AbstractThe aim: The aim of the study was to describe what women are most satisfied with in maternity care and if women´s childbirth experiences can be described by means of the QPP-I, who contains 32 statements related to maternity care. Design: The study is part of a national cross-sectional study which lasted for two weeks in Sweden in 2007. This paper analyzes one of the two questions with open answers, which reads: "What was the best with maternity care?”. Results: The results showed that out of a total of 735 responses 717 could be placed in the existing instrument QPP-I. Responses were analyzed by deductive content analysis and the majority 98% of the women's responses was about commitment, empathy and respect from the midwives. The responses (n = 18) who did not fit in QPP-I were then analyzed inductive and focused on team work and sense of coherence. Conclusion: The instrument QPP-I can be developed with additional statement to measure what it intends to measure, women's perceptions of maternity care.

Bakgrund: I arbetet som barnmorska är det viktigt att bemöta alla på samma sätt utifrån deras individuella behov, oavsett deras sexuella läggning och familjekonstellation. Med tanke på den heteronormativitet som genomsyrar samhället kan man tänka sig att det även visar sig inom mödra- och förlossningsvård. Syfte: Syftet med studien var att belysa hur gravida och födande homosexuella kvinnor upplever barnmorskornas bemötande under graviditeten och efter barnafödandet. Metod: En kvalitativ metod och en kvalitativ innehållsanalys med induktiv ansats användes, Semistrukturerade intervjuer genomfördes med tolv homosexuella kvinnor som varit eller var gravida. Resultat: I resultatet framkommer det vad homosexuella kvinnor ser som ett gott respektive ett dåligt bemötande. Resultatet behandlar även barnmorskans bemötande gentemot medföräldern. Konklusion: De homosexuella kvinnorna i studien uppgav att ett gott bemötande från barnmorskor kunde vara att de bemöttes med respekt och att barnmorskorna fokuserade på graviditeten istället för på den samkönade relationen. Barnmorskors bemötande uppfattas som bättre om könsneutrala uttryck används. Medförälderns delaktighet i graviditet, förlossning och eftervård är något barnmorskor ska beakta och uppmuntra. / Background: In the work as a midwife it’s important to respond to everyone the same way based on their individual needs, regardless their sexual orientation and family constellation. Given the heteronormativity that permeates society, one can imagine that it also proves to maternity and obstetric care. Purpose: The purpose of the study was to explore how pregnant and birthing lesbian women experience midwifes response during pregnancy and after childbirth. Method: A qualitative approach and content analysis with inductive approach was used, semi-structured interviews were conducted with twelve lesbian women who had been or where pregnant. Results: The result shows what lesbian women see as a good or a bad response. The result also addresses the midwife’s attitude towards the co-parent. Conclusion: The lesbian women in the study said that a good response could be that they where responded to with respect and that midwifes are focused on the pregnancy, instead of the same-sex relationship. Midwifes response is perceived as better if gender-neutral terms are used. The co-parents involvement in pregnancy, childbirth and postnatal care is something midwifes should consider and encourage.

Magister Curationis - MCur / The present study examined the extent of utilization of partogram among nurses and midwives in Rwamagana health facilities located in the eastern province of Rwanda. The study specifically sought to; assess knowledge and use of partogram among nurses and midwives in Rwamagana health facilities, to identify the challenges facing nurses and midwives with regards to the utilization of partogram in the health facilities and to determine factors influencing the use of partogram among nurses and midwives in Rwamagana health facilities. Patricia Benner’s model of nursing practice was used to guide this study

SUMMARY Aim of the study – to assess the attitudes of patients and their partners to the quality of service in the secondary and tertiary obstetrical in-patient clinics. Objectives: 1) to evaluate the attitudes of patients to the quality of obstetrical care services; 2) to compare the quality of services among secondary and tertiary obstetrical clinics; 3) to determine the factors influencing the satisfaction with obstetrical care services; 4) to evaluate the attitudes of patients’ partners to the quality of obstetrical care services. Methods: The anonymous survey of parturient women (patients) and their partners (participants in childbirth) was performed in different obstetrical clinics since 1st January to 30th December 2004. The survey was conducted in the secondary care obstetrical in-patient Silutė (level A) and Panevezys (level B) clinics and also in the tertiary care Kaunas obstetrical in-patient clinic (Hospital of Kaunas University of Medicine). The number of participants was following: in Silute; 304 parturient women and 145 their partners, in Panevezys 416 and 253 and in Kaunas 256 and 111 respectively. Response rate varied between 73% and 96%. The difference between categorical variable was assessed using chi-square (χ²) test. Correlation analysis was performed using Spearman coefficient of rank correlation. Results: Majority of respondents were satisfied with childbirth (91% ) and postnatal care (95%). The satisfaction with quality of services was not related... [to full text]

