Objective: We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined. Method: Online survey of women who had at least one CS Results: We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS . The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions. Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed. Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required. In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved. Conclusions: A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.

Bakgrund: Att bli förälder vid akut kejsarsnitt kan upplevas som överväldigande. Under 1900-talet blev kejsarsnitt allt vanligare som förlossningsmetod i Sverige. Syfte: Syftet med studien var att belysa pappors upplevelser vid akut kejsarsnitt. Metod: I studien tillämpades kvalitativ innehållsanalys med induktiv ansats, där sex bloggar och tre vloggar inkluderades. Resultat: Pappor upplever oro för mammor och barn vid akut kejsarsnitt, oron hanteras med olika strategier. De upplever oklara roller vid akut kejsarsnitt, känner sig utlämnade och maktlösa. Pappor kan uppleva beskedet av akut kejsarsnitt som en lättnad. De har behov av kontinuerlig information för att situationen ska bli hanterbar. Studien belyser också pappors förmåga att ta till sig information. Slutsats: Pappor upplever oro över mammors och barns hälsa, samt välbefinnande. Deras oro dämpas av kontinuerlig information. Det är viktigt att barnmorskor inom förlossningsvården erbjuder pappor information, vilket kan minska känslan av oklar roll. Pappor upplever att barnmorskor inte ger relevant information vid det akuta skedet. / Background: Becoming a parent in an emergency caesarean section can be perceived as overwhelming. During the 20th century, caesarean section became an increasingly common method of childbirth in Sweden. Aim: The aim of the study was to shed light on fathers' experiences in emergency caesarean sections. Method: The study applied qualitative content analysis with an inductive approach, where six blogs and three vlogs were included. Results: Fathers experience anxiety for mothers and children in an emergency caesarean section, the anxiety is managed with different strategies. They experience unclear roles in the acute caesarean section, feel betrayed and powerless. Fathers may experience the message of an emergency caesarean section as a relief. They need continuous information to make the situation manageable. The study also highlights fathers' ability to absorb information.Conclusion: Fathers experience concerns about the health of mothers and children, as well as well-being. Their concerns are dampened by continuous information. It is important that midwives in maternity care offer fathers information, which can reduce the feeling of unclear roles. Fathers experience that midwives do not provide relevant information during the emergency phase

The thesis is aimed at perinatal factors affecting the emotional bond between a mother and a child (boding) during the first weeks postpartum. The literature review is divided into three chapters. The first chapter discusses the childbirth, the experience of childbirth and the factors affecting a subjective evaluation of the childbirth by a parturient. The second chapter follows up with an overview of findings concerning the initial afterbirth moments, and the interaction between a mother and a child during early contact. The third chapter introduces the concept of bonding. It describes its manifestations, possible measuring methods, and factors influencing its quality. The research part analyzes perinatal factors affecting bonding on a sample of 1108 mothers with the use of generalized linear regression. The independent variables are: mode of birth, the evaluation of childbirth experience by mother, and the process of early contact between a mother and a child. The results show that bonding during the first weeks postpartum was not affected by the mode of birth or by the parturient's evaluation of the childbirth experience. A significant effect was found in the occurrence of early contact between a mother and a child; mothers who had contact with the child during the first postpartum hour reported...

