Suchergebnisse

Perinatal death is a profound and common experience, and one that is often underestimated in terms of itsfrequency and its impact. As primary caregivers of parents suffering perinatal loss, nursing and medical staffhave tremendous power to shape parental experiences. In this qualitative, exploratory study, unstructured interviews were conducted with 26 individuals (21 women and 5 men) who had experienced perinatal loss. Subjects' experiences ranged from parents whose perinatal losses had occurred during the 1st trimester, to one man who had lost two children in late pregnancy and a third child to sudden infant death syndrome shortly after birth. Using grounded theoryfor the analysis, this study identifies a number of areas parents cited as problematic during interactions with medical and nursing personnel and also reports gestures and interventions that parentsfound extremely helpful and supportive. Recommendationsfor ways caregivers couldfacilitate parental grief proactively and with insight are offered.

Background Globally, an estimated 2.7 million babies die in the neonatal period annually, and of these, about 0.7 million die from intrapartum-related events. In Tanzania 51,000 newborn deaths and 43,000 stillbirths occur every year. Approximately two-thirds of these deaths could be potentially prevented with improvements in intrapartum and neonatal care. Routine measurement of fetal intrapartum deaths and newborn deaths that occur in health facilities can help to evaluate efforts to improve the quality of intrapartum care to save lives. However, few examples exist of indicators on perinatal mortality in the facility setting that are readily available through health management information systems (HMIS). Methods From November 2016 to April 2017, health providers at 10 government health facilities in Kagera region, Tanzania, underwent refresher training on perinatal death classification and training on the use of handheld Doppler devices to assess fetal heart rate upon admission to maternity services. Doppler devices were provided to maternity services at the study facilities. We assessed the validity of an indicator to measure facility-based pre-discharge perinatal mortality by comparing perinatal outcomes extracted from the HMIS maternity registers to a gold standard perinatal death audit. Results Sensitivity and specificity of the HMIS neonatal outcomes to predict gold standard audit outcomes were both over 98% based on analysis of 128 HMIS–gold standard audit pairs. After this validation, we calculated facility perinatal mortality indicator from HMIS data using fresh stillbirths and pre-discharge newborn death as the numerator and women admitted in labor with positive fetal heart tones as the denominator. Further emphasizing the validity of the indicator, FPM values aligned with expected mortality by facility level, with lowest rates in health centers (range 0.3%– 0.5%), compared to district hospitals (1.5%– 2.9%) and the regional hospital (4.2%). Conclusion This facility perinatal mortality indicator provides an important health outcome measure that facilities can use to monitor levels of perinatal deaths occurring in the facility and evaluate impact of quality of care improvement activities.

In order to reduce the Maternal Mortality Rate (MMR) in Indonesia, the government has made various innovations to lessen the MMR. One of the improvement is to put in force Maternal Perinatal Death Notification (MPDN) technology. But in the implementation, there are still many hospitals and health centers in North Sumatra that have not longer applied MPDN optimally. Considering that North Sumatra is one of the provinces with the very best MMR in Indonesia, the utilization of MPDN desires to be extended in North Sumatera. In preceding research, it became stated that the readiness and recognition of a technology will have an affect on the successful implementation of the technology. Therefore, this take a look at pursuits to measure and notice the effect of every variable at the acceptance of MPDN technology based on the Unified Theory of Acceptance and Use of Technology (UTAUT). The variables located to have an influence at the acceptance of MPDN technology in North Sumatra are overall performance expectancy, effort expectancy, social influence, self-efficacy and technology anxiety. These five influential variables are then used as the basis for building strategies using Importance- Performance Analysis (IPA).

