A literatura mundial jà vem demonstrando, hà bastante tempo, que a assistÃncia mÃdica em obstetrÃcia trouxe benefÃcios incalculÃveis aos partos distÃcicos. Por outro lado, as tecnologias utilizadas para a assistÃncia ao parto normal, a nÃvel hospitalar, vÃm sendo questionada e, intervenÃÃes, como a episiotomia, o uso abusivo de ocitÃcicos para abreviar o perÃodo de dilataÃÃo, e a posiÃÃo horizontal (deitada) da parturiente, durante o perÃodo expulsivo do parto, estÃo sendo analisadas e criticadas por um largo nÃmero de pesquisadores. O presente estudo visou testar a hipÃtese de que a assistÃncia ao parto normal na posiÃÃo vertical (sentada), durante o perÃodo expulsivo, seria mais apropriada, por ser fisiolÃgica. AlÃm disso, nÃo se usou o procedimento da episiotomia e observou-se a influÃncia da sucÃÃo do mamilo materno pelo RN no tempo de delivramento e perdas sanguÃneas, sem o uso de ocitÃcicos. A diferenÃa mÃdia de 3,4 minutos em favor da menor duraÃÃo do perÃodo expulsivo, para as parturientes que foram assistidas sentadas, merece destaque, apesar da significÃncia do dado estar em seu limiar estatÃstico, ao nÃvel de 95% (p=0,06). A maioria das parturientes delivraram espontaneamente atà 25 minutos depois do parto, nÃo importando se assistidas na vertical, ou na horizontal; as perdas sanguÃneas tambÃm tiveram equivalÃncias estatÃsticas(p=0,52). A sucÃÃo do mamilo materno mostrou alguma influÃncia mas nÃo logrou significÃncia estatÃstica em relaÃÃo a perdas sanguÃneas (p=0,19) e ao tempo de delivramento (vertical: p=0,08; horizontal: p=0,52). Mesmo sem o procedimento da episiotomia, as laceraÃÃes vulvo-perineais se mantiveram em 44,1% e 47,1% para as mulheres que pariram na vertical e horizontal, respectivamente (incidÃncia mais baixa do que os 52,3% que se encontra na literatura), sendo que mais de 80% em ambos os grupos, a laceraÃÃo foi de 1 grau e o restante apenas de 2 grau. NÃo ficou evidenciada qualquer vantagem na posiÃÃo vertical sobre a posiÃÃo horizontal materna durante o perÃodo expulsivo do parto e delivramento, sendo portanto indicado que se permita a livre escolha da parturiente. A abstenÃÃo do uso de ocitÃcicos e de episiotomia nÃo acarretou prejuÃzo Ãs mÃes que pariram, em qualquer das duas posiÃÃes. Assim, os achados do estudo nÃo apontam para a necessidade de intervenÃÃes obstÃtricas de rotina, na assistÃncia ao parto normal; indicando, outrossim, que elas sejam mais criteriosas, evitando-se iatrogenias e promovendo assistÃncia de melhor qualidade e mais humanizada. / Since a long time, world literature has been demonstrating that medical assistance brought large benefits to complications on deliveries. In the other hand, overused obstetric technologies on normal delivery assistance in hospitals are being questioned. Interventions such as episiotomy, the abuse of oxytocic to shorten the dilatation period and the laying down posture imposed to women during labor are being criticized by a large number of researchers. This study intended to find out if the sitting position to assist the second period of womenâs delivery is more appropriate for it is considered physiological. Besides that, no episiotomy has been performed and immediate breastfeeding consequences on blood loss and on the delivery of placenta were observed. The 3.4 minutes difference on favor of the length of time expulsion period to the group of women who delivered on vertical position versus horizontalâs was considered important but not statistic significant (p=0.06). The great majority of mothers has delivered the placenta within the first 25 minutes, regardless they were on the upright (sitting) or neutral (laying down) position. Blood loss was also equivalent on both groups (p=0.52) and breastfeeding did not show any influence on that (p=0.19) and on the time for delivering the placenta (sitting-p=0.08; laying down-p=0.52). The incidence of perineal trauma was 44.1% and 47.0% for women who delivered on vertical and horizontal position, respectively (this incidence was even lower than the 52.3% which is reported on literature). More than 80% of the spontaneous injuries were 1st degree posterior perineal trauma and the rest was just 2nd degree ones, for both groups. It was not evident any advantage of the vertical position over the horizontalâs, during the expulsion period of labor and delivery of placenta. So, mothers could be given the choice in the posture to be assumed during parturition. The absence of oxytocic and episiotomy did not bring any harm to women delivering in any of the two positions. The outcomes do not support medical intervention should be used as routine on normal delivery and for that, those interventions could have a better criteria, avoiding more harm than good and offering a more humanized delivery assistance.

Several factors may affect the choice of place of delivery among expectant mothers in Ghana and few studies have examined the choice of place of delivery with a focus on differences between rural and urban areas. In this study, the factors that influence the choice of place of delivery among expectant mothers in both rural (Tolon District) and urban (Tamale) settings in the northern part of Ghana were identified and compared using the conceptual framework provided by Thaddeus and Maine. A mixed-method study was used to examine expectant mothers and their responses related to factors that affect their choice of place of delivery through a concurrent triangulation using health professional interviews and a detailed participant survey.. The sample consisted of 552 expectant mothers between the ages of 15 and 49 years. Individual interviews were held with 8 health professionals (4 each from rural and urban areas) with a minimum of 5 years of work experience and a focus group discussion with randomly selected pregnant women and lactating mothers. Themes were generated through open coding of the interview data, while multiple regression was performed to identify the factors associated with choice of place of delivery, rural area, preference (60.1%) was for home delivery compared to 20.7% for urban participants. Statistically significant variables affecting the choice of place of delivery among study participants were found to be educational background, the experience of previous deliveries, the attitude of hospital staff toward pregnant women during labor, and frequency of accessing antenatal care. The study's implications may lead to positive change where stakeholders develop and implement policies to promote health facility delivery for expectant mothers in both rural and urban areas of Ghana.