entre os grupos, talvez o impacto deste tipo de intervenção educativa pode ser diferente em outros contextos e regiões brasileiras onde a informação em saúde é mais defasada e as mulheres têm mais dificuldades no acesso ao serviço de saúde. Este foi o primeiro estudo da literatura que avaliou o impacto de mensagens educativas via SMS sobre uso de contraceptivos após três meses do parto. Além de promover informação através de SMS, numa linguagem de fácil entendimento para as mulheres sobre saúde reprodutiva, a proposta deste estudo possibilitou a participação ativa dessas mulheres, por possuir um sistema de mensagem de texto bidirecional. / Introduction: Maternal mortality is the result of direct and indirect complications of pregnancy, childbirth or puerperium, and an indicator of women\'s health as well as the performance of health care systems. Family Planning is considered to be crucial in reducing maternal mortality rates. The implementation of effective family planning strategies in the postpartum period (FPPP) could contribute to the reduction of rates of maternal and infant morbidity and mortality, as well as the number of unplanned pregnancies and unsafe abortions. The use of Information and Communication Technologies (CIT) in a FPPP health education intervention could be considered a useful complementary tool in postnatal care. Objective: To determine if the sending of text messages via Short Message Service (SMS) on FPPP is a useful complement to postnatal follow-up, encouraging postpartum contraceptive use and the return to puerperal consultation. Methods: Conglomerate-controlled randomized clinical trial. Held between February 2015 and June 2016 in Ribeirão Preto. With 420 women, 326 women from the conglomerate control and 94 women from the conglomerate with intervention, each conglomerate was composed of 10 Basic and District Health Units. Women of the conglomerate with intervention, aged 18 years or above and with gestational age less than 20 weeks, were invited to join the program, after accepting participation, was sent the first group of messages with information regarding delivery and pregnancy, this shipment ended after delivery. Within the first 48 hours postpartum, the woman was interviewed in the maternity ward, and socio-demographic data and sexual and reproductive history were collected. Four days after delivery, women from the conglomerate with intervention who accepted to receive postpartum messages received the second group of messages for eight weeks with information on postpartum contraception. In the third month after delivery, the 420 women were interviewed at home, postpartum contraceptive use and puerperal consultation were evaluated as the main outcomes. All the women signed the Free and Informed Consent Form. Results: The total contraceptive use rate was 92% in the third month after delivery, 89% were hormonal contraceptives. Regarding the puerperal consultation, 76% of the women attended the consultation. Conclusions: There was no statistically significant 9 difference between groups, perhaps the impact of this type of educational intervention may be different in other Brazilian contexts and regions where health information is more lagged and women have more difficulties in accessing the health service. This was the first study in the literature that evaluated the impact of educational messages via SMS on contraceptive use after three months of childbirth. In addition to promoting information through SMS, in a language that women can easily understand about reproductive health, the proposal of this study made possible the active participation of these women, because it has a two-way text message system.

