Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-08-04T17:24:50Z No. of bitstreams: 2 uendel_goncalves_almeida.pdf: 25566837 bytes, checksum: 8f4a43d5f5742febfd8e61390ac67e7c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-08-14T16:53:08Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) uendel_goncalves_almeida.pdf: 25566837 bytes, checksum: 8f4a43d5f5742febfd8e61390ac67e7c (MD5) / Made available in DSpace on 2017-08-14T16:53:08Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) uendel_goncalves_almeida.pdf: 25566837 bytes, checksum: 8f4a43d5f5742febfd8e61390ac67e7c (MD5) Previous issue date: 2016 / Sabe-se que a viol?ncia obst?trica caracteriza-se pela apropria??o do corpo em processos reprodutivos das mulheres pelos profissionais da sa?de. Este tipo de viola??o ao corpo feminino ocorre por meio de tratamento desumanizado, abuso da medicaliza??o e patologiza??o dos processos naturais, o que causa a perda da autonomia e capacidade de decis?o livre sobre seus corpos e sexualidade. Al?m disso, h? um impacto negativo na qualidade de vida das mulheres. Sendo assim, esta disserta??o tem como objetivo avaliar a exist?ncia de viol?ncia obst?trica entre mulheres atendidas pelo Programa Mulheres Mil, no munic?pio de Almenara, Vale do Jequitinhonha, Minas Gerais. Neste sentido, o conhecimento adequado do planejamento para o parto ? um instrumento fundamental para decidir qual dos tipos ser? escolhido. Nesta pesquisa, buscou-se apresentar os melhores ou menos arriscados caminhos para o parto, por meio de entrevistas realizadas com vinte gestantes que falaram como se sentiram e foram tratadas pelo servi?o de sa?de, especificamente da enfermagem obst?trica e, tamb?m, por meio de revis?o bibliogr?fica, ao utilizar autores que estudaram a tem?tica defendida. O estudo ? transversal, com t?cnicas quantitativas e qualitativas. Atento ? proposta do curso de mestrado profissional interdisciplinar, buscou-se alinhar aos problemas reais encontrados pelo autor no dia a dia da pr?tica assistencial ?s gestantes, ao intuito de humaniza??o da assist?ncia prestada pelos profissionais da ?rea de sa?de. Diante dos dados colhidos na pesquisa, restou clara a necessidade de uma cartilha informativa a ser mantida nos postos e hospitais e tamb?m distribu?das entre as mulheres gestantes. Sabe-se tamb?m que toda mulher tem direito ao pr?-natal de qualidade e este tem como objetivo a sa?de e o bem-estar dela e do beb?. Por?m, ainda h? registros de casos de maus-tratos e omiss?o, inclusive na hora do parto. Com a interpreta??o dos dados coletados, constatou-se que h? falta de informa??es que devem ser prestadas ?s mulheres gr?vidas. Tamb?m foi poss?vel verificar que a cesariana vem sendo usada como uma pr?tica de programa??o da m?e, sem levar em conta a necessidade ou mesmo o que seria melhor para a crian?a. Muitas mulheres t?m optado por esse tipo de parto sem que os postos de sa?de ou hospitais lhes mostrem os riscos provenientes dessa pr?tica. As parturientes entrevistadas, al?m de n?o saberem as informa??es b?sicas acerca da obstetr?cia humanizada, desconheciam seus direitos sobre o assunto. Mas, ainda mais grave, alguns foram negados a elas, como o de ter um acompanhante. A forma mais eficaz de combate ? viol?ncia obst?trica ? despertando a popula??o para a exist?ncia dessa realidade. Desta forma, o acesso ? informa??o contribui para o empoderamento das mulheres, que podem ser v?timas do medo de denunciar quem praticou a viol?ncia. A humaniza??o do parto relaciona-se, esta forma, diretamente com a atua??o dos profissionais de sa?de que, por meio da a??o coletiva, interdisciplinar, e com respeito ? fisiologia materna, pretende minimizar as interven??es desnecess?rias por meio do reconhecimento social e cultural do parto e do suporte emocional oferecido ? parturiente e a sua fam?lia de modo a promover a cria??o de la?os na rela??o m?e-beb?. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / It is known that obstetric violence is characterized by the appropriation of the body in the reproductive processes of women by health professionals. This type of violation to the female body occurs through dehumanized treatment, abuse of medicalization and pathologization of natural processes, which causes loss of autonomy and ability to decide freely on their bodies and sexuality. In addition, there is a negative impact on women's quality of life. Thus, this dissertation aims to evaluate the existence of obstetric violence among women attended by the Women Thousand Program, in the municipality of Almenara, Vale do Jequitinhonha, Minas Gerais. In this sense, adequate knowledge of childbirth planning is a key tool in deciding which type to choose. In this research, we attempted to present the best or least risky ways of delivery, through interviews with twenty pregnant women who spoke about how they felt and were treated by the health service, specifically obstetric nursing, and also by means of a review Bibliographical, when using authors who studied the theme defended. The study is transversal, with quantitative and qualitative techniques. Aiming at the proposal of the interdisciplinary professional master's degree course, we sought to align with the real problems encountered by the author in the day-today practice