This study explores the genesis of the presence of the fetus in American culture by examining the evolution of American medical attitudes towards the unborn (1800-1865) in the lead up to the Physicians Crusade Against Abortion in the mid 19th century. Specifically, it analyzes how American allopathic physicians reconciled their denunciation of abortions for reproductive limitation with their approval of abortions for medical reasons, shedding light on how American physicians resolved maternal-fetal conflict. The study begins with an exploration of the medicalization of childbirth in the 18th century and how it created medical concern for the fetus. The forceps could spare the pregnant woman the craniotomy operation (collapse of the fetal skull) and save the fetus. However, not all cases of obstructed labour could be solved with the forceps, and as physicians displaced midwives as the principal birth attendants, they were confronted with the prospect of performing craniotomy on a live fetus. As they dreaded this outcome, they proposed two operations to circumvent it: the Caesarean section and induced premature labour. This shows that medicalization created concern for the fetus, particularly in the later stages of pregnancy. With new embryological research in the 1820s, concern for the fetus was extended to all stages of pregnancy and expressed itself in advice to women to guarantee a healthy child. The publication of Alfred Velpeau’s Principles of Tokology and Embryology was influential because it both normalized the fusion of embryology and obstetrics, and it justified recourse to early abortion in cases of contracted pelvises. Indications for the medical use of abortion began to multiply as a result of this shift, even as physicians denounced clandestine abortion and sought to criminalize it. This study argued the medical ideology of vitalism, as articulated by Xavier Bichat, was key in resolving maternal-fetal conflict in favour of the pregnant woman. Vitalism characterized fetuses as having the same functions as a plant and this lower level of functioning justified the sacrificing of fetal life in certain circumstances. Vitalism also viewed women to as having more sensibility, more cerebral activity, and more social ties. Therefore, women were viewed as the more deserving human being in maternal-fetal conflict.

Bakgrund: En övergripande indikation för ett omedelbart kejsarsnitt är om mammans, barnets eller bådas hälsa riskeras under en vaginal förlossning. I samband med dessa oförutsedda situationer ska anestesisjuksköterskan ha god omvårdnadskunskap men också kunskap gällande den medicinska utrustningen och assistera anestesiologen i samband med generell anestesi. Syfte: Syftet med studien var att beskriva anestesisjuksköterskans upplevelser av att delta vid omedelbart kejsarsnitt. Metod: En kvalitativ metod tillämpades. Data samlades in genom individuella semistrukturerade intervjuer och den insamlade datan analyserades genom kvalitativ innehållsanalys med manifest ansats. Resultat: Fyra kategorier formades utifrån den data som insamlats. Att hantera en omedelbart livshotande situation där två liv står på spel. Att vara förberedd på det oförutsedda. Att känna ovisshet i informationen till och om modern. Att lära sig hantera stress och otrygghet. Anestesisjuksköterskor beskrev omedelbart kejsarsnitt som en av de viktigaste situationer som de deltog vid i sitt arbete där två liv står på spel. Känslor som ovisshet och stress påverkade hur de hanterade situationen. Slutsats: Omedelbart kejsarsnitt är en akut situation som inte liknar någon annan akut situation. Då simuleringsövningar och erfarenhet är faktorer som bidrar till ett större lugn och fokus i denna akuta situation bör regelbundna övningar vara inplanerade i verksamheten.

Au Canada, en 2018-2019 la naissance par césarienne s’élève à 29% dépassant ainsi les taux de 10-15% recommandés par l’Organisation Mondiale de la Santé (OMS). Au cours des dernières années, les naissances par césariennes ne cessent d’accroitre, malgré les risques associés qui sont rapportés dans la littérature pour la mère et l’enfant. Bien que couramment pratiquée, la césarienne reste une intervention chirurgicale avec des risques à court et à long terme. Chez les enfants nés par césarienne, nous retrouvons des taux plus élevés d’asthme, d’obésité, de problème d’allergies etc. Tandis que chez les mères subissant la césarienne, nous retrouvons plus de cas d’infection, d’hémorragie et des risques plus élevées de rupture du placenta et de fausse couche lors des grossesses subséquentes. Puisque la prévalence de la césarienne ne cesse d’augmenter, il est primordial de comprendre son influence sur le développement neurologique de l’enfant. L’association entre le mode