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OBJECTIVE: To analyze puerperal women's experiences of sexual health after childbirth from the perspective of symbolic interactionism. METHOD: Descriptive, qualitative study. Twenty semi-structured interviews were conducted by videoconference with women in the remote puerperium, captured by snowball technique and searched for "seeds" on Instagram®. Bardin's content analysis and Symbolic Interactionism were used as references. RESULTS: The puerperal women signify sexual health from a perspective of comprehensive healthcare. However, due to the duality between "being a woman" and "being a mother", they recognize fear, bodily transformations and changes in focus from the love relationship to caring for the baby as factors that interfere with sexual health. And they choose to put themselves aside, prioritizing caring for others. They re-signify sexual health by recognizing the importance of taking care of themselves in biopsychosocial aspects and try to recover self-care for a healthy sexual experience. CONCLUSION: Despite the meanings attributed, women's social interactions with the puerperium interfere negatively with sexual health. Professionals should be sensitized to the inclusion of actions that promote changes in the social action of these women towards self-care.

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Resumo Objetivo Desenvolver e validar material educativo para a construção de um plano de pós-parto pela mulher no ciclo gravídico-puerperal, com ou não profissionais da saúde. Métodos Estudo metodológico, organizado em três etapas. 1) Análise e seleção de conteúdo, elaboração teórica do projeto e adaptação na linguagem; 2) Produção do material, com elaboração do design gráfico e projeto ilustrativo; 3) Validação com sete juízes nas áreas de saúde da mulher e educação em saúde. A coleta de dados foi executada com a aplicação de um questionário de caracterização e o Suitability Assessment of Materials for evaluation of health-related information for adults (SAM). A análise se deu por estatística descritiva e Índice de Validade de Conteúdo, sendo considerados aprovados os itens que apresentassem valor igual ou superior a 0,80. Resultados O plano de cuidado intitulado "Meu plano de pós-parto" apresentou ótima aceitação e confiabilidade, evidenciado por um Índice de Validade de Conteúdo global de 0,98. As principais sugestões apresentadas foram a respeito da adaptação da escrita para uma linguagem mais simples e acessível, sendo estas aceitas pelas autoras. Os especialistas apontaram a importância e relevância do plano de pós-parto para o público-alvo. Conclusão O material demonstrou ser um instrumento válido e confiável para a utilização das mulheres durante o ciclo gravídico puerperal, favorecendo uma reflexão sobre os cuidados e preparo precoce para enfrentamento deste período.

Resumen Objetivo Elaborar y validar material educativo para la creación de un plan de posparto por la mujer durante el embarazo y el puerperio, con o sin profesionales de la salud. Métodos Estudio metodológico, organizado en tres etapas: 1) análisis y selección de contenido, elaboración teórica del proyecto y adaptación del lenguaje; 2) producción del material, con elaboración del diseño gráfico y proyecto ilustrativo, y 3) validación por siete jueces de áreas de la salud de la mujer y educación para la salud. La recopilación de datos se llevó a cabo mediante la aplicación de un cuestionario de caracterización y el Suitability Assessment of Materials for evaluation of health-related information for adults (SAM). El análisis se realizó con estadística descriptiva y con el Índice de Validez de Contenido, donde se consideraron aprobados los ítems que presentaron un valor igual o superior a 0,80. Resultados El plan de cuidado llamado "Mi plan de posparto" presentó una excelente aceptación y fiabilidad, demostradas con un Índice de Validez de Contenido global de 0,98. Las principales sugerencias propuestas fueron sobre adaptar la escritura a un lenguaje más simple y accesible, y las autoras las aceptaron. Los especialistas señalaron la importancia y la relevancia del plan de posparto para el público destinatario. Conclusión El material demostró ser un instrumento válido y confiable para que lo utilicen mujeres durante el embarazo y el puerperio, y así favorecer una reflexión sobre los cuidados y la preparación temprana para enfrentar este período.