of care for pregnant women, in order to humanize the care provided by health professionals. Given the data collected in the research, the need for an informative booklet to be maintained at the stations and hospitals and also distributed among pregnant women remained clear. It is also known that every woman has the right to prenatal quality and this is aimed at the health and well-being of her and the baby. However, there are still records of cases of maltreatment and omission, including at the time of delivery. With the interpretation of data collected, it was found that there is a lack of information that should be provided to pregnant women. It was also possible to verify that cesarean section has been used as a programming practice for the mother, regardless of the need or even what would be best for the child. Many women have opted for this type of delivery without the health posts or hospitals showing them the risks from this practice. The parturients interviewed, in addition to not knowing the basic information about humanized obstetrics, did not know their rights on the subject. But even more serious, some were denied to them, such as having an escort. The most effective way to combat obstetric violence is to awaken the population to the existence of this reality. In this way, access to information contributes to the empowerment of women, who may be victims of the fear of denouncing those who have committed violence. The humanization of childbirth is directly related to the work of health professionals who, through collective, interdisciplinary action and with respect to maternal physiology, seeks to minimize unnecessary interventions through the social and cultural recognition of childbirth And the emotional support offered to the woman and her family in order to promote the creation of bonds in the mother-baby relationship. / Sabemos que la violencia obst?trica caracteriza por la apropiaci?n del cuerpo en los procesos reproductivos de las mujeres por parte de profesionales de la salud. Este tipo de violaci?n del cuerpo femenino se produce a trav?s del tratamiento deshumanizado, abuso de medicalizaci?n y patologizaci?n de los procesos naturales, lo que provoca la p?rdida de la autonom?a y la toma de decisiones sobre sus cuerpos y sexualidad libre. Adem?s, hay un impacto negativo en la calidad de vida de las mujeres. Por lo tanto, este trabajo tiene como objetivo evaluar la existencia de la violencia obst?trica entre mujeres atendidas en el Programa de mil mujeres, en el municipio de Almenara, Valle de Jequitinhonha, Minas Gerais. En este sentido, el conocimiento adecuado de la planificaci?n para el parto es una herramienta fundamental para decidir cuales ser?n elegidos tipos. En este estudio, hemos tratado de presentar los mejores y menos arriesgadas formas de entrega, a trav?s de entrevistas con veinte mujeres que contaron c?mo se sintieron y fueron tratados por el servicio de salud, en particular la obstetricia y tambi?n a trav?s opini?n literatura, utilizando los autores que han estudiado el tema defendidos. El estudio es transversal, con t?cnicas cuantitativas y cualitativas. Atento a la propuesta de la interdisciplinario grado de maestr?a profesional, se busc? alinear a los problemas reales encontrados por el autor en la pr?ctica del d?a a d?a la atenci?n a las mujeres embarazadas, a la humanizaci?n del orden proporcionada por profesionales de la salud. Antes de que los datos recogidos en la investigaci?n, sigue siendo una necesidad clara de un folleto informativo que se le mantenga en cl?nicas y hospitales, y tambi?n distribuye entre las mujeres embarazadas. Se sabe tambi?n que toda mujer tiene derecho a la calidad de la atenci?n prenatal y esto est? dirigido a la salud y su bienestar y el beb?. Sin embargo, a?n existen registros de casos de malos tratos y de omisi?n, incluso en el momento de la entrega. La interpretaci?n de los datos recogidos, se ha descubierto que existe una falta de informaci?n que debe proporcionarse a las mujeres embarazadas. Tambi?n se observ? que la ces?rea se utiliza como pr?ctica de programaci?n de la madre, independientemente de la necesidad o incluso lo que ser?a mejor para el ni?o. Muchas mujeres han optado por este tipo de parto sin los centros de salud u hospitales mostrarles los riesgos de esta pr?ctica. Las madres entrevistadas, y no saben la informaci?n b?sica sobre los obstetricia humanizados, desconocen sus derechos en la materia. Pero a?n m?s grave, algunos se les neg? a ellos, tales como tener un compa?ero. La manera m?s efectiva para combatir la violencia obst?trica est? despertando al p?blico de la existencia de esta realidad. Por lo tanto, el acceso a la informaci?n contribuye a la potenciaci?n de la mujer, que pueden ser v?ctimas del miedo a denunciar a aquellos que cometen violencia. La humanizaci?n del parto se refiere, esta forma directamente a la actuaci?n de los profesionales de la salud que, a trav?s colectiva, la acci?n interdisciplinaria, y con respecto a la fisiolog?a materna, tiene como objetivo minimizar las intervenciones innecesarias por el reconocimiento social y cultural del parto y el apoyo emocional ofreci? a la parturienta y su familia con el fin de promover el establecimiento de lazos en la relaci?n madre-beb?.