d’accouchement et les troubles neurodéveloppementaux tel que le trouble du déficit d'attention et d’hyperactivité (TDAH) chez les enfants est peu étudié avec des résultats souvent contradictoires ou non concluants. Le TDAH est l'un des troubles neurodéveloppementaux les plus courants chez les enfants avec une prévalence mondiale qui s’élève à 7.2% (IC 95% 6.7-7.8). Ainsi, le projet de ce mémoire a pour objectif d’évaluer l’association entre les modes d’accouchements et le TDAH chez l’enfant, tout en palliant les limites méthodologiques observées dans la littérature présentement. Afin de répondre à cette question, le projet évalue trois modes d’accouchements et ainsi recherche l’association entre l’accouchement par césarienne élective, par césarienne d’urgence ou par voie vaginale assistée et le risque de TDAH chez les enfants comparativement à l’accouchement par voie vaginale non assisté. Cette étude de cohorte rétrospective populationnelle tire l’entièreté de ses données de la Cohorte des Grossesses du Québec (CGQ) sur une période allant de 1998 à 2015. L’étude retrouve une augmentation de 6 % (IC 95% 1.03 - 1.10) du risque de TDAH chez les enfants nés par césarienne d’urgence et une augmentation de 12 % (IC 95% 1.06 - 1.19) du risque de TDAH chez les enfants nés par voie vaginale assisté avec ventouse ou forceps. Aucune association (HRa=0.96 IC 95% 0.91 - 1.01) n’a été retrouvée entre l’accouchement par césarienne élective et l’augmentation du risque de TDAH chez les enfants. Par la suite, plusieurs analyses de sensibilités ont été effectuées pour évaluer la robustesse des résultats, mais aucune n’a significativement alterné nos résultats. En conclusion, l’étude démontre l’existence d’une association entre l’accouchement par césarienne d’urgence et par voie vaginale assisté et le risque de TDAH chez les enfants. Ces résultats renforcent la nécessité d’étudier davantage les répercussions de la césarienne et des accouchements assistés avec des instruments sur l’enfant dans un contexte Canadien, où nous retrouvons peu de recherche sur le sujet. / In Canada the rate of caesarean deliveries is about 29 % of all birth in 2018-2019. Despite the known risk of this major surgery, caesarean section rates are continually rising beyond the recommended rate by the world health organization (WHO) of 10 to 15 %. Scientific research has identified several short- and long-term potential risks associated with this procedure for both the child and mother. For the child, researchers have found higher rates of asthma, obesity, and allergy problems. As for the mother, some of these risks include post-partum infection, hemorrhage and higher risks of placental rupture and miscarriages in future pregnancies. Caesarean section rates have been steadily increasing and it is essential to understand its influence on the neurological development of the child. Few studies have investigated the association between the mode of delivery and neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) in children. Currently the literature shows often contradictory or inconclusive results. ADHD is one of the most common neurodevelopmental disorders in childhood with a worldwide prevalence of up to 7.2% (CI 95% 6.7-7.8). Therefore, the project of this thesis aims to evaluate the association between modes of delivery and ADHD in children while overcoming the methodological limitations observed in the literature. To answer this question, the project is evaluating three modes of delivery by looking into the association between elective caesarean, emergency caesarean or assisted vaginal delivery and the risk of ADHD in children compared to unassisted vaginal birth. This prospective population-based study uses data on pregnancies and children from 1998 to 2015 from The Quebec Pregnancy Cohort (QPC). Our adjusted analyses showed that children born via emergency caesarean and assisted vaginal delivery were 6% (CI 95% 1.03 - 1.10) and 12% (CI 95% 1.06 - 1.19) respectively more likely to have ADHD compared to children born via unassisted vaginal delivery. 6 However, no association was found between elective caesarean birth (HRa=0.96 CI 95% 0.91 - 1.01) and the risk of ADHD in children. Several sensitivities analyze were performed to assess the robustness of these findings, but none significantly altered our results. While a caesarean delivery and assisted vaginal birth are essential and lifesaving procedures, they can put children at risk. As showed in this study, emergency caesarean and assisted vaginal birth increase the risk of ADHD in children. These findings reinforce the need for further research to evaluate the impact of caesarean and assisted deliveries on the children especially in a Canadian context where studies are still limited.

