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.

Resumo: Descrever a estrutura e o processo da assistência ao parto e recémnascido no Hospital das Clínicas da Faculdade de Medicina de Botucatu-UNESP. Métodos: trata-se de estudo descritivo e transversal. Para análise da estrutura, entrevistou-se o responsável pela maternidade e utilizou-se instrumento de observação do serviço. Realizou-se análise do processo a partir de dados obtidos de prontuários de partos amostrados e da observação de partos realizados em 2004. Resultados: A análise da estrutura evidenciou disponibilidade de equipamentos, instrumentais e medicamentos. A equipe conta com obstetra, pediatra e anestesista na sala de parto e estas são adequadas para partos vaginais e cesáreas. Não há lavabos individuais, nem quartos de pré-parto, parto e puerpério. (PPP) Com relação ao processo, a análise dos prontuários mostrou que na admissão 86,3% das parturientes tiveram sua pressão arterial aferida e 78,8% passaram pelo exame de toque vaginal; 87% dos fetos foram auscultados. No trabalho de parto, segundo os observadores, 62,1% das mulheres permaneceram em jejum, o controle não farmacológico da dor foi observado em 13,8% dos casos e em 96,6% deles havia partograma preenchido; para todos os recém-nascidos, realizou-se: índice de Apgar, administração de vitamina K e cálculo da idade gestacional segundo exame físico e para mais de 99% deles realizou-se antropometria, para 28,7% exame anti-HIV e 98,6% tipagem sangüínea. Conclusões: os resultados apontam a necessidade de quartos PPP e a precariedade dos registros nos prontuários. Sugere-se a implantação de um sistema de informações que viabilize a pronta avaliação de indicadores de qualidade da atenção. / Abstract: Evaluate the infra-structure and the process of childbirth and nursery in the Medical School at Sao Paulo State University, 8otucatu, SP. Method: This is a descriptive and transversal study. The supervisor of the nursery was interviewed and the service as a whole was observed. The analysis of the process was done based on the data collected from childbirth diaries and childbirth observation since 2004. Results: The maternity area consists of equipments, instruments, and medicines. The team consisted of an obstetrician, pediatrician, and anesthetist in the delivery room and they were prepared for vaginal delivery and cesarean section. There are no private lavatories, pre-childbirth rooms, childbirth rooms or puerperium rooms. Analysing the flow, the analyze of diaries pointed out that during the admission of the pregnant women 86.3% of them had their blood pressure taken, 78.8% had a vaginal touch exam, and 87% of the embryos were listened. During the birth delivery, 62.1% of the women fasted, 13.8% did not take any medicine for pain, and 96.6% had the partograph filled. The following measures were taken in ali newborns, the Apgar index, vitamin K ingested, and gestation age based on physical exercise. 99% had an anthropometry exam, 28.7% had HIV exam, and 98.6% blood type exam. Conclusion: The final results shown that there is a necessary to have private lavatories, pre-childbirth rooms, childbirth rooms or puerperium rooms and the data in the diaries are insuficient. There is a need to implement a information system that can better measure the indicators of quality. / Orientador: Vera Therezinha Medeiros Borges / Coorientador: Cristina Maria Garcia de Lima Parada / Banca: Maria Jose Clapis / Banca: José Carlos Peraçoli / Mestre

Submitted by Luis Gustavo Narciso (luisgustavo.medvet@hotmail.com) on 2018-03-12T12:51:40Z No. of bitstreams: 1 TESE LUIS GUSTAVO 0903.pdf: 2591558 bytes, checksum: 4d518ab0bd8cefde5184d024ae6fa425 (MD5) / Approved for entry into archive by Ederson Vasconcelos Pereira null (edersonpereira@fmva.unesp.br) on 2018-03-12T19:35:52Z (GMT) No. of bitstreams: 1 narciso_lg_dr_araca_int.pdf: 2591558 bytes, checksum: 4d518ab0bd8cefde5184d024ae6fa425 (MD5) / Made available in DSpace on 2018-03-12T19:35:52Z (GMT). No. of bitstreams: 1 narciso_lg_dr_araca_int.pdf: 2591558 bytes, checksum: 4d518ab0bd8cefde5184d024ae6fa425 (MD5) Previous issue date: 2018-02-23 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Determinaram-se