Elaboración del concepto de ambiencia para el trabajo de parto y el parto normal institucionalizado

Dias, Paula Faria; Miranda, Talita Prado Simão; Santos, Raul de Paiva; Paula, Elisângela Maria de; Bem, Márcia Maria da Silva; Mendes, Maria Angélica

doi:10.1590/0034-7167-2018-0698

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

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Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Rev. Bras. Enferm. 72 (suppl 3) • Dic 2019 • https://doi.org/10.1590/0034-7167-2018-0698 copiar

Elaboración del concepto de ambiencia para el trabajo de parto y el parto normal institucionalizado

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

elaborar el concepto ambiencia para el trabajo de parto y el parto normal institucionalizado, identificando en la literatura sus antecedentes, sus atributos definidores y consecuentes.

Método:

se utilizó el método de análisis crítico de la literatura, que corresponde al primer paso de la metodología cualitativa del análisis de concepto. Se hizo una búsqueda teórica en las bases de datos CINAHL, COCHRANE, LILACS, PsycINFO y PubMed.

Resultados:

los elementos relativos a la parturienta y a la calificación del espacio físico y social se presentan como antecedentes. Los atributos definidores delimitan el proceso de interacción de la atención con el uso de las tecnologías no invasivas. Ya de los consecuentes, se destacan el resultado del parto normal, el alivio del dolor y comodidad, la satisfacción y el bienestar de la parturienta.

Consideraciones finales:

el análisis de los antecedentes, atributos definidores y consecuentes permitieron elaborar una propuesta teórica inédita de este concepto.

Descriptores:
Trabajo de Parto; Parto Normal; Hospitales; Formación de Concepto; Maternidades

