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Background: Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the impor-tance of the social space of birth.Aim: To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth.Methods: A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic.Findings: Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relation-ships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. Discussion/conclusion: The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

Background. Breech presentation at the time of delivery is 3.8–4%. Fetuses that maintain a noncephalic presentation beyond 32 weeks will have a lower probability of spontaneous version before labor. Given the increasing interest in exploring the use of complementary medicine during pregnancy and childbirth, the moxibustion technique, a type of traditional Chinese medicine, could be another option to try turning a breech baby into a cephalic presentation. Objectives. To review the evidence from systematic reviews (SR) on the efficacy and safety of acupuncture and moxibustion in pregnant women with noncephalic presentation. Main Results. Our SR synthesizes the results from five clinical trials on pregnant women with a singleton noncephalic presentation. There is evidence that moxibustion reduces the number of noncephalic presentations at the time of birth compared with no treatment. The adverse effects that acupuncture and moxibustion can cause seem to be irrelevant. Most SRs agree that there are no adverse effects directly related to acupuncture and moxibustion. Conclusions. Even though the results obtained are positive and the five reviews conclude that moxibustion reduces the number of noncephalic presentations at birth (alone or combined with postural techniques or acupuncture), there is considerable heterogeneity between them. Better methodologically designed studies are required in the future to reaffirm this conclusion.

Aim To use the reflections of primary care midwives to know the barriers and facilitators for detecting IPV during pregnancy. The second aim is to know proposals for measures to improve the detecting. Method Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with twelve midwives, who work in the sexual and reproductive health care centers in Hospitalet de Llobregat (Barcelona). Results The difficulties in detection are the system of visits, the situation of women and barriers of the professional such as fear. The follow-up in the control of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. Conclusions The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detecting IPV, coordination with other services and the ethical and legally appropriate way of recording in the clinical record.

Background Induced lactation and relactation are the processes that enable breastfeeding in non-gestating mothers. Research aim The aim of this study was to describe and interpret the challenges faced by mothers who undergo induced breastfeeding and relactation for adopted infants, infants born via surrogacy, and infants born to same-sex female partners. Methods A qualitative study was performed using in-depth interviews conducted with Spanish women ( N = 9) who had decided to undergo induced lactation or relactation. The data were collected between October 2014 and May 2017. The length of the study was due to the difficulty in locating and recruiting the sample. Interviews were transcribed and coded with the ATLAS.ti v.7.5.7 software. We performed a deductive thematic analysis, creating categories based on the interview questions, which we developed on the basis of previous literature about induced lactation and relactation. Results Participants described the following challenges: the physical hardships of the process; breastfeeding problems; difficulty with accessing information about induced lactation or relactation; and lack of support from health professionals. Breastfeeding periods lasted from 1.5 months to 4 years. Participants reported that breastfeeding increased the closeness between the mother and child and that this feeling of closeness tended to decrease after breastfeeding cessation. Conclusion We offer data and analysis that can improve our understanding of the lived experiences of women undergoing the process of relactation or induced lactation and may help guide intervention strategies to support women in this situation.

Background: obstetric violence is still far too invisible; the word “violence” generates rejection and obstetric violence is complex to define and typify, as it is a subjective experience. It has been widely analyzed from legal, sociological, and clinical perspectives, but not equally so from the bioethical point of view. This article sets out to take a more in-depth look at the experiences of midwives in order to describe the ethical perspectives of obstetric violence. We intend to describe the effects that malpractice and violence within obstetric care have on American and European bioethical principles. Methodology: A qualitative methodology of the phenomenological tradition was used: 24 midwives participated in three focus groups. Results and Discussion: four categories were arrived at; they are “the maleficence of forgetting my vulnerability”, “beneficence requires respect for my integrity and dignity”, “my autonomy is being removed from me” and “a problem of social justice towards us, women”. Conclusion: obstetric violence infringes on the main bioethical principles (non-maleficence, beneficence, autonomy, justice, vulnerability, dignity, and integrity). Beyond whether it is called violence or not, what matters from an ethical perspective is that, as long as women have such negative experiences during pregnancy and childbirth, obstetric care needs better humanizing.

