Overview and aims: Caesarean section has been considered the optimal mode of delivery for breech presentations, but in selected cases breech vaginal delivery (BVD) may be acceptable. The aim of this study was to evaluate the importance attributed by obstetricians and gynecologists (ObGyns) to a set of good prognostic factors for BVD. Study Design: Cross-sectional study Population: Specialists and residents of Obstetrics and Gynecology from two hospitals with advanced perinatal support. Methods: Fifteen good prognostic factors for BVD were scored by ObGyns, according to a 5-point Likert scale (5=maximum clinical relevance). Medians and interquartile ranges were calculated and the Mann-Whitney test was used to compare ObGyns with experience with <15 versus ≥15 BVD. Results: Of the 58 participants, 74.1% were specialists but only 34.4% had experience with ≥15 BVD. Twelve of the 15 good prognostic factors were scored with a median of 4, while two factors (>10 years of experience in BVD and training in fetal head extraction with forceps) obtained a median of 5 and one (maternal pelvis imaging evaluation) a median of 2. The main differences between more or less experienced ObGyns was in the importance given by the former to training with simulators (p=0.006) and existence of internal protocol for BVD assistance (p= 0.032). Conclusion: Most good prognostic factors for BVD were well scored by ObGyns, but it is disturbing that the two most scored ones (experience in BVD assistance and training in fetal head extraction with forceps) represent areas with reported low levels of experience among us

RESUMO OBJETIVO Avaliar a influência da imigração na saúde psicológica da mulher após o parto. MÉTODOS Neste estudo transversal, mulheres imigrantes e portuguesas com partos nos quatro hospitais públicos da região metropolitana de Porto, Portugal, foram contatadas por telefone entre fevereiro e dezembro de 2012, durante o primeiro mês pós-parto, para agendar uma visita domiciliar e preencher um questionário. A maioria das mães imigrantes (76,1%) e das mães portuguesas (80,0%) aceitou participar e aceder a visitas domiciliares, totalizando 89 imigrantes e 188 mulheres portuguesas incluídas no estudo. O questionário incluiu a aplicação de quatro escalas validadas: Inventário de Saúde Mental-5, Escala de Depressão Pós-parto de Edimburgo, Escala de Stress Percebido e Escala de Satisfação com o Suporte Social. As análises estatísticas incluíram os testes t-student, Qui-quadrado ou teste de Fisher e o cálculo de modelos de regressão logística. RESULTADOS As imigrantes tiveram risco aumentado de depressão pós-parto (OR 6,444; IC95% 1,858–22,344) e de baixa satisfação com o suporte social (OR = 6,118; IC95% 1,991–18,798). Não houve associação entre migração, stress percebido e saúde mental empobrecida. CONCLUSÕES Mães imigrantes apresentam vulnerabilidades aumentadas no período pós-parto, aumentando o risco de depressão pós-parto e havendo menor satisfação com o apoio social recebido.

ABSTRACT OBJECTIVE To assess the influence of I mmigration on the psychological health of women after childbirth. METHODS In this cross-sectional study, immigrant and Portuguese-native women delivering in the four public hospitals of the metropolitan area of Porto, Portugal, were contacted by telephone between February and December 2012 during the first postpartum month to schedule a home visit and fill in a questionnaire. Most immigrant (76.1%) and Portuguese mothers (80.0%) agreed to participate and with the visits, thus a total of 89 immigrants and 188 Portuguese women were included in the study. The questionnaire included the application of four validated scales: Mental Health Inventory-5, Edinburgh Postpartum Depression Scale, Perceived Stress Scale, and Scale of Satisfaction with Social Support. Statistical analysis included t-test and Chi-square or Fisher’s test, and logistic regression models. RESULTS Immigrants had an increased risk of postpartum depression (OR = 6.444, 95%CI 1.858–22.344), and of low satisfaction with social support (OR = 6.118, 95%CI 1.991–18.798). We did not perceive any associations between migrant state, perceived stress, and impoverished mental health. CONCLUSIONS Immigrant mothers have increased vulnerabilities in the postpartum period, resulting in an increased risk of postpartum depression and lesser satisfaction with the received social support.

RESUMO OBJETIVO Avaliar a influência da imigração na saúde psicológica da mulher após o parto. MÉTODOS Neste estudo transversal, mulheres imigrantes e portuguesas com partos nos quatro hospitais públicos da região metropolitana de Porto, Portugal, foram contatadas por telefone entre fevereiro e dezembro de 2012, durante o primeiro mês pós-parto, para agendar uma visita domiciliar e preencher um questionário. A maioria das mães imigrantes (76,1%) e das mães portuguesas (80,0%) aceitou participar e aceder a visitas domiciliares, totalizando 89 imigrantes e 188 mulheres portuguesas incluídas no estudo. O questionário incluiu a aplicação de quatro escalas validadas: Inventário de Saúde Mental-5, Escala de Depressão Pós-parto de Edimburgo, Escala de Stress Percebido e Escala de Satisfação com o Suporte Social. As análises estatísticas incluíram os testes t-student, Qui-quadrado ou teste de Fisher e o cálculo de modelos de regressão logística. RESULTADOS As imigrantes tiveram risco aumentado de depressão pós-parto (OR 6,444; IC95% 1,858–22,344) e de baixa satisfação com o suporte social (OR = 6,118; IC95% 1,991–18,798). Não houve associação entre migração, stress percebido e saúde mental empobrecida. CONCLUSÕES Mães imigrantes apresentam vulnerabilidades aumentadas no período pós-parto, aumentando o risco de depressão pós-parto e havendo menor satisfação com o apoio social recebido.

ABSTRACT OBJECTIVE To assess the influence of I mmigration on the psychological health of women after childbirth. METHODS In this cross-sectional study, immigrant and Portuguese-native women delivering in the four public hospitals of the metropolitan area of Porto, Portugal, were contacted by telephone between February and December 2012 during the first postpartum month to schedule a home visit and fill in a questionnaire. Most immigrant (76.1%) and Portuguese mothers (80.0%) agreed to participate and with the visits, thus a total of 89 immigrants and 188 Portuguese women were included in the study. The questionnaire included the application of four validated scales: Mental Health Inventory-5, Edinburgh Postpartum Depression Scale, Perceived Stress Scale, and Scale of Satisfaction with Social Support. Statistical analysis included t-test and Chi-square or Fisher’s test, and logistic regression models. RESULTS Immigrants had an increased risk of postpartum depression (OR = 6.444, 95%CI 1.858–22.344), and of low satisfaction with social support (OR = 6.118, 95%CI 1.991–18.798). We did not perceive any associations between migrant state, perceived stress, and impoverished mental health. CONCLUSIONS Immigrant mothers have increased vulnerabilities in the postpartum period, resulting in an increased risk of postpartum depression and lesser satisfaction with the received social support.