Reference	Year/Country	Design/ number of patients	Intervention/Focus	Outcome/Conclusion
Larkin, Begley, Devane, 2017⁽¹¹11 Larkin P, Begley CM, Devane D. Women's preferences for childbirth experiences in the Republic of Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2017;17(1):19. doi: 10.1186/s12884-016-1196-1 https://doi.org/10.1186/s12884-016-1196-... ⁾	2017 Ireland	Cross Quantitative Approach n = 531	Most significant element to women in labor	Pain relief
Kologeski, Strapasson, Schneider, Renosto, 2017⁽¹²12 Strapasson MR, Kologeski TK, Schneider V, Renosto JM. Skin to skin contact of the newborn with its mother in the perspective of the multiprofessional team. J Nurs UFPE [Internet]. 2017;11(1):94-101. doi: 10.5205/reuol.9978-88449-6-1101201712 https://doi.org/10.5205/reuol.9978-88449... ⁾	2017 Brazil	Qualitative Content Analysis Approach n = 15	Professional's perception of skin contact	Staff has difficulties in adhering to the practice
Gupta, Sood, Hofmeyr, Vogel, 2017⁽¹³13 Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012 May 16;(5):CD002006. doi: 10.1002/14651858.CD002006.pub3 https://doi.org/10.1002/14651858.CD00200... ⁾	2017 United Kingdom	Review n = 30	Labor position	Upright position reduced the labor length
Happel-Parkins, Azim, 2016⁽¹⁴14 Happel-Parkins A, Azim KA. At pains to consent: a narrative inquiry into women's attempts of natural childbirth. Women Birth. 2016;29(4):310-20. doi: 10.1016/j.wombi.2015.11.004 https://doi.org/10.1016/j.wombi.2015.11.... ⁾	2016 USA	Thematic Qualitative Analysis Approach n = 6	Primigravida experience with normal delivery	Often their basic rights were disregarded
Aune, Torvik, Selboe, Skogås, Persen, Dahlberg, 2015⁽¹⁵15 Aune I, Torvik HM, Selboe S-T, Skogås A-K, Persen J, Dahlberg U. Promoting a normal birth and a positive birth experience: Norwegian women's perspectives. Midwifery. 2015;31(7):721-7. doi: 10.1016/j.midw.2015.03.016 https://doi.org/10.1016/j.midw.2015.03.0... ⁾	2015 Norway	Qualitative Approach/ Systematic Texts Condensation n = 12	Factors that influence the woman's positive experience of normal delivery	Safe environment and emotional strength
Borem, Ferreira, Silva, Valério Júnior, Orlanda, 2015⁽¹⁶16 Borem P, Ferreira JBB, Silva UJ, Valério Jr J, Orlanda CMB. Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model. Rev Bras Ginecol Obstet. 2015;37(10):446-54. doi: 10.1590/SO100-720320150005264 https://doi.org/10.1590/SO100-7203201500... ⁾	2015 Brazil	Descriptive Study n = 1449	Redesign of the Birth Model of Care	Reduction in the percentage of caesarean sections
Côrtes, Santos, Caroci, Oliveira, Oliveira, Riesco, 2015⁽¹⁷17 Côrtes CT, Santos RCS, Caroci AS, Oliveira SG, Oliveira SMJV, Riesco MLG. Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study. Rev Esc Enferm USP. 2015;49(5):716-24. doi: 10.1590/S0080-623420150000500002 https://doi.org/10.1590/S0080-6234201500... ⁾	2015 Brazil	Quasi-experimental n = 50	Implementation of best practices in normal delivery	Positive impact
Coxon, Sandall, Fulop, 2015⁽¹⁸18 Coxon K, Sandall J, Fulop NJ. How do pregnancy and birth experiences influence planned place of birth in future pregnancies? Findings from a longitudinal, narrative study. Birth. 2015;42(2):141-8. doi: 10.1111/birt.12149 https://doi.org/10.1111/birt.12149... ⁾	2015 United Kingdom	Qualitative Approach n = 41	Influence of the current labor on planning the next pregnancy	Current experience influences the choice of the next delivery location - Hospital or Birth Center
Hajian, Shariati, Mirzaii Najmabadi, Yunesian, Ajami, 2015⁽¹⁹19 Hajian S, Shariati M, Mirzaii Najmabadi K, Yunesian M, Ajami MI. Use of the extended parallel process model (EPPM) to predict Iranian women's intention for vaginal delivery. J Transcult Nurs. 2015;26(3):234-43. doi: 10.1177/1043659614524247 https://doi.org/10.1177/1043659614524247... ⁾	2015 Iran	Quali/Quanti Approach n = 290	Cultural influence on the intention by normal delivery	Confident mothers are more likely to have normal delivery