a vitalidade e os perfis hematológicos, hemogasométricos e bioquímicos de 37 cabritos prematuros com, aproximadamente, 141 dias de vida intrauterina, oriundos de cabras submetidas a diferentes protocolos de corticoterapia, a saber: Grupo I -Constituído por dez cabritos com ± 141 dias de vida intrauterina, nascidos por meio de cesarianas, de cabras que receberam, por via intramuscular (IM) em dose única, 20 mg de dexametasona, dois dias antes da cirurgia eletiva (139 dias); Grupo II - Composto por nove cabritos com ± 141 dias de vida intrauterina, nascidos por meio de cesarianas, de mães que receberam, por via IM/SID, a saber : 2 mg de dexametasona, dos 133 aos 136 dias de gestação; 4 mg dos 137 aos 139; e 20 mg aos 140 dias de prenhez; Grupo III - constituído por nove cabritos com ± 141 dias de vida intrauterina, nascidos por meio de cesarianas, de cabras que receberam, por via IM/BID, 16 mg de dexametasona aos 139, com doses repetidas a cada 12 horas até a cirurgia eletiva; e Grupo IV - composto por nove cabritos com ± 141 dias de vida intrauterina, nascidos por meio de cesarianas, de cabras que receberam 4, 8, 16 e 20 mg de dexametasona, por via IM/SID, aos 137, 138, 139 e 140 dias de gestação, respectivamente. Os mesmos foram avaliados no que tange à vitalidade, pelo escore APGAR. Obtiveram-se amostras sanguíneas de cabritos ao nascimento, aos 60 minutos, às 12, 24 e às 48 horas, visando à determinação do hemograma, como também das variáveis hemogasométricas, insulina, cortisol, ureia, creatinina, glicose e lactato séricos, bem como da atividade sérica de gamaglutamiltransferase e da concentração de proteína total. Para determinação e avaliação das taxas e das possíveis causas de morbimortalidade, os recém-nascidos foram observados até os 30 dias de vida / Was determined the vitality and hematological profiles, hemogasometrics and biochemists of 37 kids approximately premature 141 days of intrauterine life, from goats subjected to different treatment protocols, namely: Group I- Consisting of ten goats with ± 141 days old, born through c-section, of goats that will receive, intramuscularly (IM) and once, 20 mg of dexamethasone, two days prior to elective surgery (139 days); Group II-composed of nine goats with ± 141 days old, born through c-section, of mothers who receive, via IM/SID: 2 mg of dexamethasone, 133 to 136 days of gestation; 4 mg of 137 to 139; and 20 mg to 140 days of pregnancy; Group III-consisting of nine goats with ± 141 days old, born through c-section, of goats that will receive, via IM/IDB, 16 mg of dexamethasone to 139, with repeated doses every 12 hours before elective surgery; and Group IV-composed of nine goats with ± 141 days old, born through c-section, of goats will receive 4, 8, 16 and 20 mg of dexamethasone, via IM/SID, to 137, 138, 139 and 140 days of gestation, respectively. The same will be evaluated with respect to vitality, APGAR score. This will give blood samples from goats at birth, to 60 minutes, at 12, 24 and 48 hours, aiming at determining the CBC, as well as the variables hemogasometrics, insulin, cortisol, urea, creatinine, serum lactate and glucose, as well as the Serum activity of associated disease and the concentration of total protein.For determination and assessment fees and the possible causes of morbidity and mortality, the newborns will be observed until the 30 days of life. Keywords: ruminants, dexamethasone, induced childbirth / FAPESP: 16/00808-6

Introdução: As influências lunares e ambientais no início do trabalho de parto ainda são pouco estudadas. Foi avaliada a influência extrínseca em eventos obstétricos. Métodos: em um hospital secundário, situado na cidade de São Paulo, Brasil, foram selecionados 1.826 dias em que ocorreram 17.417 partos. As internações por o trabalho de parto foram associadas à temperatura ambiental, pressão atmosférica, variação das marés e das fases lunares na incidência do excesso deste evento, pelo percentil 75. O índice Z (desvio padrão/ pela média) de cada variável foi calculado e a diferença diária indicou o aumento ou a diminuição. Foi utilizada a análise de regressão logística para a predição do excesso da admissão e p<0,05 foi considerado significativo. Resultados: