NPunto

16

Authors: Toro Martín, S

Giving birth is certainly one of the situations in a woman´s life that causes the strongest pain in her life, which on various occasions can be excessive and unbearable. Due to this, good pain management during delivery is essential so that the care provided by the health team is adequate and has quality. Currently, epidural analgesia is the most widely used during obstetric procedures related to childbirth, although this technique is invasive and like any invasive procedure, presents risks for pregnant women and the foetus. To develop this assignment a systematic bibliographic review has been carried out in order to analyze the existing literature on the subject in the most important scientific databases. Therefore, the objective of this study is to obtain remarkable information on the relationship that may exist between the use of epidural analgesia during labour and the increase in the length of the dilation phase, the expulsion phase or if it influences in any way the increment in the number of deliveries that require the use of supporting instruments or involve any other complicated situations. In conclusion, it can be confirmed that epidural analgesia is related to a longer dilation time, an increment on the time dedicated to the expulsion phase, in the same way that there is an increment in deliveries that require the use of supporting instruments, the use of medications such as oxytocin or the association with additional complications.

20

Authors: León Soto, M

Objectives: Determine the main interventions of the midwife for the prevention of perineal trauma that occurs during childbirth, review and detail the effectiveness of the main interventions during pregnancy and delivery for the prevention of perineal trauma, describe the role of the midwife on interventions for the prevention of perineal trauma. Method: Bibliographic review of scientific articles in databases PubMed, MedLine, Cinahl, Scielo, Dialnet, Cuidatge, published in the last 5 years, in Spanish, English and Portuguese. Books and some guides have also been included. No ethical restrictions or limitations were made. The abstracts and, if necessary, the complete articles were reviewed, taking into account all the articles that met the selection criteria. Results / Discussion: Interventions of the midwife who have enough literature to have scientific support in the prevention of perineal trauma are: Exercises during pregnancy to strengthen the pelvic floor, perineal massage during pregnancy, maternal position during the expulsive, spontaneous pushing techniques, hands-free or hand-off technique and application of hot packs. Conclusion: We have indicated several interventions as beneficial in the prevention of perineal trauma. However, more reliable studies are needed to support these interventions, we must join efforts in the dissemination of the results among the different health professionals for their subsequent application to the daily work and thus make interventions for the prevention of perineal trauma a reality.

21

Authors: Garnica Martínez, I

During the last century the management of childbirth has undergone an intense transformation. Until half a century ago, most deliveries took place in the pregnant woman’s own home, assisted by a midwife, where health conditions were generally not optimal (no running water and heating) as well as the nutritional and health conditions of many women. All this, together with the fact that the number of children was high and the short inter-seasonal space, made the maternal and infant mortality rate during childbirth very high. Over the years, the practice of giving birth in the hospital was imposed, which significantly reduced these mortality rates. However, the process of hospitalization of births also brought with it some negative consequences: an increase in the number of caesarean sections, episiotomies and inductions of childbirth far above the recommendations of the World Health Organization (WHO) and, in general, a "dehumanization" of the process. With the rigid application of hospital protocols and the widespread use of epidural analgesia in childbirth, It is extremely common to disconnect women with their experiences and use techniques and drugs to conduct a childbirth in which the complex hormonal mechanism that guides it is disrupted. One of the most widely used drugs in obstetrics, along with anesthetics, is synthetic oxytocin in order to produce or increase the number and intensity of uterine contractions. The use of this endogenous oxytocin analogue causes the hormonal feedback system to be interrupted and the endogenous oxytocin secretion to be completely modified. The most well-known physiological functions of oxytocin have to do with the production of contractions as an engine of childbirth and the initiation and maintenance of breastfeeding. However, it has been found that the hormone oxytocin is responsible for modulating many behaviors of relationship and attachment of the human being among other functions, of which, there is still a great ignorance. This literature review attempts to explain what short- and long-term consequences the massive use of synthetic oxytocin may have during in-hospital management of childbirth.