A coleta de sangue de cordão umbilical e placentário (SCUP) é uma atividade delegada ao enfermeiro, abrindo um novo campo de atuação para esse profissional que se configura em um novo processo de trabalho e na inserção de mais um procedimento no contexto da assistência obstétrica. O objetivo deste estudo foi compreender a vivência de enfermeiras no exercício da atividade de coleta de amostras de SCUP para armazenamento de células progenitoras hematopoiéticas. Trata-se de um estudo descritivo com abordagem metodológica qualitativa. Os referenciais teórico e metodológico adotados neste estudo foram o Interacionismo Simbólico e a Teoria Fundamentada nos Dados. Participaram do estudo nove enfermeiras que atuam na atividade de coleta de SCUP para bancos de sangue de privados e públicos. Os dados foram obtidos por meio de entrevistas que foram gravadas e transcritas. A experiência da enfermeira que exerce a atividade de coleta de SCUP é compreendida pelas categorias: ACEITANDO A PROPOSTA DE TRABALHO, TENDO ATRIBUIÇÕES A CUMPRIR, PREPARANDO-SE PARA PROCEDER A COLETA DE SCUP, ENCONTRANDO CONDIÇÕES FAVORÁVEIS PARA REALIZAR A COLETA DE SCUP, UTILIZANDO ESTRATÉGIAS PARA GARANTIR A COLETA DE SCUP, ENCONTRANDO CONDIÇÕES DESFAVORÁVEIS PARA REALIZAR A COLETA DE SCUP, PROCEDENDO À COLETA DE SCUP, CONCLUINDO A COLETA DE SCUP e AVALIANDO O TRABALHO REALIZADO. Trabalhar como um profissional tendo de se inserir em um contexto desconhecido com profissionais que atuam em equipe nas diversas maternidades, coloca a enfermeira coletadora frente a situações que exigem rápida adaptação para que realize a coleta de SCUP, atendendo todas as recomendações exigidas para a coleta desse material. Um dos aspectos evidenciados e merecedor de destaque é o fato da enfermeira coletadora deparar-se com dificuldades referentes ao relacionamento com a equipe que presta assistência obstétrica; esta necessita compreender e incorporar em seu processo de trabalho no contexto da assistência ao parto que a enfermeira coletadora de SCUP presta serviço ao BSCUP público ou privado. Apesar das dificuldades relatadas pelas enfermeiras coletadoras no desenvolvimento de sua atividade, percebe-se que elas se encontram motivadas a continuar atuando nesse novo campo, seja pela remuneração, seja pela percepção de estar realizando uma atividade que beneficiará o tratamento de doenças. Vale ressaltar que este estudo poderá ajudar aos profissionais envolvidos no contexto do parto e nascimento a entenderem a atividade de coleta e a compreenderem que a equipe multiprofissional deve atuar em prol de um objetivo comum, além de serem informados a respeito do potencial que as células-tronco vêm mostrando no tratamento de doenças hematológicas / The umbilical cord blood (UCB) collection is an activity delegated to the nurse, opening a new field of action for this professional who is set on a new process of work and the insertion of a further procedure in the context of obstetrical care. The objective of this study was to understand the experience of nurses in the exercise of the activity of collecting samples of UCB for storage hematopoietic progenitor cells. This is a descriptive study with qualitative approach. The benchmarks theoretical and methodological used in this study were the Interacionism Symbolic and Grounded Theory. Were involved in the study nine nurses who serve in the activity of UCB collection for blood banks, on private and public institutions. The data were obtained through interviews that were recorded and transcribed. The experience of the nurse who carries out the activity of UCB collection is understood by the categories: ACCEPTING THE WORK PROPOSAL, HAVING TASKS TO DELIVER, PREPARING TO PROCEDER THE UCB COLLECTION, FACING FAVOURABLE CONDITIONS TO PROCEDURE THE UCB COLLECTION, USING STRATEGIES TO ASSURE THE UCB COLLECTION, FACING UNFAVOURABLE CONDITIONS TO PROCEDURE THE UCB COLLECTION, DOING THE UCB COLLECTION PROCEDURE, FINALIZING THE UCB COLLECTION PROCEDURE and UNALIZING THE WORK CARRIED. Working as a professional who needs to take part into an unknown context with other professionals who works together in various maternity, puts the nurse through situations that require quick adaptation to develop the UCB collection, attending all the recommendations required for the material collection. One of the aspects highlighted and worthy of note is the fact the nurse encounter themselves with difficulties relating to the relationship with the team that provides obstetrical care, which needs to understand and incorporate in the process of work in the context of assistance for delivery that the nurse provides service to coord bank. Despite the difficulties reported by nurses who develop this activity, is known that they are motivated to continue working in this new field, by the remuneration or by the perception of performing an activity that will benefit the treatment of diseases. This study may help the professionals involved in the obstetrical care to understand the activity of UCB collection and that the multiprofessional team should work towards a common goal, besides being informed about the potential that stem cells come showing in the treatment of hematological diseases

