ETHNOMEDICAL PERCEPTIONS OF PREGNANCY THREATS AND HOMEBIRTH PREFERENCE IN RURAL CAMEROON: THE CASE OF NCHANG, SOUTH WEST REGION

The principal objective of this research has been to highlight ethnomedical understanding of risk factors causing mishaps in childbirth as the fundamental determinant to low facility-based deliveries. Skilled obstetric assistance has been proven to significantly reduce maternal morbidity and mortality. Reliance on facility-based delivery is therefore fundamental to maternal wellbeing. However, preference for homebirth is still common and prevalent in rural Cameroon where socio-cultural perceptions still exert strong influence on health-seeking decisions and behaviors. Understanding the reasons for this preference is important to design targeted interventions for more effective maternal death control schemes. This qualitative research was carried out in all ten quarters of Nchang using both random and snowball sampling techniques to select participants. Forty in-depth interviews and four focus group discussions were conducted using corresponding research tools. Verbatim translation and transcription of audio recordings was done from pidgin or kenyang to English, followed by codification and a thematic analysis. Our findings reveal that low demand for obstetric assistance and its consequential correspondingly higher maternal mortality rates are fundamentally determined by socio-cultural perceptions of pregnancy threats. KEYWORDS: perceptions, facility-based delivery, obstetric assistance, homebirth, maternal mortality

Benefícios da verticalização do parto

São vários os achados históricos que confirmam que o parto, na antiguidade, era realizado em posição vertical. Contudo, com o passar do tempo, aspetos sociais, científicos, culturais e religiosos foram modificando a forma vertical de parir. Aos poucos, as cadeiras de parto foram caindo em desuso, dando lugar ao parto na posição horizontal. No entanto, tem-se vindo a comprovar que a verticalização do parto, tem múltiplas vantagens que fragilizam a defesa de uma prática de parto na posição horizontal. Nesse sentido, pretendeu-se com este estudo, identificar os benefícios da posição vertical no trabalho de parto. A opção metodológica foi a revisão integrativa da literatura, de artigos publicados no friso temporal de 2017-2020, em Português e Inglês disponíveis nas bases de dados Medline (n= 236), CINAHL (n= 163) e B-On (n= 244), seguindo a estratégia PICOD. Em dezembro de 2020, fez-se a consulta às bases de dados, utilizando a expressão de pesquisa booleana “Delivery, Obstetric”[Mesh]) AND “Patient Positioning”[Mesh] OR (“Delivery, Obstetric” [Mesh] AND upright) OR (upright labor positioning) OR (Vertical[Title] OR upright[Title]) AND (childbirth[Title] OR labor[Title]). Foram critérios de inclusão artigos em texto integral, de acesso livre, estudos qualitativos ou quantitativos, estudos randomizados controlados (RCT), revisões e ensaios clínicos. Não foram consideradas publicações de resumos simples, comunicações em conferências ou artigos de revista sem avaliação por pares. Com base no método de pesquisa foram selecionados 10 artigos, dos quais emergiram os seguintes resultados principais: a verticalização do parto tem benefícios provocados pela ação da gravidade, favorece o bem-estar fetal, melhora a dinâmica uterina e a estática fetal, diminui a duração do trabalho de parto, diminui a incidência de episiotomia, aumenta os diâmetros pélvicos e proporciona benefícios psicoafectivos à parturiente.Com base nos diferentes estudos, conclui-se assim que parir na posição vertical beneficia a parturiente e o feto devido a fatores fisiológicos e biomecânicos.