Background The complications of getting affected by perineal ruptures by giving birth can cause anxiety and consequences that affect the daily life of the woman. Over ninety percent of Indonesian midwives had neither acquired any basic skills nor received any further professional development training in this area during the three years following their graduation. The main risk factors for perineal ruptures are instrumentally terminated childbirths, nulliparous and a high birth weight of the baby. The midwife has a major impact on the women's further risk of suffering from a perineal rupture. Perineal protection can play a significant role to reduce perineal ruptures.   Aim The aim of the study was to describe midwives experience of perineal ruptures preventive work in Indonesia.   Method This study is based on a MFS in Indonesia. The method chosen was a  qualitative interview study with unstructured interview questions  In total, fifteen midwives were interviewed. Data was analyzed using qualitative content analysis.   Findings During the analysis three categories were identified; The preventive work to protect the perineum, Midwives experience and knowledge of perineal rupture and Factors that increase vaginal ruptures. Six subcategories were identified; Support perineum by hand, To not proceed too fast, Learning by doing, Factors midwife can affect, Factors women can affect and Other factors that may affect.   Conclusion Indonesian midwife's grip to prevent perineal ruptures are similar to what the authors are educated in Sweden. Knowledge and experience appear to be limited due to the midwive´s small number of vaginal births. Midwives emphasized the importance of education and information in their work with perineal protection. They all claimed that if no perineal protection was used, it was more likely for the woman to get a grade three or four rupture. The midwives in Indonesia didn’t use warm compresses and did only use one birth position, Lithotomy position, the women laying on her back. To further make a progress in the midwives preventive work against perineal ruptures is to educate and empower Indonesian midwives knowledge. This is an important aspect due to the large number of midwives with poor experiences. / Bakgrund Att drabbas av en perinealbristning vid förlossning kan orsaka ångest och ge konsekvenser som påverkar kvinnors dagliga liv. Över nittio procent av de Indonesiska barnmorskorna saknar fortfarande grundläggande färdigheter och professionell kompetensutveckling inom området tre år efter examen. De främsta riskfaktorerna för att drabbas av en perinealbristning är instrumentell förlossning, att vara förstföderska och barnets födelsevikt. Barnmorskan har stor påverkan för kvinnans risk att drabbas av en perinealbristning. Perinealskydd har en stor betydelse för att minska perinealbristningar.   Syfte Syftet med studien var att beskriva barnmorskors erfarenhet av perinealbristningar[ och det förebyggande arbetet i Indonesien.   Metod Denna studie bygger på en MFS (Minor field study) fältstudie i Indonesien. Den valda metoden var en kvalitativ intervjustudie med ostrukturerade intervjufrågor. Sammanlagt intervjuades femton barnmorskor. Data analyserades med hjälp av en kvalitativ innehållsanalys.   Resultat Under analysen identifierades tre kategorier; Det förebyggande arbetet för att skydda perineum, Barnmorskans erfarenhet och kunskap om perinealbristningar samt Faktorer som ökar perinealbristningar. Sex underkategorier identifierades; Stöd perineum för hand, Långsamt framfödande, Träning ger färdighet, Det barnmorskan kan påverka, De faktorer kvinnan kan påverka och Andra faktorer som kan påverka perinealbristningar.   Slutsats Den indonesiska barnmorskans perinealskydd för att förhindra bristningar är liknande de perinealskydd barnmorskan är utbildad att tillhandahålla i Sverige. Kunskap och erfarenhet verkar däremot vara begränsad på grund av barnmorskans få assisterade vaginala födslar i Indonesien. Barnmorskorna som intervjuades betonade vikten av utbildning och information i deras arbete att tillhandahålla perinealskydd. De hävdade att om inget perinealskydd används, är det mer sannolikt att kvinnan drabbas av en grad tre eller fyra bristning. Barnmorskorna i Indonesien använder inte varma kompresser och de använder enbart en förlossningsställning, Lithotomy positionen, kvinnan liggandes på rygg. För att ytterligare göra framsteg i det förebyggande arbetet är det nödvändigt med ytterligare kompetensutveckling för de indonesiska barnmorskorna. Detta är en viktig aspekt på grund av de stora antalet indonesiska barnmorskor som inte har tillräckligt med erfarenhet.

