A decade of heightened awareness concerning safety issues in healthcare since the Institute of Medicine’s awakening call has resulted in a string of counteroffensive measures. The pace of improvement has been slow and not altogether clear. Rates of patient harm are in general now measured by voluntary reporting and indicator measurements. The use of triggers or clues in random nurse-based reviews to enable identification of patient harm is a more effective method for measuring the overall rate of harm in a health care organisation. Measured actual overall rates of patient harm, their variations and patterns during delivery in the south-east health-care region of Sweden are not previously known. Measurement is important to patient safety improvement, as a foundation for accountability, effort selection and keeping track of results. The patient’s voice must also be much clearer in quality and safety improvement efforts in healthcare. The Institute of Healthcare Improvements Global Trigger Tool for measuring adverse events was used to review 1137 deliveries during 2011 in the seven departments (10% of all cases). Mother and new-born were both evaluated. Thirty eight patient harm events per 1000 patient days were identified, correlating to 13% of admissions. Presupposed rates among staff were double this value. Current patient safety indicators are half this value. One third of patient harm events at birth affected the new-born. Twenty different categories of harm were found. This study shows significantly higher rates of patient harm than previously reported. The nurse reviewers defined the method as valuable and a useful method for measuring harm at delivery. Limitations at this stage are no observed changes in health care delivery or clinical outcomes and that value assessment is based entirely on the judgement of the data-abstractors.

Background/Aim: Historical evidences indicate that maternal health care by a skilled birth attendant is one of the key strategies for maternal survival. However, the rate of maternity care utilisation and reduction of maternal death is very low in Nigeria. This study was designed to investigate factors influencing access to emergency obstetric care with a view to guiding programmatic efforts targeted at overcoming these barriers and also contribute to health reforms in Nigeria. Hence, the need to understand factors influencing access to emergency obstetric care in Nigeria using the Socio-ecological Model (SEM) and Gender and Development (GAD) to identify associated factors operating at different levels. Methods: A mixed method was employed for this study. Data collection used questionnaires and in-depth interviews. Questionnaires were distributed to 330 respondents of which 318 of them were retrieved and qualitative in-depth interviews were conducted for 6 participants. Data collection were done using a sequential approach. The study was conducted in one of the tertiary health facilities in Nigeria from January-April, 2015, amongst mothers aged 15-45 years meeting the study inclusion criteria. Statistical Package for Social Sciences (SPSS) was used in analysing the quantitative data. Bivariate and logistic regressions were conducted for the quantitative data whilst a qualitative content analysis was done for the qualitative data. Results: The study established that education, income level, costs associated with seeking care, distance and time taken to travel were significantly associated with maternity healthcare services utilisation. Quality of service, staff attitude and women's autonomy showed consistent significant association with maternal health care utilisation. Conclusions: The study concludes that; costs of treatment, distance and time, income level, staff attitude and women's autonomy were critical in determining women utilisation of maternity care services. Recommendation: As an outcome of this research, best practice framework has been developed. The framework presents a coherent and systematic approach for achieving sustainable MH by providing a roadmap for instituting measures at the policy, health facility, community and at the individual levels, taking into account factors that are likely to promote or impede the achievement of sustainable MH.

Background: The incidence of caesarean section for breech presentation has reached approximately 90 % in Sweden. In many of these cases, by means of specific selection criteria, it would be as safe to plan for vaginal breech delivery.   Aim: The objective of this study was to investigate differences in management and to compare maternal and fetal outcomes according to delivery mode of breech presentation; vaginal vs. caesarian section. The study included breech presentation in full term singleton pregnancies at the UppsalaUniversityHospital, Uppsala, Sweden (UAS).   Method: The study was based on medical record data with a retrospective, descriptive, comparative design with quantitative approach. The method for data collection was a manual review of patient records using a structured questionnaire.   Results: Of the women with children in breech presentation during the period studied, 11 % gave birth vaginally. Mother's wish was the most common cause of caesarean section. The group with caesarean section included more first-time mothers, longer length of stay at the hospital, increased bleeding and need for pain medication, separation from the child, later lactation and earlier introduction of formula. Vaginally delivered mothers had increased incidence of straight urine catheterization postpartum and of infants with lower Apgar scores.   Conclusion: This study does not support the suggestion that it would be safer to give birth by caesarean section for breech presentation in cases where the woman at full term meets strict selection criteria. Instead of applying medical criteria, the decision regarding mode of delivery was more often left up to the mother.