Background Birth cultures have been transforming in recent years mainly affecting birth care and its socio-political contexts. This situation has affected the feeling of well-being in women at the time of giving birth. Aim For this reason, our objective was to analyse the social meaning that women ascribe to home births in the Chilean context. Method We conducted thirty semi-structured interviews with women living in diverse regions ranging from northern to southern Chile, which we carried out from a theoretical-methodological perspective of phenomenology and situated knowledge. Qualitative thematic analysis was used to analyse the information collected in the field work. Findings A qualitative thematic analysis produced the following main theme: 1) Home birth journeys. Two sub-categories: 1.1) Making the decision to give birth at home, 1.2) Giving birth: (re)birth. And four sub-categories also emerged: 1.1.1) Why do I need to give birth at home? 1.1.2) The people around me don’t support me; 1.2.1) Shifting emotions during home birth, 1.2.2) I (don’t) want to be alone. Conclusion We concluded that home births involve an intense and diverse range of satisfactions and tensions, the latter basically owing to the sociocultural resistance surrounding women. For this reason, they experienced home birth as an act of protest and highly valued the presence of midwives and their partners.

To assess the association between superficial perineal muscle trauma and perineal pain and dyspareunia.Prospective cohort study of 405 women with a spontaneous vaginal birth comparing an intact perineum and first-degree perineal trauma group (n = 205) with a second-degree perineal trauma and episiotomy group (n = 200). Perineal pain was measured at 2 days, 10 days, 7 weeks, 3 months and 6 months postpartum. Dyspareunia was assessed at 7 weeks, 3 months and 6 months postpartum.All second-degree perineal traumas and episiotomies involved damage to the bulbospongiosus muscle (BSM), but not always to the superficial transverse perineal muscle (STPM). In case of second-degree trauma or episiotomy, the odds of pain at 10 days and dyspareunia at 6 months postpartum were four- and five-fold greater, respectively, than if the perineum had remained intact or suffered a first-degree perineal trauma [OR 4.4 (95% CI: 2.8-6.9) and OR 5.5 (95% CI: 2.8-10.9), respectively]. When comparing injuries where50% BSM ± STPM against those with50% BSM torn, pain was significantly higher at 10 days postpartum [OR 1.9 (95% CI: 1.1-3.6], with no difference at 7 weeks, while dyspareunia was significantly higher at 6 months postpartum [OR 3.3 (95% CI: 1.4-7.8)]. There was no difference in perineal pain or dyspareunia when comparing first-degree with50% BSM traumas.When perineal muscle trauma encompasses50% BSM ± STPM, perineal pain and dyspareunia persisted until 10 days and 6 months postpartum, respectively.

Aims Exploring social and health care representations of home birth by conducting an integrative review of the literature. Design Integrative Literature Review. Data sources The search was based on the following keywords: "birth, home," "home birth," "childbirth, home." And the terms: "planned home birth," and "empowerment women homebirth" (in English). "partos en casa," and "partos domiciliarios" (in Spanish) in the following databases: Biomedical Central, Cochrane Library, Dialnet, DOAJ, Lilacs, PubMed, Scopus, Scielo, and Web of Science. Review methods A total of 156 publications dated between 2004 and 2017 were initially obtained and a total of 41 articles were finally selected according to the criteria of inclusion, methodological rigor, and researchers' triangulation. Results Four dimensions of the issue emerged out of the 41 articles analyzed: (a) the Dimension of "Empowerment in Childbirth;" (b) the Dimension of "Comparative Socio-Medical Childbirth Studies;" (c) the "Institutional Dimension of Childbirth;" (d) the "Cultural Dimension of Childbirth." Conclusion From the health management perspective, home birth is not widely accepted today as a valid and safe alternative. However, women's social representations indicate an interest in returning to birth at home as a response to the excessive medicalization and institutionalization of childbirth, and value highly its autonomy and comfort.