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

The degree work deals with the parents of pre-maturely-born children. The part dedicated to theory handles the issue of the immaturity of prematurely-born children including the latest trends in nursing the given children. The other issue tackled in this part is the family and its specifics concerning a prematurely-born child and the choices of how to enhance the family. This part also focuses on the communication with and the expertise of people working in the field involved in the care of premature children and their parents. The target of the work has been to discover and reflect upon what the mothers of prematurely-born children are experiencing, what needs they may have in the field of communication with and expertise of the healthcare staff and to define what enhancing therapy interventions are at the disposal of parents while their children are hospitalized. To achieve the targets of my work, quality research has been conducted and the method employed was asking questions and a semi-standardized interviewing technique of the mothers of prematurely-born children and the people working in the field. In addition, the document?s contents analysis was completed. The research files were formulated by the people working in the field from the obstetric facility ?The Institute for Mother and Child Care? and by the mothers of prematurely-born children who gave birth at the above healthcare facility. Another intention of the research was to confront the views of mothers of prematurely-born children with the approach of the people working in the field. Resultant from the analysis of the above testimonies, hypotheses have been inferred. The work points out the necessity of a tender approach, of providing emotional support and also empathetic communication from the side of the healthcare staff. Further, the healthcare staff should be trained on how to provide timely-crisis enhancement to the parents. The expertise of the staff is also important in providing the complex follow-up mental and social support to the parents. The outcomes of the degree work may be applied as a feedback for the particular healthcare facility and/or generally to improve the care quality for parents of prematurely-born children.

Estudo qualitativo. Teve como objetivos Identificar os significados atribuídos à dor por mulheres que vivenciaram o parto vaginal, Analisar a vivência da dor segundo a percepção de mulheres que pariram por via vaginal e Discutir as estratégias vivenciadas pelas mulheres para aliviar a dor durante o trabalho de parto e parto vaginal. Os dados foram coletados no Alojamento Conjunto da maternidade da Unidade Integrada de Saúde Herculano Pinheiro com puérperas que passaram algum tempo dos seus trabalhos de parto na instituição. O instrumento para coleta de dados foi a entrevista semi-estruturada. As entrevistas foram gravadas, transcritas e os dados tratados com a técnica de Análise temática de Conteúdo. Para análise dos dados foi utilizado um referencial teórico pertinente aos diversos modelos assistenciais ao parto no Brasil. Vimos que as mulheres significam a dor no parto como sofrimento e/ou prazer e esse sofrimento tem a dimensão redentora influenciada pela Igreja, a dimensão heróica influenciada pela cultura e a dimensão inútil influenciada pela medicalização que retira os significados da dor. Elas significam a dor também com o prazer quando a relaciona com o bebê e com a saúde. As depoentes viveram a dor no parto sentindo uma sensação intensa e até violenta ou fisiológica que tem características próprias e são pertinentes ao processo de parturição. Algumas mulheres não focaram sua atenção na dor. Ela valorizaram mais as respostas psicoemocionais. As depoentes sentiram mais dor quando estavam dentro do hospital sofrendo as intervenções do seu modelo assistencial. Perante a dor no parto elas estrategicamente seguem os conselhos medicalizadas e comportam-se de forma civilizada. Outras mulheres utilizam estratégias instintivas para lidar com a dor no parto. Todas as estratégias utilizadas parecem ter por finalidade a finalização do processo parturitivo. / Qualitative study. Its object was to identity the meanings attributed to the pain by women who experienced vaginal childbearing, analyze the experience of the pain according to the perception of women who gave birth through vaginal delivery and discuss the strategies experienced by women to alleviate the pain during labor and delivery. The data was collected at the Unidade Integrada de Saúde Herculano Pinheiro with women in their immediate puerperium who had their childbearing labor at that institution. The data was collected through a semi-structured interview. The interviews were recorded, transcribed and the data treated through the technique of Thematic Content Analysis. For the data analysis, a theoretical standpoint was adopted pertaining to the various models of childbearing assistance in Brazil. We discovered that women see the pain in labor as suffering and/or pleasure and that suffering carries the redeeming aspect as influenced by the Church, the heroic aspect as influenced by culture and the useless aspect as influenced by the medicalization which removes all the significance of pain. They also see the pain as pleasure when they associate it to the child and health. The interviewed women experienced the pain in labor as an intense sensation, sometimes even violent or physiological, which bears its own characteristic relating to the delivery process. Some women did not focus on the pain. They valued the psycho-emtional response more. The interviewed women felt more pain while inside the hospital enduring the interventions of their assistential model. When facing the pain in labor, those women strategically follow the medicalized advice and behave in a civilized manner. Other women employ instinctive strategies to deal with the pain in labor. All the strategies used seem to aim to complete the delivery process.

Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / Trata-se de uma pesquisa qualitativa que buscou descrever e analisar a vivência do pai no trabalho de parto, parto e pós-parto de seu filho e discutir as repercussões advindas com essa vivência em sua vida conjugal e familiar. Foram entrevistados 24 homens-pais, aleatoriamente, dentre aqueles que estavam presentes no momento das consultas/atividades de puericultura de seus filhos, realizadas em quatro centros municipais de saúde do município do Rio de Janeiro e que participaram do processo de parturição de sua companheira. Para coleta de dados foi utilizada a entrevista semi-estruturada na qual se investigou condições sócio demográficas e aspectos relativos à sua vivência no parto. Para análise dos dados, foi utilizada a Análise Temática. Emergiram um tema (A vivência do pai no parto) e quatro subtemas: sentimentos, sensações e emoções paterna, a importância da presença paterna e as repercussões na vida do pai: conjugal e familiar. Os resultados revelaram que o parto foi para os pais um momento único com mistura de sentimentos. Outros se sentiram úteis por terem conseguido oferecer suporte emocional. Sua presença foi vista por eles mesmos como fundamental, seja por desejo da mulher, seja por decisão do casal. Mostraram ainda a existência de um novo modelo de pai, que se preocupa com o sustento de sua nova família e está à disposição para cooperar nas tarefas domésticas. Ressalta-se que a figura do pai provedor ainda se faz presente. Destaca-se a preocupação dos pais para não prejudicar a equipe e os procedimentos médicos no momento do parto. A vivência do pai no parto mudou o imaginário social da figura da mulher, mãe de seu filho, tornando-a mais corajosa, mais forte e até mais bonita aos olhos desse homem. Para outros, sua presença trouxe uma aproximação na relação conjugal, uma demonstração de que agora ele é um homem de confiança. Considera-se urgente uma reavaliação dos profissionais de saúde sobre a presença e preparação do pai durante todo o processo de nascimento. Na vida familiar, os resultados mostraram que os pais não souberam retratar como esta vivência afetou os membros, ditos por eles, como família. Principalmente aqueles que enumeraram pais, irmãos e enteados como integrantes. Nesse sentido, ressalta-se a importância de uma efetiva preparação dos pais para as transformações que uma vivência do parto repercute em todos os campos de sua vida. / This is a qualitative research which tried to describe and analyze the experience of the father present during childbirth labor, childbirth and post childbirth of his child and discuss the repercussions resulting of this experience in his conjugal and family life. There were random interviews with twenty-four fathers, among the ones present at the moment of consultation appointments/ child care of their children, occurred in four municipal health care centers in Rio de Janeiro, who attended their partners childbirth process. For data collection it was used semi-structured interviews in which were investigated social demographic conditions and aspects related to their experience in the childbirth. For data analyses, it was used thematic analyses, which gave origin to a theme (the experience of the father in the childbirth) and four sub-themes: feelings, fathers sensations and emotions, the importance of fathers presence, repercussions in the fathers life: conjugal and familiar. The results revealed that the childbirth was a unique moment with a mix of feelings. Some felt useful for offering emotional support. Their presence was seen by them as fundamental, for the wifes desire or the couples decision. It also showed a new pattern of father, who is concerned with the family sustainability and also ready to help in the domestic chores, the figure of the financially supportive father is still present. The concern of fathers in order not to disturb or interfere on the delivery team work and the medical procedures in the moment of the parturition is highlighted. The experience of the father in the childbirth has changed the social image of the mother, making her seem more courageous, stronger and even more beautiful on the eyes of the man. For others, their presence created a better conjugal atmosphere, a demonstration that he is a man of trust. It is considered urgent to reevaluate health professionals on the fathers presence and preparation during all the childbirth process. In family life, fathers could not explain how the experience affected the members of the family, mainly those who enumerated fathers, brothers and stepson as family members. In this sense, it is important to mention the relevance of an effective preparation for transformations that the experience of childbirth attending can cause in all the fields of his life.