Scarton, Prates, Wilhelm, Silva, Possati, Ilha, 2015⁽²⁰20 Scarton J, Prates LA, Wilhelm LA, Silva SC, Possati AB, Ilha CB, et al. "It was worth it when I saw his face": experiences of primiparous women during natural childbirth. Rev Gaúcha Enferm. 2015;36(spe):143-51. doi: 10.1590/1983-1447.2015.esp.56786 https://doi.org/10.1590/1983-1447.2015.e... ⁾	2015 Brazil	Qualitative Description Approach n = 10	Experience of primiparous in normal delivery	The care reflects on the coping experience and delivery
Serçekuş, Egelioglu Cetisli, İnci, 2015⁽²¹21 Serçekus P, Egelioglu Cetisli N, Inci FH. Birth preferences by nulliparous women and their partners in Turkey. Sex Reprod Healthc. 2015;6(3):182-5. doi: 10.1016/j.srhc.2015.03.002 https://doi.org/10.1016/j.srhc.2015.03.0... ⁾	2015 Turkey	Cross-sectional study n = 162	Preference on the type of birth	90.8% of women and 92% of their partners chose normal delivery
Silva, Nascimento, Coelho, 2015⁽²²22 Silva ALS, Nascimento ER, Coelho EAC. Nurses practices to promote dignity, participation and empowerment of women in natural childbirth. Esc Anna Nery. 2015;19(3):424-31. doi: 10.5935/1414-8145.20150056 https://doi.org/10.5935/1414-8145.201500... ⁾	2015 Brazil	Qualitative/Descriptive Exploratory Approach n = 30	Autonomy, dignity and participation of women in normal delivery	The dignifying practices were the most observed.
Hammond, Foureur, Homer, 2014⁽²⁴24 Hammond A, Foureur M, Homer CSE. The hardware and software implications of hospital birth room design: a midwifery perspective. Midwifery. 2014;30(7):825-30. doi: 10.1016/j.midw.2013.07.013 https://doi.org/10.1016/j.midw.2013.07.0... ⁾	2014 Australia	Ethnography n = 8	Physical and aesthetic design of the delivery room	Changes in the setting and delivery room aesthetics can generate safer, more comfortable and effective practices
Liu, Liu, Huang, Du, Peng, Huang et al., 2014⁽²⁵25 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160. doi: 10.1186/1471-2393-14-160 https://doi.org/10.1186/1471-2393-14-160... ⁾	2014 China	Clinical Trial n = 108 (38/70)	Immersion in water during labor	Immersion in water can reduce pain in labor and is associated with lower rate of cesarean delivery and postpartum urinary incontinence
Nutter, Meyer, Shaw-Battista, Marowitz, 2014⁽²⁶26 Nutter E, Meyer S, Shaw-Battista J, Marowitz A. Waterbirth: an integrative analysis of peer-reviewed literature. J Midwifery Womens Health. 2014;59(3):286-319. doi: 10.1111/jmwh.12194 https://doi.org/10.1111/jmwh.12194... ⁾	2014 USA	Integrative Analysis n = 38	Water birth	It is associated with a positive outcome of the delivery
Jamas, Hoga, Reberte, 2013⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾	2013 Brazil	Narrative Analysis n = 17	Assistance received in a Birth Center	Positive evaluation by women
Karlsdottir, Halldorsdottir, Lundgren, 2013⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ⁾	2013 Iceland	Phenomenology n = 14	Women's experience in pain preparation and management in delivery	The staff contributes to the pain management during delivery
Lawrence, Lewis, Hofmeyr, Styles, 2013⁽²⁹29 Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(2):CD003934. doi: 10.1002/14651858.CD003934.pub4 https://doi.org/10.1002/14651858.CD00393... ⁾	Australia 2013	Systematic Review n = 25 (5,218 women)	Upright versus recumbent position in labor	Reduced labor length in the upright position
Simmonds, Peter, Hodnett, McGillis Hall, 2013⁽³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ⁾	2013 Canada	Narrative Analysis n = 14	Moral responsibility of nurses in relation to the woman in labor	Main influencing factor relative to the expectations of the woman in labor
Hodnett, Downe, Walsh, 2012⁽³¹31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... ⁾	2012 Canada	Systematic Review n = 10 (11,795 women)	Alternative versus conventional institutional settings for birth	Alternative institution is associated with lower rates of medical intervention and high maternal satisfaction