Darbo tikslas – įvertinti gimdyvių ir akušerių nuomonę apie teikiamą priežiūrą mažos rizikos gimdyvių atvejais. Darbo uždaviniai – įvertinti akušerių bei gimdyvių nuomonę apie mažos rizikos gimdymo priežiūrą ir palyginti Vilniaus bei Kauno perinatologijos centruose akušerių nuomones apie mažos rizikos gimdymo priežiūrą. Tyrimo metodika. Tyrimo objektas – gimdyvių ir akušerių nuomonė apie gimdyvėms teikiamą priežiūrą mažos rizikos gimdymų atvejais. Tyrimo metodai – anoniminė anketinė akušerių ir gimdyvių apklausa, vykdyta 2013 11 01 – 2013 11 30 Vilniaus ir Kauno perinatologijos centruose. Tyrime dalyvavo 66 akušerės ir 306 gimdyvės. Statistinė duomenų analizė atlikta, panaudojant „SPSS 17.0“ kompiuterinę programą. Tyrimo rezultatai. Akušerės, kurios prižiūri ir teikia pagalbą mažos rizikos gimdymų metu visada ir dažnai, savo profesines žinias įvertino vidutiniškai 8,56±0,94 balo, o akušerės, darančios tai retai arba niekada, savo žinias įvertino vidutiniškai 7,19±2,62 balo iš 10 galimų (p<0,001). Profesinius įgūdžius akušerės įvertino atitinkamai vidutiniškai 8,71±1,03 ir 6,87±2,97 balo iš 10 galimų (p<0,001). Gimdyvės akušerių, prižiūrėjusių jų gimdymą paslaugų kokybę, įvertino vidutiniškai 9,5±1,0 balo iš 10 galimų. Gydytojo akušerio ginekologo teiktų paslaugų kokybę gimdyvės įvertino vidutiniškai – 9,4±1,2 balo iš 10 galimų. Kauno akušerės savo profesines žinias ir įgūdžius, prižiūrint mažos rizikos gimdymą, vertino atitinkamai vidutiniškai 8,5±1,022 balo ir 8,61±1,178... [toliau žr. visą tekstą] / SUMMARY Aim of the study – to assess the midwives‘ and mothers‘ opinion towards the obstetrical care in cases of the low-risk laboring. Objectives – to assess the opinion of mothers and midwives separately towards the obsterical care in cases of the low-risk laboring, as well as to compare the opinions of the midwives who work in the Perinatology Centers of Vilnius and Kaunas towards the obstetrical care in cases of the low-risk laboring. Methods. The object of the study is the midwives‘ and mothers opinion towards the obstetrical care in cases of the low-risk laboring. The questionnaire – based anonymous study was carried out between November 01, 2013 through November 30, 2013 in the Perinatology Centers of Vilnius and Kaunas. 66 midwives and 306 mothers participated in the study. Statistical analysis of the data was performed by SPSS 17.0 software package. Results. Midwives who always or frequently take care of the low-risk laboring autonomously evaluated their professional knowledge by giving 8,56±0,94 scores on average out of 10, whereas those midwives who never or rarely take care of the low-risk laboring evaluated their professional knowledge by giving 7,19±2,62 scores on average out of 10 (p<0,001). Professional skills were evaluated by the same midwives 8,71±1,03 and 6,87±2,97 scores on average out of 10, respectively (p<0,001). The mothers evaluated the quality of the services performed by the midwives or the obstetricians gynaecologists who took care of their... [to full text]

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Introdução A participação dos pais e companheiros afetivos no processo de parto e nascimento vem crescendo desde a década de 1960. Este fenômeno tem marcado a história das famílias e da Obstetrícia nos mais diversos contextos. Ouvir os pais é uma estratégia importante para melhorar a atenção à saúde das mães e dos bebês, assim como para prover um melhor acolhimento ao acompanhante. Objetivo Descrever e analisar a perspectiva paterna acerca do processo reprodutivo, buscando conhecer os elementos de preparação para o parto, se há implicações para o desfecho da gravidez, assim como as percepções sobre os riscos e benefícios da assistência obstétrica em diferentes modelos de atenção. Métodos Pesquisa qualitativa realizada por meio de entrevistas semi-estruturadas presenciais, via Skype e e-mail, com amostra auto-selecionada a partir de divulgação institucional e em mídias sociais. Dados analisados a partir de categoriais iniciais propostas pelo roteiro, e novas