Reproductive Ethics in Clinical Practice

Reproductive healthcare professionals in fields such as obstetrics and gynecology, family medicine, and pediatrics routinely face unique ethical issues at the crossroads of patient decision-making, scientific advancement, political controversy, legal regulation, and profound moral considerations. This book is a carefully curated compilation of essays written by leading experts in the fields of medicine, ethics, law, and the social sciences who address key issues at the forefront of reproductive ethics. It is organized into three main sections: Preventing Pregnancy and Birth (Contraception and Abortion Ethics), Initiating Pregnancy (Assisted Reproduction Ethics), and Managing Pregnancy and Delivery (Obstetric Ethics). Each section begins with a short introduction by the editors, providing an overview of this area of reproductive ethics and contextualizing the essays that follow. Two features make the book appealing and useful to practicing clinicians as well as students and trainees: the short length of the essays and the practical yet exciting topics they cover (e.g., issues around race, religion, abortion, violations of confidentiality, conflicts of interest, legal liability, maternal choices that risk future children’s health, and reproductive practice in Europe and developing nations). The collection provides clinicians at all levels of training with frameworks within which to approach challenging encounters.

Humanização do parto à luz da teoria do cuidado transpessoal: revisão integrativa

O presente estudo objetiva analisar as evidências científicas a respeito da percepção dos profissionais de enfermagem frente ao cuidado humanizado no parto normal. Trata-se de uma revisão integrativa de literatura em 6 bases de dados, sem recorte temporal quanto ao ano de publicação, com utilização dos descritores Parto Humanizado e Enfermagem Obstétrica nas línguas inglesa e portuguesa. Os dados foram avaliados por meio da análise de conteúdo e à luz da Teoria do Cuidado Transpessoal de Jean Watson. Seis artigos foram selecionados dos quais emergiram duas categorias: o cuidado humanizado no parto normal é o estabelecimento de um relacionamento de ajuda-confiança; e o cuidado humanizado no parto normal é a provisão de um ambiente mental, físico, sociocultural e espiritual sustentador, protetor. Apesar de todo o avanço tecnológico, os profissionais de enfermagem enxergam o cuidado humanizado em sua essência tornando-se coadjuvantes nesse processo.Descritores: Parto Humanizado, Enfermagem Obstétrica, Teoria de Enfermagem, Saúde da Mulher. Humanization of childbirth in the light of the theory of transpersonal care: integrative reviewAbstract: The present study aims to analyze the scientific evidence regarding the perception of nursing professionals regarding humanized care in normal delivery. It is an integrative literature review in 6 databases, with no time frame as to the year of publication, using the descriptors Humanized Childbirth and Obstetric Nursing in English and Portuguese. The data were evaluated through content analysis and in light of Jean Watson's Theory of Transpersonal Care. Six articles were selected from which two categories emerged: humanized care in normal childbirth is the establishment of a help-trust relationship; and humanized care during normal birth is the provision of a supportive, protective mental, physical, socio-cultural and spiritual environment. Despite all the technological advancement, nursing professionals see humanized care in its essence, becoming supporting in this process.Descriptors: Humanizing Delivery, Obstetric Nursing, Nursing Theory, Woman’s Health. Humanización del parto a la luz de la teoría del cuidado transpersonal: revisión integrativaResumen: El presente estudio tiene como objetivo analizar la evidencia científica con respecto a la percepción de los profesionales de enfermería con respecto a la atención humanizada durante el parto normal. Es una revisión de literatura integradora en 6 bases de datos, sin un marco de tiempo en cuanto al año de publicación, que utiliza los descriptores Humanized Childbirth and Obstetric Nursing en inglés y portugués. Los datos se evaluaron a través del análisis de contenido y a la luz de la Teoría de la atención transpersonal de Jean Watson. Se seleccionaron seis artículos, de los cuales surgieron dos categorías: la atención humanizada en el parto normal es el establecimiento de una relación de ayuda y confianza; y la atención humanizada durante el parto normal es la provisión de un entorno de apoyo, protección mental, físico, sociocultural y espiritual. A pesar de todos los avances tecnológicos, los profesionales de enfermería ven la atención humanizada en su esencia, convirtiéndose en un apoyo en este proceso.Descriptores: Parto Humanizado, Enfermería Obstétrica, Teoría de Enfermería, Salud de la Mujer.

