Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T12:34:17Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AmáliaLúciaMachrySantos.pdf: 6006416 bytes, checksum: 000184e261be0a0b742304d521d20137 (MD5) / Made available in DSpace on 2018-08-22T12:34:17Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AmáliaLúciaMachrySantos.pdf: 6006416 bytes, checksum: 000184e261be0a0b742304d521d20137 (MD5) Previous issue date: 2016-12-20 / Obstetric care is one that provides care, support, and protection with the minimum of interventions needed. The objective of this study was to investigate the knowledge of nursing professionals about obstetric violence in order to construct a guideline book. As specific objectives, this study considered: to identify the types of obstetric violence recognized by nursing professionals and to construct information material on humanized care for pregnant women. The study was carried out from September 2015 to November 2016 through an individual interview with thirty-one nursing professionals, of a maternity, of medium level of complexity, of the central region of the interior of Rio Grande do Sul. Data emerged two thematic categories: obstetric violence practiced by health professionals and the implications for professional practice. Obstetric violence in the interviewees' perception is not respecting the wishes of the expectant mother. This is a subjective situation involving all health professionals. Nursing can incorporate in its practices of care for women, coping and prevention of injuries in situations of violence, allowing the Humanized Childbirth premises to be respected. For this, a booklet was developed for the prevention of Obstetric Violence containing the rights of the pregnant woman in the prepartum, delivery and postpartum, as well as the attributions of the nursing professionals to the nursing care. This theme requires frequent approaches and reflections, through lifelong education, so that more humane and dignified care can occur, capable of generating more security and confidence for nursing professionals to carry out care procedures. It has been observed that obstetrical care without scientific support, which is aggressive and often violates the basic human rights of women, is linked to the current model of childbirth care. Through obstetrical nursing, it is possible to rescue the protagonism and the empowerment of the pregnant woman in the process of gestating and giving birth. This topic requires more studies and the development of new research in this area, in order to allow important decision-making of health professionals and advise in the elaboration of new public policies. / Cuidado obstétrico é aquele que oferece assistência, apoio e proteção com o mínimo de intervenções necessárias. O presente trabalho teve como objetivo geral investigar o conhecimento dos profissionais de enfermagem acerca da violência obstétrica no intuito de construir uma cartilha de orientações. Como objetivos específicos, este estudo considerou: identificar os tipos de violência obstétrica reconhecidos pelos profissionais de enfermagem e construir um material informativo sobre atendimento humanizado para as gestantes. O estudo foi desenvolvido no período de setembro de 2015 à novembro de 2016 através de entrevista individual com trinta e um profissionais de enfermagem, de uma maternidade, de nível médio de complexidade, da região central do interior do Rio Grande do Sul. Da análise dos dados emergiram duas categorias temáticas: violência obstétrica praticada por profissionais de saúde e as implicações para a prática profissional. Violência obstétrica na percepção dos entrevistados é não respeitar a vontade da gestante/puérpera. Trata-se de uma situação subjetiva que envolve todos os profissionais de saúde. A enfermagem pode incorporar em suas práticas de cuidado às mulheres, ações de enfrentamento e de prevenção dos agravos nas situações de violência, permitindo que as premissas do Parto Humanizado sejam respeitadas. Para isso, desenvolveu-se uma cartilha para a prevenção da Violência Obstétrica contendo os direitos da gestante no pré-parto, parto e pós-parto, e também as atribuições dos profissionais de enfermagem para a realização da assistência de enfermagem. Este tema requer abordagens e reflexões frequentes, através de educação permanente, para que ocorra uma assistência mais humana e digna, capaz de gerar mais segurança e confiança para os profissionais de enfermagem realizarem os procedimentos acerca do cuidado. Percebeu-se que a assistência obstétrica sem respaldo científico, agressiva e que em muitas vezes viola os direitos humanos básicos das mulheres está atrelada ao modelo de atenção ao parto vigente. Através da enfermagem obstétrica pode-se resgatar o protagonismo e o empoderamento da gestante no processo de gestar e parir. Este tema requer mais estudos e o desenvolvimento de novas pesquisas nesta área, a fim de permitir importantes tomadas de decisões dos profissioanis de saúde e assessorar na elaboração de novas políticas públicas.

