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Database - Alliance francophone pour l'accouchement respecté (AFAR)

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Created on : 20 Aug 2018
Modified on : 03 Nov 2018

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Bibliographical entry (without author) :

Labor and birth care by nurse with midwifery skills in Brazil. Reprod Health. 2016

Author(s) :

Gama SG, Viellas EF, Torres JA, Bastos MH, Brüggemann OM, Theme Filha MM, Schilithz AO, Leal MD

Year of publication :

2016

URL(s) :

https://www.ncbi.nlm.nih.gov/pubmed/27766971
https://doi.org/10.1186/s12978-016-0236-7

Résumé (français)  :

Contexte :
La participation des infirmières et des sages-femmes aux accouchements par voie basse est limitée au Brésil et il n’existe pas de données nationales concernant leur implication. L’objectif était de décrire la participation des infirmières et des infirmières sages-femmes aux soins de l’accouchement au Brésil en 2011 et en 2012 et d’analyser l’association entre les hôpitaux avec infirmières et infirmières sages-femmes en matière de travail et de naissance et le recours aux bonnes pratiques. et leur influence sur la réduction des interventions inutiles, y compris les césariennes.

Méthode :
Etude nationale sur la naissance au Brésil sur une population composée de 23 894 femmes post-partum, réalisée entre février 2011 et octobre 2012 dans 266 établissements de soins de santé. L’étude incluait tous les accouchements par voie basse impliquant des médecins ou des infirmières / sages-femmes. Un modèle de régression logistique a été utilisé pour examiner l’association entre la mise en œuvre de bonnes pratiques et les interventions appropriées pendant le travail et l’accouchement, et déterminer si les soins étaient dispensés par un médecin ou une infirmière / sage-femme. Nous avons développé un autre modèle pour évaluer l’association entre l’utilisation d’interventions obstétricales pendant le travail et la naissance au personnel responsable des soins du patient, en comparant les hôpitaux avec des décisions exclusivement axées sur un médecin à celles qui incluaient les infirmières / infirmières sages-femmes. pour les accouchements par voie basse.

Conclusion :
16.2 % des voies basses étaient assurées par des infirmières/sage-femmes.
Les bonnes pratiques étaient significativement plus fréquentes dans ces cas (nutrition, mobilité durant le travail, soulagement de la douleur non médicamenteux, usage du cartogramme) tandis que certaines interventions étaient bien moins fréquentes (anesthésie, décubitus dorsal, expression utérine et épisiotomie). Dans les maternités comprenant des sage-femmes pour la gestion du travail et les soins périnataux, la fréquence de la césarienne était plus basse.

Abstract (English)  :

BACKGROUND:
The participation of nurses and midwives in vaginal birth care is limited in Brazil, and there are no national data regarding their involvement. The goal was to describe the participation of nurses and nurse-midwives in childbirth care in Brazil in the years 2011 and 2012, and to analyze the association between hospitals with nurses and nurse-midwives in labor and birth care and the use of good practices, and their influence in the reduction of unnecessary interventions, including cesarean sections.

METHODS:
Birth in Brazil is a national, population-based study consisting of 23,894 postpartum women, carried out in the period between February 2011 and October 2012, in 266 healthcare settings. The study included all vaginal births involving physicians or nurses/nurse-midwives. A logistic regression model was used to examine the association between the implementation of good practices and suitable interventions during labor and birth, and whether care was a physician or a nurse/nurse-midwife led care. We developed another model to assess the association between the use of obstetric interventions during labor and birth to the personnel responsible for the care of the patient, comparing hospitals with decisions revolving exclusively around a physician to those that also included nurses/nurse-midwives as responsible for vaginal births.

RESULTS:
16.2 % of vaginal births were assisted by a nurse/nurse-midwife. Good practices were significantly more frequent in those births assisted by nurses/nurse-midwives (ad lib. diet, mobility during labor, non-pharmacological means of pain relief, and use of a partograph), while some interventions were less frequently used (anesthesia, lithotomy position, uterine fundal pressure and episiotomy). In maternity wards that included a nurse/nurse-midwife in labour and birth care, the incidence of cesarean section was lower.