BACKGROUND: When used effectively, the Maternal and Perinatal Death Surveillance and Response (MPDSR) system can bring into reality a revolutionary victory in the fight against maternal and perinatal mortality from avoidable causes. This study aimed at determining the status of implementation of the system among health facilities in the Morogoro Region. METHOD: This study was conducted among 38 health facilities from three districts of the Morogoro region, Tanzania, from April 27, 2020, to May 29, 2020. Quantitative data were collected through document review for MPDSR implementation status. The outcome was determined by using a unique scoring sheet with a total of 30 points. Facilities that scored less than 11 points were considered to be in the pre-implementation phase, those scored 11 to 17 were considered in the implementation phase, and those scored 18 to 30 were considered to be in the institutionalization phase. RESULTS: The majority 20(53 %) of health facilities were in the pre-implementation phase, only 15(40 %) of assessed health facilities were in the implementation phase, and few 3(8 %) of health facilities were in institutionalization phase. There was a strong evidence that MPDSR implementation was more advanced in urban compared to rural health facilities (Fisher's test = 6.158, p = 0.049), hospitals compared to health centers (Fisher's test =14.609, p <0.001) and private and faith-based organization than public facilities (Fisher's test, 15.897 = p = 0.002). CONCLUSIONS: The study revealed that health facilities in Morogoro Region have not adequately implemented the MPDSR system. The majority of health facilities in rural settings and owned by the government showed poor MPDSR implementation and hence called for immediate action to rectify the situation. Strengthen MPDSR implementation, health facilities should be encouraged to adhere to the available MPDSR guidelines in the process of death reviews. Transparent systems should also be established to ensure thorough tracking and follow-up of ...

A collection of lectures by eminent members of the British Psycho-analytical Society. Includes papers on the experience of having a baby, pregnancy and the internal world, pregnancy after stillbirth or neonatal death, and therapeutic intervention for post-partum disturbance. 100 pages

This study takes the body (of mother and child), the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments. Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth. ; Este estudo entende o corpo (da mãe e criança), o panorama tecno-científico do hospital e o ritual profissional como o lócus de um esforço em entender a experiência de morte perinatal, para compreender melhor como alternar entendimentos e ontologias sobre maternidade, pessoalidade e luto que emergem durante os atos de cuidado. Baseado numa perspectiva descritiva e etnográfica a pesquisa analisa dados de registros de 22 membros de um fórum de apoio ao luto na perda gestacional e 10 entrevistas narrativas. A pesquisa traça a experiência desde a gravidez, passando pelo diagnóstico até a experiência do espaço do hospital, incluindo o nascimento, o contato postmortem e a remoção do cadáver. Marcadas pela repentina destruição da segurança ontológica absoluta essas mulheres vivenciam uma crise existencial que resulta num eu estigmatizado destruído. A pesquisa explora como o cuidado obstétrico medicalizado trazem entendimentos de morte perinatal e luto que problematiza mais as relações postmortem, criando identidades tóxicas e incorporados eus (embodied selves). Em contraponto, a obstetrícia centrada na mulher que tem entendimentos relacionais e sociais como uma base para o cuidado pode criar condições materiais de possibilidade para uma restauração da confiança em si mesmo (carnal self) e uma reconstrução dos laços e ordens sociais. Reunidos através da prática, discurso e política (policy), esses corpos são emersos individualmente, socialmente e politicamente, mas são também múltiplas, mutantes e cobertas combinações de natureza e cultura. Essa pesquisa propõe que a prática do cuidado na saúde poderia se beneficiar ao considerar os natimortos naturais, como a obstetrícia contemporânea entende o nascimento como natural. ; Este estudio considera el cuerpo (de la madre y del niño) y el entorno tecno-científico como lugar paradigmático para analizar la experiencia tras la muerte perinatal, con el fin de comprender como se desarrollan ontologías alternativas de la maternidad, la personalidad y del duelo. La investigación analiza las entradas de 22 miembros de un foro de apoyo a la muerte perinatal y 10 entrevistas narrativas. El articulo aborda la experiencia asociada al embarazo hasta la experiencia con el espacio físico del hospital, incluyendo el nacimiento, contacto posparto y la disposición del cuerpo. Delimitado por la destrucción repentina de seguridad ontológica estas mujeres experimentan una crisis existencial que se traduce en un yo deconstruido y estigmatizado. Exploramos la manera en que la atención obstétrica excesivamente biomédica promulga comprensiones de la muerte y el duelo perinatal que problematizan aún más las relaciones posmortem, creando así identidades encarnadas tóxicas, y por tanto exacerbando el duelo. Por el contrario, la atención centrada en la mujer y liderada por la comadrona puede crear las condiciones para una restauración de la confianza en uno mismo y la maternidad, y una reconstrucción de los lazos sociales. Estos cuerpos son situados en un espacio y condición individual a pesar de los múltiples ensamblajes culturales y sociales que atestiguan su condición última. La investigación propone que la atención sanitaria debería considerar el stillbirth natural, de la misma manera que la obstetricia moderna aboga por el parto natural.For the English abstract, please select "English" in the language settings on the right column.