Orientador: Ana Maria Segall Correa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T19:09:49Z (GMT). No. of bitstreams: 1 Gouveia_CristianeMoretti_M.pdf: 2691354 bytes, checksum: c5ebcf4d90fe493f5689917c710d408c (MD5) Previous issue date: 2008 / Resumo: As intervenções durante o trabalho de parto e parto têm sido objeto de debates de órgãos nacionais e internacionais. No Brasil há mobilização, por meio dos gestores de suas políticas públicas, no sentido de diminuir o número de cesarianas, episiotomias e outras intervenções que se revelaram inadequadas quando utilizadas sem indicação clínica. O objetivo desta pesquisa é estudar a relação entre intervenções clínicas e cirúrgicas no trabalho de parto e parto e a saúde física e psicológica (transtornos mentais menores) das mulheres no puerpério imediato, mediato e tardio de um hospital público do interior do Estado de São Paulo. Trata-se de um estudo de caráter descritivo, com abordagem quantitativa, no qual foram entrevistadas 278 mulheres no puerpério imediato e mediato (em torno do 10o dia), com perguntas referentes ao seu estado físico e psicológico. No 40o dia pós parto foi possível entrevistar 130 mulheres com o objetivo de analisar possíveis intercorrências tardias. A análise estatística inicial foi exploratória, com descrição de freqüência dos eventos e testes bivariados para nível de significância de 95%. A análise da medida de efeito foi realizada através da prevalência para observar complicações no puerpério imediato e tardio de acordo com as categorias de cada variável. Os resultados mostraram índices de analgesia e parto fórcipe acima dos citados em literatura. O parto fórcipe se mostrou fator de risco para lacerações perineais mais severas e Rns com Apgar menor que 7 no 1º minuto. / Abstract: The interventions during labor and delivery have been subject of national and international agency debates. In Brazil, health policies has been implemented in order to reduce the rates of surgical delivery, episiotomies, and other birth procedures revealed as inadequate when used without clinical indication. The aim of this study is to identify the relationship between interventions during labor and delivery and, the physical and psychological women's condition in the puerperal period in a public hospital in the State of São Paulo. It's a quantitative descriptive study that depicts the assistance received in the labor and its association to the kind of delivery, the interventions performed, the occurrence of depression and complications to the mothers in their puerperium. A sample of 278 women have been interviewed about their physical and psychological state on the 10th day of their puerperium, and 130 out of these 278 on the 40th day. An analysis was undertaken for potential risky factors, with outcome variable being presence or absence of complications. Confidence intervals at 95% level were calculated for each variable. Prevalence was calculated to identify the relationship between delivery clinical and surgical procedures and woman's health during puerperium period. The results showed a prevalence of analgesia and instrumental delivery above the expected by the current literature. Forceps delivery was a risk factor for more severe perineal lacerations and for newborns with and Apgar index lower than 7 in the first minute of life. / Mestrado / Epidemiologia / Mestre em Saude da Criança e do Adolescente

A Institucionalização da assistência ao parto colaborou muito para o avanço da obstetrícia. Foi possível acompanhar o desenvolvimento primeiro do parto e puerpério e depois do período gestacional, o que proporcionou aos profissionais detectar e tratar as complicações do período gravídico-puerperal, fazendo com que o principal objetivo da institucionalização da assistência ao parto fosse alcançado, a diminuição das taxas de mortalidade materna e neonatal. Mas com o avanço das práticas obstétricas, a maioria das gestações e partos, de baixo risco obstétrico, com evolução fisiológica, também foram encarados como de alto potencial para complicações. Isso fez com que procedimentos desnecessários e de rotina fossem introduzidos na assistência a gestação, parto e puerpério. O uso desenfreado desses procedimentos na assistência ao parto, no final do século passado, trouxe como consequência um aumento da morbimortalidade materna e perinatal, e a incorporação de intervenções danosas se tornou problemática. Objetivo: identificar a prevalência de intervenções obstétricas realizadas em mulheres durante o trabalho de parto e parto. Metodologia: trata-se de um