A coleta de sangue de cordão umbilical e placentário (SCUP) é uma atividade delegada ao enfermeiro, abrindo um novo campo de atuação para esse profissional que se configura em um novo processo de trabalho e na inserção de mais um procedimento no contexto da assistência obstétrica. O objetivo deste estudo foi compreender a vivência de enfermeiras no exercício da atividade de coleta de amostras de SCUP para armazenamento de células progenitoras hematopoiéticas. Trata-se de um estudo descritivo com abordagem metodológica qualitativa. Os referenciais teórico e metodológico adotados neste estudo foram o Interacionismo Simbólico e a Teoria Fundamentada nos Dados. Participaram do estudo nove enfermeiras que atuam na atividade de coleta de SCUP para bancos de sangue de privados e públicos. Os dados foram obtidos por meio de entrevistas que foram gravadas e transcritas. A experiência da enfermeira que exerce a atividade de coleta de SCUP é compreendida pelas categorias: ACEITANDO A PROPOSTA DE TRABALHO, TENDO ATRIBUIÇÕES A CUMPRIR, PREPARANDO-SE PARA PROCEDER A COLETA DE SCUP, ENCONTRANDO CONDIÇÕES FAVORÁVEIS PARA REALIZAR A COLETA DE SCUP, UTILIZANDO ESTRATÉGIAS PARA GARANTIR A COLETA DE SCUP, ENCONTRANDO CONDIÇÕES DESFAVORÁVEIS PARA REALIZAR A COLETA DE SCUP, PROCEDENDO À COLETA DE SCUP, CONCLUINDO A COLETA DE SCUP e AVALIANDO O TRABALHO REALIZADO. Trabalhar como um profissional tendo de se inserir em um contexto desconhecido com profissionais que atuam em equipe nas diversas maternidades, coloca a enfermeira coletadora frente a situações que exigem rápida adaptação para que realize a coleta de SCUP, atendendo todas as recomendações exigidas para a coleta desse material. Um dos aspectos evidenciados e merecedor de destaque é o fato da enfermeira coletadora deparar-se com dificuldades referentes ao relacionamento com a equipe que presta assistência obstétrica; esta necessita compreender e incorporar em seu processo de trabalho no contexto da assistência ao parto que a enfermeira coletadora de SCUP presta serviço ao BSCUP público ou privado. Apesar das dificuldades relatadas pelas enfermeiras coletadoras no desenvolvimento de sua atividade, percebe-se que elas se encontram motivadas a continuar atuando nesse novo campo, seja pela remuneração, seja pela percepção de estar realizando uma atividade que beneficiará o tratamento de doenças. Vale ressaltar que este estudo poderá ajudar aos profissionais envolvidos no contexto do parto e nascimento a entenderem a atividade de coleta e a compreenderem que a equipe multiprofissional deve atuar em prol de um objetivo comum, além de serem informados a respeito do potencial que as células-tronco vêm mostrando no tratamento de doenças hematológicas / The umbilical cord blood (UCB) collection is an activity delegated to the nurse, opening a new field of action for this professional who is set on a new process of work and the insertion of a further procedure in the context of obstetrical care. The objective of this study was to understand the experience of nurses in the exercise of the activity of collecting samples of UCB for storage hematopoietic progenitor cells. This is a descriptive study with qualitative approach. The benchmarks theoretical and methodological used in this study were the Interacionism Symbolic and Grounded Theory. Were involved in the study nine nurses who serve in the activity of UCB collection for blood banks, on private and public institutions. The data were obtained through interviews that were recorded and transcribed. The experience of the nurse who carries out the activity of UCB collection is understood by the categories: ACCEPTING THE WORK PROPOSAL, HAVING TASKS TO DELIVER, PREPARING TO PROCEDER THE UCB COLLECTION, FACING FAVOURABLE CONDITIONS TO PROCEDURE THE UCB COLLECTION, USING STRATEGIES TO ASSURE THE UCB COLLECTION, FACING UNFAVOURABLE CONDITIONS TO PROCEDURE THE UCB COLLECTION, DOING THE UCB COLLECTION PROCEDURE, FINALIZING THE UCB COLLECTION PROCEDURE and UNALIZING THE WORK CARRIED. Working as a professional who needs to take part into an unknown context with other professionals who works together in various maternity, puts the nurse through situations that require quick adaptation to develop the UCB collection, attending all the recommendations required for the material collection. One of the aspects highlighted and worthy of note is the fact the nurse encounter themselves with difficulties relating to the relationship with the team that provides obstetrical care, which needs to understand and incorporate in the process of work in the context of assistance for delivery that the nurse provides service to coord bank. Despite the difficulties reported by nurses who develop this activity, is known that they are motivated to continue working in this new field, by the remuneration or by the perception of performing an activity that will benefit the treatment of diseases. This study may help the professionals involved in the obstetrical care to understand the activity of UCB collection and that the multiprofessional team should work towards a common goal, besides being informed about the potential that stem cells come showing in the treatment of hematological diseases