Abstract Objective To develop and validate an educational material for the construction of a postpartum plan by women in the pregnancy-puerperal cycle, with or without health professionals. Methods Methodological study, organized in three stages. 1) Content analysis and selection, theoretical elaboration of the project and language adaptation; 2) Production of material, with preparation of graphic design and illustrative project; 3) Validation with seven judges in the areas of women's health and health education. Data collection was carried out using a characterization questionnaire and the Suitability Assessment of Materials for evaluation of health-related information for adults (SAM). The analysis was carried out using descriptive statistics and Content Validity Index, with items that presented a value equal to or greater than 0.80 being considered approved. Results The care plan entitled "My postpartum plan" showed excellent acceptance and reliability, evidenced by an overall Content Validity Index of 0.98. The main suggestions presented were about adapting the writing to a simpler and more accessible language, which were accepted by the authors. Experts highlighted the importance and relevance of the postpartum plan for the target audience. Conclusion The material proved to be a valid and reliable instrument for use by women during the pregnancy and puerperal cycle, encouraging reflection on care and early preparation to face this period.

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ABSTRACT Objective: To investigate the repercussions of COVID-19 on the length of breastfeeding and analyze the associated factors in Belo Horizonte, Minas Gerais, Brazil. Method: This is an epidemiological, prospective cohort study. Data were collected from medical records and through telephone interviews. Women who weaned were estimated using Kaplan-Meier survival analysis. The log-rank test was used to verify differences between groups, analyzing weaning time, according to sociodemographic and clinical characteristics. The values of hazard ratio and 95% confidence intervals were estimated using Cox regression analysis. Results: A total of 1,729 women participated in the study. During the COVID-19 pandemic, brown women and women undergoing cesarean section were more likely to stop breastfeeding. Conclusion: The birth route and mothers' ethnic characteristics were associated with early weaning during the COVID-19 pandemic. Such findings are important to guide the assistance of the multidisciplinary team, especially nursing, during the post-pandemic period and in future epidemiological scenarios.

RESUMEN Objetivo: Investigar las repercusiones de la COVID-19 en la duración de la lactancia materna y analizar los factores asociados en Belo Horizonte, Minas Gerais, Brasil. Método: Se trata de un estudio de cohorte prospectivo epidemiológico. Los datos se recogieron de historias clínicas y mediante entrevistas telefónicas. Las mujeres que destetaron se estimaron mediante el análisis de supervivencia de Kaplan-Meier. La prueba de Mantel-Cox se utilizó para verificar diferencias entre grupos, analizando el tiempo de destete, según características sociodemográficas y clínicas. Los valores de cociente de riesgo y los intervalos de confianza del 95% se estimaron mediante análisis de regresión de Cox. Resultados: Un total de 1.729 mujeres participaron en la investigación. Durante la pandemia de COVID-19, las mujeres pardas y aquellas sometidas a cesárea tenían más probabilidades de dejar de amamantar. Conclusión: La ruta de nacimiento y las características étnicas de las madres se asociaron con el destete temprano durante la pandemia de COVID-19. Tales hallazgos son importantes para orientar la asistencia del equipo multidisciplinario, especialmente de enfermería, durante el período pospandemia y en futuros escenarios epidemiológicos.

RESUMO Objetivo: Investigar as repercussões da COVID-19 na duração do aleitamento materno e analisar os fatores associados em Belo Horizonte, Minas Gerais, Brasil. Método: Trata-se de estudo epidemiológico, de coorte prospectiva. Os dados foram coletados em prontuários médicos e por meio de entrevistas telefônicas. As mulheres que apresentaram o desmame foram estimadas por meio da análise de sobrevivência de Kaplan-Meier. O teste log-rank foi utilizado para verificar diferenças entre os grupos, analisando-se o tempo de desmame, segundo as características sociodemográficas e clínicas. Os valores de hazard ratio e intervalos de confiança de 95% foram estimados utilizando-se análise de regressão de Cox. Resultados: Participaram da pesquisa 1.729 mulheres. Durante a pandemia de COVID-19, mulheres pardas e mulheres submetidas à cesariana foram mais suscetíveis a interromper a amamentação. Conclusão: A via de nascimento e as características étnicas das mães associaram-se ao desmame precoce durante a pandemia de COVID-19. Tais achados são importantes para nortear a assistência da equipe multiprofissional, sobretudo da enfermagem, durante o pós-pandemia e em cenários epidemiológicos futuros.