Pattern of Vaginal Birth after Cesarean, its Variables and Outcome at the Interval of One Decade in Dhulikhel Hospital

Background: There should be high index of suspicion for timely detection of any complications for safe trial of labor in case of vaginal birth after cesarean. Emergency obstetric care must be available. Even with these provisions the vaginal birth after cesarean rate is decreasing in Dhulikhel Hospital in recent years. Methods: This retrospective study was conducted to compare different modes of delivery and pattern vaginal birth after cesarean in a gap of ten years in Dhulikhel Hospital (i.e. 2007 to 2009 versus 2017 to 2019). In this study factors associated with the successful vaginal birth after cesarean were also analyzed. Results: A total of 4215 deliveries conducted in the year 2007 to 2009, of them 890 (21.1%) were cesarean deliveries. Likewise altogether 9298 deliveries conducted in the year 2017 to 2019, of them 2849 (30.6%) were cesarean deliveries. Vaginal birth after cesarean rate is significantly decreased from 18.33% (33/180) to 8.8% (63/713) (p value = 0.0004). Instrumental deliveries, normal vaginal deliveries were significantly decreased in comparison to these in the year 2007 to 2009. Duration of labor of vaginal birth after cesarean (7.05±1.25 vs 7.13±2.02, p=0.8362) and mean fetal weight of vaginal birth after cesarean baby (2818.71±686.37 vs 2820.79±511.78, p=0.9867) were not much different. Conclusions: Over the years, vaginal birth after cesarean rate is decreased. Keywords: Cesarean section; fetal distress; institutional delivery; obstetric care; uterine rupture

Pregnancy and labor outcomes in squat versus western style sitting toilet users: a pilot study

Background: Squatting posture may appear outdated and primitive, but in the antenatal period, it is an important resistance exercise to strengthen the abdominal and pelvic floor muscles which are believed to potentially prepare the women for a more natural delivery. No study till date has evaluated the effect of type of toilet seat regularly used during pregnancy. This was a pilot study to assess obstetric outcomes in antenatal women using squat versus western style sitting toilet seat.Methods: In an observational prospective pilot study, low risk primigravida at 28-32 weeks gestation were recruited from the outpatient department and divided into two groups after matching baseline characteristics. Group I (n=50) included women regularly using squatting type toilet seat and group II (n=50) comprised women using western style toilet seat. Pregnancy was followed till delivery; obstetric and neonatal outcomes were noted.Results: Squatting group, as compared to sitting type seat users, had lower incidence of vaginal discharge (10% vs 16%), urinary tract infection(12% vs. 24%), constipation (2% vs. 6%), labor induction (52% vs. 58%), shorter second-stage duration (0.60 vs. 1.24 hours) and a higher incidence of normal vaginal delivery (94% vs. 86%), albeit not statistically significant. NICU admissions (16% vs. 20%) and mean birth weight (2.83 vs. 2.97 kg) were comparable in the two groups.Conclusions: Squatting type toilet seat users had many favourable obstetric outcomes, especially a higher incidence of normal vaginal delivery; although, the difference was not statistically significant. Large community based surveys in this regard can reveal the true effects of squatting type toilet seat on pregnancy and labour outcomes.

Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.

Obstetrics and gynaecology

This chapter in the Oxford Handbook of Emergency Medicine investigates obstetrics and gynaecology in the emergency department (ED). It reviews gynaecological problems, vaginal discharge, contraceptive problems, genital injury, assault and female genital mutilation, gynaecological pain, and vaginal bleeding. It discusses the pregnant patient and explores prescribing, hyperemesis gravidarum, vaginal bleeding, miscarriage, ectopic pregnancy, vaginal bleeding in later pregnancy, abdominal pain, and medical complications of pregnancy. It also reviews emergency normal delivery, obstetric emergencies, trauma and cardiac arrest in pregnancy, and post-partum problems.