categorias temáticas advindas do conjunto dos dados. Resultados 23 sujeitos foram incluídos na pesquisa, todos estiveram presentes no momento do nascimento, em partos normais hospitalares, em partos domiciliares planejados, cesáreas intraparto e cesáreas agendadas. Os dados evidenciam que os pais têm desejo para participar do parto como parte essencial de sua experiência reprodutiva, e usufruem de benefícios subjetivos para o exercício da paternidade. Durante o parto, os pais qualificam sua presença com elementos de proteção e companheirismo. O modelo de assistência de conduta expectante só é possível após negociação com o provedor do parto normal, o que depende ainda da qualidade do preparo dos pacientes em termos de informações sobre direitos reprodutivos e recomendações de boas práticas. Nos hospitais, descrevem também os diferentes constrangimentos para o cumprimento estrito da Lei do Acompanhante, assim como para a vivência do nascimento como evento familiar. Conclusões Garantir a presença irrestrita do acompanhante no parto traz benefícios não só para a saúde do binômio mãe-bebê, mas ainda para a experiência subjetiva dos homens com o processo reprodutivo e a paternidade. No entanto, a participação paterna ainda é um desafio imposto por muitos serviços de saúde, sendo valorizada somente em espaços restritos, mais comumente se extra-hospitalares. Em grande parte, os constrangimentos são da ordem do controle e restrição da autonomia dos sujeitos nas instituições de saúde, contrariando as melhores evidências que apóiam o cuidado efetivo centrado na mulher, e valorização do parto como experiência familiar. / Introduction Fathers and husbands attendance to chilbirth is an increasing trend since 1960s. This phenomenon has marked the history of families and Obstetrics in various contexts. Listening to fathers is an important strategy to improve the mother\'s and babies\' health care, as well as to provide better support to the labour companion. Goals To describe and analyze paternal perspective about the reproductive process, getting to know the elements of childbirth prepare, whether there are implications for the outcome of pregnancy, as well as perceptions about the risks and benefits of obstetric care in different care models. Methods Qualitative research conducted through semi-structured interviews in person, via Skype and e-mail, with a self-selected sample from institutional publicity and social media. Data analyzed from pre-determinates categories, and new themes arising from the data set. Results 23 men were included in the study, all were present at childbirth, attending vaginal birth at hospitals, planned home births, cesarean section intrapartum and scheduled cesarean section. Data show that parents have the desire to attend childbirth as an essential part of their reproductive experience, as well as they enjoy subjective benefits for their fatherhood. During childbirth, fathers qualify their presence with elements of protection and companionship. The expectant management model of care is possible only after negotiation with the birth provider, which also depends on the quality of pacient\'s preparation in terms of information on reproductive rights and best practice recommendations. At the hospital, they also describe the different constraints for the strict compliance of brazilian \'Attendance Childbirth Law\', as well as for the experience of birth as a family event. Conclusions Ensure the unrestricted presence of companion during childbirth brings benefits not only to the health of both mother and baby, but also to the subjective experience of men with the reproductive process and fatherhood. However, fathers involvement is still a challenge posed by many health services being valued only in restricted spaces, more commonly outside hospitals. In large part, the constraints are of the order of control and restriction of personal autonomy in health institutions, contrarying best evidence on effective support and women centered care, which values childbirth as a family experience.