Made available in DSpace on 2016-08-19T18:16:06Z (GMT). No. of bitstreams: 1 Dissertacao Thaiana.pdf: 528185 bytes, checksum: 3b0b8bd2ffffcc21653f51c9c42e1317 (MD5) Previous issue date: 2012-06-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / BACKGROUND: Pregnancy and delivery route influence the strength of pelvic floor muscles, which are considered risk factors for the onset of urinary incontinence and genital dystopias. OBJECTIVES: To evaluate the effects of kinesiotherapy in the pelvic floor muscles in women with a single delivery. METHODS: Participants were 503 women who responded to the protocol record, 297 (59.0%) aged between 35 and 45 years underwent functional evaluation of the pelvic floor by bidigital touch and perineometer. There were 165 (32.8%) women with deficiency on muscles strength participating in the trial, which were allocated into two groups according to the delivery route (A - vaginal delivery and B - abdominal delivery). They were randomized into groups A1 (n = 44) and B1 (n = 42), and were submitted to kinesiotherapy and groups A2 (n = 39) and B2 (n = 40) without kinesiotherapy. The protocol had perineal contraction exercises in the supine, sitting and standing posture and was performed twice a week for a total of 15 sessions. Statistical analysis used the chi-square test, Mann-Whitney test, Z test, Kruskall Wallis test, and ANOVA one criterion, the Spearman Correlation Coefficient, the Pearson Correlation Coefficient and PHI, with significance level 0.05. RESULTS: As the result of the kinesiotherapeutic protocol by comparing the force of contraction of the pelvic floor before and after application of kinesiotherapy compared to those without kinesiotherapy, there was significant increase in strength on women with both routes of delivery, by the both methods of evaluation (p < 0.0001). Among the variables possibly associated with the DFMAP, only parity was statistically significant (p &#706; 0.0001). CONCLUSIONS: The protocol proposed proved to be effective in the increase of pelvic floor muscle s strength at the assessment by both methods of evaluation. The delivery route was not responsible for weakening perineal but parity, demonstrating that the perineal muscles strength is inversely proportional to the number of births, suggesting that kinesiotherapy during pregnancy may be an alternative to prevent the weakening of pelvic floor. / INTRODUÇÃO: A gravidez e a via de parto alteram a força muscular do assoalho pélvico, considerados fatores de risco para o surgimento de incontinências urinárias e distopias genitais. OBJETIVO: avaliar os efeitos da cinesioterapia na musculatura do assoalho pélvico em mulheres com via de parto única e verificar a existência de associação entre as variáveis estudadas e o déficit de força muscular do assoalho pélvico (DFMAP). METODOLOGIA: Obteve-se um total de 165 mulheres com idade entre 35 e 45 anos, apresentando déficit de força muscular que participaram do ensaio clínico, as quais foram alocadas em dois grupos de acordo com a via de parto (A parto vaginal e B parto cesárea). Em seguida, foram divididas aleatoriamente em Grupos A1 (n = 44) e B1 (n = 42), para realização do protocolo cinesioterapêutico e em Grupos A2 (n = 39) e B2 (n = 40), grupos controle. O protocolo continha exercícios de contração perineal em decúbito dorsal, postura sentada e bípede e foi realizado duas vezes por semana em um total de 15 atendimentos. Para análise estatística utilizaram-se os testes qui-quadrado, Mann-Whitney, teste Z, teste Kruskall Wallis, ANOVA um critério, Coeficiente de Correlação de Spearman, de Correlação de Pearson e de Correlação PHI, com nível de significância 0,05. RESULTADOS: Verificou-se aumento significativo de força nas mulheres com ambas as vias de parto, pelos dois métodos de avaliação (p < 0,0001) após a realização da cinesioterapia. Dentre as variáveis possivelmente associadas ao DFMAP, somente a paridade mostrou-se estatisticamente significante (p &#706; 0,0001). CONCLUSÃO: O protocolo cinesioterapêutico proposto mostrou-se eficaz no fortalecimento muscular do assoalho pélvico quer seja pela avaliação pelo toque bidigital, quer seja pelo perineômetro. Continua controverso na literatura o efeito protetor da cesareana em relação aos danos ao assoalho pélvico, já que neste estudo a via de parto não foi responsável pelo enfraquecimento perineal e sim a paridade, sugerindo que a cinesioterapia durante o período gestacional pode ser uma alternativa para a prevenção do enfraquecimento do assoalho pélvico.

Thesis (M. A. (Clinical Psychology)) -- University of Limpopo, 2003 / Refer to document

