Objetivo: Determinar los factores limitantes en la atención del parto con acompañante desde la percepción de puérperas atendidas en el INMP. Material y método: Estudio, transversal, retrospectivo y descriptivo, compuesta por 322 puérperas mayores de 20 años de parto vaginal que no tuvieron parto con acompañante en el Instituto Nacional Materno Perinatal. Donde el tipo de muestreo fue probabilístico, aleatorio simple. Se les realizó una entrevista estructurada realizada en el período de noviembre a diciembre del 2011. Estos datos fueron analizados y tabulados en tablas y gráficas del programa SPSS 18. Se utilizó estadística inferencial Chi Cuadrado para las variables cualitativas relacionadas a un nivel de significación estadístico menor de 0,05. Resultados: Con respecto a los factores que limitan a la usuaria para la atención de un parto con acompañante encontramos que no tuvieron información el 38.5% acerca del tema (p<0.01). El 70.5% de la población estudiada no asistió al curso de Psicoprofilaxis Obstétrica, de estas un 51.6% está en la categoría de informada. El 14.6% no hubieran deseado estar acompañadas en su parto. El 75.4% desconoce los beneficios del parto con acompañante (p<0.01), a pesar de que la puérpera manifiesta haber tenido información del tema. Los factores que limitan la participación del acompañante según la percepción de la puérpera es la falta de información de su acompañante elegido (58.7%) (p<0.01) y que no se encuentran preparados (53.4%), no tienen disponibilidad de tiempo para acompañar en el parto (18.3%) ya que tienen una ocupación dependiente en un 14.3% (p<0.02).De acuerdo a la percepción de la usuaria respecto a las limitaciones de la atención de parto con acompañante por la institución, el 67% no tuvo control prenatal en la INMP y los que realizaron su control prenatal lo iniciaron tardíamente en el INMP (III trimestre) con un 14.6% (p<0.01); el 68.3% no obtuvo información sobre el parto con acompañante en el INMP (p<0.01), en cuanto a la calidad de información en el INMP (p<0.01) la calificaron como regular en un 56.8%; el interés de promover la atención de parto con acompañante por el personal de salud (p<0.03) fue calificado por las puérperas entrevistadas: Médico (36%) regular, Obstetra (42%) bueno, enfermería (67%) malo y personal técnico (48%) malo. Finalmente el 82.6% desconoce la Psicoprofilaxis obstétrica de emergencia (p<0.01), mientras de las que tuvieron información del parto con acompañante en el INMP (31.7%), el 18.9 la desconoce. Conclusiones: Se determinó que hay factores limitantes relacionados al parto con acompañante: en la usuaria, en el acompañante y predominantemente en la institución, que son influyentes. Palabras clave: Puérpera; parto con acompañante; parto vaginal.

Human-Centered Design (HCD), sometimes referred to as Design Thinking, is increasingly gaining recognition as an approach that promotes people-centered care in global health. With its history embedded in the technical and engineering fields, HCD has potential to create interventions that are feasible and acceptable to program beneficiaries. Providing emotional and psychosocial support through the use of a birth companion of choice is associated with several significant clinical health outcomes as well as satisfying birth experiences. This intervention is recognized and recommended by the World Health Organization (WHO) as fundamental and is included in the WHO guidelines for improving quality care for women and their newborns. Despite all this background information, there is insufficient evidence on the factors influencing design and implementation of birth companion programs in people-centered ways in low- and middle-income countries (LMICs). The dissertation investigated the specific factors influencing implementation of a birth companion program in two health facilities in Dar es Salaam, Tanzania. Additionally, the dissertation explored key learnings of Human-Centered Design as it was the approach utilized to design and implement a birth companion program in the two facilities. By understanding the factors influencing birth companion programs, as well as people-centered approaches such as HCD, it is hoped that the findings will provide important practice recommendations as well as inform policy and research. The dissertation used two data sets that employed qualitative design methodologies to meet its two broad objectives. The first data set was primary data collected to critique and reflect on the utility of the Human-Centered Design approach that was used to design and implement a birth companion program at Mwananyamala Referral Hospital and Tandale Health Center in Dar es Salaam, Tanzania. Data were collected using observations of design workshops, field notes, and face-to-face in-depth interviews as well as Zoom interviews of 13 participants including program staff, research team members, HCD experts, and providers who participated in the process. These data were analyzed using Critical Systems Heuristics (CSH) for framework analysis as well as thematic analysis. The second data set was secondary data for a pilot study conducted