Os preditores do excesso da internação por trabalho de parto foram: o aumento da temperatura (risco relativo: 1,742, p=0,045) e diminuição da pressão atmosférica (risco relativo: 1,269, p=0,029). O aumento da amplitude das marés foi associado com a probabilidade menor do excesso da internação (risco relativo: 0,762, p=0,030). A fase lunar não era preditora do excesso da admissão (p=0,339). Conclusão: Pela análise multivariada, o aumento da temperatura e a diminuição da pressão atmosférica predisseram a ocorrência do excesso da admissão por trabalho de parto e o aumento da amplitude das marés, como uma medida da força gravitacional lunar, foi preditora de uma menor probabilidade do excesso do trabalho de parto / Background: lunar and environmental influences in vaginal delivery remain unclear. We assessed extrinsic influence in obstetric events. Methods: in a secondary line hospital, located in São Paulo city, Brazil, we selected 1,826 days, in which occurred 17,417 admissions for obstetric labor, and we studied influence of air temperature, atmospheric pressure, tides range, and lunar phases in incidence of excess of obstetric labor, defined as more than 9 admissions per day. Z score (standard deviation from mean) of each variable was calculated, and diary difference to indicate increase or decrease was assessed by logistic regression for prediction of admission excess. Two-side P< 0.05 was considered significant. Results: predictors of admission excess were increase of temperature (relative risk: 1.742, P=0.045), and decrease of atmospheric pressure (relative risk: 1.269, p=0.029). Increase of tides range was associated with lower probability of admission excess (relative risk: 0.762, P=0.030). Lunar phases was not predictor of admission excess (P=0,339). Conclusion: By multivariate analysis, increase of temperature and decrease of atmospheric pressure predicted occurrence of excess of obstetric labor admission, and increase of tidal range, as lunar gravitational force measurement, predicted lower probability of admission excess

Apesar dos esforços a favor da humanização do nascimento, sabemos que ainda se fazem presentes na prática uma série de procedimentos intervencionistas no trabalho de parto e parto que interferem nesse processo. Assim, a depender de como se dá o processo de parturição, este acarretará nas condições maternas e neonatais para o início do aleitamento materno, e como consequência, no processo da amamentação, uma vez que a mulher deve ser o elemento chave para esta prática. A prontidão do recém-nascido (RN) para mamar, depende do seu estado de consciência, sendo que pode apresentar-se mais sonolento em situações que envolvem o uso de anestésicos ou outras intervenções em suas mães durante o trabalho de parto. O objetivo do presente estudo é identificar a relação entre a prontidão do RN para sugar a mama materna na primeira mamada no alojamento conjunto e a condução do trabalho de parto, parto e nascimento. Trata-se de um estudo observacional, transversal, descritivo exploratório, realizado com 43 binômios, com RN de idade gestacional entre 37 e 41 semanas e 6 dias, Apgar >= 7 no 5º minuto, filhos de mães primíparas. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, com protocolo (Nº1219/2010). As informações do processo de nascimento foram coletadas dos prontuários, e a partir das entrevistas às puérperas. A avaliação da prontidão dos RN para sugarem, foi feita por meio de filmagens dos neonatos desde o início ao término da primeira mamada no alojamento conjunto, sendo avaliados os estados de sono e vigília e mamada, com base no Formulário de Observação da mamada da OMS (1997). De acordo com o formulário os itens foram categorizados como \"sinais positivos\" e \"sinais negativos\", relacionados às condições favoráveis e às dificuldades na mamada. A análise foi fundamentada na estatística descritiva e na realização de testes estatísticos para análise comparativa entre as variáveis. Quanto aos resultados, em sala de parto, 17 (39,5%) neonatos foram colocados em contato pele imediato e apenas 4 (9,3%) sugaram o seio materno. Das 43 parturientes, 39 (90,7%) receberem analgesia, porém apenas 14 (32,6%) receberam a