estudo transversal descritivo, de caráter quantitativo, com coleta retrospectiva de dados em prontuário, sobre o emprego de intervenções obstétricas em parturientes atendidas no Centro de Referência da Saúde da Mulher - MATER, durante outubro, novembro e dezembro de 2009 e janeiro, fevereiro e março de 2010, totalizando 810 prontuários. Resultados: A maioria (83,6%) das mulheres apresentavam entre 18 e 34 anos de vida, realizaram pré-natal e estavam na primeira gestação. A amniotomia foi praticada em 41,7% das mulheres, sendo a maioria realizada (56,9%) na fase ativa do trabalho de parto; a infusão de ocitocina foi utilizada em 61,7% das parturientes e o início da infusão, em 63,4% das mulheres, aconteceu na fase ativa do trabalho de parto; 56,8% das mulheres receberam analgesia de parto, a maioria (75,4%) realizada na fase ativa do trabalho de parto e 77,6% das mulheres que receberam analgesia receberam apenas uma dose da medicação; a monitorização eletrônica fetal (cardiotocografia) foi realizada em 32,5% das mulheres, na maioria (65,4%) apenas uma vez; e a episiotomia esteve presente em 37,3% dos partos vaginais; a incidência de parto cesárea foi de 28,8% e de parto fórceps de 3,2%. Conclusão: considerando os resultados obtidos e a discussão realizada, podemos constatar que a maternidade em estudo possui índice da maioria das intervenções abaixo dos índices nacionais e, algumas vezes, índices próximos a de países desenvolvidos, porém a maioria das intervenções tem índices acima dos recomendados pela Organização Mundial da Saúde e pelo Ministério da Saúde brasileiro. Sendo assim, é necessária a revisão de alguns protocolos institucionais, assim como uma conscientização da equipe assistencial quanto aos riscos e benefícios reais das intervenções obstétricas empregadas durante o trabalho de parto e parto. / The institutionalization of delivery care contributed greatly to the advancement of obstetrics. It was possible to first follow the development of childbirth and later the period of pregnancy, which allowed professionals to detect and treat complications of the pregnancy and puerperal period, enabling the achievement of the main goal of institutionalization of labor care, to decrease maternal and neonatal mortality rates. The advancement of obstetrical practices, however, made most pregnancies and births with low obstetric risk, with physiological evolution, to be seen as with high potential risk for complications. This caused unnecessary and routine procedures to be introduced into pregnancy, childbirth and postpartum care. The rampant use of these procedures in delivery care, at the end of last century, caused an increase in maternal and perinatal morbidity and mortality, and the practice of damaging interventions has become problematic. Objective: to identify the prevalence of obstetric interventions performed on women during labor and delivery. Methods: this is a cross-sectional, quantitative and descriptive study, with retrospective data collection in patient files, about the use of obstetric interventions in pregnant women who receive care at the Reference Center for Women\'s Health - MATER, from October 2009 to March 2010, totaling 810 patient files. Results: Most (83.6%) women were aged between 18 and 34 years, received prenatal care and were at their first pregnancy. Amniotomy was performed in 41.7% of women, most (56.9%) were held in the active phase of labor, oxytocin infusion was used in 61.7% of pregnant women and start of infusion for 63.4% of women occurred at the active phase of labor. Of the total, 56.8% received labor analgesia, most (75.4%) were performed at the active phase of labor and 77.6% of women who underwent analgesia received only one dose of medication. Electronic fetal monitoring (cardiotocography) was performed in 32.5% of women, in most (65.4%) only once, and episiotomy was present in 37.3% of the vaginal deliveries, the incidence of cesarean section was 28.8% and of forceps deliveries was 3.2%. Conclusion: considering the results obtained and discussions held, it was noted that the studied hospital has rates for most interventions lower than the Brazilian rates, and sometimes levels are close to the ones found in developed countries, however, most interventions have rates above those recommended by the World Health Organization and the Brazilian Ministry of Health. Thus, there is need to review some institutional protocols, as well as raising awareness of the health care team regarding the real risks and benefits of obstetric interventions used during labor and delivery.