Background Induced lactation enables a woman who has not given birth to breastfeed a child. Lactation may be induced through both pharmacological and non-pharmacological methods, although the desired outcome cannot always be achieved. Research Aims The aims of this scoping review was to assess the different methods used to induce lactation, as well as the factors related to sucking the breast effectively and the production of human milk. Methods We searched five databases from June 2019–February 2020 for studies referring to methods and factors related to breast suckling and/or the volume of milk produced after inducing lactation, using the following search terms and Boolean operators: breastfeeding AND induced lactation AND adoptive mothers OR surrogate mothers OR female homosexuality OR non-gestating. The final review included a total of 24 articles. Results Pharmacological methods were not always used to produce milk, although breast stimulation was essential. The age of the child, interference due to bottle feeding, breast stimulation, and the support received were important factors in the induction of lactation. There were several factors that may account for the differences between developing and higher income countries in methods of induced lactation and the amount of milk that study participants produced. There was no consensus over whether previous pregnancy and/or breastfeeding experience influenced induced lactation. Conclusion Health professionals need to have adequate knowledge about induction methods, the preferences of each woman, and the reasons for inducing lactation, to provide proper assistance. However, the lack of standardization about induction of lactation makes it difficult.

Resumen Objetivo Conocer a traves de las narraciones de las matronas de Atencion Primaria los factores que obstaculizan o contribuyen a la deteccion y el abordaje de la violencia de genero durante el embarazo, asi como sus propuestas de mejora para tal fin. Metodo Estudio cualitativo con un enfoque fenomenologico interpretativo. Se hicieron entrevistas semiestructuradas a las 12 matronas que trabajan en los centros de Atencion Primaria de L’Hospitalet de Llobregat (Barcelona). Resultados Las dificultades en la deteccion se relacionan con el sistema de visitas, el contexto de las mujeres y barreras del propio profesional como el miedo. Destacan como factores facilitadores el seguimiento en el control del embarazo y la relacion de confianza con la matrona. Las propuestas de mejora se relacionan con la formacion y el uso de procedimientos seguros y fiables. Conclusiones Seria deseable poner en marcha acciones de mejora, tales como ampliar la formacion y consensuar un circuito interno de trabajo que incluya instrumentos objetivos de ayuda de la deteccion, la coordinacion con otros servicios y la forma etica, y legalmente adecuada de registro en la historia clinica.

El concepto de procreación consciente y responsable fue acuñado por el neomaltusianismo como reflexión demográfica sobre las consecuencias de la reproducción humana considerada como un hecho natural y vinculado, exclusivamente, al ciclo de la vida. Se trataba de un planteamiento surgido ante un contexto de recursos escasos, como consecuencia del crecimiento, sin control, de la población. Unos años más tarde surgieron, con fuerza, los movimientos feministas y la idea de la emancipación de la mujer, reivindicando su capacidad de decisión frente al matrimonio y la maternidad y planteando el derecho de las mujeres a una maternidad consciente y elegida. En estos momentos, en el contexto occidental, tener un hijo/a se transforma en un acto consciente y madurado de elección y realización personal, perdiéndose esta idea de «maternidad natural», para conceptualizarse en el entramado social con implicaciones éticas y políticas. La maternidad y paternidad conscientes se convierte también en maternidad y paternidad responsables., The notion of conscious and responsible procreation was coined by neo-Malthusianism as a demographic reflection on the consequences of human reproduction considered as a natural phenomenon and linked, exclusively, to the cycle of life. It was an approach that arose in a context of scant resources that resulting from an uncontrolled growth of the population. A few years later, feminist movements and the idea of women’s emancipation emerged, vindicating their capacity for decision in the face of marriage and motherhood and raising the right of women to a conscious and chosen motherhood. Today, in the Western context, having a child has become a conscious act of personal choice and fulfillment, losing this idea of «natural motherhood», which is now conceptualized in the social fabric bearing ethical and political implications. Conscious motherhood and fatherhood also becomes responsible motherhood and fatherhood.