segunda analgesia (repique). No momento em que as mesmas receberam a primeira analgesia, a dilatação cervical variou entre 2 e 9 cm, sendo que 13 (33,3%) estavam com 5 cm. No repique, a dilatação cervical variou entre 4 e 10 cm, sendo que 6 (42,9%) estavam com 8 cm. O período mínimo de duração do trabalho de parto, foi de 25 minutos, e o tempo máximo, 11 horas. A menor duração do período expulsivo foi de 1 minuto e o tempo máximo, 59 minutos. Quanto aos dados referentes ao puerpério imediato, 36 (83,7%) mães referiram que estavam com sono logo após o parto e apenas 9 (20,9%) delas relataram estar sentindo algum tipo de dor e quanto ao cansaço, a maioria 41 (95,3%) referiu estar cansada. O período sem ingerir líquido variou de 33 minutos a 22h e 35 min e o período em jejum alimentar variou entre 2h 50 min e 21h 05 min. Em relação ao estado de sono e vigília no período que antecedeu a mamada, 18 (41,9%) dos recém nascidos estiveram no estado alerta quieto. Durante a mamada em 21(48,8%) dos neonatos, o estado sono ativo foi predominante. Na avaliação da mamada, os índices positivos se fizeram presentes nos diferentes domínios avaliados: 86,1% na sucção, 85,6% na postura corporal, 82,3% nas respostas do RN, 100% na anatomia da mama, no 78,4% tempo gasto na sucção durante a mamada. Quanto às associações entre as variáveis do trabalho de parto, parto e nascimento e as da mamada, obteve-se dados significativos entre a duração do período expulsivo e grupo sono e sonolento de estado de sono e vigília, com p=0,03. Embora as mães tivessem recebido intervenções durante o trabalho de parto e parto que pudessem interferir na qualidade da primeira mamada em alojamento conjunto, a maioria dos neonatos apresentou-se em estado de alerta, isto foi o suficiente para que eles apresentassem boa prontidão para mamar neste momento. O alojamento conjunto precoce, se mostrou uma prática favorável para a obtenção de sinais positivos na avaliação da primeira mamada à admissão de ambos. / Despite efforts to promote the humanization of birth, we know that still present in practice a number of interventional procedures during labor and childbirth that interfere with this process. So, depending on how is the parturition process, this will result in maternal and neonatal conditions for the initiation of breastfeeding, and as consequence, in the process of breastfeeding, since the woman should be the key element to this practice. The readiness of the newborn (NB) to nurse, depends on your state of consciousness, and may present more drowsy in situations involving the use of anesthetics or other interventions in their mothers during labor. The aim of this study is to identify the relationship between NB readiness to suck the maternal breast in the first feeding on the rooming in and conduct of labor, and birth. This is an observational, cross-sectional, descriptive and exploratory, conducted with 43 binomials, with NB in the gestational age between 37 and 41 weeks and 6 days, Apgar score >= 7 in the fifth minute, the children of first-time mothers. The project was approved by the Research Ethics Committee of the Nursing School of Ribeirão Preto, University of São Paulo, with protocol (No. 1219/2010). Information from the birth process was collected from medical records and from interviews with puerperal. The assessment of the NB readiness to suck, was made by filming the neonates from the beginning to the end of the first feeding in rooming in, evaluated the states of sleep and wakefulness and feeding, based on Observation of breastfeeding from WHO (1997). According to the form of the items were categorized as \"positive signals\" and \"negative signals\", related to the favorable conditions and difficulties in feeding. The analysis was based on descriptive statistics and statistical tests for comparative analysis between the variables. As for the results in the delivery room, 17 (39.5%) neonates were placed in immediate contact skin and only 4 (9,3%) sucked the breast. Of the 43 pregnant women, 39 (90.7%) received analgesia, but only 14 (32.6%) received the second analgesia (reinjection). At the moment in which they receive a first analgesia, cervical dilation varied between 2 and 9 