Cheung, Mander, Wang, Fu, Zhou, Zhang, 2011a⁽³²32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... ⁾	2011 China	Paired Retrospective Cohort n = 452 (226/226)	Clinical results of a Birth Center and a Hospital	Normal delivery at the Birth Center - 87.6%, and at the Hospital - 58.8%
Cheung, Mander, Wang, Fu, Zhou, Zhang, 2011b⁽³³33 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27(6):842-7. doi: 10.1016/j.midw.2010.09.001 https://doi.org/10.1016/j.midw.2010.09.0... ⁾	2011 China	Qualitative Approach n = 40	Perception of the woman (n = 30) and professional (n = 10) on the Delivery Unit	Positive in relation to the Unit and its Model of Care
Silva, Oliveira, Silva, Alvarenga, 2011⁽³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ⁾	2011 Brazil	Descriptive Study n = 35	Use of the Swiss ball	100% in Normal Birth Centers and 40.9% in Obstetric Centers
Liu, Chang, Chen, 2010⁽³⁵35 Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers. J Clin Nurs. 2010;19(7-8):1065-72. doi: 10.1111/j.1365-2702.2009.03028.x https://doi.org/10.1111/j.1365-2702.2009... ⁾	2010 Taiwan	Randomized clinical trial experimental n = 60 (30/30)	Effects of music therapy on the labor	Decrease in pain, anxiety and temperature
Riesco, Oliveira, Bonadio, Schneck, Silva, Diniz et al., 2009⁽³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾	2009 Brazil	Narrative review n = 12	Scientific production on the Normal Birth Center	Predominant foci are obstetric practices and maternal outcomes
Da Silva, De Oliveira, Nobre, 2009⁽³⁷37 Silva FMB, Oliveira SMJV, Nobre MRC. A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery. 2009;25(3):286-94. doi: 10.1016/j.midw.2007.04.006 https://doi.org/10.1016/j.midw.2007.04.0... ⁾	2009 Brazil	Clinical randomized trial n = 108 (54/54)	Water immersion in labor	Significant reduction in pain in the experimental group
Romano, Lothian, 2008⁽³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ⁾	2008 EUA	Theoretical-reflective study	Obstetric practices based on evidence	Six obstetric practices highlighted
Lundgren, Berg, 2007⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾	2007 Suécia	Secondary Analysis n = 8	Central concepts in the woman-nurse relationship	Six pairs of the woman-nurse relational concept highlighted
Walsh, 2007⁽⁴⁰40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... ⁾	2007 UK	Ethnography n = 30 women and n = 5 professionals	Culture, beliefs, values, customs and practices at the Birth Center	The Normal Birth Center can encourage new ways of childbirth assistance
Bio, Bittar, Zugaib, 2006⁽⁴¹41 Bio E, Bittar RE, Zugaib M. Influência da mobilidade materna na duração da fase ativa do trabalho de parto. Rev Bras Ginecol Obstet. 2006;28(11):671-9. doi: 10.1590/S0100-72032006001100007 https://doi.org/10.1590/S0100-7203200600... ⁾	2006 Brazil	Prospective clinical trial n = 100 (50/50)	Influence of maternal mobility during labor	Better tolerance to pain, less use of drugs and better dilation evolution
Mousley, 2005⁽⁴²42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... ⁾	2005 UK	Descriptive Study	Aromatherapy use within Maternity	Effective in normalization of childbirth and increase in the satisfaction of mothers
Hoga, 2004⁽⁴³43 Hoga LAK. Motivação de enfermeiras obstétricas para o desenvolvimento de seu trabalho em uma casa de parto. Rev Min Enferm [Internet]. 2004 [cited 2018 Jul 02];8(3):369-73. Available from: http://www.reme.org.br/artigo/detalhes/725 http://www.reme.org.br/artigo/detalhes/7... ⁾	2004 Brazil	Thematic Oral History n = 6	Motivation of nurse insertion at the Birth Center	Dissatisfaction with the Biomedical Model, with the hospital interventionist character and the desire to transform
Yildirim, Sahin, 2004⁽⁴⁴44 Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9(4):183-7. doi: 10.1155/2004/686913 https://doi.org/10.1155/2004/686913... ⁾	2004 Turkey	Clinical trial n = 40 (20/20)	Effects of the breathing and massage technique on labor	Effective in reducing pain
Lauzon, Hodnett, 2001⁽⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾	2001 Canada	Systematic Review n = 209 (105/104)	Effects of the Labor Assessment Program	Evidence of benefits to women in labor with term pregnancy