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BACKGROUND: It has been hypothesized that the coronavirus disease 2019 (COVID-19) pandemic may have changed the conduct of obstetric practices at the time of labor, delivery, and birth. In Brazil, many practices lacking scientific evidence are implemented in this care, which is charcaterized by excessive use of unnecessary interventions. This scenario may have been worsened by the pandemic. Thus, we analyzed the effects of the pandemic on care during prenatal care and delivery by comparing the results of two surveys (one was administered before the pandemic and the other during the pandemic) in public hospitals in Belo Horizonte - Minas Gerais (MG), Brazil. METHODS: This cross-sectional and comparative study analyzed preliminary data from the study "Childbirth and breastfeeding in children of mothers infected with SARS-CoV-2", which was conducted in three referral maternity hospitals in Belo Horizonte - MG during the pandemic in the first half of 2020 in Brazil. The final sample consisted of 1532 eligible women. These results were compared with data from 390 puerperae who gave birth in the three public hospitals in the study "Birth in Belo Horizonte: labor and birth survey", conducted before the pandemic to investigate the changes in practices of labor and delivery care for the mother and her newborn, with or without COVID-19 infection, before and during the pandemic. In this research, "Birth in Belo Horizonte: labor and birth survey", data collection was performed between November 2011 and March 2013 by previously trained nurses. Between study comparisons were performed using Pearson's chi-square test, with a confidence level of 95%, and using Stata statistical program. RESULTS: We found a significant increase in practices recommended by the World Health Organization during the pandemic including the following: diet offering (48.90 to 98.65%), non-pharmacological pain relief (43.84 to 67.57%), and breastfeeding in the newborn´s first hour of life (60.31 to 77.98%) (p < 0.001). We found a significant reduction of non-recommended interventions, such as routine use of episiotomy (15.73 to 2.09%), the Kristeller maneuver (16.55 to 0.94%), oxytocin infusion misused (45.55 to 28.07%), amniotomy (30.81 to 15.08%), and lithotomy position during labor (71.23 to 6.54%) (p < 0.001). CONCLUSION: Our study revealed a statistically significant increase in the proportion of use of recommended practices and a reduction in non-recommended practices during labor and delivery. However, despite advances in the establishment of World Health Organization recommended practices in labor, delivery, and birth, the predominance of interventionist and medicalized practices persists, which is worsened by events, such as the pandemic.

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ABSTRACT Objective: To analyze puerperal women's experiences of sexual health after childbirth from the perspective of symbolic interactionism. Method: Descriptive, qualitative study. Twenty semi-structured interviews were conducted by videoconference with women in the remote puerperium, captured by snowball technique and searched for "seeds" on Instagram®. Bardin's content analysis and Symbolic Interactionism were used as references. Results: The puerperal women signify sexual health from a perspective of comprehensive healthcare. However, due to the duality between "being a woman" and "being a mother", they recognize fear, bodily transformations and changes in focus from the love relationship to caring for the baby as factors that interfere with sexual health. And they choose to put themselves aside, prioritizing caring for others. They re-signify sexual health by recognizing the importance of taking care of themselves in biopsychosocial aspects and try to recover self-care for a healthy sexual experience. Conclusion: Despite the meanings attributed, women's social interactions with the puerperium interfere negatively with sexual health. Professionals should be sensitized to the inclusion of actions that promote changes in the social action of these women towards self-care.

RESUMEN Objetivo: Analizar las experiencias de salud sexual de las puérperas después del parto desde la perspectiva del interaccionismo simbólico. Método: Estudio descriptivo y cualitativo. Se realizaron 20 entrevistas semiestructuradas por videoconferencia con mujeres puérperas a distancia, captadas mediante bola de nieve y búsqueda de las "semillas" a través de Instagram®. Se utilizaron como referencias el análisis de contenido de Bardin y el Interaccionismo Simbólico. Resultados: Las puérperas significan la salud sexual desde una perspectiva de atención sanitaria integral. Sin embargo, debido a la dualidad entre "ser mujer" y "ser madre", reconocen el miedo, las transformaciones corporales y los cambios de enfoque de la relación amorosa al cuidado del bebé como factores que interfieren en la salud sexual. Y deciden dejarse a un lado, dando prioridad al cuidado de los demás. Resignifican la salud sexual reconociendo la importancia de cuidarse en los aspectos biopsicosociales e intentan recuperar el autocuidado para una experiencia sexual saludable. Conclusión: A pesar de los significados atribuidos, las interacciones sociales de las mujeres con el puerperio interfieren negativamente en la salud sexual. Los profesionales deben ser sensibilizados para la inclusión de acciones que promuevan cambios en las acciones sociales de estas mujeres hacia el autocuidado.