Résumé Objectif : Identifier les facteurs institutionnels qui influencent la mortalité maternelle (MM) hospitalière dans les maternités chirurgicales au Sénégal. Méthode : cette étude est une analyse secondaire des données de la troisième Enquête Nationale sur la Couverture Obstétrico-chirurgicale au Sénégal en 2001. Les données analysées, issues des fiches d'activité des maternités, comptaient pour 38,239 admissions en obstétrique dans 19 hôpitaux et 450 décès maternels. Les taux de mortalité maternelle hospitalière (TMMH) brut et ajusté ont été utilisés comme variables dépendantes. Le TMMH ajusté sur les caractéristiques de la clientèle ('cases-mix') a été estimé pour chaque établissement de santé par la méthode de standardisation directe. Les indicateurs de la qualité des structures, de la gestion des ressources, et un score de qualité ont été utilisés comme variables indépendantes pour prédire la MM hospitalière. Les tests de Mann-Whitney et de Kruskal-Wallis ont été utilisés pour analyser l’association entre les variables indépendantes, le score de qualité et la MM. Une analyse multivariée a été utilisée pour estimer l’impact du score de qualité sur la MM, en tenant compte de la situation géographique (Dakar versus autre région).Résultats: En analyse bivariée, la présence d'anesthésiste, la disponibilité de boîtes de césarienne complète et la supervision de tous les accouchements par du personnel qualifié sont les facteurs institutionnels associés significativement à une réduction du TMMH brut. Quant au TMMH ajusté ce sont la présence de scialytique, la disponibilité du sulfate de magnésium, l'utilisation des guides de pratiques cliniques (GPC) pour la prise en charge des complications obstétricales. Le score de qualité est associé significativement au TMMH brut, y compris en analyse multivariée, mais pas au TMMH ajusté. Conclusion : La disponibilité du Sulfate de magnésium, et du scialytique pourrait contribuer à la réduction de la MM. En complément, une réorganisation adéquate des ressources pour réduire la disparité géographique rurale/urbaine est essentielle ainsi qu’une sensibilisation du personnel à l’usage des GPC. De plus, l’assistance par un personnel qualifié de tous les accouchements est nécessaire pour améliorer la qualité des soins et la prise en charge des complications obstétricales. / Abstract Objective: To identify which institutional factors are associated to the hospital maternal mortality in surgical maternities in Senegal. Method: This study is a secondary data analysis of the third National survey of the Surgical-Obstetric Coverage in Senegal in 2001. The hospital statistics data analyzed represent 38,239 admissions in obstetrics in 19 hospitals and 450 maternal deaths. The hospital maternal death rates (TMMH) crude and adjusted were used as dependent variables. The TMMH adjusted on the characteristics of the customers (`cases-mix') was estimated for each health structure by the direct standardization method. The indicators of the structure, resources management’s complexity score quality were used as independent variables to predict hospital MM. The Mann-Whitney and Kruskal-Wallis tests were used to analyze the association between independent variables, the complexity score of quality and MM. A multivariate analysis was used to estimate the impact of quality score on the MM, taking into account the geographical location (Dakar versus other region). Results: In bivariate analysis, the presence of anaesthetist, the availability of Caesarean kit and supervision of all births by trained personnel are the institutional factors significantly associated with the crude TMMH decreased. For the adjusted TMMH, the presence of Scialytic, the availability of Magnesium Sulphate, the use of clinical guidelines of good practice (GPC) for obstetrical complications are the institutional factors associated to his decreased. The complexity score quality is significantly associated with the crude TMMH, including multivariate analysis, but not with adjusted TMMH. Conclusion: The availability of the Magnesium Sulphate, and the Scialytic could contribute to the reduction of maternal mortality. In addition, an adequate reorganization of the resources to reduce the geographical rural/urban disparity is essential, as well as a developing the personnel’s awareness for the use of GPC. Moreover, qualified assistance at birth for all women is necessary to improve the quality of care and the treatment obstetrical complications.