Background The consequences of breastfeeding during pregnancy (BDP) have not been clearly established. Available studies have addressed isolated aspects of this issue using different methodologies, often resulting in contradictory results. To our knowledge, no systematic review has assessed and compared these studies, making it difficult to obtain a clear picture of the consequences of BDP. Aim To review and summarise all the scientific evidence relating to BDP, and determine whether this evidence is sufficient to establish clear implications for the mother, breastmilk, breastfed child, current pregnancy, and ultimately, the newborn. Methods We conducted a systematic review of the English and Spanish literature published between 1990 and 2015 using Cinahl, PubMed, IME, CUIDEN, Cochrane Library, Web of Science and PyscINFO. Findings 3278 publications were identified from databases, their titles and abstracts were checked to ensure the studies were related to the subject and met the selection criteria. Only 19 studies met all requirements and were included in the review. Conclusions and implications Data suggest that BDP does not affect the way pregnancies end or even birth weights. However, several questions remain unanswered. Specifically, it is unclear how BDP affects maternal nutritional status in developed countries, the growth and health of breastfed siblings, the composition of breastmilk, or the growth of the newborn after delivery. Further studies of BDP are needed with larger samples, adequate methodology and proper control of the main confounders.

Objetivo: evaluar la efectividad del tratamiento con acupuntura y moxibustión en un entorno hospitalario, en mujeres embarazadas de 33 a 38 semanas de gestación con presentación no cefálica del feto. Método: estudio experimental de intervención, unicéntrico, en un centro hospitalario de tercer nivel, sobre una muestra de 250 mujeres embarazadas de 33 a 38 semanas de gestación con presentación no cefálica fetal. Como variable principal se consideró la versión o no a presentación cefálica posintervención y como variables secundarias las semanas de gestación en el inicio del tratamiento, la paridad, cómo finalizó el parto, el peso del recién nacido al nacer y la edad de la madre. Resultados: la prevalencia posintervención de reversión del feto a una presentación cefálica fue del 53,5% de todas las embarazadas que hicieron tratamiento con acupuntura y moxibustión y se obtuvieron diferencias significativas (p < 0,0001 en el test de la χ2) con un intervalo de confianza del 95%. El 75% finalizo en parto vaginal, mientras que en el grupo que permaneció en presentación no cefálica el 97,9% de los partos finalizó en cesárea. Durante el tratamiento no mostraron efectos adversos y hubo una gran aceptación y adherencia al tratamiento. Conclusiones: el tratamiento con acupuntura y moxibustión resulto ser efectivo y seguro practicado entre las semanas 33 a 38 de gestación en una presentación no cefálica y disminuyó el número de cesáreas. Se considera recomendable la realización de un ensayo clínico aleatorizado que pueda aportar mayor evidencia científica.

Objective: The objective of this study was to investigate the opinions of women regarding the satisfaction about the quality of maternity care received. We hope to establish whether health care technology increases satisfaction or whether it actually interferes with the construction of personal satisfaction in the process of care. Design and setting: Information was gathered using the focus group technique. The area of study comprised the post-natal groups run as part of the Sexual and Reproductive Health Programme of the Catalan Health Authority. (Spain) Participants: Five focus groups were held between May 2006 and July 2007. Findings: Quality of care is a complex concept in which a number of independent core features can be identified. We have grouped these core features into three basic categories. Safety: the hospital and its technological facilities, and the technical expertise of health professionals. The other two main pillars of quality of care are the human dimension of the relationship between the carers and the patient, and finally the structural aspects that determine the context in which the heath care is provided. Key conclusions and implications for practice: The mothers of our study feel satisfied with healthcare technology and view it as a source of security; technology become indispensable features in order to reduce the anxiety provoked by the perceived lack of confidence in their ability as mothers. In this study, women, both during pregnancy and especially when giving birth, believe their feelings and values should be understood by professionals, from whom they seek empathy and a personal commitment, and not just information.