RESUMO Objetivo: Analisar experiências de puérperas sobre saúde sexual após o parto na perspectiva do interacionismo simbólico. Método: Estudo descritivo, qualitativo. Realizadas 20 entrevistas semiestruturadas por videoconferência com mulheres no puerpério remoto, captação por "snowball" e busca das "sementes" pelo Instagram®. Utilizou-se a análise de conteúdo de Bardin e o Interacionismo Simbólico como referencial. Resultados: As puérperas significam saúde sexual numa perspectiva de integralidade dos cuidados em saúde. Contudo, pela dualidade entre o "ser mulher" e o "ser mãe", reconhecem o medo, as transformações corporais e as mudanças de foco da relação amorosa para os cuidados com o bebê como fatores que interferem na saúde sexual. E, escolhem se deixar de lado, priorizando o cuidado com os outros. Ressignificam saúde sexual pelo reconhecimento da importância de cuidar de si nos aspectos biopsicossociais e tentam resgatar o autocuidado para vivência sexual saudável. Conclusão: Apesar dos significados atribuídos, as interações sociais das mulheres com o puerpério interferem negativamente na saúde sexual. Profissionais devem ser sensibilizados quanto à inclusão de ações que promovam mudanças da ação social dessas mulheres para o cuidado de si.

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OBJECTIVE: To assess the relationship between prenatal care adequacy and the demand for hospital obstetric care. METHOD: A cross-sectional, quantitative study, conducted in a Brazilian capital, at six basic units and a hospital unit, from 2017 to 2020. Pregnant women who met the predefined inclusion and exclusion criteria participated in the study. Data were collected by structured questionnaire, and follow-up of participants was in person, by phone and by application. Descriptive and analytical statistics were performed using a statistical program. RESULTS: A total of 224 women were investigated. Prenatal care was adequate in 42.4% of cases, and the mean percentage of adequacy was 76.7% of assessed indicators. Of the 1,067 hospital visits, 63.1% were inopportune. The regression model showed that the variable "prenatal care adequacy" was statistically relevant (0.043), with a 2.2 times higher Odds Ratio (OR) of women who had inadequate prenatal follow-up seeking the hospital inanely. CONCLUSION: Prenatal care inadequacy was related to the inopportune search for emergency room care, with care overload for this point in the care network.

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ABSTRACT Objective: To assess the relationship between prenatal care adequacy and the demand for hospital obstetric care. Method: A cross-sectional, quantitative study, conducted in a Brazilian capital, at six basic units and a hospital unit, from 2017 to 2020. Pregnant women who met the predefined inclusion and exclusion criteria participated in the study. Data were collected by structured questionnaire, and follow-up of participants was in person, by phone and by application. Descriptive and analytical statistics were performed using a statistical program. Results: A total of 224 women were investigated. Prenatal care was adequate in 42.4% of cases, and the mean percentage of adequacy was 76.7% of assessed indicators. Of the 1,067 hospital visits, 63.1% were inopportune. The regression model showed that the variable "prenatal care adequacy" was statistically relevant (0.043), with a 2.2 times higher Odds Ratio (OR) of women who had inadequate prenatal follow-up seeking the hospital inanely. Conclusion: Prenatal care inadequacy was related to the inopportune search for emergency room care, with care overload for this point in the care network.