by Averting Maternal Death and Disability (AMDD) that aimed to develop a birth companionship model that responded to the context and needs of women, considered health provider expectations and concerns, and adhered to and observed Tanzania’s health system requirements. Data were collected using in-depth interviews, focus group discussions, observations, and other project data such as meeting minutes, guided tours, influence maps, document review, and field notes. Data from this data set were analyzed using the Consolidated Framework for Implementation Research (CFIR) for framework analysis. No comparisons were made between the two facilities as the key findings that surfaced were similar across both facilities. However, the author made mention of the specific health facility where a key finding was more pronounced in one facility compared to the other facility. Findings for the Human-Centered Design Approach were guided by the Critical Systems Heuristics framework. The findings showed that power dynamics exist across different stages during the HCD process, for example between local researchers and expatriate design experts. However, power differences were more pronounced in complex settings such as health facilities, especially between provider needs and those of women. Power dynamics were also seen between nurses and other providers such as doctors and facility heads, and these differences influenced important decision-making. These power imbalances stemmed from existing power hierarchies that are part of government-led entities such as the two facilities. The power asymmetry also stemmed from the providers’ responsibility to prioritize human lives and also to protect themselves against potential litigation, as birth companions become an eyewitness of the birth experience. In such environments, the execution of HCD is challenging and requires a lot of compromise. Due to these and other provider concerns, providers became the primary co-designers of the birth models implemented at the facilities. However, HCD proved to be an approach that sparked creativity, enabling participants to realize their capacity to solve problems on their own without external influence or being told what to do. Findings for the factors influencing implementation were guided by the CFIR framework. Before program implementation, providers and women generally accepted the birth companion program and saw it as an important intervention to offer women needed non-clinical support such as providing food, supporting the mothers emotionally, and helping women exercise. However, there were general concerns from most stakeholders, especially providers, on limited space, proliferation of infections, and privacy and confidentiality violations by providers. During implementation, most of these concerns disappeared, as providers and women co-created a birth companion model that was feasible, acceptable, and low cost. However, at Mwananyamala Hospital, space challenges continued, as the program implementers could only start with small numbers due to limited space. Space issues also manifested in other forms as birth companions could not be accommodated at night in the event of complications such as cesarean birth or admissions into the Neonatal Intensive Care Unit. Other key findings that emerged during implementation included poor communication networks, failure to engage other stakeholders, and lack of leadership engagement. The dissertation concludes by illustrating that implementation of a birth companion program in health settings such as Tandale Health Center and Mwananyamala Hospital is feasible, acceptable, and can be done without huge financial investments. There is a significant opportunity to adopt this model across Tanzania and in other settings with comparable contexts. What made this model feasible and acceptable is the Human-Centered Design approach that enabled a shift in the mindset of providers, sparked innovation, and allowed women and providers to develop their own solutions and test them out without imposition from the program planners. The Human-Centered Design approach, therefore, offers opportunities to design and implement interventions that are acceptable to users and other key stakeholders on the frontlines, leading to potential increased use of the interventions. HCD should not, however, be viewed as an antidote to all complex public health challenges-but should be used as a guiding framework together with other participatory approaches that explore deeper into the complexities of the wicked problems pervasive in global health. The power dynamics it seeks to dismantle are sometimes difficult to disrupt due to other systemic variables that interplay within global health systems. Considerable efforts to locate where the power lies, what contributes to that hegemony, and how it can be reconfigured are necessary for the utilization of HCD. Application of HCD should prioritize the different contexts and evolve and adapt to suit the complexities within each context, yet at the same time maintain the major characteristics that separate it from other participatory approaches.

Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-03-13T18:39:08Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) patricia_oliveira_lima.pdf: 920635 bytes, checksum: 08963c1248e0b4cd59423c354c2a171a (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-03-30T16:45:13Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) patricia_oliveira_lima.pdf: 920635 bytes, checksum: 08963c1248e0b4cd59423c354c2a171a (MD5) / Made available in DSpace on 2017-03-30T16:45:13Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) patricia_oliveira_lima.pdf: 920635 bytes, checksum: 08963c1248e0b4cd59423c354c2a171a (MD5) Previous issue date: 2016 / A equipe da maternidade de uma das unidades hospitalares do Vale do Jequitinhonha, em parceria com a Institui??o de Ensino Superior local, inseriu a doula no ambiente hospitalar visando tra?ar caminhos para humanizar a assist?ncia ? mulher durante o processo de parturi??o. Como parte do processo de implementa??o deste projeto surgiu a necessidade de avaliar essa estrat?gia sob diferentes pontos de vista, al?m de refletir sobre a influ?ncia da doulagem na forma??o acad?mica, tendo em vista que a maioria das doulas se encontram em processo de forma??o universit?ria. Dessa forma, o presente estudo, objetivou analisar a compreens?o das pu?rperas, das doulas e da equipe assistencial sobre a presen?a da doula durante o trabalho de parto das gestantes no cen?rio em estudo e a influ?ncia do exerc?cio da doulagem para a forma??o das acad?micas inseridas na maternidade. Trata-se de um estudo explorat?rio/descritivo, de abordagem qualitativa, utilizando como instrumento de coleta de dados entrevistas semiestruturadas. O quantitativo dos entrevistados foi limitado conforme o crit?rio de satura??o, totalizando dezenove entrevistados e os dados foram analisados por meio da an?lise de conte?do. Na an?lise tem?tica da presente pesquisa foram identificadas cinco unidades de contexto que geraram quinze unidades de registros das quais emergiram tr?s categorias e nove subcategorias. As categorias foram: Presen?a da doula durante o trabalho de parto das gestantes e seus significados; Acompanhamento da doula durante o trabalho de parto das gestantes e suas melhorias; A influ?ncia da doulagem na forma??o acad?mica. Foi poss?vel com o estudo reconhecer a doula como parte do cuidado humanizado, prover subs?dios para uma reflex?o do seu trabalho a partir da compreens?o das categorias em estudo, al?m de identificar a relev?ncia da pr?tica da doulagem para forma??o acad?mica das doulas universit?rias. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / The insertion of doulas in a hospital setting in a Jequitinhonha Valley`s maternity was a strategy developed by the maternity team in partnership with a local university, aiming to delineate ways to humanize care for women during the parturition process. As part of this implementation process, arose the necessity to measure this strategy from different points of view, besides on the influence of activities of doulas in an academic education because most of the doulas are university students. Thus, this research aimed to identify the understanding of postpartum women, of doulas and the care team about the presence of the doula during labor of pregnant and the influence of doula?s exercise for process of training of students in the maternity. This research is an exploratory / descriptive study of qualitative approach, semi-structured interviews was used to collect data. The amount of interviewed was limited according the criterion of the saturation. The total of interviewed was nineteen and the data were analyzed by the content analysis. In thematic analysis of this study, it was identified five context units, which generated fifteen units of records, from which emerged three categories and nine sub-categories. The categories were: presence of the doula during labor and their meanings; Monitoring of the doula during labor of pregnant and their improvement; The influence of practice of doula?s exercise in academic education. Witer this study it was possible to recognize the doula as part of humanized care, provide subsidies for a reflection of their job from the understanding of the categories in research, as well as revealing the influence of the practice of doulas for academic training of university studentes.