Considerando que o ato fisiológico de parir e nascer passou a ser visto como patológico, onde se privilegia a assistência medicalizada e despersonalizada, o presente estudo através de uma abordagem qualitativa, teve como objetivo evidenciar, através dos discursos das enfermeiras e médicos obstetras, as ações desenvolvidas no processo de nascimento, com vistas à humanização da assistência; e identificar fatores que têm dificultado a implementação dessa assistência. Foram sujeitos deste estudo 25 profissionais de saúde da Maternidade do Complexo Aeroporto-MATER, localizada em Ribeirão Preto, interior do estado de São Paulo, distribuídos da seguinte forma: sete (7) enfermeiras residentes do primeiro ano de enfermagem obstétrica, quatro (4) enfermeiras residentes do segundo ano de enfermagem obstétrica, quatro (4) enfermeiras contratadas; dois (2) residentes de medicina do primeiro ano de ginecologia e obstetrícia; três (3) residentes de medicina do segundo ano de ginecologia e obstetrícia e cinco (5) médicos obstetras contratados. A organização dos dados constou da transcrição dos discursos microgravados nas entrevistas e tabulação, seguindo a proposta do Discurso do Sujeito Coletivo. Os resultados demonstraram que as enfermeiras entendem que o processo de humanização se deu como uma estratégia política que objetiva a melhoria da assistência, e o resgate do parto mais natural possível, desmedicalizando a assistência. Acreditam que para existir há necessidade de uma mudança de paradigma. Consideram ainda, que na implementação deste modelo, sentem-se impedidas/barradas pelos médicos. No entanto os médicos referiram como responsável ao processo da humanização a política governamental para dimuição de gastos, julgando como parto humanizado aquele em se permite a presença do acompanhante e analgesia precoce. Em relação às barreiras apontaram a infra-estrutura física e pessoal. Os achados mostraram diversidades nos conceitos e que as enfermeiras apresentam-se mais integradas ao parto humanizado como um processo e não como um evento. / Considering that the physiologic act of giving birth and be born is seen as pathologic, the medicalized and depersonalized assistence is emphasized. Aimed at evidencing the develop actions during the birth process with humanized assistence foundation, the qualitative approach was used for the nurses and obstetric doctors discusses to identify factors that could hinder this assistance. The subjects of this study were 25 health professionals from a Maternity of Complexo Aeroporto-MATER, in Ribeirão Preto City inner of São Paulo State. They were distributed as: seven (7) resident nurses from second year of obstetric nursing, four (4) employed nurses, two (2) resident doctors from first year of obstetric and gynecologic, three (3) resident doctors from second year of obstetric and gynecologic and five (5) employed obstetric doctors. The data was micro recorded during the interviews then transcribed, following the Collective Subject Discuss Purpose. The results reveal the nurses understand the humanization process as a political strategy to improve the assistence and the rescue the normal birth desmedicalizing the assistence. They believe that for its existence, the paradigm must be changed. They also think that they collaborate with this movement but some barriers are created by doctors. Otherwise doctors mentioned the governmental politic to reduce costs as responsible for humanized process. They also judged humanized birth as which that allows companion presence and early analgesia. As barriers they pointed at physical infra-structure and personal ones. The finds revealed diversity in concepts and that nurses showed more integrated with the humanized birth as a process and not as an event.

Objective: Unknown ethiology Background: Capnocytophaga ochracea is a gram-negative anaerobic organism commonly found in human oral flora. It is characteristically sensitive to beta-lactams and resistant to aminoglycosides. Case Report: A 23-year-old woman presented with lower abdominal pain and was admitted for premature labor at 24-weeks of gestation. At presentation, the cervix was closed and the membrane was intact; however, contractions continued, the membrane subsequently ruptured before receiving any steroids or magnesium, and the mother gave birth to a 540-gram female baby. At birth, Apgar scores were 1 at 5 minutes, 1 at 10 minutes, and 2 at 15 minutes. On the fifth day of life, the blood culture grew Capnocytophaga species. Consequently, Cefotaxime was started and ampicillin continued for a total of 14 days; however, on the 6th day, the head ultrasound showed grade 4 intraventricular hemorrhage and a Do Not Resuscitate (DNR) order was placed in the chart. The patient's health continued to deteriorate, having multiple episodes of bradycardia and desaturation until cardiac arrest on the 17th day. Conclusions: Capnocytophaga ochracea was isolated from the blood culture of a preterm neonate. It was thought to be the cause of the premature labor and subsequent neonatal septicemia. This case report suggests that the prevalence of Capnocytophaga infections is most likely underestimated and that additional premature labors and abortions could have been caused by Capnocytophaga infections that were never detected. Hence, more studies are needed to investigate the route of transmission.