RESUMEN Objetivo: Evaluar la relación entre la adecuación de la atención prenatal y la demanda de atención obstétrica hospitalaria. Método: Estudio transversal, cuantitativo, realizado en una capital brasileña, en seis unidades básicas y una unidad hospitalaria, de 2017 a 2020. Participaron gestantes que cumplieron con los criterios de inclusión y exclusión predefinidos. Los datos fueron recolectados a través de un cuestionario estructurado y el seguimiento de los participantes fue presencial, telefónico y por aplicación. La estadística descriptiva y analítica se realizó mediante un programa estadístico. Resultados: 224 mujeres fueron investigadas. La atención prenatal fue adecuada en el 42,4% de los casos, y el porcentaje medio de adecuación fue del 76,7% de los indicadores evaluados. De las 1.067 visitas hospitalarias, el 63,1% fueron inoportunas. El modelo de regresión mostró que la variable "adecuación de la atención prenatal" fue estadísticamente relevante (p 0,043), con una razón de probabilidad (OR) 2,2 veces mayor para las mujeres que tuvieron atención prenatal inadecuada para buscar el hospital de manera inoportuna. Conclusión: La inadecuación de la atención prenatal se relacionó con la demanda inoportuna de visitas a urgencias, con sobrecarga asistencial para ese punto de la red asistencial.

RESUMO Objetivo: Avaliar a relação entre a adequação do pré-natal e a demanda de atendimentos obstétricos hospitalares. Método: Estudo transversal, quantitativo, conduzido em uma capital brasileira, em seis unidades básicas e uma unidade hospitalar, de 2017 a 2020. Participaram gestantes que atenderam aos critérios de inclusão e exclusão pré-definidos. Os dados foram coletados por questionário estruturado e o seguimento das participantes foi presencial, telefônico e por aplicativo. Procedeu-se à estatística descritiva e analítica, utilizando um programa estatístico. Resultados: Foram investigadas 224 mulheres. O pré-natal foi adequado em 42,4% dos casos, e o percentual médio de adequação foi de 76,7% dos indicadores avaliados. Dos 1.067 atendimentos hospitalares, 63,1% foram inoportunos. O modelo de regressão mostrou que a variável "adequação do pré-natal" foi estatisticamente relevante (p 0,043), com razão de chance (OR) 2,2 vezes maior de as mulheres que tiveram um acompanhamento pré-natal inadequado buscarem o hospital de forma inoportuna. Conclusão: A inadequação do pré-natal teve relação com a procura inoportuna por atendimentos em pronto-socorro, com sobrecarga assistencial para este ponto na rede de cuidado.

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RESUMO Objetivo Verificar o conhecimento de estudantes sobre o plano individual de parto e conhecer sua opinião a respeito da utilização dessa estratégia de ensino-aprendizagem e das boas práticas obstétricas. Método Estudo descritivo, com alunos de Obstetrícia que cursavam estágios na atenção básica. A coleta dos dados realizada de 01/2017 a 05/2017, por meio digital, na Plataforma Google Formulários®. A análise foi realizada por estatística descritiva de categorização de enunciados. O estudo seguiu os padrões éticos exigidos. Resultados O formulário foi enviado a 97 discentes e respondido por 40% deles. Todos os respondentes informaram conhecer o plano de parto, e 87% aplicaram-no durante o atendimento de pré-natal. Os apontamentos mais frequentes (45%) acerca do plano de parto foram os que promoviam empoderamento e autonomia à mulher. As sugestões metodológicas mais citadas para a sua aplicação foram focar o conteúdo (76%) e aumentar o número de encontros (50%). O plano individual de parto foi reconhecido por 79% dos participantes como importante estratégia de ensino. Conclusão Além de conhecerem o plano de parto e aplicá-lo, os estudantes o consideram muito relevante para o ensino e a aprendizagem das boas práticas obstétricas.

RESUMEN Objetivo Verificar el conocimiento de estudiantes acerca del plan individual de parto y conocer su comprensión respecto de la utilización de dicha estrategia de enseñanza aprendizaje y de las buenas prácticas obstétricas. Método Estudio descriptivo, con alumnos de Obstetricia que cursaban pasantías en la atención básica. La recolección de datos fue realizada de 01/2017 a 05/2017, por medio electrónico, en la Plataforma Google Formularios®. El análisis fue llevado a cabo por estadística descriptiva de categorización de enunciados. El estudio siguió los estándares éticos exigidos. Resultados El formulario fue enviado a 97 discentes y respondido por el 40% de ellos. Todos los respondedores informaron conocer el plan de parto, y el 87% lo aplicaron durante la atención de prenatal. Los planteamientos más frecuentes (45%) acerca del plan de parto fueron los que promovían empoderamiento y autonomía a la mujer. Las sugerencias metodológicas más citadas para su aplicación fueron enfocar el contenido (76%) y aumentar el número de encuentros (50%). El plan individual de parto fue reconocido por el 79% de los participantes como importante estrategia de enseñanza. Conclusión Además de conocer el plan de parto y aplicarlo, los estudiantes lo consideran muy relevante para la enseñanza y el aprendizaje y de las buenas prácticas obstétricas.