A presente pesquisa aborda a temática da assistência ao parto hospitalar na Região Médio-Paraíba, considerando a política pública de humanização do parto e nascimento A medicalização do parto e nascimento vem ocorrendo em todo o mundo. Mesmo em países desenvolvidos, a grande maioria dos partos vaginais e de baixo risco ainda é conduzida com práticas intervencionistas sem evidências científicas de sua eficácia. Em contraposição a este modelo assistencial implantou-se a política de humanização do parto e nascimento. A enfermeira obstétrica tem sido elemento importante para a consolidação do uso de práticas consideradas humanizadas na assistência ao parto de baixo risco em ambiente hospitalar. O objeto deste estudo foi o emprego de tecnologias não invasivas de cuidado de enfermagem em partos acompanhados por enfermeiras obstétricas na Associação de Proteção a Maternidade e à Infância de Resende/RJ (APMIR). Os objetivos foram: identificar as tecnologias não invasivas de cuidado de enfermagem obstétrica (TNICE) usualmente empregadas por enfermeiras obstétricas no cuidado a parturientes; discutir o emprego dessas TNICE por enfermeiras obstétricas no cuidado a parturientes sob a perspectiva da humanização do parto e nascimento; caracterizar o processo de implementação das TNICE na assistência ao parto na maternidade. Trata-se de pesquisa descritiva, quantitativa desenvolvida em uma maternidade filantrópica da região sul-fluminense que pertence ao Médio-Paraíba, na qual enfermeiras obstétricas estão incluídas na equipe de acompanhamento do parto. Foram analisados os registros correspondentes aos partos acompanhados por enfermeiras obstétricas compreendendo o período de Novembro de 2012 à Julho de 2013. Houve registro de 84 partos neste período. Os dados foram obtidos através de Livro de Registros de Parto do serviço. Os registros foram feitos em formulário próprio implantado a partir da pesquisa. O projeto foi submetido à apreciação do Comitê de Ética em Pesquisa do Centro Universitário de Barra Mansa, tendo sido aprovado segundo parecer número 347.254 de 30/07/2013. Os dados foram analisados por procedimentos estatísticos descritivos. Os resultados apontaram que a atuação da enfermeira obstétrica no cuidado à mulher em trabalho de parto caracteriza-se por medidas que promovem a autonomia da mulher no cenário onde ela é protagonista marcando assim a forte presença dessas profissionais neste cenário onde a existência de práticas intervencionistas é significante e muito presente. O estudo concluiu que o cuidado de enfermagem obstétrica pautado sobre as tecnologias não invasivas de cuidado favorece uma assistência humanizada ao parto. Acredita-se que para um cuidado no transcorrer fisiológico do parto é necessário estabelecer uma relação de intimidade, de interação e de empatia com cada mulher dentro do seu contexto, dando a ela encorajamento para tomar posse daquilo que compete somente a ela. / This research addresses the issue of assisted birth in a hospital in the Middle Paraíba region, considering the public policy of humanization of childbirth. The medicalization of childbirth is occurring worldwide. Even in developed countries, the vast majority of low-risk vaginal deliveries are still conducted with interventionist practices, some of them without scientific evidence of its effectiveness. In opposition to this care model, it was implemented the policy of humanization of childbirth. The midwife has been an important element in the consolidation of using practices considered humanized in the low-risk delivery care in the hospital environment. The object of this research was the use of non - invasive technologies for nursing care in childbirth attended by nurse-midwives in the Association for the Protection of Motherhood and Childhood Resende / RJ (APMIR). The objectives were: to identify the non invasive technologies of midwifery care (TNICE) usually employed by nurse-midwives in the care of mothers, to discuss the use of these TNICE by nurse-midwives in the care of mothers from the perspective of humanization of childbirth, and to characterize the process of implementing TNICE in childbirth at the hospital. It is descriptive, quantitative study, carried out in a philanthropic maternity the South Region of Rio de Janeiro State, mainly in the region of the Middle Paraíba, in which nurse-midwives are participants of the team of delivery attendance. The records included the childbirths attended by nurse-midwives covering the period from .November 2012 to July 2013. 84 childbirths were recorded in this period. Data were obtained from the Book of Registers from the institution. The recordings were made in a form especially made for the study. The study was submitted to the Ethics Research Board of the University Center of Barra Mansa and was approved according to the protocol #347.254 of 30/07/2013. Data were analyzed by descriptive statistical procedures. The results showed that the performance of the nurse midwives in care of women in labor is characterized by attitudes and procedures that promote the empowerment of women in the scene where she is the protagonist. It highlights the presence of these professionals in this scenario where the existence of interventionist practices is significant. The study concluded that the nurse-midwifery based on non invasive technologies of care favors humanized childbirth assistance. It is believed that regarding the care for a physiological childbirth is necessary to establish an intimate relationship, interaction and empathy with every woman in this context, giving her encouragement to exercise their autonomy while giving birth.