Orientador: Nelson Filice de Barros / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T16:32:26Z (GMT). No. of bitstreams: 1 FerreiraJunior_AntonioRodrigues_D.pdf: 6992884 bytes, checksum: 0fd90b68ebcc04571178f6d93bbb67da (MD5) Previous issue date: 2015 / Resumo: As diversas modificações do cuidado prestado nos serviços de saúde à mulher têm exigido melhor preparo profissional e das instituições que as atendem. Isso propicia o surgimento de rumos alternativos ao atendimento convencional, possibilitando maior visibilidade de mulheres como as doulas, que prestam constante apoio à parturiente e seu acompanhante, promovendo variadas técnicas de relaxamento, respiração, massagens para minoração da dor, orientação acerca das posições mais confortáveis durante as contrações, além de prover encorajamento e tranquilidade durante o parto. Neste contexto foi realizado um estudo com objetivo de compreender o processo de formação e profissionalização das doulas no Brasil. Os resultados encontram-se disponibilizados em quatro capítulos (artigos e capítulos de livro). O primeiro aborda metassíntese com evidências qualitativas sobre o acompanhamento por doulas no trabalho de parto e no parto. O segundo discute a normatização da Rede Cegonha. O terceiro denota o papel da doula na assistência ao parto e nascimento. O quarto apresenta motivos para formação e atuação profissional das doulas. Com o desenvolvimento da pesquisa foi possível: a) demonstrar evidências positivas para o trabalho da doula (capítulo 1); b)apresentar a necessidade de divulgação e discussão sobre as propostas da rede cegonha(capítulo 2); c) explicitar as facilidades e dificuldades encontradas pelas doulas para o desenvolvimento de seus trabalhos (capítulo 3); d) apresentar os motivos para mulheres buscarem formação para doula, bem como a importância do grupo de referência para sua atuação profissional (capítulo 4). Os estudos sobre doulas precisam ser aprofundados, considerando o desenvolvimento desta ocupação no Brasil. Atentar para a formação destas mulheres pode impulsionar mudanças positivas para qualificar a atenção ao parto e nascimento em todas as regiões brasileiras / Abstract: The various modifications occurring in the care provided by health services to women have demanded better training of the professionals and institutions which attend them. This gives rise to alternatives for the conventional treatments, enabling greater visibility of women such as the "doulas", who provide continuous support to laboring women and their companions, promoting various techniques of relaxation, breathing, massage for the alleviation of pain, guidance on the most comfortable positions during contractions, besides providing encouragement and quietness throughout the period of parturition. In this context a detailed study was carried on in order to understand the overall process of training and action of doulas in Brazil. The research results were available in this thesis in four chapters (articles and book chapters). The first deals metasynthesis with Qualitative evidence of monitoring by doulas during labor and childbirth. The second discusses the standardization of Stork Network. The third denotes the role of doula in childbirth and birth. Fourth features reasons for training and professional performance about doulas. With the development of the research was possible : a) demonstrate positive evidence for the work of doula (Chapter 1 ) ; ) present the need for dissemination and discussion of the proposals Stork network ( Chapter 2 ) ; c ) explain the advantages and difficulties encountered by doulas for the development of their work ( Chapter 3); d ) submit the reasons for women to seek training for doula, and the importance of the reference group for their professional activities (Chapter 4). Studies on doulas need to be deepened, considering this occupation development in Brazil. Pay attention to the training of these women can boost positive changes to qualify the care of childbirth and birth in all as Brazilian regions / Doutorado / Ciências Sociais em Saúde / Doutor em Saude Coletiva

Poor childbirth outcomes, and the disparities they highlight, continue to be of great concern in the United States. Birth doulas, professionals who provide support for pregnant people during the perinatal period, have been identified as a way to improve maternity outcomes while combating disparities in birth faced by marginalized groups of people. While existing research supports the positive benefits of doula care, limited research exists on the views and experiences of maternity care teams, specifically the relationship between obstetricians and doulas. This project aimed to explore the views, knowledge, and experiences of both obstetricians and birth doulas in New York City. The data for this study comprised a sample of all obstetricians attending births in Manhattan, New York City (response rate 125 of 220, 57%) and interviews with a purposive sample of 27 experienced birth doulas. The positive themes that emerged centered on the benefits a supportive doula could provide, specifically assistance to people wanting a natural childbirth and those lacking support. Negative themes included the comparatively high cost of a doula as well as unprofessional doula behavior, most notably interfering with medical recommendations and acting out of their scope of practice. Doulas reported that the obstetricians who do value their care are a “self-selecting” group, whereas those who do not tended to be controlling and unknowledgeable regarding the role of a doula. In addition to further exploration into the relationship between obstetricians and doulas, these findings indicate the need for more education in both groups, particularly if the goal is for a cooperative, integrated model of effective maternity care in which doula care is a component.