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[1] Corresponding Author: Paula Faria Dias. E-mail: paulafariadias@hotmail.com

ANTECEDENT OF THE CONCEPT OF AMBIENCE FOR LABOR AND NORMAL INSTITUTIONALIZED DELIVERY
Meaning ascribed to motherhood by the women in labor plus the self-esteem and confidence in their body in the childbirth process and in health professionals, and the preference and willingness to surrender to the labor and delivery with good expectations regarding the institution
Meaning ascribed to motherhood⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; High self-esteem⁽³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ⁾; Self-confidence⁽¹⁵15 Aune I, Torvik HM, Selboe S-T, Skogås A-K, Persen J, Dahlberg U. Promoting a normal birth and a positive birth experience: Norwegian women's perspectives. Midwifery. 2015;31(7):721-7. doi: 10.1016/j.midw.2015.03.016 https://doi.org/10.1016/j.midw.2015.03.0... ^,³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Trust in your body and in the delivery process⁽¹⁴14 Happel-Parkins A, Azim KA. At pains to consent: a narrative inquiry into women's attempts of natural childbirth. Women Birth. 2016;29(4):310-20. doi: 10.1016/j.wombi.2015.11.004 https://doi.org/10.1016/j.wombi.2015.11.... ^,¹⁵15 Aune I, Torvik HM, Selboe S-T, Skogås A-K, Persen J, Dahlberg U. Promoting a normal birth and a positive birth experience: Norwegian women's perspectives. Midwifery. 2015;31(7):721-7. doi: 10.1016/j.midw.2015.03.016 https://doi.org/10.1016/j.midw.2015.03.0... ^,²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ⁾; Trust in health professionals⁽¹¹11 Larkin P, Begley CM, Devane D. Women's preferences for childbirth experiences in the Republic of Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2017;17(1):19. doi: 10.1186/s12884-016-1196-1 https://doi.org/10.1186/s12884-016-1196-... ^,¹⁹19 Hajian S, Shariati M, Mirzaii Najmabadi K, Yunesian M, Ajami MI. Use of the extended parallel process model (EPPM) to predict Iranian women's intention for vaginal delivery. J Transcult Nurs. 2015;26(3):234-43. doi: 10.1177/1043659614524247 https://doi.org/10.1177/1043659614524247... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Preference for normal delivery⁽²¹21 Serçekus P, Egelioglu Cetisli N, Inci FH. Birth preferences by nulliparous women and their partners in Turkey. Sex Reprod Healthc. 2015;6(3):182-5. doi: 10.1016/j.srhc.2015.03.002 https://doi.org/10.1016/j.srhc.2015.03.0... ^,³¹31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... ⁾; Willingness to surrender to the labor and delivery⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Good expectations regarding the institution⁽⁴⁰40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... ⁾.
Qualified physical and social space
Subcategories	Codes and references
Qualified physical space	Propitious institutional physical setting⁽²²22 Silva ALS, Nascimento ER, Coelho EAC. Nurses practices to promote dignity, participation and empowerment of women in natural childbirth. Esc Anna Nery. 2015;19(3):424-31. doi: 10.5935/1414-8145.20150056 https://doi.org/10.5935/1414-8145.201500... ^,²⁴24 Hammond A, Foureur M, Homer CSE. The hardware and software implications of hospital birth room design: a midwifery perspective. Midwifery. 2014;30(7):825-30. doi: 10.1016/j.midw.2013.07.013 https://doi.org/10.1016/j.midw.2013.07.0... ^,³¹31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... ⁾; Resources for Non-Invasive Technologies⁽²²22 Silva ALS, Nascimento ER, Coelho EAC. Nurses practices to promote dignity, participation and empowerment of women in natural childbirth. Esc Anna Nery. 2015;19(3):424-31. doi: 10.5935/1414-8145.20150056 https://doi.org/10.5935/1414-8145.201500... ^,³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ^,³⁷37 Silva FMB, Oliveira SMJV, Nobre MRC. A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery. 2009;25(3):286-94. doi: 10.1016/j.midw.2007.04.006 https://doi.org/10.1016/j.midw.2007.04.0... ⁾; Relaxing environment⁽³²32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... ⁾.