Le Cambodge est l'un des neuf pays au monde à avoir atteint l'OMD 5 des Nations Unies, c'est-à-dire à avoir diminué de trois quarts le taux de mortalité maternelle au niveau national entre 1990 et 2015. Ce taux est ainsi passé de 1020 à 161 décès maternels pour 100 000 naissances au cours de ces 25 années. Ce succès est le résultat de politiques publiques volontaristes : une politique de planification familiale, la mise en place de systèmes de financements de la santé, la formation puis le déploiement de milliers de sages-femmes sur le territoire. Cette réussite s'explique également par une mutation sociologique de premier plan : l'accouchement, qui était historiquement un événement avant tout social et qui se déroulait dans l'intimité de la maison, est devenu un événement public pour la femme et sa famille. Alors qu'en 2000 moins de 10% des femmes accouchaient dans une structure médicalisée, elles étaient plus de 80% dans cette situation en 2014, traduisant ainsi la biomédicalisation massive et soudaine de l'accouchement dans tout le pays. Cette recherche sociodémographique remet en question la vision idéalisée des Nations Unies concernant la santé maternelle au Cambodge en rendant visibles et en observant les pratiques obstétricales « par le bas » à partir d'une enquête empirique sur plusieurs terrains à Phnom Penh et en Kandal (milieu rural). La méthodologie développée conjugue une observation participante, à des entretiens semi-directifs auprès de soignants et de non soignants (hommes et femmes), des questionnaires auprès de femmes enceintes puis accouchées (cohorte), ainsi qu'une collecte de données médicales dans quatre maternités de Phnom Penh. Les résultats montrent que certains hôpitaux et cliniques pratiquent des épisiotomies systématiques, ce qui est contraire aux recommandations internationales, et que le taux de césariennes dans la capitale a presque triplé en quinze ans, dépassant depuis le début des années 2000 le seuil de 10% recommandé par l'OMS. Enfin, une pratique répandue de périnéorraphies visant à resserrer fortement le vagin de femmes jeunes et en bonne santé après des accouchements par voie basse, sans indication médicale, est courante dans la capitale. Ces pratiques obstétricales, historiquement construites, vont alors fréquemment être détournées de leur usage médical pour répondre à une demande sociale. Le corps des femmes a été appréhendé dans cette recherche comme un corps social et politique, révélateur des rapports sociaux, sur lequel se jouent de nombreux enjeux de pouvoirs. La thèse a révélé que ces trois pratiques obstétricales faisaient système en se renforçant les unes les autres. A l'intersection entre corps, genre et biomédecine, la recherche a montré que ces différentes pratiques obstétricales pouvaient être conçues comme des instruments de domination. Le genre, tel qu'il est pensé dans la société, va contribuer à fabriquer un sexe féminin, mais aussi à construire un corps féminin de façon plus générale. Mais la thèse a dévoilé également que certaines de ces pratiques vont être saisies par les femmes, afin d'accroître leur attractivité sexuelle, leur permettant de renégocier les rapports de genre, et de maintenir l'harmonie et la stabilité du couple. / Cambodia is one of the nine countries worldwide to have reached the United Nations - MDG 5. A reflection of this achievement is a 75% drop in the national maternal mortality ratio from 1020 to 161 deaths for 100 000 live births between 1990 and 2015. This success is the result of voluntary public policies i.e. a family planning policy; the set-up of health care financing systems; and the training of thousands of midwives across the country. A deep sociological transformation can also help to explain this success. While childbirth in Cambodia used to be a private event, which took place at home, it has now become a public event for women and their families. In 2000, less than 10% of women were giving birth in a medicalized structure. By 2014, this number rose to over 80%, showing the sudden and massive biomedicalization of childbirth across the country. This socio-demographic research challenges the idealized vision of the United Nations regarding maternal health in Cambodia by showing and observing obstetrical practices on the ground, from an empirical study led in several setups in Phnom Penh and in Kandal province (rural sector). This mixed method research draws from participant observation, semi-structured interviews with healthcare professionals and patients (men and women), questionnaires with pregnant women (pre- and post- childbirth), as well as examination of medical records from four Phnom Penh maternity wards. The results show that episiotomies are systematically performed in some hospitals and clinics, in contradiction with international recommendations. Furthermore, the number of caesarean sections in Phnom Penh has almost tripled in fifteen years, and since the beginning of the 2000s it is above the 10% threshold recommended by the WHO. Finally, in the capital city, a common practice is observed: perineorraphy, which aims at tightening the vagina of young and healthy women shortly after a vaginal delivery without any medical indication. These three obstetrical practices have historical roots and are now frequently used outside of their medical purpose, as a response to a rising social demand. In this research, women' body has been considered as a social and political object that reveals social relationships, where many power negotiations occur. The thesis shows that these three obstetrical practices are interconnected and form a system. At the intersection between body, gender and biomedicine, these different obstetrical practices can be understood as tool of domination that seeks to shape the female body according to social expectations. In this way, the perception of gender in a society shapes the female body, and more precisely, the female sexual organs. Nevertheless, some of these practices are nowadays consciously chosen by women to increase their erotic capital, in an attempt to renegotiate gender relationships and preserve marital harmony.