Objetivo: Comparar el trabajo de parto con acompañante capacitado, acompañante informado y sin acompañante en el Instituto Nacional Materno Perinatal durante el año 2011. Materiales y Método: El grupo estudio comprendió 185 gestantes divididas en 3 grupos: grupo 1: gestante con acompañante capacitado, grupo 2: gestante con acompañante informado y grupo 3: gestante sin acompañante que acudieron al Instituto Nacional Materno Perinatal para la atención de parto. Resultados: Entre los resultados maternos se evidenció que el grupo con acompañante capacitado tuvo un inicio espontáneo del trabajo de parto, un menor uso de oxitócicos, menor uso de analgésicos, una menor duración del tiempo de trabajo de parto, menor uso de episiotomía y una menor ocurrencia de desgarros en comparación al grupo con acompañantes informados y con el grupo sin acompañantes. Conclusión: Los resultados maternos fueron significativamente favorables para el grupo con acompañantes capacitados. Palabras Claves: Parto, acompañante, capacitado, informado y sin acompañante.

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 102-109).

Made available in DSpace on 2016-08-29T14:10:29Z (GMT). No. of bitstreams: 1 tese_8336_Duarte, Camila Nogueira Bonfim - Dissertação versão digital.pdf: 809018 bytes, checksum: 2607f2465617864e77029e4a50f63245 (MD5) Previous issue date: 2016-02-22 / Tendo em vista a importância do apoio oferecido às mulheres pelas doulas, e sua crescente atuação no cenário mundial e brasileiro a pesquisa relatada nesta dissertação buscou investigar processos identitários de um grupo de doulas que atua em conjunto, tendo como base a Teoria da Identidade Social. Para isso foram realizados dois estudos com um grupo de cinco doulas, com nome fictício Bem Nascer, atuante em uma cidade do estado do Espírito Santo. Elas concordaram, voluntariamente, em participar desta pesquisa. Os dois estudos são apresentados em formato de artigo para apresentar os resultados e discussões de forma estruturada. O primeiro artigo apresenta os resultados obtidos através de observação participante, realizada em dez encontros mensais sobre gestação e parto, promovidos pelo grupo Bem Nascer junto a gestantes. Foi produzido um diário de campo, cujos dados são analisados a partir do método hermenêutico-dialético (Minayo, 1992). Foram identificadas três categorias: 1) Descrição dos encontros; 2) Cenas de interações com o endogrupo; 3) Cenas de interações com exogrupos. Observou-se que as doulas, nas interações com as gestantes, exerciam papeis tais como: amigas; instrutoras-esclarecedoras; profissionais; militantes feministas; e que valorizavam homens pró-parto e médicos humanizados em detrimento de homens tradicionais e médicos tecnocratas. Infere-se que essa valorização ocorre por categorização cruzada. Verificou-se que as contribuições das doulas para a saúde reprodutiva eram condizentes com diretrizes do sistema público de saúde brasileiro e que elas disseminavam ideais feministas para mulheres de classe média. O segundo artigo utiliza entrevistas individuais semiestruturadas, analisadas através da análise de conteúdo temática (Bardin, 1977), que permitiu identificar 134 temas e seis categorias. Os processos identitários das doulas estão ligados à militância feminista, ao movimento de humanização do parto, e ao pertencimento a um grupo de trabalho que constitui laços profissionais, de amizade e confiança. Há atitudes negativas quanto à maioria dos profissionais de medicina, com exceção daqueles percebidos como humanizados. Observa-se que doulas estão construindo processos identitários ligados ao feminismo; e que o ativismo, o grupo de trabalho das doulas e a promoção de encontros com mulheres grávidas constituem estratégias de mudança social, contribuindo para a transformação da assistência à saúde e das relações de gênero. Palavras-chave: cuidado pré-natal; doulas; saúde reprodutiva; atitudes; feminismo; identidade social.