O papel do enfermeiro na promoção do parto humanizado

Compreender o papel do enfermeiro na promoção do parto humanizado, e contribuir de forma indireta na assistência e segurança de todo o processo parturitivo. Trata-se de estudo de revisão integrativa, com busca dos artigos nas bases de dados, Scientific Electronic Library Online (SciELO) e Google Acadêmico, publicados nos últimos 05 anos (entre 2015 e 2019). O enfermeiro traz como benefícios para o parto humanizado, a inserção de boas práticas, como a diminuição das dores com métodos não farmacológicos, proporciona segurança, autonomia e a participação ativa da mulher durante todo o processo de parturição. Conclui-se que o enfermeiro é peça fundamental no processo de parturição, no empoderamento e na autonomia da parturiente.Descritores: Parto Humanizado, Enfermagem Obstétrica, Parturiente. The role of the nurse in the promotion of humanized childbirthAbstract: To understand the role of nurses in promoting humanized childbirth, and to contribute indirectly to the care and safety of the entire parturitive process. This is an integrative review study, with search of articles in databases, Scientific Electronic Library Online (SciELO) and Google Scholar, published in the last 5 years (between 2015 and 2019). The nurse brings as benefits to humanized childbirth, insertion of good practices, such as reducing pain with non-pharmacological methods, providing safety, autonomy and active participation of women throughout the parturition process. It concludes that the nurse is a fundamental part in the process of parturition, in the empowerment and autonomy of the parturient.Descriptors: Humanized Delivery, Obstetric Nursing, Parturient. O papel del enfermero en la promoción del parto humanizadoResumen: Comprender el papel del enfermero en la promoción del parto humanizado, y contribuir de forma indirecta en la asistencia y seguridad de todo el proceso parturitivo. Se trata de un estudio de revisión integrativa, con búsqueda de los artículos en las bases de datos, Scientific Electronic Library Online (SciELO) y Google Académico, publicados en los últimos 5 años (entre 2015 y 2019). El enfermero trae como beneficios para el parto humanizado, la inserción de buenas prácticas, como disminuir los dolores con métodos no farmacológicos, proporcionar seguridad, autonomía y participación activa de la mujer durante todo el proceso de parturición. Se concluye que el enfermero es pieza fundamental en el proceso de parturición, en el empoderamiento y en la autonomía de la parturienta.Descriptores: Parto Humanizado, Enfermería Obstétrica, Parturienta.

Functional gastrointestinal disorders in infants and toddlers. Online survey results

Aim: to study the possibilities of online surveys for mothers using a questionnaire on the basis of the Rome IV criteria (2016) as a screening for functional gastrointestinal disorders (FGID) in infants and toddlers. Patients and Methods: an anonymous online survey of 477 mothers was conducted regarding the health condition of their children under the age of 4 years. The survey consisted of 2 question pools. The first pool included general questions regarding the age of the mother at the time of delivery, obstetric and gynecological history, feeding of an infant/toddler at the time of the survey. The second pool included questions regarding FGID in infants and toddlers on three separate topics: functional disorders of the first year of life; diagnosis of cyclic vomiting syndrome; bowel movement disorder. Results: among 130 infants, regurgitation was in 50% of cases (at the age of 6 months — in 75%, at the age of 6 to 12 months — in 35%), baby colic — in 49%. The incidence of functional constipation in children under 6 months was 5.8%, from 6 to 12 months — 7.6%, gradually increasing by 3–4 years to 21.5%. Toilet skills were taught to 15 (12%) children aged 1 year — 1 year 11 months, 58 (59%) — at the age of 2 years — 2 years 11 months, and 119 (98%) — at the age of 3 years — 3 years 11 months. Mothers who were unaware of their child’s physical development and/or defecation problems accounted for 20.1% of those who took part in the survey. Conclusion: online survey results of mothers coincide with modern statistical data on FGID disorder. The survey results generally reflect the anatomical and physiological patterns of the child’s GI development. Online survey on the detection of FGID in infants/toddlers allows to make a preliminary diagnosis, identify existing problems and determine further patient management tactics. KEYWORDS: functional gastrointestinal disorders, infant, toddler, Rome IV criteria, questionnaire for parents, functional constipation, online survey, baby colic, regurgitation, toilet skills. FOR CITATION: Dubrovskaya M.I., Gryaznova E.I. Functional gastrointestinal disorders in infants and toddlers. Online survey results. Russian Medical Inquiry. 2020;4(5):274–281. DOI: 10.32364/2587-6821-2020-4-5-274-281.