Orientador: Vitor Engrácia Valenti / Resumo: Os impactos do peso ao nascer (PN) em relação à variabilidade da frequência cardíaca (VFC), não estão bem esclarecidos. Objetivo: investigar o envolvimento do PN e composição corporal na recuperação da VFC após exercício físico (EF) em crianças de 9 a 11 anos (40♀ e 27♂; n=67) divididas em dois grupos: G1 (PN≤3.400g, n=33) e G2 (PN>3.400g, n=34) que completaram protocolo de EF em esteira. Nos grupos G1 e G2 a pressão arterial sistólica (PAS) e frequência respiratória (f) foram diminuídas. No grupo G2, a média da frequência cardíaca (FC), índices HF, RMSSD, SD1 e L-mean foram diminuídos e o índice L-max aumentou. Regressão linear revelou relação do percentual de gordura (%GC) e PN com recuperação não linear da VFC. Em conclusão, a recuperação autonômica após EF foi um pouco atrasada em crianças com alto PN. O PN e o %GC influenciaram levemente a recuperação da VFC. A forma como o tipo de parto poderia afetar a VFC em crianças ainda é obscura. O objetivo desta pesquisa foi investigar a recuperação autonômica do ritmo cardíaco após EF em crianças com diferentes tipos de parto. O estudo foi realizado em crianças de 9 a 11 anos (17♀ e 16♂; n=33) divididas em dois grupos: PVN (7♀ e 6♂) e PC (10♀e 10♂) que completaram protocolo de EF em esteira ergométrica. PAS, f e a média da FC foram diminuídas grupo PVN. RMSSD e os índices 2ULV e SD1 foram diminuídos no grupo PC. Em conclusão, a análise linear e não-linear da VFC mostrou que o grupo PVN apresentou tendência de recuperação autonôm... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The impacts of birth weight (BW) in relation to heart rate variability (HRV) are not well understood. Objective: To investigate the involvement of BW and body composition in HRV recovery after physical exercise (PE) in children aged 9 to 11 years (40♀ and 27♂; n = 67) divided into two groups: G1 (BW ≤3,400g, n=33) and G2 (BW >3,400g, n=34) who completed treadmill PE protocol. In groups G1 and G2, systolic blood pressure (SBP) and respiratory rate (f) were decreased. In group G2, the mean heart rate (HR), HF, RMSSD, SD1 and L-mean indices were decreased and the L-max index increased. Linear regression revealed an relationship between fat percentage (%FP) and BW with nonlinear HRV recovery. In conclusion, autonomic recovery after PE was a little late in children with high BW. BW and %FP slightly influenced HRV recovery. How childbirth could affect HRV in children is still unclear. The aim of this research was to investigate the autonomic recovery of heart rate after PE in children with different types of delivery. The study was conducted in children aged 9 to 11 years (17♀ and 16♂; n=33) divided into two groups: PVN (7♀ and 6♂) and PC (10♀ and 10♂) who completed PE protocol in treadmill. SBP, f and mean HR were decreased in PVN group. RMSSD and 2ULV and SD1 indices were decreased in the PC group. In conclusion, the linear and nonlinear HRV analysis showed that the PVN group showed a tendency for faster autonomic and cardiovascular recovery after PE. / Doutor

Esta dissertação procura evidenciar a dimensão socioambiental do parto humanizado, com foco nos conceitos que permeiam a saúde da mulher e do seu protagonismo enquanto parturiente, revelando a importância do saber ambiental nas pesquisas sociais. Desde a caça às bruxas e a medicalização da saúde, culminando na retirada das parteiras no momento do parto, as mulheres vêm sofrendo controle e vigilância dos seus corpos e lidam frequentemente com autoritarismos médicos e violências obstétricas. Ao longo da história da humanidade, a mulher vem sendo inferiorizada nos mais diversos campos de atuação e do conhecimento, ocupando poucos cargos políticos, além disso sofrem feminicídios, estupros, violências, sendo as mais prejudicadas pela industrialização e pela deterioração do ambiental natural. Ou seja, é subjugada diante de diversos elementos socioambientais, demonstrando a necessidade de um olhar mais apurado, empático e científico para a importância de seu protagonismo para os diversos níveis da construção humana. Pensar a dimensão socioambiental que agrega a mulher na hora do parto é um importante olhar para integrar as problemáticas sociais e ambientais. Agregando textos de autores de diversos campos do conhecimento, como biologia, filosofia, geografia humana e ciências sociais, procura-se estabelecer um diálogo com tais estudos, culminando na análise do protagonismo da parturiente como um evento significativo do socioambientalismo, que, aliado a determinados movimentos sociais, é capaz de produzir efeitos para além de si, promovendo não apenas uma melhoria no bem-estar da parturiente e do bebê, mas modificando estruturalmente o funcionamento das instituições e da sociedade como um todo / This dissertation aims to evidence the socio-environmental dimension of humanized birth, with a focus on the concepts that permeate women\'s health and their autonomy as a parturient, highlighting the importance of environmental understanding in social researches. Ever since the witch hunting time and the medicalization of health, culminating withdrawal of midwives at the childbirth moment, women have been suffering control and surveillance over their bodies and frequently have to deal with the medical authoritarism and obstetric violence. Throughout the history of humanity, women have been diminished in the most diverse fields of activity and knowledge, occupying the minority of political positions, also suffering feminicides, rapes, violence, being the most harmed by industrialization and the deterioration of natural environment. Therefore, women are subjugated in the face of several socio-environmental elements, demonstrating the need for more accurate, empathic and scientific look at the importance of their protagonism on different levels human construction. To consider the socio-environmental dimension that women add at the moment of childbirth is an importance way to go to integrate social and environmental issues. This work seeks to demonstrate the need for a more accurate, empathetic and scientific look at the female protagonism and its importance in the most diverse levels of human construction, especially at the moment of childbirth, a context that involves different socioenvironmental problems. Aggregating texts from authors of different fields of knowledge as biology, philosophy, human geography and social studies, it seeks to establish a dialogue with such studies, culminating in the analysis of the autonomy of the parturient as a significant event of socio-environmentalism, which, together with certain social movements, is capable of producing effects beyond itself, promoting not only an improvement in the well- being of the parturient and the baby, but also structurally modifying the functioning of the institutions and society as a whole