Abstract Background: Hypoxaemia during tracheal intubation in obstetrics remains a lifethreatening complication. This study aimed to identify common clinical preinduction predictors of difficult intubation. Methods: A retrospective analysis was performed of data pertaining to tracheal intubation in patients requiring general anaesthesia for caesarean delivery, with a gestational age from 20 weeks, and until 7 days post-delivery, obtained from an obstetric airway management registry (ObAMR) at the University of Cape Town. Data was entered anonymously into a secure UCT REDCap database. Data categories were: patient and pregnancy characteristics, airway characteristics, details of management, and operator experience. The primary aim of the study was to identify anatomical and physiological risk factors for hypoxaemia. The primary outcome was defined as arterial desaturation to < 90% during obstetric airway management. For this purpose, multivariable binary logistic regression was performed. Hypoxaemia was thus used as a composite indicator of anatomical and physiological difficulty. Results: Data was collected for 1095 general anaesthetics in the ObAMR. Overall, 143/1091 of patients (13.1%, 95%CI 11.1 to 15.4%) experienced peripheral oxygen saturation below 90%. Univariate analysis showed that 91/142 (64.1%) of patients who desaturated were obese (body mass index [BMI]> 30 kg/m2 ), compared with 347/915 (37.9%) who were obese and did not experience desaturation (p< .001). A receiver operating curve (ROC) was constructed post hoc, which showed a cut-point for BMI of 29.76, and a sensitivity of 0.66, and specificity 0.62 for the prediction of hypoxaemia. Desaturation occurred in 17.0% of patients with hypertensive disorders of pregnancy, versus 11.0 % without (p=0.005). Increasing Mallampati class was associated with an increased incidence of hypoxaemia. The incidence of hypoxaemia was 25.8% for interns, compared with 8.0 % for consultant anaesthesiologists (p=0.005). In the multivariate analysis of factors associated with hypoxaemia, body mass index (p< 0.001), room air saturation prior to preoxygenation (p=0.008), and the presence of airway oedema (p=0.027), were independently associated with hypoxaemia. Conclusions: In this study, both anatomical and physiological predictors of hypoxaemia were identified. Using this concept, a predictive tool could be developed to aid in the identification of a difficult airway in obstetrics. Simple interventions such as face mask ventilation and the use of high flow nasal oxygenation, could be introduced to protect the parturient from the consequences of life-threatening hypoxaemia.

Objetivo: Determinar si la edad materna está asociada a un aumento o disminución de riesgo de complicaciones obstétricas y perinatales, ajustándola por diversas variables confusoras. Métodos: Estudio de cohorte retrospectiva de 67 693 gestantes en Lima, entre enero del 2000 a diciembre del 2010, usando la base de datos del Sistema informático perinatal del Hospital Nacional María Auxiliadora. Las complicaciones fueron comparadas entre gestantes adolescentes (< 20 años) y gestantes adultas (20-35 años); el grupo adolescente se clasificó en adolescentes tardías (15-19 años) y adolescentes tempranas (< 15 años). Se obtuvieron los Odds Ratio ajustados con la regresión logística simple y múltiple. Resultados: Al ajustar las diversas variables, se encontró mayor riesgo de cesárea e infección puerperal en las adolescentes menores de 15 años, así como mayor riesgo de episiotomía en el grupo total de adolescentes. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia, hemorragia de la 2da mitad del embarazo, ruptura prematura de membranas, amenaza de parto pretérmino y desgarro vaginal. Conclusiones: Se encontró al embarazo adolescente como factor de riesgo para complicaciones obstétricas. Por lo tanto, se recomienda un control prenatal multidisciplinario para éste grupo etario. / Objective: To determine whether maternal age is associated with increased or decreased risk of obstetric and perinatal outcomes, adjusting by several factors. Metods: Retrospective cohort study of 67 693 pregnant women in Lima, from January 2000 to December 2010, using the perinatal database computer system from the Hospital Nacional María Auxiliadora. Outcomes were compared among pregnant adolescents (< 20 years) and adults (20-35 years); in addition, the adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years). Adjusted odds ratios were obtained through logistic regression analysis. Results: Adjusting by several factors, an increased risk of cesarean and puerperal infection in adolescents less than 15 years was found, as well as an increased risk of episiotomy in the total group of adolescents. In addition, this study identified a lower risk of preeclampsia, 2nd half-pregnancy bleeding, premature rupture of membranes, preterm labor and vaginal tearing among adolescent mothers. Conclusion: Teenage pregnancy was found as a risk factor for adverse obstetric outcomes; hence, a multidisciplinary prenatal care for this group of adolescent is recommended. Key Word: Adolescent pregnancy, obstetric outcomes, perinatal outcomes / Tesis