Introdução A participação dos pais e companheiros afetivos no processo de parto e nascimento vem crescendo desde a década de 1960. Este fenômeno tem marcado a história das famílias e da Obstetrícia nos mais diversos contextos. Ouvir os pais é uma estratégia importante para melhorar a atenção à saúde das mães e dos bebês, assim como para prover um melhor acolhimento ao acompanhante. Objetivo Descrever e analisar a perspectiva paterna acerca do processo reprodutivo, buscando conhecer os elementos de preparação para o parto, se há implicações para o desfecho da gravidez, assim como as percepções sobre os riscos e benefícios da assistência obstétrica em diferentes modelos de atenção. Métodos Pesquisa qualitativa realizada por meio de entrevistas semi-estruturadas presenciais, via Skype e e-mail, com amostra auto-selecionada a partir de divulgação institucional e em mídias sociais. Dados analisados a partir de categoriais iniciais propostas pelo roteiro, e novas categorias temáticas advindas do conjunto dos dados. Resultados 23 sujeitos foram incluídos na pesquisa, todos estiveram presentes no momento do nascimento, em partos normais hospitalares, em partos domiciliares planejados, cesáreas intraparto e cesáreas agendadas. Os dados evidenciam que os pais têm desejo para participar do parto como parte essencial de sua experiência reprodutiva, e usufruem de benefícios subjetivos para o exercício da paternidade. Durante o parto, os pais qualificam sua presença com elementos de proteção e companheirismo. O modelo de assistência de conduta expectante só é possível após negociação com o provedor do parto normal, o que depende ainda da qualidade do preparo dos pacientes em termos de informações sobre direitos reprodutivos e recomendações de boas práticas. Nos hospitais, descrevem também os diferentes constrangimentos para o cumprimento estrito da Lei do Acompanhante, assim como para a vivência do nascimento como evento familiar. Conclusões Garantir a presença irrestrita do acompanhante no parto traz benefícios não só para a saúde do binômio mãe-bebê, mas ainda para a experiência subjetiva dos homens com o processo reprodutivo e a paternidade. No entanto, a participação paterna ainda é um desafio imposto por muitos serviços de saúde, sendo valorizada somente em espaços restritos, mais comumente se extra-hospitalares. Em grande parte, os constrangimentos são da ordem do controle e restrição da autonomia dos sujeitos nas instituições de saúde, contrariando as melhores evidências que apóiam o cuidado efetivo centrado na mulher, e valorização do parto como experiência familiar. / Introduction Fathers and husbands attendance to chilbirth is an increasing trend since 1960s. This phenomenon has marked the history of families and Obstetrics in various contexts. Listening to fathers is an important strategy to improve the mother\'s and babies\' health care, as well as to provide better support to the labour companion. Goals To describe and analyze paternal perspective about the reproductive process, getting to know the elements of childbirth prepare, whether there are implications for the outcome of pregnancy, as well as perceptions about the risks and benefits of obstetric care in different care models. Methods Qualitative research conducted through semi-structured interviews in person, via Skype and e-mail, with a self-selected sample from institutional publicity and social media. Data analyzed from pre-determinates categories, and new themes arising from the data set. Results 23 men were included in the study, all were present at childbirth, attending vaginal birth at hospitals, planned home births, cesarean section intrapartum and scheduled cesarean section. Data show that parents have the desire to attend childbirth as an essential part of their reproductive experience, as well as they enjoy subjective benefits for their fatherhood. During childbirth, fathers qualify their presence with elements of protection and companionship. The expectant management model of care is possible only after negotiation with the birth provider, which also depends on the quality of pacient\'s preparation in terms of information on reproductive rights and best practice recommendations. At the hospital, they also describe the different constraints for the strict compliance of brazilian \'Attendance Childbirth Law\', as well as for the experience of birth as a family event. Conclusions Ensure the unrestricted presence of companion during childbirth brings benefits not only to the health of both mother and baby, but also to the subjective experience of men with the reproductive process and fatherhood. However, fathers involvement is still a challenge posed by many health services being valued only in restricted spaces, more commonly outside hospitals. In large part, the constraints are of the order of control and restriction of personal autonomy in health institutions, contrarying best evidence on effective support and women centered care, which values childbirth as a family experience.

