A systematic review of the profile and density of the maternal and child health workforce in China

Background To track progress in maternal and child health (MCH), understanding the health workforce is important. This study seeks to systematically review evidence on the profile and density of MCH workers in China. Methods We searched 6 English and 2 Chinese databases for studies published between 1 October 1949 and 20 July 2020. We included studies that reported on the level of education or the certification status of all the MCH workers in one or more health facilities and studies reporting the density of MCH workers per 100 000 population or per 1000 births. MCH workers were defined as those who provided MCH services in mainland China and had been trained formally or informally. Results Meta-analysis of 35 studies found that only two-thirds of obstetricians and paediatricians (67%, 95% CI: 59.6–74.3%) had a bachelor or higher degree. This proportion was lower in primary-level facilities (28% (1.5–53.9%)). For nurses involved in MCH care the proportions with a bachelor or higher degree were lower (20.0% (12.0–30.0%) in any health facility and 1% (0.0–5.0%) in primary care facilities). Based on 18 studies, the average density of MCH doctors and nurses was 11.8 (95% CI: 7.5–16.2) and 11.4 (7.6–15.2) per 100 000 population, respectively. The average density of obstetricians was 9.0 (7.9–10.2) per 1000 births and that of obstetric nurses 16.0 (14.8–17.2) per 1000 births. The density of MCH workers is much higher than what has been recommended internationally (three doctors and 20 midwives per 3600 births). Conclusions Our review suggests that the high density of MCH workers in China is achieved through a mix of workers with high and low educational profiles. Many workers labelled as “obstetricians” or “paediatrician” have lower qualifications than expected. China compensates for these low educational levels through task-shifting, in-service training and supervision.

Perineal Lacerations: A Retrospective Study in a Habitual-Risk Public Maternity

Objective In around 85% of vaginal births, the parturients undergo perineal lacerations and/or episiotomy. The present study aimed to determine the incidence of lacerations and episiotomies among parturients in 2018 in a habitual-risk public maternity hospital in southern Brazil, and to determine the risk and protective factors for such events. Methodology A retrospective cross-sectional study. Data were obtained from medical records and analyzed using the Stata software. Univariate and multivariate logistic regressions were performed. Values of p < 0.05 were considered significant. Results In 2018, there were 525 vaginal births, 27.8% of which were attended by obstetricians, 70.7% by obstetric nurses, and 1.5% evolved without assistance. Overall, 55.2% of the parturients had some degree of laceration. The professional who attended the birth was a significant variable: a greater number of first- and second-degree lacerations, as well as more severe cases, occurred in births attended by nurses (odds ratio [OR]: 2,95; 95% confidence interval [95%CI]: 1,74 to 5,03). Positions at birth that did not enable perineal protection techniques (expulsive period with the “hands-off” method), when analyzed in isolation, determined the risk; however, in the final regression model, this relationship was not confirmed. Although reported in the literature, there were no associations between the occurrence of laceration and age, skin color, or birth weight. In 24% of the births, episiotomy was performed, and doctors performed 63.5% of them. Conclusion Births attended by nurses resulted in an increased risk of perineal lacerations, of varying degrees. In turn, those assisted by physicians had a higher occurrence of episiotomy.

Dança circular em maternidade: Vivência extensionista

A Dança Circular é uma prática corporal na qual as pessoas compõem um círculo e dançam juntas, buscando a integração humana na roda através do seu canto, ritmo e execução, a fim de promover o equilíbrio, bem estar físico, mental e social, integrando hoje uma das propostas de implementação das Práticas Integrativas e Complementares em Saúde (PICS) no Sistema Único de Saúde (SUS). O objetivo geral desse artigo é descrever a experiência de promoção da saúde de gestantes, parturientes e puérperas internadas em maternidade através da Dança Circular, por meio das ações extensionistas. Trata-se de um relato de experiência em uma maternidade pública no interior da Bahia, que aborda o desenvolvimento de quatro sessões de Dança Circular, com duração média de 15 minutos cada uma, com a participação de 6 gestantes, 8 puérperas, 6 acompanhantes, 1 profissional de saúde e 1 graduanda em Psicologia; os momentos foram conduzidos por 2 professoras (Enfermeiras Obstetras) e 5 discentes do curso de graduação em Enfermagem, com treinamento prévio na técnica da Dança. Durante a realização das sessões, os participantes mostraram-se sorridentes, alegres e receptivos, sentimentos esses que foram comprovados nos relatos escritos nas fichas de avaliação. As sessões de Dança Circular foram realizadas em mais de um local dentro da maternidade, com a participação de diferentes públicos em cada sessão. Foi possível perceber que a Dança Circular impactou positivamente no bem-estar das participantes. Palavras-chave: Terapias Complementares; Enfermagem Obstétrica; Relações Comunidade-Instituição Pharmaceutical care in social institutions: extension as a strategy for learning and health promotion Abstract: Circular Dance is a corporal practice in which people form a circle and dance together, seeking human integration in the circle through their singing, rhythm, and execution, in order to promote balance, physical, mental and social well-being, integrating today one of the proposals for the implementation of Integrative and Complementary Practices in Health (PICS) in the Unified Health System (SUS). The general objective of this article was to describe the health promotion experience of pregnant women, parturients, and puerperal women admitted to maternity through Circular Dance, through extension actions. It is an experience report in a public maternity hospital in the countryside of Bahia State, which addresses the development of four Circular Dance sessions. The sessions had an average duration of 15 minutes each, with the participation of 6 pregnant women, 8 puerperal women, 6 companions, 1 health professional, and 1 undergraduate student in Psychology; the moments were conducted by 2 instructors (Obstetric Nurses) and 5 students of the undergraduate nursing course, with previous training in the dance technique. During the sessions, the participants were smiling, happy and receptive, feelings that were confirmed in the reports written in the evaluation forms. The Circular Dance sessions were held in more than one place within the maternity ward, with the participation of different audiences in each session. It was possible to notice that the Circular Dance had a positive impact on the well-being of the participants. Keywords: Complementary Therapies; Obstetric Nursing; Community-Institutional Relations