No existing measure to date captures mother-infant togetherness. A valid measure of togetherness is essential to engage in evidence-based practice, evaluate obstetric delivery models and nursing interventions, and measure the level of togetherness which promotes optimal maternal-infant outcomes. When together and in close proximity, a women and her infant have access to one another to allow for mutual caregiving or caregiving on cue. A new measure entitled the Mother-Infant Togetherness Scale (MITS) was developed based on a review of the literature and conceptual framework of Mother-Newborn Mutual Caregiving. The MITS is a 35- item instrument composed of four subscales that measures the timing, duration, and intensity of togetherness of the mother-infant dyad during entire hospitalization. The purpose of this multiphase study was to obtain support for the validity of the MITS. Phase 1 determined the content validity at the scale (S-CVI), subscale, and item level (ICVI) with a panel of expert judges. The final sample for the content validation consisted of 7 judges from medicine (n = 2), maternal-child nursing (n = 1), nursing research (n = 3), and social work (n = 1). Judges were instructed to use a 4-point Likert scale to rate the relevance of each item (I-CVI) to the construct of togetherness. The S-CVI was calculated from the mean I-CVI scores. The CVI-S of .88 was just slightly below the desired CVI-S ( > .90). Of the four subscales, all had adequate CVI ( > .90) at the subscale level except the delivery affective subscale (CVI = .74) and postpartum affective subscale (CVI = .89). The delivery events and postpartum events subscales had satisfactory CVI scores (CVI > .90), 1.00 and .94, respectively. The CVI-I results identified a total of seven items on the affective subscales that did not meet the desired I-CVI ( > .78). iv Phase 2 pre-tested the readability and understandability of the MITS among eight postpartum women. During the interviews, the women were asked to complete the MITS and provide opinions about the readability and understandability of the directions and items. The audiotapes were transcribed word for word, reviewed for thematic content, and revisions made to the study instrument accordingly. This same sample of postpartum women participated in the content validation of the delivery affective subscale (items #4a-j) and postpartum affective subscale (items #17a-j). The I-CVI results identified that a total of six items on the affective subscales had a CVI-I of .75, just slightly below the desired I-CVI ( > .78). Scale items were deleted or revised and the instrument retested until the desirable CVI at the scale and subscale level was achieved. Phase 3 used a descriptive study design to examine women's ability to accurately selfreport birth events on the MITS delivery events subscale at 4 weeks postpartum, as compared to observer-collected data obtained at delivery to determine the most valid mode of administration. A purposive sample consisted of 45 women having delivered at a community hospital in southwest Florida. The research team completed the MITS delivery events subscale immediately after delivery. Women were sent the MITS for completion 4 weeks after delivery. McNemar Chi-Squares were (χ) were calculated from the self-reported MITS delivery events subscale scores and the observer-collected MITS delivery events subscale scores. No significant difference (p < .05) was found supporting self-reported mode of administration for the MITS. Phase 4 is in-progress and evaluates the reliability and validity of the MITS subscale and total scale scores. The interim analysis was performed on a sample of 113 postpartum participants (composed of the final sample of 31 participants from Phase 3 and the first 82 participants from Phase 4) having delivered at three of the four participating hospital study sites. Adequate internal consistency reliability was found at the scale level with Cronbach’s alpha ( = .89) and split-half reliability results ( = .79 – 81, r = .83 - .88). Of the 35 MITS items, 10 items (28.6%) were found to have item-total correlations less than .30, arguing against treating MITS items as a single total scale measure. Good internal consistency was found at the delivery events subscale level (α = .78). Exploratory factor analysis (EFA) identified a twofactor solution. The two factors were named Taking In and Taking Control and had internal consistency reliability.79 and .65, respectively. Additional work needs to be done to improve the internal consistency of the Taking Control factor. The postpartum events subscale also had low internal consistency ( = .58). This subscale was not factor analyzed because the item response data did not meet the criteria for factor analysis. The items on the postpartum events subscale were assessed to be unique, singular, heterogeneous items that did not correlate well with other items. These results are conceptually logical given the nature of what the items are measuring (occurrence/intensity of specific events in time). The delivery affective subscale had good internal consistency reliability ( = .85) and a two factor solution. The two factors, named Feelings At Delivery and Delivery Concerns, had adequate