De första timmarna efter födseln ska en rad åtgärder, viktiga för såväl kvinnan som det nyfödda barnet, utföras. Den nyblivna familjen lämnas ofta innan dessa åtgärder är slutförda.  Förbättringsarbetets syfte var att skapa bättre förutsättningar för god eftervård på förlossningsavdelningen under barnets första två–tre levnadstimmar. Studiens syfte var att efter förbättringsarbetet undersöka personalens erfarenheter av förbättringsarbetet och av att ostört arbeta klart med den omedelbara eftervården Förbättringsarbetet utfördes med hjälp av 5p, Nolans förbättringsmodell och sensemaking-aktiviteter. Studiens gruppintervjuer analyserades med kvalitativ innehållsanalys. Andelen kvinnor som fick ha ostörd personal kvar ökade. Kvinnornas upplevelser av den omedelbara eftervården förbättrades liksom medarbetarnas bedömning om rimlig arbetsbelastning. Andelen barn som ammat ökade. Den kvalitativa intervjustudien visade att arbetssättet upplevdes ha betydelse för patientsäkerhet och arbetstillfredsställelsen. Sensemaking-aktiviteterna hade skapat förståelse för syftet med förbättringsarbetet.  Att ostört arbeta vidare med den omedelbara eftervården gav ökat värde för kvinnan och för barnet.  Personalens arbetstillfredsställelse ökade. Det krävs arbete för att påminna om när anpassningar mellan kvalitet och effektivitet är nödvändiga. Sensemaking är verkningsfullt för att skapa förståelse för förändring men metoden är tidskrävande. / In the first hours after birth, a number of measures, important for both the woman and the newborn, must be performed. The new family is often left alone before these measures are completed.  The aim was to create better conditions for good postpartum care during the child's first 2-3 hours of life. The aim of the study was to examine the staff's experiences of the improvement work and of working undisturbed with the immediate postpartum care.  The improvement work was carried out with the help of 5p, Nolan's improvement model and sensemaking activities. The study's group interviews were analyzed with qualitative content analysis. The proportion of women who were allowed to keep undisturbed staff increased. The women's experiences of immediate postpartum care were improved, as was the employees' assessment of a reasonable workload. The proportion of children who breastfed increased. The interviews showed that the working method was perceived to be important for patient safety and job satisfaction. The sensemaking activities reminded of the importance of postpartum care.  Being able to work undisturbed with the immediate postpartum care increased value for both the woman and the newborn. It also improved job satisfaction for the staff. Efforts are needed to remind when adjustments between quality and efficiency are necessary. Sensemaking is effective in creating motivation for change, but the method is time-consuming.

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The contribution of Emergency Obstetric Care (EmOC) in reducing maternal mortality in Ethiopia is very minimal as evidenced by poor provision and low utilization of EmOC. Client centred EmOC provision improves the provision and utilization of EmOC; leading to the treatment of the majority of obstetric complications which are the main causes of maternal mortality. This study describes clients’ views and perspectives concerning the quality of EmOC provision in Ethiopian public health facilities. An explorative and descriptive phenomenological qualitative study design was used in the study in order to explore and describe the lived experiences of clients with EmOC services. Key informant interviews with women who had direct obstetric complications and received EmOC at three public health facilities in Addis Ababa generated rich data on their lived experiences. Content analysis was used to analyze the data as it complies with the phenomenological data analysis and Atlas ti version 6.2 qualitative data analysis software was employed. The findings revealed that quality EmOC is a welcoming, life-saving timely care given in a clean environment with humility, respect, equal treatment and encouragement. It is care that is safe for the client, technically sound, responsive and meets clients’ needs and expectations. Accessibility of life saving care at all time and collaborative and coordinated care created good experiences for the clients. The causes of clients’ disappointment with the provision of EmOC were higher expectations from female providers, underestimation by providers, non responsive providers, and ethical misconduct by providers such as mocking, insulting, yelling, advantage taking providers, undelivered promises by providers, expectation with place of delivery, expectation with newborn care and a limited number of health workers attending delivery. Discrimination, high cost of care and asking client to buy drugs and supplies and referrals from centres, are some of the barriers on r the use of EmOC at public health facilities. The provision of EmOC is constrained by overloaded staffs, shortage of space to accommodate clients and inadequate number of beds. In conclusion, clients have expectations and experiences of provision of EmOC that influence their future decision to seek care. Finally, a client centred guideline for the provision of client centred EmOC provision was developed. / Health Studies / D. Litt. et Phil. (Health Studies)