Pesquisa piloto de intervenção com dados prospectivos, grupo único de intervenção, cujo desfecho é a medida da dor de mulheres em trabalho de parto. Apresenta como objetivo discutir os efeitos da crioterapia no alívio da dor das parturientes. Como referencial teórico este trabalho apresentou o descrito por Soares e Low, onde se encontra que os mecanismos de ação do gelo para alívio da dor propiciam o decréscimo da transmissão das fibras de dor, a diminuição da excitabilidade nas terminações livres, a redução no metabolismo tecidual aumentando o limiar das fibras de dor e a liberação de endorfinas. Baseou-se ainda nos princípios da desmedicalização e do emprego de tecnologias não-invasivas de cuidado de enfermagem obstétrica conforme descritos por Vargens e Progianti. A pesquisa foi realizada no Centro Obstétrico do Hospital Municipal Maternidade Carmela Dutra, no Rio de Janeiro de abril a agosto de 2011. O gelo foi aplicado, utilizando-se para tal uma bolsa-cinta ajustável à região tóraco-lombar de 36 gestantes. A bolsa/cinta é descartável, de tecido TNT, com abertura na parte superior para introdução de gelo picado envolto em plástico. As aplicações se deram aos cinco centímetros de dilatação do colo uterino; e/ou aos sete centímetros de dilatação do colo uterino; e/ou aos nove centímetros de dilatação uterina, totalizando ao final das três aplicações um tempo de 60 minutos, que corresponde ao somatório de 20 minutos para cada uma. O gelo foi produzido em fôrma exclusiva para o projeto, em freezer da unidade. Os dados referentes à avaliação da dor foram coletados através de entrevista estruturada guiada por formulário previamente elaborado. Os resultados evidenciaram que a crioterapia produziu extinção ou alívio da dor quando aplicada na região tóraco-lombar das parturientes aos cinco, sete ou nove centímetros de dilatação do colo uterino, dando-lhes maiores condições de vivenciar o seu trabalho de parto; produziu um relaxamento geral e local (na região lombar) das parturientes; não interferiu na dinâmica uterina e, não causou dano ao binômio mãe-filho. Concluiu-se que a crioterapia, na forma como descrita no presente estudo, pode ser considerada uma tecnologia não-invasiva de cuidado de enfermagem obstétrica para alivio da dor no trabalho de parto. / This pilot intervention study, with prospective data and a single intervention group, the outcome of which was the pain measured in women in labour, was designed to discuss the pain relief effects of cryotherapy in childbirth. The theoretical framework for this study was as described by Soares & Low, in which the mechanisms of the pain-relief action of ice foster decreased pain fibre transmission, reduced free nerve ending excitability, reduced tissue metabolism, increased pain fibre threshold and release of endorphins. It also drew on the principles of de-medicalisation and non-invasive obstetric nursing techniques as described by Vargens & Progianti. The study was conducted at the Obstetrics Centre of the Carmela Dutra Municipal Maternity Hospital, in Rio de Janeiro, from April to August 2011. Ice was applied using an adjustable belt-bag to the lumbar/thoracic region of 36 expectant mothers. The disposable TNT fabric belt-bag has an opening at the top for introducing plastic-wrapped ground ice. Applications were given at five centimetres cervical dilation; and/or at seven centimetres cervical dilation; and/or at nine centimetres cervical dilation: to a total of three applications over a 60-minute timespan, corresponding to the sum of 20 minutes each. The ice was produced exclusively for the project in the units freezer. Pain assessment data were collected by structured interview guided by a previously prepared script. The results provided evidence that cryotherapy produced extinction or relief of pain when applied to the lumbar-thoracic region of women in labour at five, seven or nine centimetres cervical dilation, affording them better conditions in which to experience their labour; it produced relaxation (both overall and locally, in the lumbar-thoracic region) in the women in labour; and it neither interfered in the dynamics of the uterus nor caused harm to the mother and child. It was concluded that cryotherapy, as described in this study, can be considered a non-invasive obstetric nursing technology for pain relief in labour.