internal constancy ( = .81 and  = .80, respectively). The postpartum affective subscale had good internal consistency reliability ( = .92) and a one factor solution. Results for known groups testing based on feeding type and mode of delivery found all group differences were in the predicted direction. Higher scores were found for mother-infant dyads who breastfed than for mother-infant dyads who bottle fed. However, only group differences for the events subscales were substantive and statistically significant (p < 001.). Higher scores were found for mother-infant dyads who experiencing a vaginal delivery than for mother-infant dyads who experienced a cesarean delivery. Group differences were substantive and statistically significant (p < .01) for three of the four subscale scores. A post hoc power analysis on the means and standard deviations from the interim analysis and the between-groups comparison effect size observed for feeding type (d = .50) found a sample of 45 adequate to have statistical power at the recommended beta of .80 and alpha of .05. The post hoc power analysis on the effect size for mode of delivery (d = .75), found a sample of 156 are needed to obtain statistical power at the recommended beta of .80 and alpha of .05. Therefore, the desired sample size of 200 women for the final analysis is adequate to obtain statistical power. A third known group testing for the variable of central nursery availability could not be performed with the interim analysis data because no participants in the interim analysis sample reported this experience. However, this analysis will be performed with the final data set. This is the first study to operationalize togetherness during the entire hospitalization and to include all dimensions of the construct. The findings from this multi-phase study provide initial support for the reliability and validity of the MITS. Although the results from Phase 4 are interim and therefore tentative, they provide preliminary psychometric evidence for construct validity.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T14:13:11Z No. of bitstreams: 2 Dissertacao_JulianaSilvieiraBordignon.pdf: 1594491 bytes, checksum: cb8423b2daa22b2a87543e466e4954cd (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-08-22T14:13:12Z (GMT). No. of bitstreams: 2 Dissertacao_JulianaSilvieiraBordignon.pdf: 1594491 bytes, checksum: cb8423b2daa22b2a87543e466e4954cd (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-09-15 / The pain of childbirth is part of the human essence. However, some women do not refer to good experiences during their labor, even citing the pain of childbirth as the worst already felt, or far superior to what they expected. The aim of this study was to elaborate an extended systematic review of randomized clinical trials, updated to June 2017, which considers the Swiss ball as a non-pharmacological method of pain relief in labor, evaluate and list the heterogeneous points in the research methodologies of these clinical trials and to elaborate a protocol of randomized clinical trial considered "ideal" from the methodological point of view. The results of the six randomized controlled trials evaluated in the systematic review reinforce the possibility of this benefit but are limited by the poor quality of the available studies. This fact demonstrates the need to carry out new, methodologically adequate clinical trials that investigate the use of the ball in the first phase of labor. We conclude, therefore, that the use of non-invasive technologies, especially the Swiss ball, during labor should be implemented in all maternity wards, whether they are of normal risk or high risk, since it consists of an efficient, inexpensive and of easy handling and that offers to the parturients and their families a more humanized care. / A dor do parto faz parte da essência humana. Porém, algumas mulheres não remetem a boas experiências durante seus trabalhos de parto, chegando a citar a dor do parto como a pior já sentida, ou muito superior ao que esperavam. Dessa maneira, este estudo teve por objetivo elaborar uma revisão sistemática ampliada de ensaios clínicos randomizados, atualizada a junho de 2017, que contemple a temática do uso da bola suíça como método não farmacológico de alívio da dor no trabalho de parto, avaliar e listar os pontos heterogêneos nas metodologias de pesquisa desses ensaios clínicos e elaborar um protocolo de ensaio clínico randomizado considerado ―ideal‖ do ponto de vista metodológico. Os resultados dos seis ensaios clínicos randomizados avaliados na revisão sistemática reforçam a possibilidade deste benefício, mas é limitado pela baixa qualidade dos estudos disponíveis. Tal fato demonstra a necessidade de realização de novos ensaios clínicos, metodologicamente adequados, que pesquisem a utilização da bola na primeira fase do trabalho de parto. Concluímos, portanto, que o uso de tecnologias não invasivas, principalmente a bola suíça, durante o trabalho de parto deve ser implementada em todas as maternidades, sejam elas de risco habitual ou alto risco, pois consiste em uma técnica eficaz, de baixo custo e de fácil manejo e que oferece às parturientes e suas famílias um cuidado mais humanizado.