xvi, 243 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / Human birth represents a complex interplay between our evolved biology and the cultural norms and expectations surrounding birth. This project considers both the evolutionary and cultural factors that impact the birth outcomes of teen mothers that received support from a trained labor support person, or doula. Doula support has repeatedly been found to decrease the length of labor, the use of pain medication, the rates of caesarian section, and instrumental births and to increase rates of breastfeeding and bonding. However, virtually no studies evaluate why these positive outcomes occur. Current life history models suggest that traits such as short inter-birth intervals, early weaning, extended dependency, and simultaneously raising multiple dependent offspring co-evolved with child-rearing support from multiple caregivers. These models suggest that mothers should be particularly sensitive to perceived cues of social and material support for childrearing; doulas might provide such cues. The goal of this project was to explore how doula support impacted teen mothers' perceptions of their birth experience and outcomes. Data for the project were drawn from three sources: a 15-month participant observation at a non-profit organization providing doula support to teen mothers, 20 semi-structured interviews with mothers who received doula support for the birth of their babies, and by my attendance as a doula at over 50 births. Results suggest that teen mothers experience upheavals in social relationships with their friends, families, and partners following the discovery of their pregnancy. Participants indicated that doula support increased their knowledge of the birth process, provided unbiased and non judgmental support and information, gave them confidence in their ability to give birth, and encouraged mothers to be proactive in communicating with their care providers. Teens used friendship and kinship terms when describing their doula, suggesting that doula support provides cues of kinship that women have used throughout evolutionary history to assess the availability of alloparental care. While doulas themselves provide salient cues of social support, participants also indicated that doulas increased support from fathers and families, thus mobilizing support from existing social networks. Cues of adequate support may lead to increased maternal investment, thereby improving both maternal and fetal outcomes. / Committee in charge: Lawrence Sugiyama, Chairperson, Anthropology Frances White, Member, Anthropology; James Snodgrass, Member, Anthropology; Melissa Cheyney, Member, Not from U of O; John Orbell, Outside Member, Political Science

BACKGROUND: The United States maternal mortality ratio (MMR) has increased in the past few decades and disparities that negatively impact birthing individuals of color persist. While there are many potential causes for health inequity, distinct factors such as obstetric racism, lack of informed and shared decision-making approaches, and lack of continuous birthing support can prevent positive birthing outcomes. The present study investigates the impact of doula support on perinatal mood disorders while also evaluating potential differences in racial/cultural concordance and cultural competence in the context of the doula-patient relationship, in a Northeastern U.S. urban setting. METHODS: Seven focus group discussions (FGDs) were conducted amongst prenatal and postpartum patients (n=9) and actively practicing doulas (n=18). Participants shared their thoughts and lived experiences related to doula support during the perinatal period through open-ended questions. Researchers transcribed qualitative data from FGDs and analyzed them using a modified grounded theory approach. RESULTS: Five major themes emerged from qualitative data analysis: (1) doula support can reduce stress during the perinatal period, (2) doulas can make the process of seeking out mental health support more efficient, (3) cultural competency in doula care is a learning process (4) racial concordance does not guarantee successful doula-patient relationships, and (5) doulas play an important role in the decision-making process. CONCLUSIONS: The presence of doula support can combat perinatal mood disorders through two pathways identified in the present study. Although there may be distinct differences between culturally competent versus culturally congruent doula-patient relationships, matching by race or culture is not the solution to a fulfilling relationship. Doulas practicing cultural competence and cultural humility – regardless of client background – can make a meaningful impact on the perinatal experience and long-term mental health outcomes. / 2022-11-10T00:00:00Z