Made available in DSpace on 2016-08-10T10:53:32Z (GMT). No. of bitstreams: 1 JULIANE ZANOVELLI DOMINGUES VALADAO.pdf: 1138394 bytes, checksum: fa40a9a4b960bbfcd66a066da05aa71a (MD5) Previous issue date: 2012-06-02 / During pregnancy and at the moment of birth women should be oriented by health professionals in order to support and inform them about the procedures to be carried out in the normal delivery recovering this way her active role in the birth process. The Health Department established recommendations to improve the support to the normal delivery, introducing the Program of Humanization from Prenatal to Birth and the National Policy of Obstetric and Neonatal Attention with the attempt of consolidating the humanization in the birth process, decreasing the excessive medicalisation, hospitalization time due to the birth and the mortality and neonatal rates. The research is aimed at identifying the actions that were implemented by the public power in the maternities Augusta Gomes Bastos (public) and Modelo (Private) in Rio Verde / GO referring to the campaigns for the carrying out of humanized delivery indicated by the Health Department making a comparison between the years of 2000 and 2010. It was a comparative / quantitative study, carried out with 341 women that had normal deliveries and caesarean sections in 2000 and 2010 selected through medical records with appropriate authorization of the managers of the definite maternities for the research. Also took part of the research 46 doctors and nursing teams that work with PAISM (Programa de Atenção Integral a Saúde da Mulher - Program of Full Attention to Women Health) and managers of 04 selected Health Units. The data were organized and presented in graphics, charts and tables and the interpretation showed the following results - the predominance of normal delivery in the public institution related to 2000 and 2010. The caesarean sections were carried out in women at the age between 25 and 34 years old (76%) and the normal delivery was 59% in the same age group. Related to the assistance received by the women in the maternities it was considered good with 49% in the public and 51% in the private one. The data also showed that the women accept the normal delivery in the two institutions with 100%, however do not carry it out due to lack of attention of the professionals and the pain. It is concluded that the public maternity carries out more normal delivery than caesarean sections despite weakness in the attention and that the private one is not adapting to the Public Policy and do not promote suitable capacity to the health professionals. / Durante a gestação e o momento do parto as mulheres devem ser orientadas pelos profissionais de saúde no sentido de apoiá-las e informá-las sobre os procedimentos a serem realizados no parto normal resgatando assim seu papel ativo no processo parturitivo. O Ministério da Saúde estabeleceu recomendações para melhoria da assistência ao parto normal, implantando o Programa de Humanização do Pré-Natal ao Nascimento e a Política Nacional de Atenção Obstétrica e Neonatal na tentativa de consolidar a humanização na parturição, diminuir a medicalização excessiva, o tempo de hospitalização do parto e as taxas de mortalidade materna e neonatal. A pesquisa tem como objetivo: Identificar as ações que foram implementadas pelo poder Público nas maternidades Augusta Gomes Bastos(Pública) e Modelo (Privada) de Rio Verde/GO referentes às Campanhas para a realização do Parto Humanizado indicadas pelo Ministério da Saúde fazendo uma comparação entre os anos de 2000 e 2010. Tratou-se de um estudo comparativo/quantitativo, realizado junto a 341 mulheres que tiveram partos normais e cesáreos em 2000 e 2010 selecionadas por meio de prontuários médicos com a devida autorização dos Gestores das maternidades definidas para a pesquisa. Também participaram DA PESQUISA 46 profissionais médicos/equipe de enfermagem que atuam no PAISM (Programa de Atenção Integral a Saúde da Mulher) e gestores de 04 Unidades de Saúde selecionadas. Os dados obtidos foram organizados e apresentados em gráficos, quadros e tabelas cuja interpretação revelou os seguintes resultados- na instituição pública em relação a 2000 e em 2010 a predominância de parto normal. Os partos cesáreos foram realizados em mulheres com idade entre 25 a 34 anos (76%) e o parto normal foram 59% na mesma faixa etária. Em relação à assistência recebida pelas mulheres nas maternidades foi considerada boa com 49% na pública e 51% na particular. Os dados também revelaram que as mulheres aceitam o parto normal nas duas instituições com 100%, porém não o realizam devido à falta de atenção dos profissionais e a dor. Conclui-se que a maternidade pública realiza mais o parto normal do que cesáreo mesmo com debilidade na atenção e que a privada não está se adequando conforme as Políticas Públicas faltando promover a devida capacitação dos profissionais de saúde.