<p>The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth. </p><p>The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports. </p><p>Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.</p>

<p>The experience of childbirth is an important life event for women, which may follow them throughout life. The overall aim of this thesis has been to describe and analyse these experiences from the women's perspective as well as the encounter between the woman and the midwife, and the possibility that a birth plan might improve women's experience of childbirth. The setting has been the ABC-centre (Alternative Birth Care), antenatal clinics and Sahlgrenska University hospital in Göteborg, and Karolinska hospital in Stockholm, Sweden. The studies have used both qualitative (phenomenological and hermeneutic) and quantitative approaches. The essential structure of the experiences of pregnancy and childbirth may be conceptualised under the heading ‘releasing and relieving encounters’, which for the woman constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as being in the moment; exemplified as presence and being one's body. Change is expressed as transition; to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person that listens to and follows the woman through the process of childbirth. To be anchored is to be the person that in the transition process respects the limits of the woman's ability as well as her own professional limits. The releasing and relieving encounter is not improved for women by a birth plan. Instead, in some aspects the relationship between the woman and her midwife during childbirth is reported as less satisfactory if preceded by a birth plan although some experiences of fear, pain and concerns for the child might be improved. </p>

In India, globalized flows of bio-medical discourse, practices and technologies are reshaping the field of reproductive healthcare, and the performance of childbirth more specifically. These projects aim to produce institutional delivery rooms that are "safe and modernized" by equating the utilization of westernized, obstetric techniques for managing delivery with better birth outcomes. Yet, these projects often evoke dynamic tensions between the imagined labor rooms NGOs seek to produce and the lived realties of labor in a local context. In this thesis, I examine the ways NGOs market and disseminate state and global discourses around safe, institutional delivers to local communities through a case study of one NGO working in rural southern Rajasthan. Drawing on data from participant observation and in-depth, semi-structured interviews with NGO staff and skilled-birth attendants employed by community health centers, I argue that at the interface of NGO, state, and global relations of power, a commodified discourse in the form of Evidenced-based Delivery (EBD) practices is emerging. This discourse is marketed through a political economy of hope that promotes EBDs as essential for safe delivery. In this system, NGOs function as conduits for transmitting idealized notions of the safe and modern delivery room, and thereby affect a shift in what skilled-birth attendants and communities come to expect from their childbirth experiences -- expectations that I argue are often difficult to meet given current training levels, limited economic resources, and a diverse set of cultural values around childbirth. My findings indicate that while Evidence-based Delivery practices may improve birth outcomes in some contexts, in the delivery rooms of rural Rajasthan, they are functioning essentially as technologies that capitalize on the political economy of hope by evoking the medical imaginary. / Graduation date: 2012