Resumen Objetivo Identificar las dificultades de las matronas de la provincia de Barcelona implicadas en el control del embarazo, en relacion con la comunicacion y atencion a mujeres inmigradas procedentes de los paises del Magreb o de Senegal y Gambia. Metodo Estudio observacional descriptivo, con recogida de datos mediante cuestionario autocumplimentado, por parte de las matronas de la provincia de Barcelona, durante el ano 2002. Resultados El numero medio de mujeres magrebies visitadas por cada matrona fue de 14, y 11 el promedio para mujeres procedentes de Senegal y Gambia. El 68% de matronas consideraba que el desconocimiento del idioma suponia una dificultad importante para la realizacion de la educacion sanitaria. El abordaje de temas como la sexualidad, el ejercicio fisico o la alimentacion resulto problematico. El 53% de matronas utilizaba material de soporte. El 66% habia realizado algun tipo de actividad formativa en interculturalidad. Conclusiones Los problemas de comunicacion dificultan la realizacion de una actividad asistencial de calidad, y consideramos necesario potenciar las medidas para mejorar esta comunicacion. El conocimiento de la diversidad y la interculturalidad se convierte en un tema de especial importancia en los albores del siglo XXI. Las matronas han demostrado especial interes en mejorar su formacion en la materia.

Las enfermedades tienen sus propios ritmos que se van modificando a lo largo de los siglos; cada sociedad construye su forma de pensar y sentir las enfermedades. La interdependencia entre las condiciones biológicas y sociales de la vida civilizada, ha ocasionado que cada momento histórico viva de forma distinta la enfermedad . El objetivo de este artículo es reflexionar sobre la forma de ver y vivir la enfermedad en Occidente, a lo largo de la historia, centrándonos especialmente en la creencia, surgida a partir del siglo XVIII, que el progreso humano erradicaría la enfermedad. Las raíces de la forma de sentir la enfermedad en el Occidente de inicios del siglo XXI deben buscarse en los orígenes griegos y judeo-cristianos, que se continúan a lo largo de la Edad Media, hasta que con la llegada de la Modernidad se produce un giro desde la búsqueda de la eternidad en el otro mundo, hacia un caminar a la inmortalidad en la tierra. En los inicios del siglo XXI, el hombre post-moderno traslada la crisis de pensamiento vigente al campo de la salud, ello plantean tensiones que se hacen patentes en la forma de vivir y atender la enfermedad.Illnesses have an own rhythm that has been modified all through centuries. Every society builds own way of thinking and feeling the illnesses. The interdependence between biological and sociological conditions in civilized society shows the form of living the illness in each historical moment.Objectives: Thinking about the way of seeing and living the illness in the western world all through the history. This work is specially centred in the believing emerged in the 18th century that the human progress can eradicate the illness.The roots of the way of filing the illness in the western world at the beginning of the 20th century are to be found in the ancient Greece and in the Judaic-Christian culture. This form of thinking has continued all troughs the Middle Age, until the arrival of the Modernity. From this moment a change has been produced: from searching the eternity in the other world to looking for the immortality on the earth. In the beginning of the 21th century, the post-modern man translates the crisis of thinking to the illness field. It produces tensions, which have evident impact in the form of living and taking care of the illness.

Resumen En este trabajo se pretende realizar una reflexion sobre el tipo de asistencia que en materia de salud reproductiva demanda nuestra sociedad actual. Para ello es importante tomar en consideracion el entorno sociocultural en el que se desarrollan los cuidados de enfermeria en materia de salud reproductiva. Tras realizar un repaso a la evolucion del concepto de salud como marco conceptual se llega a profundizar en el ambito de salud reproductiva. En pocos anos se ha pasado de una asistencia centrada en el proceso de embarazo, parto y puerperio a una vision mas amplia y holistica de la salud reproductiva. Consecuentemente los cuidados en la atencion de salud a la mujer han tenido que evolucionar tambien.