cm, while 13 (33.3%) had 5 cm. In reinjection, cervical dilation varied between 4 and 10 cm, and 6 (42.9%) had 8 cm. The minimum duration of labor was 25 minutes and the maximum period 11 hours. The lowest delivery duration was 1 minute and the maximum time, 59 minutes. As for the data relating to postpartum, 36 (83.7%) mothers reported that they were sleepy soon after birth and only 9 (20.9%) of them reported to be feeling some sort of pain and tiredness, the most 41 (95.3%) reported being tired. The period without ingesting fluid ranged from 33 minutes to 22h and 35 min and fasting period varied between 50 min and 21h 2h 05 min. Regarding the state of sleep and wakefulness in the run-feeding, 18 (41.9%) of the infants were in quiet alert state. While feeding in 21 (48.8%) of the neonates, the active sleep state was predominant. In the assessment of breastfeeding, positive indices were present in different areas evaluated: 86.1% in sucking, 85.6% in body posture, 82.3% of infants\' responses, 100% in the anatomy of the breast, 78, 4% time spent sucking during breastfeeding. Regarding the associations between the variables of labor, and birth and breastfeeding, significant data was obtained from the delivery duration and sleep group and sleepy state of sleep and wakefulness, with p = 0.03. Although mothers had received interventions during labor and delivery that could interfere with the quality of the first feeding in rooming in, most neonates presented on alert, that was enough for them to present good readiness to nurse this time. The early rooming in practice proved favorable for obtaining positive signals in the evaluation of the first feed intake both.

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

Introdução: No parto normal, muitas mulheres têm lacerações perineais espontâneas, mas a prevalência, as características e os fatores relacionados a estas são pouco estudados. Objetivos: 1. Caracterizar as lacerações perineais espontâneas no parto normal; 2. Analisar as lacerações perineais espontâneas no parto normal, conforme as condições sociodemográficas maternas, as condições clínicas e obstétricas na gestação e no parto e as condições do recém-nascido; 3. Avaliar as morbidades perineais relacionadas às lacerações espontâneas até 48 horas após o parto. Método: Estudo transversal, realizado no Amparo Maternal, São Paulo (SP), entre outubro de 2011 e janeiro de 2012. Foram incluídas 100 mulheres com idade 18 anos; gestação a termo; feto único, em apresentação cefálica; parto normal com laceração espontânea. Os desfechos primários foram tipo, localização, grau, forma e tamanho da laceração espontânea, avaliados com a Peri-Rule. As análises descritiva e inferencial foram realizadas por meio dos testes Qui-quadrado, t-Student, ANOVA e correlação de Pearson, com p-valor <0,05 apontado como estatisticamente significante. Resultados: 51% das mulheres tiveram laceração única, 49% lacerações múltiplas; 58% tiveram laceração na região anterior do períneo, 80% na região posterior e 23% na parede vaginal; 77,5% tiveram laceração de 1º grau, 20% de 2º grau e 2,5% de 3º grau (sem rotura completa do esfíncter anal); 62,5% das lacerações eram de forma linear, 35% em forma de U e 2,5% ramificadas; na região anterior, a média da extensão das lacerações foi 28,6mm (±12,9); na região posterior, a média da extensão da mucosa foi 26,1mm (±10,5), a média da extensão da pele foi 24,3mm (±10,4) e a média da profundidade foi 18,1(±8,6). Na parede vaginal, a média da extensão foi 19,8mm (±6,5). Para o cálculo da média do tamanho das lacerações, foi considerado o maior valor para cada mulher. Houve diferença estatisticamente significante em relação às seguintes variáveis: localização (região anterior e posterior do períneo e parede vaginal) e idade materna; grau (primeiro, segundo e terceiro) e realização de exercícios perineais na gestação, edema perineal no parto, tipo de puxo, variedade de posição no desprendimento cefálico e tamanho da circunferência cefálica; forma (linear, U ou ramificada) e exercício perineal na gestação, uso de misoprostol, tipo de puxo, variedade de posição no desprendimento cefálico e circunferência cefálica; tamanho das lacerações na