Qualified staff with informative experience, clinical autonomy, critical thinking, emotional self-control and contribution of each professional	Qualified staff⁽¹¹11 Larkin P, Begley CM, Devane D. Women's preferences for childbirth experiences in the Republic of Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2017;17(1):19. doi: 10.1186/s12884-016-1196-1 https://doi.org/10.1186/s12884-016-1196-... ^,⁴³43 Hoga LAK. Motivação de enfermeiras obstétricas para o desenvolvimento de seu trabalho em uma casa de parto. Rev Min Enferm [Internet]. 2004 [cited 2018 Jul 02];8(3):369-73. Available from: http://www.reme.org.br/artigo/detalhes/725 http://www.reme.org.br/artigo/detalhes/7... ⁾; Experience informed by the staff⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Appropriation of clinical autonomy⁽²³23 Skogheim G, Hanssen TA. Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sex Reprod Healthc. 2015;6(4):230-5. doi: 10.1016/j.srhc.2015.05.001 https://doi.org/10.1016/j.srhc.2015.05.0... ⁾; Critical thinking⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Emotional self-control⁽³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ⁾; Contribution as a professional⁽³³33 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27(6):842-7. doi: 10.1016/j.midw.2010.09.001 https://doi.org/10.1016/j.midw.2010.09.0... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Belief in assistance to normal delivery⁽²³23 Skogheim G, Hanssen TA. Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sex Reprod Healthc. 2015;6(4):230-5. doi: 10.1016/j.srhc.2015.05.001 https://doi.org/10.1016/j.srhc.2015.05.0... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾.
Close relationship, trust, therapeutic and equal affection with the mother, based on the recognition of her uniqueness, her capacity for normal delivery and stimulating the protagonism in delivery;	Recognition of uniqueness⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Belief in the capacity of the mother⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; close relationship⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Trust relationship⁽¹⁸18 Coxon K, Sandall J, Fulop NJ. How do pregnancy and birth experiences influence planned place of birth in future pregnancies? Findings from a longitudinal, narrative study. Birth. 2015;42(2):141-8. doi: 10.1111/birt.12149 https://doi.org/10.1111/birt.12149... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Equal relationship⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Therapeutic Affective Relationship⁽⁴⁰40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... ⁾.
Teamwork process based on confidence in the clinical competence of professionals to ensure the safety of the mother, the Admission Assessment Program, the possibility of spontaneous onset of labor, soft food intake, the choice of companion and labor position and delivery for the woman in labor.	Confidence in the clinical competence among professionals⁽³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ⁾; Team work⁽²³23 Skogheim G, Hanssen TA. Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sex Reprod Healthc. 2015;6(4):230-5. doi: 10.1016/j.srhc.2015.05.001 https://doi.org/10.1016/j.srhc.2015.05.0... ^,³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ⁾; Presentation of the mother to the institution of choice for labor and delivery⁽⁴⁰40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... ⁾; Safety of the mother⁽³⁷37 Silva FMB, Oliveira SMJV, Nobre MRC. A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery. 2009;25(3):286-94. doi: 10.1016/j.midw.2007.04.006 https://doi.org/10.1016/j.midw.2007.04.0... ⁾; Guarantee of the possibility of spontaneous onset of labor⁽³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ⁾; Admission Assessment Program⁽¹⁵15 Aune I, Torvik HM, Selboe S-T, Skogås A-K, Persen J, Dahlberg U. Promoting a normal birth and a positive birth experience: Norwegian women's perspectives. Midwifery. 2015;31(7):721-7. doi: 10.1016/j.midw.2015.03.016 https://doi.org/10.1016/j.midw.2015.03.0... ^,⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾; Guarantee of choice of the mother's companion⁽¹⁴14 Happel-Parkins A, Azim KA. At pains to consent: a narrative inquiry into women's attempts of natural childbirth. Women Birth. 2016;29(4):310-20. doi: 10.1016/j.wombi.2015.11.004 https://doi.org/10.1016/j.wombi.2015.11.... ⁾; Guarantee of the choice of the mother on the intake of soft foods and liquids⁽³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾; Guidelines on benefits of upright positions during labor and delivery⁽²⁹29 Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(2):CD003934. doi: 10.1002/14651858.CD003934.pub4 https://doi.org/10.1002/14651858.CD00393... ⁾; Guarantee of the choice of childbirth position⁽¹³13 Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012 May 16;(5):CD002006. doi: 10.1002/14651858.CD002006.pub3 https://doi.org/10.1002/14651858.CD00200... ⁾; Staff flexibility regarding standards and institutional routines⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾.