Background: Ethical conflicts in nursing have generally been studied in terms of temporal frequency and the degree of conflict. This study presents a new perspective for examining ethical conflict in terms of the degree of exposure to conflict and its typology. Objectives: The aim was to examine the level of exposure to ethical conflict for professional nurses in critical care units and to analyze the relation between this level and the types of ethical conflict and moral states. Research design: This was a descriptive correlational study. Central and dispersion, normality tests, and analysis of variance were carried out. Participants and research context: A total of 203 nurses were from two third-level teaching hospitals in Spain. Both centers are part of the University of Barcelona Health Network. Participants filled out the Ethical Conflict in Nursing Questionnaire–Critical Care Version. Ethical considerations: This investigation received the approval of the ethical committees for clinical investigation of the two participating hospitals. Participants were informed of the authorship and aims of the study. Findings: The index of exposure to ethical conflict was [Formula: see text]. The situations involving analgesic treatment and end-of-life care were shown to be frequent sources of conflict. The types of ethical conflict and moral states generally arranged themselves from lesser to greater levels of index of exposure to ethical conflict. Discussion: The moderate level of exposure to ethical conflict was consistent with other international studies. However, the situations related with family are infrequent, and this presents differences with previous research. The results suggest that there is a logical relationship between types of conflict and levels of exposure to ethical conflict. Conclusion: The types of ethical conflict and moral states were related with the levels of exposure to ethical conflict. The new perspective was shown to be useful for analyzing the phenomenon of ethical conflict in the nurse.

Background The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives’ level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. Methods A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Results Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p

The authors describe the diseases which are detectable by means of neonatal screening programs available in the different Spanish Autonomous Communities. They analyze some of the ethical and social implications which may occur and they emphasize what those programs mean for nursing professionals, fundamentally midwives and nurses who work in primary health care units or pediatric units.

Las enfermedades tienen sus propios ritmos que se van modificando a lo largo de los siglos; cada sociedad construye su forma de pensar y sentir las enfermedades. La interdependencia entre las condiciones biológicas y sociales de la vida civilizada, ha ocasionado que cada momento histórico viva de forma distinta la enfermedad . El objetivo de este artículo es reflexionar sobre la forma de ver y vivir la enfermedad en Occidente, a lo largo de la historia, centrándonos especialmente en la creencia, surgida a partir del siglo XVIII, que el progreso humano erradicaría la enfermedad. Las raíces de la forma de sentir la enfermedad en el Occidente de inicios del siglo XXI deben buscarse en los orígenes griegos y judeo-cristianos, que se continúan a lo largo de la Edad Media, hasta que con la llegada de la Modernidad se produce un giro desde la búsqueda de la eternidad en el otro mundo, hacia un caminar a la inmortalidad en la tierra. En los inicios del siglo XXI, el hombre post-moderno traslada la crisis de pensamiento vigente al campo de la salud, ello plantean tensiones que se hacen patentes en la forma de vivir y atender la enfermedad. Illnesses have an own rhythm that has been modified all through centuries. Every society builds own way of thinking and feeling the illnesses. The interdependence between biological and sociological conditions in civilized society shows the form of living the illness in each historical moment.Objectives: Thinking about the way of seeing and living the illness in the western world all through the history. This work is specially centred in the believing emerged in the 18th century that the human progress can eradicate the illness.The roots of the way of filing the illness in the western world at the beginning of the 20th century are to be found in the ancient Greece and in the Judaic-Christian culture. This form of thinking has continued all troughs the Middle Age, until the arrival of the Modernity. From this moment a change has been produced: from searching the eternity in the other world to looking for the immortality on the earth. In the beginning of the 21th century, the post-modern man translates the crisis of thinking to the illness field. It produces tensions, which have evident impact in the form of living and taking care of the illness.

Objetivo: analizar los distintos elementos que influyen en la calidad tecnica y la calidad de servicio percibida por las mujeres en relacion con la asistencia recibida en el parto normal hospitalario. Metodologia: Se trata de una busqueda bibliografica en las bases de datos Medline, Cinhal, Biblioteca Cochrane Plus, Enfispo, asi como paginas web de organismos oficiales y guias de practica clinica. Resultados: Se observo que numerosas estrategias han sido elaboradas para reducir el exceso de medicalizacion en el parto normal e identificar los predictores claves para medir la satisfaccion de las mujeres. Conclusion: En los ultimos anos se ha mostrado un crecimiento en el deseo de las mujeres de estar informadas, asi como una creciente demanda de que la fuerza de sus voces sea respetada en la toma de decisiones con respeto al nacimiento de su bebe. Descriptores: Satisfaccion paciente. Practicas basadas en la evidencia. Calidad. Parto. Palabras clave: satisfaccion paciente, practicas basadas en la evidencia, calidad, parto.