The prevalence of the technocratic model in obstetric care from the perspective of health professionals

ABSTRACT Objectives: to identify the reasons for the prevalence of the technocratic model in obstetric care from the perspective of health professionals. Methods: Grounded Theory. Study approved by two Research Ethics Committees and conducted by theoretical sampling, from July 2015 to June 2017. Twenty-nine interviews were conducted with health professionals from two maternity hospitals in the Southern Region of Brazil. Data collection and analysis was performed alternately; and analysis by open, axial, and selective coding/integration. Results: the technocratic model still persists because the assistance is performed in a mechanized way, centered on the professionals. There is a lack of systematization of care, and under-dimensioning of the nursing staff. Final Considerations: obstetric nurses need to review their performance in obstetric centers, the internal organization, the dimensioning of nursing professionals, and become protagonists of care. Investment in academic training/updating the knowledge of midwifery professionals, based on scientific evidence and user-centered care is necessary.

Early skin-to-skin contact in a child friendly hospital: perceptions of the obstetric nurses

ABSTRACT Objective To know the nurses' perception about early skin-to-skin contact. Methods A qualitative and exploratory-descriptive study carried out at the Obstetric Center of a university hospital in southern Brazil. The participants were eight nurses who answered a qualitative interview in April 2019. The interviews followed a guiding script and were analyzed according to thematic content analysis: data sorting and classification and final analysis. Results Nurses know the skin-to-skin contact practice and the importance of doing it properly. In their work routine, they perceive that this contact does not happen as it should and they understand the importance of recording it. Conclusion Nurses aim for skin-to-skin contact to be carried out in an early and uninterrupted manner; however, the limitations related to the health team's work processes are highlighted. The study reinforces the importance of reducing unnecessary interventions at birth.

Enfermagem obstétrica e sua força de trabalho em tempos de Covid-19: relato de experiência das regiões do Brasil