DEFINING ATTRIBUTES OF THE CONCEPT OF AMBIENCE FOR LABORAND NORMAL INSTITUTIONALIZED DELIVERY
Assistance process focused on the woman in labor triggered by the empowerment and protagonism of labor and delivery, sequenced by clinical assessment and interventions guided by the evidence of changes in the natural dynamics of labor and delivery, the judicious use of oxytocin, the amniotomy and episiotomy, and early promotion of skin contact;
Assistance focused on the woman with continued attention⁽¹¹11 Larkin P, Begley CM, Devane D. Women's preferences for childbirth experiences in the Republic of Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2017;17(1):19. doi: 10.1186/s12884-016-1196-1 https://doi.org/10.1186/s12884-016-1196-... ^,²³23 Skogheim G, Hanssen TA. Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sex Reprod Healthc. 2015;6(4):230-5. doi: 10.1016/j.srhc.2015.05.001 https://doi.org/10.1016/j.srhc.2015.05.0... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Awareness of the mother of continued care, focused on her⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Resolutive welcoming⁽²⁰20 Scarton J, Prates LA, Wilhelm LA, Silva SC, Possati AB, Ilha CB, et al. "It was worth it when I saw his face": experiences of primiparous women during natural childbirth. Rev Gaúcha Enferm. 2015;36(spe):143-51. doi: 10.1590/1983-1447.2015.esp.56786 https://doi.org/10.1590/1983-1447.2015.e... ^,²²22 Silva ALS, Nascimento ER, Coelho EAC. Nurses practices to promote dignity, participation and empowerment of women in natural childbirth. Esc Anna Nery. 2015;19(3):424-31. doi: 10.5935/1414-8145.20150056 https://doi.org/10.5935/1414-8145.201500... ^,²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Clinical assessment⁽²³23 Skogheim G, Hanssen TA. Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sex Reprod Healthc. 2015;6(4):230-5. doi: 10.1016/j.srhc.2015.05.001 https://doi.org/10.1016/j.srhc.2015.05.0... ^,⁴⁰40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... ^,⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾; Prioritization of emergency calls⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Guidance on labor and delivery⁽²⁰20 Scarton J, Prates LA, Wilhelm LA, Silva SC, Possati AB, Ilha CB, et al. "It was worth it when I saw his face": experiences of primiparous women during natural childbirth. Rev Gaúcha Enferm. 2015;36(spe):143-51. doi: 10.1590/1983-1447.2015.esp.56786 https://doi.org/10.1590/1983-1447.2015.e... ^,²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ^,³⁰30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Empowerment to the protagonism of the mother for labor and delivery⁽¹¹11 Larkin P, Begley CM, Devane D. Women's preferences for childbirth experiences in the Republic of Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2017;17(1):19. doi: 10.1186/s12884-016-1196-1 https://doi.org/10.1186/s12884-016-1196-... ^,¹⁸18 Coxon K, Sandall J, Fulop NJ. How do pregnancy and birth experiences influence planned place of birth in future pregnancies? Findings from a longitudinal, narrative study. Birth. 2015;42(2):141-8. doi: 10.1111/birt.12149 https://doi.org/10.1111/birt.12149... ^,²²22 Silva ALS, Nascimento ER, Coelho EAC. Nurses practices to promote dignity, participation and empowerment of women in natural childbirth. Esc Anna Nery. 2015;19(3):424-31. doi: 10.5935/1414-8145.20150056 https://doi.org/10.5935/1414-8145.201500... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Active listening⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Interventions on the evidence of changes in the natural dynamics of the labor and delivery⁽³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ^-³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Judicious use of oxytocin infusion, the amniotomy and episiotomy⁽³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾; Early promotion of skin contact⁽¹²12 Strapasson MR, Kologeski TK, Schneider V, Renosto JM. Skin to skin contact of the newborn with its mother in the perspective of the multiprofessional team. J Nurs UFPE [Internet]. 2017;11(1):94-101. doi: 10.5205/reuol.9978-88449-6-1101201712 https://doi.org/10.5205/reuol.9978-88449... ⁾; Umbilical cord ligation⁽⁴³43 Hoga LAK. Motivação de enfermeiras obstétricas para o desenvolvimento de seu trabalho em uma casa de parto. Rev Min Enferm [Internet]. 2004 [cited 2018 Jul 02];8(3):369-73. Available from: http://www.reme.org.br/artigo/detalhes/725 http://www.reme.org.br/artigo/detalhes/7... ⁾.
Use of NIT as presence and continuous support companion, relaxing environment, acupuncture, walking, bathing, Swiss ball, massage, compresses, ventilatory exercises, soft food intake and freedom of labor and delivery position.
Subcategories	Codes and references
Presence and continued support of the companion of choice of the mother	Presence of the companion of choice of the mother; Continued support of the companion⁽³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ⁾.
Relaxation techniques	Relaxation techniques⁽³²32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... ^,³⁵35 Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers. J Clin Nurs. 2010;19(7-8):1065-72. doi: 10.1111/j.1365-2702.2009.03028.x https://doi.org/10.1111/j.1365-2702.2009... ^,⁴²42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... ⁾.
Walking	Walking⁽¹⁷17 Côrtes CT, Santos RCS, Caroci AS, Oliveira SG, Oliveira SMJV, Riesco MLG. Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study. Rev Esc Enferm USP. 2015;49(5):716-24. doi: 10.1590/S0080-623420150000500002 https://doi.org/10.1590/S0080-6234201500... ^,²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ^,³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾.
Bath	Spraying and immersion baths⁽²⁰20 Scarton J, Prates LA, Wilhelm LA, Silva SC, Possati AB, Ilha CB, et al. "It was worth it when I saw his face": experiences of primiparous women during natural childbirth. Rev Gaúcha Enferm. 2015;36(spe):143-51. doi: 10.1590/1983-1447.2015.esp.56786 https://doi.org/10.1590/1983-1447.2015.e... ^,²⁶26 Nutter E, Meyer S, Shaw-Battista J, Marowitz A. Waterbirth: an integrative analysis of peer-reviewed literature. J Midwifery Womens Health. 2014;59(3):286-319. doi: 10.1111/jmwh.12194 https://doi.org/10.1111/jmwh.12194... ^-²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ^,³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ^,³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾.
Swiss ball	Use of the Swiss ball⁽³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ⁾.
Massages	Massages⁽¹⁷17 Côrtes CT, Santos RCS, Caroci AS, Oliveira SG, Oliveira SMJV, Riesco MLG. Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study. Rev Esc Enferm USP. 2015;49(5):716-24. doi: 10.1590/S0080-623420150000500002 https://doi.org/10.1590/S0080-6234201500... ^,³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾.
Compresses	Hot or cold compresses⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ⁾.
Ventilatory exercises	Ventilatory exercises⁽⁴⁴44 Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9(4):183-7. doi: 10.1155/2004/686913 https://doi.org/10.1155/2004/686913... ⁾.
Soft food intake	Soft food during labor⁽³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾.
Freedom of labor and delivery position	Freedom of labor and delivery position⁽³²32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... ^,³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ^,⁴¹41 Bio E, Bittar RE, Zugaib M. Influência da mobilidade materna na duração da fase ativa do trabalho de parto. Rev Bras Ginecol Obstet. 2006;28(11):671-9. doi: 10.1590/S0100-72032006001100007 https://doi.org/10.1590/S0100-7203200600... ⁾.