Introduction Several tools have been developed to objectively identify women who are experiencing intimate partner violence (IPV). The objective of this systematic review is to identify and describe the properties and clinical usefulness of the validated tools for detecting IPV published in the past 15 years. Methods A systematic review was performed of the bibliographic databases PubMed, Cochrane Library, ENFISPO, IME, CINHAL, CUIDEN and Cuidatge. The search was restricted to articles published in the past 15 years. It was broadened to include grey literature. The articles selected present tools for screening, evaluating and measuring the risk of IPV, along with information on the validation of the tool. They are either written in Spanish or English. Results 536 articles were found in total, of which eight were excluded as they appeared in two different databases. A further 461 were excluded after reading the title and summary. 67 full articles were reviewed. 63 articles were finally included and 39 tools. Conclusion This systematic review provides a big-picture perspective of validated IPV tools published since 2003. It can help health professionals and researchers choose the most appropriate tool for their specific purposes and context.

Background: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37–42 weeks) singleton births. Results: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births. This study forms part of the research project, FEM2012-33067, which is funded by Spain’s Ministry of Economy and Competitiveness

Introducción:La violencia de género es una realidad terrible que afecta a todos los países. Cuando dicha lacra afecta a la mujer gestante, los efectos negativos se multiplican y afectan también al feto. Mejorar en los procedimientos para su detección y abordaje es una de las medidas para superarla. Por las funciones que desarrollan durante el seguimiento del embarazo, parto y posparto, y por la relación de confianza que establecen con la mujer gestante, las matronas son profesionales que se encuentran en una posición especialmente adecuada para proceder a su detección.Material y Métodos:Presentamos los objetivos, metodología, contenidos y evaluación de una actividad formativa dirigida a matronas del municipio de Hospitalet de Llobregat, que se llevó a cabo en el pasado año en el seno de una Investigación Acción Participativa que pretende mejorar la detección y abordaje de los casos de violencia de género durante el embarazo.Resultados:Los resultados de evaluación de la actividad informan favorablemente de su repetición y apuntan, para su mejora, más actividades de aplicación de contenidos y ampliación de la formación recibida sobre servicios de atención a las mujeres, circuitos de derivación e inteligencia emocional.Discusión y Conclusiones:Se ha planteado la evaluación desde su carácter formativo. Se han evaluado objetivos e impacto de la actividad. De manera coherente con la Investigación Acción Participativa de la que procede, se ha optado por un enfoque horizontal y participativo. Promover acciones formativas y someterlas a evaluación es una de las vías para combatir la violencia de género., Introduction:Intimate partner violence is a terrible reality that is present in all countries. When it involves a pregnant woman, the negative effects multiply affecting also the fetus. Improving the procedures for detection and treatment is one of the measures that will allow to eventually overcome intimate partner violence. Because of the functions that midwives perform during pregnancy, monitorization, and post-partum, and because of the relationship of trust they establish with the pregnant woman, midwives are in a particularly suitable position to proceed with their detection.Materials and Method:In this article we present the objectives, contents and evaluation of a training activity aimed at midwives of the municipality of Hospitalet de Llobregat that took place this year in the context of a Participatory Action Research that aims to improve the detection and approach of cases of intimate partner violence during pregnancy.Results:The results of the training activity’s assessment report favorably on its repetition and point, for its improvement, to the realization of more activities focused on the application of contents and to increase the training received on services of attention to women in contexts of intimate partner violence, circuits of referral, and emotional intelligence.Discussion and Conclusions:The assessment has focused on the activity's formative nature. The objectives and the impact of the activity have been evaluated. In accordance with the Participatory Action Research, we have chosen a horizontal and participatory approach. Promoting training actions and submitting them to evaluation is one of the ways to combat intimate partner violence.