This study takes the body (of mother and child), the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments. Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth. ; Este estudio considera el cuerpo (de la madre y del niño) y el entorno tecno-científico como lugar paradigmático para analizar la experiencia tras la muerte perinatal, con el fin de comprender como se desarrollan ontologías alternativas de la maternidad, la personalidad y del duelo. La investigación analiza las entradas de 22 miembros de un foro de apoyo a la muerte perinatal y 10 entrevistas narrativas. El articulo aborda la experiencia asociada al embarazo hasta la experiencia con el espacio físico del hospital, incluyendo el nacimiento, contacto posparto y la disposición del cuerpo. Delimitado por la destrucción repentina de seguridad ontológica estas mujeres experimentan una crisis existencial que se traduce en un yo deconstruido y estigmatizado. Exploramos la manera en que la atención obstétrica excesivamente biomédica promulga comprensiones de la muerte y el duelo perinatal que problematizan aún más las relaciones posmortem, creando así identidades encarnadas tóxicas, y por tanto exacerbando el duelo. Por el contrario, la atención centrada en la mujer y liderada por la comadrona puede crear las condiciones para una restauración de la confianza en uno mismo y la maternidad, y una reconstrucción de los lazos sociales. Estos cuerpos son situados en un espacio y condición individual a pesar de los múltiples ensamblajes culturales y sociales que atestiguan su condición última. La investigación propone que la atención sanitaria debería considerar el stillbirth natural, de la misma manera que la obstetricia moderna aboga por el parto natural.For the English abstract, please select "English" in the language settings on the right column. ; Este estudo entende o corpo (da mãe e criança), o panorama tecno-científico do hospital e o ritual profissional como o lócus de um esforço em entender a experiência de morte perinatal, para compreender melhor como alternar entendimentos e ontologias sobre maternidade, pessoalidade e luto que emergem durante os atos de cuidado. Baseado numa perspectiva descritiva e etnográfica a pesquisa analisa dados de registros de 22 membros de um fórum de apoio ao luto na perda gestacional e 10 entrevistas narrativas. A pesquisa traça a experiência desde a gravidez, passando pelo diagnóstico até a experiência do espaço do hospital, incluindo o nascimento, o contato postmortem e a remoção do cadáver. Marcadas pela repentina destruição da segurança ontológica absoluta essas mulheres vivenciam uma crise existencial que resulta num eu estigmatizado destruído. A pesquisa explora como o cuidado obstétrico medicalizado trazem entendimentos de morte perinatal e luto que problematiza mais as relações postmortem, criando identidades tóxicas e incorporados eus (embodied selves). Em contraponto, a obstetrícia centrada na mulher que tem entendimentos relacionais e sociais como uma base para o cuidado pode criar condições materiais de possibilidade para uma restauração da confiança em si mesmo (carnal self) e uma reconstrução dos laços e ordens sociais. Reunidos através da prática, discurso e política (policy), esses corpos são emersos individualmente, socialmente e politicamente, mas são também múltiplas, mutantes e cobertas combinações de natureza e cultura. Essa pesquisa propõe que a prática do cuidado na saúde poderia se beneficiar ao considerar os natimortos naturais, como a obstetrícia contemporânea entende o nascimento como natural.