região posterior do períneo (extensão na pele) e edema perineal, altura do períneo e uso de ocitocina; tamanho das lacerações na região anterior do períneo (extensão da mucosa) e idade materna, uso de misosprostol e peso do recém-nascido; extensão parede vaginal e edema perineal. Não houve diferença estatisticamente significante em relação ao tipo de laceração (única ou múltipla). As principais morbidades perineais no pós-parto foram ardência, edema, hematoma, equimose e dor. Conclusão: A região posterior do períneo foi a mais afetada e as médias do tamanho das lacerações variaram de acordo com o local atingido. A ocorrência de lacerações de terceiro grau e a frequência de lacerações na parede vaginal indicam a importância da avaliação criteriosa do esfíncter anal, assim como do canal de parto, mesmo quando não há solução de continuidade aparente na região perineal. / Introduction: Most vaginal delivery are accompanied by spontaneous perineal lacerations. However there is a lack of knowledge related to prevalence, characteristics and risk factors of these lacerations in the literature. Aims: 1. To characterize the spontaneous lacerations in normal birth; 2. To analyze the spontaneous perineal lacerations in normal birth, according to socio-demographic, clinical and obstetric conditions during pregnancy and childbirth and the conditions of the newborn; 3. To evaluate morbidities related to spontaneous perineal lacerations until 48 hours after delivery. Methods: A cross-sectional study was carried out in Amparo Maternal maternity unit, São Paulo, BR. The data was collected from October, 2011 to January, 2012. There were included 100 women aged 18 years; fullterm pregnancy; single live fetus and vertex presentation; normal birth with spontaneous laceration. The primary outcomes were type, area, degree, shape and size of spontaneous lacerations, using the Peri-Rule. Descriptive and inferential analyzes were appraised using the chi- square test, Student\'s t-test, ANOVA and Pearsons correlation, with p-value<0.05 indicated as statistically significant. Results: 51% of women had single laceration and 49% multiple ones; 58% had anterior perineum lacerations, 80% in the posterior area and 23% in the vaginal wall; 77.5% had 1st degree, 20% 2nd degree and 2.5% 3rd degree lacerations (without complete rupture of the anal sphincter); 62.5% of lacerations were linear, 35% were \"U\" shape and 2.5% star shape. The average length of lacerations was 28.6 mm (sd ± 12.9) in the anterior area; the average length of the mucosa in the posterior area was 26.1 mm (sd ± 10.5), the length of skin was 24.3 mm (sd ± 10 4) and the depth was 18.1 (± 8.6); the average length of the vaginal wall was 19.8 mm (sd ± 6.5). In order to calculate the average size of lacerations, the highest value for each woman was considered. There were significant differences for the following variables: area (anterior and posterior perineum area and vaginal wall) and maternal age; degree (first, second and third) and perineal exercises during pregnancy, presence of perineal edema during labor, type of pushing, fetal position variety and size of head circumference; shape (linear, \"U\" or star) and perineal exercise during pregnancy, use of misoprostol, type of pushing, head delivery position and head circumference; size of lacerations in the posterior perineum area (skin length) and perineal edema, perineum height and use of oxytocin; size of lacerations in the anterior perineum area (mucosa length) and maternal age, use of misoprostol and weight of the newborn; length of the laceration on vaginal wall and perineal edema. There was no statistically significant difference in the type of laceration (single or multiple). Major postpartum perineal morbidities were blazing, edema, hematoma, ecchymosis and pain. Conclusion: The posterior perineum area was the most affected and the average size of lacerations varied according to the affected area. The occurrence of third degree lacerations and the frequency of lacerations in the vaginal wall indicate the importance of careful evaluation of the anal sphincter, as well as the birth canal, even if when the is no apparent solution of continuity in the perineum.