Introdução: Sabe-se que a cesariana sem indicação clínica está associada a desfechos adversos para a saúde da mulher e de seus filhos a curto e longo prazos. A variação da proporção de cesáreas entre serviços e países não pode ser explicada somente por características inerentes à mulher. Fatores como a fonte de financiamento da assistência também têm forte influência sobre a via de nascimento. Objetivo: Descrever e comparar os fatores socioeconômicos, demográficos, clínicos e obstétricos associados à cesariana entre mulheres assistidas no Sistema Único de Saúde (SUS) e no setor de saúde suplementar (SSS). Método: Estudo transversal, a partir dos dados do inquérito Nascer no Brasil, referentes à Região Sudeste. A amostra foi composta por puérperas que tiveram recém-nascidos vivos, natimortos (peso 500 gramas e/ou idade gestacional 22 semanas) e parto normal ou cesariana, em hospitais com 500 partos em 2007. A associação entre a cesariana e as variáveis estudadas foi verificada por meio de regressão logística binária univariada e múltipla. Calcularam-se odds ratios (OR) brutas e ajustadas e intervalos de confiança (IC) de 95 por cento . Resultados: A amostra foi composta por 9.828 mulheres. A taxa de cesariana foi de 52,9 por cento , com proporção maior no SSS (84,0 por cento ). Ser adolescente (SUS: OR=0,68; IC 95 por cento 0,57-0,81/SSS: OR=0,48; IC 95 por cento 0,27-0,84) e ter o nascimento assistido em hospitais de alguma das capitais (SUS: OR=0,39; IC 95 por cento 0,34-0,45/SSS: OR=0,48; IC 95 por cento 0,36-0,65) ofereceram chances menores para cesárea nos dois financiamentos. Exercer trabalho remunerado (SUS: OR=1,32; IC 95 por cento 1,16-1,51/SSS: OR=2,94; IC 95 por cento 2,14-4,03), ter cesariana anterior (SUS: OR=22,06 IC 95 por cento 18,33-26,56/SSS: OR=64,48; IC 95 por cento 32,78-126,84), ser primípara (SUS: OR=4,86; IC 95 por cento 4,16-5,69/SSS: OR=8,37; IC 95 por cento 5,96-11,75) e ter apresentado intercorrências durante a gestação (SUS:OR=9,27; IC 95 por cento 8,17-10,53/SSS:OR=3,09; IC 95 por cento 2,22-4,31) representaram chances aumentadas para cesariana entre mulheres assistidas no SUS e no SSS. Estiveram associados independentemente à cesariana, apenas no SUS: ter 35 anos ou mais (OR=1,36; IC 95 por cento 1,09-1,69); ter cursado ensino superior ou mais (OR=2,53; IC 95 por cento 1,78-3,59); não ter companheiro(a) (OR=0,78; IC 95 por cento 0,68-0,90); pertencer às classes econômicas A, B ou C (respectivamente: OR=1,72; IC 95 por cento 1,39-2,12/OR=1,29; IC95 por cento 1,09-1,53) e ter apresentado intercorrências durante o trabalho de parto (OR=3,18; IC 95 por cento 2,62-3,85). Conclusões: A fonte de financiamento foi determinante na indicação da cesariana no SSS, uma vez que se sobrepôs à maioria dos fatores socioeconômicos, demográficos, clínicos e obstétricos. Já no SUS, determinantes sociais referentes à melhor condição socioeconômica se associaram à cesariana. / Introduction: Caesarean section without clinical reason is associated with women and their children adverse outcomes at short and long term. Variation of caesarean section rates among services and countries can not be explained only by women´s characteristics. Payment source has strong influence on the decision of mode of birth. Objective: To describe and compare socioeconomic, demographic, clinical and obstetric factors associated with caesarean section among women in public health system (SUS) and private health care sector (SSS). Methods: Cross-sectional study with Southeast´ data of \"Born in Brazil\" national survey. The sample included women who had live births or stillbirths (weighing 500 g and/or gestational age 22 weeks) and normal or caesarean deliveries, in hospitals with 500 births in 2007. The association between caesarean section and other variables was verified by univariate and multiple binary logistic regression, on which crude and adjusted odds ratios (OR) and confidence intervals (CI) of 95 per cent were calculated. Results: The sample comprised 9,828 women. The caesarean section rate was 52.9 