Résumé Objectif : Identifier les facteurs institutionnels qui influencent la mortalité maternelle (MM) hospitalière dans les maternités chirurgicales au Sénégal. Méthode : cette étude est une analyse secondaire des données de la troisième Enquête Nationale sur la Couverture Obstétrico-chirurgicale au Sénégal en 2001. Les données analysées, issues des fiches d'activité des maternités, comptaient pour 38,239 admissions en obstétrique dans 19 hôpitaux et 450 décès maternels. Les taux de mortalité maternelle hospitalière (TMMH) brut et ajusté ont été utilisés comme variables dépendantes. Le TMMH ajusté sur les caractéristiques de la clientèle ('cases-mix') a été estimé pour chaque établissement de santé par la méthode de standardisation directe. Les indicateurs de la qualité des structures, de la gestion des ressources, et un score de qualité ont été utilisés comme variables indépendantes pour prédire la MM hospitalière. Les tests de Mann-Whitney et de Kruskal-Wallis ont été utilisés pour analyser l’association entre les variables indépendantes, le score de qualité et la MM. Une analyse multivariée a été utilisée pour estimer l’impact du score de qualité sur la MM, en tenant compte de la situation géographique (Dakar versus autre région).Résultats: En analyse bivariée, la présence d'anesthésiste, la disponibilité de boîtes de césarienne complète et la supervision de tous les accouchements par du personnel qualifié sont les facteurs institutionnels associés significativement à une réduction du TMMH brut. Quant au TMMH ajusté ce sont la présence de scialytique, la disponibilité du sulfate de magnésium, l'utilisation des guides de pratiques cliniques (GPC) pour la prise en charge des complications obstétricales. Le score de qualité est associé significativement au TMMH brut, y compris en analyse multivariée, mais pas au TMMH ajusté. Conclusion : La disponibilité du Sulfate de magnésium, et du scialytique pourrait contribuer à la réduction de la MM. En complément, une réorganisation adéquate des ressources pour réduire la disparité géographique rurale/urbaine est essentielle ainsi qu’une sensibilisation du personnel à l’usage des GPC. De plus, l’assistance par un personnel qualifié de tous les accouchements est nécessaire pour améliorer la qualité des soins et la prise en charge des complications obstétricales. / Abstract Objective: To identify which institutional factors are associated to the hospital maternal mortality in surgical maternities in Senegal. Method: This study is a secondary data analysis of the third National survey of the Surgical-Obstetric Coverage in Senegal in 2001. The hospital statistics data analyzed represent 38,239 admissions in obstetrics in 19 hospitals and 450 maternal deaths. The hospital maternal death rates (TMMH) crude and adjusted were used as dependent variables. The TMMH adjusted on the characteristics of the customers (`cases-mix') was estimated for each health structure by the direct standardization method. The indicators of the structure, resources management’s complexity score quality were used as independent variables to predict hospital MM. The Mann-Whitney and Kruskal-Wallis tests were used to analyze the association between independent variables, the complexity score of quality and MM. A multivariate analysis was used to estimate the impact of quality score on the MM, taking into account the geographical location (Dakar versus other region). Results: In bivariate analysis, the presence of anaesthetist, the availability of Caesarean kit and supervision of all births by trained personnel are the institutional factors significantly associated with the crude TMMH decreased. For the adjusted TMMH, the presence of Scialytic, the availability of Magnesium Sulphate, the use of clinical guidelines of good practice (GPC) for obstetrical complications are the institutional factors associated to his decreased. The complexity score quality is significantly associated with the crude TMMH, including multivariate analysis, but not with adjusted TMMH. Conclusion: The availability of the Magnesium Sulphate, and the Scialytic could contribute to the reduction of maternal mortality. In addition, an adequate reorganization of the resources to reduce the geographical rural/urban disparity is essential, as well as a developing the personnel’s awareness for the use of GPC. Moreover, qualified assistance at birth for all women is necessary to improve the quality of care and the treatment obstetrical complications.