M.Cur. / The standard of care in midwifery services improves all the time. Because of this reason mothers are experiencing more of midwifery services and also of antenatal preparation services. This can be seen in the increasing demand for active birth, plychoprophlaxis and preparation for delivery. The higher the standard of antenatal preparation, the more positive the influence on the birthing process. Because of the isolation of the nuclear family from the traditional family and its recourcee, more pressure is put on professional people and other recources for formal antenatal preparation programs. Standards are therefore essential for effective antenatal preparation to ensure optimal care.

M.Cur. (Advanced Midwifery and Neonatal Nursing Science) / The aim of this study was to explore and describe antenatal education needs of low-risk pregnant clients receiving basic antenatal care in the public health setting, in a health care facility in Tshwane. Very little antenatal education is being given to pregnant clients receiving basic antenatal care in the public health setting, in contrast to antenatal education provided to women who make use of private health care facilities during their pregnancy and attend private antenatal classes. The need for antenatal education of clients receiving care in the public health setting may well be intensified due to the often marginalised circumstances from which these clients originate and a lack of informal learning opportunities on childbirth, coupled with the possibly aggravating influence of cultural practices which may be harmful to both mother and child. Not having access to this education may negatively affect the pregnancy, birth, and postnatal period. The lack of antenatal education often causes woman to unnecessarily seek medical help at already overloaded clinics, which could be prevented if the women received proper antenatal education. The opposite is also true: many women do not seek medical help in time because of a lack of antenatal education. Through a qualitative study, antenatal educational needs of clients receiving basic antenatal care in a community health setting in Tshwane within the public health setting, were explored and described. The specific needs which should be addressed were identified by the clients through individual interviews, as well as by the health care workers caring for them, through focus group interviews. Both the interviews and focus groups were audio-taped, transcribed and analysed using Tesch’s steps to qualitative data analysis. An independent coder was used to ensure trustworthiness. This analysed data was compared to the relevant available literature and was found to be corresponding. The identified needs were then utilised to make recommendations for midwifery practice to meet the antenatal educational needs, including a proposed programme to be presented in the public health setting in Tshwane to clients receiving basic antenatal care. The programme suggests three education classes which can be presented, addressing all the needs identified through the study. Recommendations for midwifery education and further research were additionally presented.

M.Cur. / Few South African studies have been done with regard to private midwives and their clients. The practices of these midwives are overloaded, indicating a growing need for their services. An exploratory, contextual and descriptive study was undertaken to investigate some of the issues relating to the practice of the private midwife. This was done from the perspective ofthe women attending these practices. The aims of this study were to explore and describe how women experience the care they receive from their private midwives in Gauteng during antenatal visits, labour and postnatal contacts; to explore and describe the reasons for clients of private midwives in Gauteng to choose an independent midwife as birth attendant and to explore how these clients get to hear about their midwives. Eight women, attending a total of two different midwifery practices, were interviewed. The main categories that emerged from analysing the women's experience of private midwifery care were that the midwives were caring, family orientated, informative, knowledgeable, guiding and unintrusive. Time was both respected and given by the midwives. The midwives saw childbirth as a normal and natural process. The midwives empowered the women and left them in control oftheir childbirth. A mutual, intimate relationship was formed between the women and their midwives, which was based on trust and continuity of care. The women felt they were treated as unique individuals. One woman related some negative aspects ofthe care she received. A variety of reasons were given for choosing a private midwife as birth attendant. Some had specific wishes for their birth, such as a homebirth and knew that private midwives would grant them Other reasons included cost effectiveness, control over childbirth, one on one care, shorter waiting periods, longer consulting times and wanting an experienced birth attendant. Previous negative experience with staff at government hospitals and private gynaecologists; and hearing about positive experiences with private midwives also contributed to women opting for independent midwives. The women got to hear about their private midwives through their general practitioner, obstetrician, antenatal class instructor, friends, family members or health professional that delivered a previous baby. These research findings were supported by existing literature and recommendations were made to midwifery practice, education and research.