per cent , with higher proportion in SSS (84.0 per cent ). Being an adolescent (SUS: OR=0.68, CI 95 per cent 0.57-0.81/SSS: OR=0.48, CI 95 per cent 0.27-0.84) and having a hospital in a capital city as a place of birth (SUS: OR=0.39, CI 95 per cent 0.34-0.45/SSS: OR=0.48, CI 95 per cent 0.36-0.65) were associated to lower chances of caesarean section in both funding sources. Paid employment (SUS: OR=1.32, CI 95 per cent 1.16-1.51/SSS: OR=2.94, CI 95 per cent 2.14-4.03), a previous caesarean section (SUS: OR=22.06 CI 95 per cent 18.33-26.56/SSS: OR=64.48 CI 95 per cent 32.78-126.84), to be primiparous (SUS: OR=4.86, CI 95 per cent 4.16-5.69/SSS: OR=8.37, CI 95 per cent 5.96-11.75) and complications during pregnancy (SUS:OR=9,27; IC 95 per cent 8,17-10,53/SSS:OR=3,09; IC 95 per cent 2,22-4,31) represented increased chances for caesarean section among women in SUS and SSS. The following variables were independently associated with caesarean section, only in SUS: 35 years old or more (OR=1.36, CI 95 per cent 1.09-1.69); higher education or more (OR=2.53, CI 95 per cent 1.78-3.59); no partner (OR=0.78, CI 95 per cent 0.68-0.90); belonging to A, B or C economic classes (respectively: OR=1.72, CI 95 per cent 1.39-2.12/OR=1.29, CI 95 per cent 1.09-1.53) and complications during labor (OR=3.18, CI 95 per cent 2.62- 3.85). Conclusions: The high proportion of caesarean sections in the SSS demonstrated that this funding source was crucial on caesarean section indications and overcame socioeconomic, demographic, clinical and obstetrical factors. Indicators of better socioeconomic condition were associated to caesarean section in SUS.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T17:03:02Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_ElisandraMedianeiraRazeraNogueira.pdf: 1885193 bytes, checksum: 73789c4b74f2dd3f15dd637b55a1760d (MD5) / Made available in DSpace on 2018-08-22T17:03:02Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_ElisandraMedianeiraRazeraNogueira.pdf: 1885193 bytes, checksum: 73789c4b74f2dd3f15dd637b55a1760d (MD5) Previous issue date: 2017-12-18 / Introduction: The process of childbirth and birth went through relevant transformations over a long time, but it is still predominantly institutionalized and technological, with the predominance of cesarean sections. Despite the stimulus to normal birth, Brazil has high rates of cesareans, so there is a need to implement humanized practices in cesarean care, so as to also enable a qualified and humanized service for these women. Objective: Therefore, the main objective was to elaborate a protocol for the humanization of the birth through cesarean delivery in a medium-sized hospital in the city of Santa Maria - RS. Method: The first manuscript was a narrative review of literature. A search was made in the Lilacs database about the professional practices of humanization in childbirth care and hospital birth. The final sample consisted of 9 articles, which are unanimous in pointing out the efforts to change the predominant obstetric model. The humanized practices are being implemented in the health services, however, there is a need to broaden the look of humanized care during cesarean section. The second manuscript emerged from a qualitative, descriptive and cross-sectional study performed in the mid-sized hospital, from a semi-structured interview with 106 postpartum women. Data collection occurred between October 2016 and April 2017. Regarding the kind of delivery, it was observed that the puerperae chose cesarean due to the fear of pain in normal delivery and also by their own desire. During the preparation for the cesarean section, the majority of the puerperae received all the information and explanations they wanted. It was also evidenced that the team provided a humanized care throughout the process in the surgical center, through the reception, skin-to-skin contact between mother and baby soon after birth and the presence of accompanying person throughout the process. The third manuscript aimed to identify the humanization