The objective of the work I am hereby presenting was to map pain by women during and after delivery with regards to age, number of births, attendance in prenatal courses and satisfaction of women in labour. The secondary objective was to find out the influence of interpersonal relationships during the hospitalization of the woman in labour and her perception of pain. Methodology: The set-up goals were accomplished through a quantitative research carried out in hospitals across the South Bohemian region with the use of a questionnaire consisting of two parts. The first part included a questionnaire of my own construction and the second part involved a standardized PCS questionnaire dealing with catastrophization of pain. The questionnaire was filled in by women after vaginal delivery with an interval of 48 - 72 hours after birth. Results: The testing sample involved 635 women giving birth in maternity hospitals in South Bohemian region. The average age of the respondents was 29,7. 49,1 % were primiparas and 50,9 % were women giving birth for the second or several times. The results of the research showed that the age of the woman in labour does not affect the perception of pain during the delivery, on the contrary the post-labour pain decreases with the increasing age of women in labour. Primiparas stated bigger pain than women who were giving births for several times. Undergoing the prenatal course did not prove any relationship with regards to pain during the labour. On the contrary the information they had gained in the prenatal course were proved to be beneficial for the evaluation of post-labour pain as respondents who participated in these courses stated lower level of pain in post-labour period. Statistically significant factors that respondents stated as the most helping in relieving pain, was the support of the midwife, communication with the midwife, staying in the shower, support of the doctor and communication with him/her, interpersonal relationships of the medical staff and the environment of the delivery room. The least satisfied with their delivery were women that used pharmacological treatment for reduction of pain. Women with lower stated labour pain described greater satisfaction with birth. The perception of pain during the delivery is influenced also with the interpersonal relationship at that given maternity hospital, on the contrary these relationships do not affect the evaluation of pain in the post-labour period. Conclusion: This thesis provides a view at the problematics of pain during and after delivery. The results of the research showed the important role of the midwife as well as the doctor's role in the process of care of woman in this uneasy period. The midwife not only evaluates the pain, but also offers the possibility of pain relieve and her behaviour can influence this pain.

Bakgrund: Förlossning är en del av transitionen till föräldraskap. Transitionen underlättas genom professionellt stöd. I barnmorskors ansvarsområde ingår det att ge stöd. Det som påverkar pappors förlossningsupplevelser är bland annat professionellt stöd och förväntningar. Förlossningsupplevelser påverkar pappors välmående och föräldraskap. Syfte: Beskriva blivande förstagångspappors förväntningar inför förlossningen. Metod: Kvalitativa semistrukturerade enskilda intervjuer utfördes med sex blivande förstagångspappor, vars kvinnor var i graviditetsvecka 29 till 35. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Blivande pappor har svårt att föreställa sig vad som kommer ske under förlossningen. Förstagångspappor förväntar sig en lugn stund med sin familj efter födseln för att kunna bearbeta att två blivit tre. Blivande pappor förväntar sig att de kommer ha en stödjande roll under förlossningen. De förväntar sig att det kommer vara mycket känslor under förlossningen och barnets första timmar. Barnmorskor förväntas inneha en stödjande roll gentemot både blivande pappor och födande kvinnor. Konklusion: Barnmorskor bör ge stöd till blivande pappor utifrån individuella behov. Professionellt stöd till blivande pappor möjliggör för dem att vara ett stöd till de födande kvinnorna under förlossningen. Förstagångspappor förväntar sig att stöd kommer vara viktigt för att de ska känna sig trygga under förlossningen. / Background: Childbirth is part of the transition to parenthood. The transition is eased by support from midwives. It’s within the midwives area of responsibility to offer support to parents. Childbirth experiences are affected by received support and expectations of labour. Fathers’ childbirth experiences affect their well-being and parenting. Aim: Describe expecting first-time fathers’ expectations of the labour. Method: Qualitative individual semi-structured interviews with six expecting first-time fathers, whose women were in gestational week 29 to 35. The interviews were analyzed using qualitative content analysis. Results: Expecting fathers’ find it hard to imagine what will happen during childbirth. They expect that after the delivery they will be able to have a quiet moment alone with their families to adjust to their new life-situation. Besides this, fathers expect that they will have an important supportive role during childbirth. Midwives are expected to support both the labouring mother and the father during childbirth. Conclusion: Midwives should support parental couples based on their individual needs of support. Support to expecting fathers enables them to be supportive during childbirth. First-time fathers expects support to be important during childbirth to create a feeling of security for themselves.