CONCLUSIONS:
The results of this study illustrate the potential benefit of collaborative work between physicians and nurses/nurse-midwives in labor and birth care. The adoption of good practices in managing labor and birth could be the first step toward more effective obstetric and midwifery care in Brazil. It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.

Sumário (português)  :

FUNDO:
A participação de enfermeiras e parteiras na assistência ao parto vaginal é limitada no Brasil, e não há dados nacionais sobre seu envolvimento. Objetivou-se descrever a participação de enfermeiras e enfermeiras obstétricas na assistência ao parto no Brasil nos anos de 2011 e 2012, e analisar a associação entre hospitais com enfermeiros e enfermeiras obstétricas no trabalho de parto e nascimento e o uso de boas práticas, e sua influência na redução de intervenções desnecessárias, incluindo cesáreas.

MÉTODOS:
Nascimento no Brasil é um estudo nacional de base populacional, composto por 23.894 puérperas, realizado no período de fevereiro de 2011 a outubro de 2012, em 266 unidades de saúde. O estudo incluiu todos os partos vaginais envolvendo médicos ou enfermeiras / enfermeiras obstétricas. Um modelo de regressão logística foi usado para examinar a associação entre a implementação de boas práticas e intervenções adequadas durante o trabalho de parto e parto, e se o atendimento era um médico ou um enfermeiro / enfermeira-parteira liderada pela assistência. Nós desenvolvemos outro modelo para avaliar a associação entre o uso de intervenções obstétricas durante o trabalho de parto e nascimento para o pessoal responsável pelo cuidado do paciente, comparando hospitais com decisões que giravam exclusivamente em torno de um médico àqueles que também incluíam enfermeiras / parteiras como responsáveis para partos vaginais.

RESULTADOS:
16,2% dos partos vaginais foram assistidos por uma enfermeira / enfermeira-parteira. As boas práticas foram significativamente mais frequentes nos partos assistidos por enfermeiras / enfermeiras obstétricas (dieta improvisada, mobilidade durante o trabalho de parto, meios não farmacológicos de alívio da dor e uso de partograma), enquanto algumas intervenções foram menos utilizadas (anestesia , posição de litotomia, pressão uterina final e episiotomia). Nas maternidades que incluíam enfermeira / enfermeira-parteira em assistência ao parto e nascimento, a incidência de cesariana foi menor.

CONCLUSÕES:
Os resultados deste estudo ilustram o potencial benefício do trabalho colaborativo entre médicos e enfermeiras / enfermeiras obstétricas no trabalho de parto e nascimento. A adoção de boas práticas na gestão de trabalho de parto e parto pode ser o primeiro passo para um atendimento obstétrico e obstétrico mais eficaz no Brasil. Pode ser mais fácil introduzir novas abordagens do que eliminar antigas, o que pode explicar por que a redução de intervenções desnecessárias durante o parto e nascimento foi menos pronunciada do que a adoção de novas práticas.

Full text (public) :

Comments :

Argument (français) :

Moins d’interventions (anesthésie, position imposée, expression abdominale, épisiotomies) lors des voies basses assurées par des infirmières et sages-femmes au Brésil, un modèle à développer. Incidence notable sur les césariennes également.

Argument (English):

It may be easier to introduce new approaches rather than to eliminate old ones, which may explain why the reduction of unnecessary interventions during labor and birth was less pronounced than the adoption of new practices.

Argumento (português):

Pode ser mais fácil introduzir novas abordagens do que eliminar antigas, o que pode explicar por que a redução de intervenções desnecessárias durante o parto e nascimento foi menos pronunciada do que a adoção de novas práticas.

Keywords :

➡ c-section/caesarean ; episiotomy ; fundal pressure

Author of this record :

Alison Passieux — 20 Aug 2018
➡ latest update : Bernard Bel — 03 Nov 2018

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