practices performed by the professional team of a surgical center during the cesarean section and to elaborate a humanization protocol for care. It was an exploratory-descriptive and qualitative research carried out with eight professionals who work in the surgical center. The focal group technique was applied between July and August of 2017 and later analysis of thematic content. Results: Two thematic categories emerged which discuss the humanized practices described by the participants in the operating room environment during cesarean section. Conclusion: From the data collected with the puerperal and professional women, a protocol of delivery and cesarean delivery was constructed in a surgical center, directed to the implementation of humanized practices, which configured the product resulting from the research process. This protocol aims to implement humanized practices, contributing to the qualification of care provided to patients and their families and record the activities performed by professionals. / Introdução: o processo de parto e nascimento passou por transformações relevantes ao longo tempo, porém, ainda se configura predominantemente institucionalizado e tecnológico, com predomínio das cesarianas. Apesar do estímulo ao parto normal, o Brasil apresenta elevadas taxas de cesarianas, assim há a necessidade de implementar práticas humanizadas na assistência a cesariana, de maneira a possibilitar também um atendimento qualificado e humanizado para essas mulheres. Objetivo: criar um protocolo de humanização do nascimento por meio do parto cesárea em um hospital de médio porte da cidade de Santa Maria – RS. Método: o primeiro manuscrito realizado foi uma revisão narrativa de literatura, por meio de busca na base de dados Lilacs, sobre as práticas profissionais de humanização na assistência ao parto e nascimento hospitalar. A amostra final foi composta de 9 artigos. O segundo manuscrito emergiu de uma pesquisa quali-quantitativa, descritiva e transversal, realizada no hospital de médio porte, a partir de entrevista semiestruturada com 106 puérperas. A coleta de dados ocorreu entre outubro de 2016 a abril de 2017. O terceiro manuscrito objetivou identificar as práticas de humanização realizadas pela equipe profissional de um centro cirúrgico, durante a cesariana e elaborar um protocolo de humanização para a assistência. Tratou-se de uma pesquisa exploratório-descritiva e qualitativa, com oito profissionais que atuam no centro cirúrgico. Aplicou-se a técnica de grupo focal, entre julho e agosto de 2017 e posterior análise de conteúdo temática. Resultados: em relação à revisão narrativa, os artigos são unânimes em apontar esforços para a mudança do modelo obstétrico ainda predominante. As práticas humanizadas estão sendo implementadas nos serviços de saúde, mas é necessário ampliar o olhar para o atendimento humanizado na cesariana. O segundo artigo constata que, quanto à escolha pela via de parto, as puérperas optaram pela cesárea devido ao medo da dor no parto normal e por desejo próprio. Durante a preparação para o procedimento, a maioria das puérperas recebeu orientações. A equipe prestou um atendimento humanizado durante todo o processo no centro cirúrgico, por meio do acolhimento, contato pele a pele entre mãe-bebê logo após o nascimento e a presença de acompanhante durante todo o processo. A partir do terceiro artigo, emergiram duas categorias temáticas as quais discutem as práticas humanizadas descritas pelos participantes no ambiente do centro cirúrgico durante a cesariana. Conclusão: a partir dos dados coletados com as puérperas e profissionais, foi construído um protocolo de assistência ao parto e nascimento por cesariana, em um centro cirúrgico, direcionado para a implementação de práticas humanizadas, o qual configurou o produto resultante do processo de pesquisa. Este protocolo tem por objetivo, implementar práticas humanizadas, contribuindo para a qualificação do atendimento prestado às pacientes e suas famílias e registro das atividades realizadas pelos profissionais.