ABSTRACT Objective To verify students' knowledge about individual birth planning and learn their opinion about the use of this teaching-learning strategy for good obstetric practices. Method This is a descriptive study conducted with midwifery students who made primary health care internships. Data collection was performed digitally from 01/2017 to 05/2017 through the Google Forms®Platform. The analysis was performed by descriptive categorization statistics of statements. The study followed the required ethical standards. Results The form was sent to 97 students and answered by 40% of them. All respondents reported knowing the birth planning, and 87% applied it during prenatal care. The most frequent (45%) points about the birth plan were those that promoted women's empowerment and autonomy. The most cited methodological suggestions for its application were to focus on content (76%) and increase the number of meetings (50%). Individual birth planning was recognized by 79% of the participants as an important teaching strategy. Conclusion In addition to knowing birth planning and applying it, the students consider it very relevant for teaching and learning good obstetrical practices.

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Abstract Objectives: to describe the perineal outcomes of women who had delivered in water and out of water. Methods: a cross-sectional and quantitative study developed in a public hospital in Setúbal, Portugal. The population was of women who participated in the "Water Birth Project" in the period from 2011 to 2014, which gave birth in water and out of water. 104 women were selected according to established inclusion criteria. The groups were compared according to the following variables: demographics, obstetric information, delivery care and perineal outcomes. The data were analyzed in the Stata(r) software, with descriptive and bivariate statistics (chi-square and Fisher's test). Results: the medical records of 73 women who gave birth in water and 31 women who gave birth out of water were studied. Water deliveries were significantly associated with fewer perineal lacerations, lower rates of episiotomy, and shorter delivery time. Conclusions: the results of the study suggest that childbirth in water has a protective effect against severe third or fourth degree perineal tears, during fetal expulsion in water.

Resumo Objetivos: descrever os resultados perineais de mulheres que tiveram parto na água e fora da água. Métodos: estudo transversal e quantitativo desenvolvido em um hospital público de Setúbal, Portugal. A população foi de mulheres que participaram do "Projeto Parto na Água", no período de 2011 a 2014, que deram à luz na água e fora da água. Foram selecionadas para o estudo 104 mulheres de acordo com os critérios de inclusão estabelecidos. Os grupos foram comparados de acordo com as seguintes variáveis: demografia, informação obstétrica, assistência ao parto e resultados perineais. Os dados foram analisados no software Stata(r), com estatísitica descritiva e bivariada (qui-quadrado e teste de Fisher). Resultados: foram estudados os prontuários de 73 mulheres que deram à luz na água e 31 mulheres que deram à luz fora da água. Os partos na água foram significativamente associados a menos lacerações perineais, menores taxas de episiotomia e menor tempo de parto. Conclusão: os resultados do estudo sugerem que o parto na água tem um efeito protetor contra lacerações perineais severas de terceiro ou de quarto grau durante a expulsão fetal na água.

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OBJECTIVE: To verify students' knowledge about individual birth planning and learn their opinion about the use of this teaching-learning strategy for good obstetric practices. METHOD: This is a descriptive study conducted with midwifery students who made primary health care internships. Data collection was performed digitally from 01/2017 to 05/2017 through the Google Forms®Platform. The analysis was performed by descriptive categorization statistics of statements. The study followed the required ethical standards. RESULTS: The form was sent to 97 students and answered by 40% of them. All respondents reported knowing the birth planning, and 87% applied it during prenatal care. The most frequent (45%) points about the birth plan were those that promoted women's empowerment and autonomy. The most cited methodological suggestions for its application were to focus on content (76%) and increase the number of meetings (50%). Individual birth planning was recognized by 79% of the participants as an important teaching strategy. CONCLUSION: In addition to knowing birth planning and applying it, the students consider it very relevant for teaching and learning good obstetrical practices.

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