Objetivo: Descrever a experiência de trabalhadores/pesquisadores em realizar o Webinário: Enfermagem Obstétrica e sua força de trabalho em tempos de COVID -19: um retrato das ações no Brasil. Método: Relato de experiência sobre as reflexões a respeito da força de trabalho das Enfermeiras Obstétricas representadas pelas cinco regiões do Brasil no Webinário das ações da ABENFO nacional. Resultados: A experiencia demonstrou a força de trabalho de Enfermagem Obstétrica articulada aos direitos a saúde das mulheres em fase reprodutiva em tempos de COVID-19 a partir do pensamento crítico, a comunicação, a colaboração e a criatividade. Conclusão: É fundamental e necessária a interação, mediante o uso das tecnologias disponíveis, entre os profissionais da enfermagem obstétrica de todas as regiões do país, afim de compartilhar experiências e encontrar novas possibilidade para o cuidado de mulheres no ciclo gravídico puerperal neste momento de crise.Descritores: Enfermagem Obstétrica; Infecções por Coronavírus; Direitos da Mulher. OBSTETRIC NURSING AND ITS WORK FORCE IN COVID-19 PANDEMIC: EXPERIENCE REPORT FROM BRAZILIAN REGIONSObjective: To describe experience of workers/researchers in performing the Webinar: Obstetric Nursing and its workforce in COVID-19 pandemic: a portrait of actions in Brazil. Method: Experience report on thereflections regarding the work force of Obstetric Nurses represented by five regions of Brazil in Webinar of the actions of the Brazilian Association of Obstetrics and Nurses Obstetricians. Results: The experience demonstrated the work force of Obstetric Nursing articulated to the women's health rights in reproductive phase in COVID-19 pandemic from critical thinking, communication, collaboration, and creativity. Conclusion: The need for interaction, through the use of available technologies, among obstetric nursing professionals from all regions of the country is fundamental, in order to share experiences and find new possibilities for the care of women in pregnancy and postpartum a tthis time of crisis.Descriptors: Obstetric Nursing; Coronavirus Infections; Women's Rights. ENFERMERÍA OBSTÉTRICA Y SU FUERZA DE TRABAJO EN EL TIEMPO COVID-19: INFORME DE EXPERIENCIA DE LAS REGIONES BRASILEÑASObjetivo: Describir la experiencia de los trabajadores / investigadores en la realización del seminario web: Enfermería obstétrica y su fuerza laboral en tiempos de COVID -19: un retrato de las acciones en Brasil. Método: Informe de experiencia sobre las reflexiones acerca de la fuerza laboral de enfermeras obstétricas representadas por las cinco regiones de Brasil en el seminario web nacional de acciones ABENFO. Resultados: La experiencia demostró la fuerza laboral de Enfermería Obstétrica articulada a los derechos de salud de las mujeres en edad reproductiva en tiempos de COVID-19 desde el pensamiento crítico, la comunicación, la colaboración y la creatividad. Conclusión: Es fundamental y necesaria la interacción, a través del uso de las tecnologías disponibles, entre profesionales de enfermería obstétrica de todas las regiones del país, para compartir experiencias y encontrar nuevas posibilidades para el cuidado de las mujeres en el ciclo de embarazo puerperal en este momento de crisis.Descriptores: Enfermería Obstétrica; Infecciones por Coronavirus; Derechos de la Mujer.

Interação social de puérperas com procedimentos invasivos no parto [The social interaction of puerperal women towards invasive childbirth procedures] [La interacción social de puérperas hacia los procedimientos invasivos en el parto]

Objetivo: apresentar modelo representativo da interação social de puérperas com procedimentos invasivos durante o trabalho de parto, a partir dos significados por elas atribuídos. Método: estudo interpretativo, qualitativo, realizada em maternidade pública do Rio de Janeiro. Foram entrevistadas 12 puérperas, de 18 a 45 anos, divididas em 3 grupos amostrais. Dados analisados segundo o Interacionismo Simbólico e a Grounded Theory. Resultados: procedimentos invasivos significam tudo que foge ao curso natural do parto ou viole. Entrando na situação, as mulheres sentem-se desconfortáveis com situações fisiológicas do parto. Confiando no profissional, submetem-se a procedimentos considerando-os necessários ao nascimento do bebê. Conclusão: o modelo representativo aponta que as mulheres se submetem a procedimentos invasivos sem considerá-los invasivos. É necessário criar estratégias que permitam à mulher compreender e tomar decisões sobre seu próprio corpo, bem como estimular a atuação de enfermeiras obstétricas para o cuidado à mulher com base na não invasão.ABSTRACTObjective: to present a representative model of puerperal women’s social interaction with invasive childbirth procedures, based on the meanings they attribute to them. Method: this interpretative, qualitative study was conducted at a public maternity hospital in Rio de Janeiro by interview of 12 puerperal women in three sample groups. Data were analyzed in accordance with Symbolic interactionism and Grounded Theory. Results: an invasive procedure is anything that lies outside or violates the natural course of childbirth. Women in labor feel uncomfortable with the physiological situations of childbirth. Trusting in the care professional, they submit to procedures that they consider necessary to their baby’s birth. Conclusion: the representative model shows that women submit to invasive procedures, not considering them invasive. Strategies must be developed to permit women to understand and decide on their own bodies, and to encourage obstetric nurses to provide women’s care based on non-invasive procedures.RESUMENObjetivo: presentar un modelo representativo de la interacción social de las puérperas con los procedimientos invasivos de parto, a partir de los significados que les atribuyen. Método: este estudio interpretativo, cualitativo, se realizó en una maternidad pública de Río de Janeiro mediante entrevista a 12 puérperas en tres grupos de muestra. Los datos se analizaron de acuerdo con el interaccionismo simbólico y la teoría fundamentada. Resultados: un procedimiento invasivo es todo aquello que se encuentra fuera o viola el curso natural del parto. Las mujeres en trabajo de parto se sienten incómodas con las situaciones fisiológicas del parto. Confiando en el profesional asistencial, se someten a los procedimientos que consideran necesarios para el nacimiento de su bebé. Conclusión: el modelo representativo muestra que las mujeres se someten a procedimientos invasivos, no considerándolos invasivos. Se deben desarrollar estrategias para permitir que las mujeres comprendan y decidan sobre su propio cuerpo, y para alentar a las enfermeras obstétricas a brindar atención a las mujeres con base en procedimientos no invasivos.