CONSEQUENT OF THE CONCEPT OF AMBIENCE FOR LABOR AND NORMAL INSTITUTIONALIZED DELIVERY
Pain management, relief and comfort
Self-confidence of the mother⁽¹⁵15 Aune I, Torvik HM, Selboe S-T, Skogås A-K, Persen J, Dahlberg U. Promoting a normal birth and a positive birth experience: Norwegian women's perspectives. Midwifery. 2015;31(7):721-7. doi: 10.1016/j.midw.2015.03.016 https://doi.org/10.1016/j.midw.2015.03.0... ^,³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾; Acupuncture⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ⁾; Music therapy⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ^,³⁵35 Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers. J Clin Nurs. 2010;19(7-8):1065-72. doi: 10.1111/j.1365-2702.2009.03028.x https://doi.org/10.1111/j.1365-2702.2009... ⁾; Aromatherapy⁽⁴²42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... ⁾; Mobility of the woman⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ^,³³33 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27(6):842-7. doi: 10.1016/j.midw.2010.09.001 https://doi.org/10.1016/j.midw.2010.09.0... ⁾; Shower⁽²⁵25 Liu Y, Liu Y, Huang X, Du C, Peng J, Huang P, et al. A comparison of maternal and neonatal outcomes between water immersion during labor and conventional labor and delivery. BMC Pregnancy Childbirth. 2014;14:160. doi: 10.1186/1471-2393-14-160 https://doi.org/10.1186/1471-2393-14-160... ^-²⁶26 Nutter E, Meyer S, Shaw-Battista J, Marowitz A. Waterbirth: an integrative analysis of peer-reviewed literature. J Midwifery Womens Health. 2014;59(3):286-319. doi: 10.1111/jmwh.12194 https://doi.org/10.1111/jmwh.12194... ⁾; Practice exercises⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... 28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... 29 Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(2):CD003934. doi: 10.1002/14651858.CD003934.pub4 https://doi.org/10.1002/14651858.CD00393... 30 Simmonds AH, Peter E, Hodnett ED, McGillis Hall L. Understanding the moral nature of intrapartum nursing. J Obstet Gynecol Neonatal Nurs. 2013;42(2):148-56. doi: 10.1111/1552-6909.12016 https://doi.org/10.1111/1552-6909.12016... 31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... 32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... 33 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27(6):842-7. doi: 10.1016/j.midw.2010.09.001 https://doi.org/10.1016/j.midw.2010.09.0... 34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... 35 Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers. J Clin Nurs. 2010;19(7-8):1065-72. doi: 10.1111/j.1365-2702.2009.03028.x https://doi.org/10.1111/j.1365-2702.2009... 36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... 37 Silva FMB, Oliveira SMJV, Nobre MRC. A randomised controlled trial evaluating the effect of immersion bath on labour pain. Midwifery. 2009;25(3):286-94. doi: 10.1016/j.midw.2007.04.006 https://doi.org/10.1016/j.midw.2007.04.0... 38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... 39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... 40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... 41 Bio E, Bittar RE, Zugaib M. Influência da mobilidade materna na duração da fase ativa do trabalho de parto. Rev Bras Ginecol Obstet. 2006;28(11):671-9. doi: 10.1590/S0100-72032006001100007 https://doi.org/10.1590/S0100-7203200600... 42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... 43 Hoga LAK. Motivação de enfermeiras obstétricas para o desenvolvimento de seu trabalho em uma casa de parto. Rev Min Enferm [Internet]. 2004 [cited 2018 Jul 02];8(3):369-73. Available from: http://www.reme.org.br/artigo/detalhes/725 http://www.reme.org.br/artigo/detalhes/7... ^-⁴⁴44 Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9(4):183-7. doi: 10.1155/2004/686913 https://doi.org/10.1155/2004/686913... ⁾; Massage favoring pain management⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ^,³⁶36 Riesco MLG, Oliveira SMJV, Bonadio IC, Schneck CA, Silva FMB, Diniz CSG, et al. Birth centers in Brazil: scientific production review. Rev Esc Enferm USP. 2009;43(spe2):1291-6. doi: 10.1590/S0080-62342009000600026 https://doi.org/10.1590/S0080-6234200900... ⁾; Swiss ball⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ^,³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ⁾; Compresses on the perineum⁽²⁸28 Karlsdottir SI, Halldorsdottir S, Lundgren I. The third paradigm in labour pain preparation and management: the childbearing woman's paradigm. Scand J Caring Sci. 2013;28(2):315-27. doi: 10.1111/scs.12061 https://doi.org/10.1111/scs.12061... ⁾.
Promotion of the natural evolution of labor with outcome for normal delivery
Avoidance of routine interventions⁽³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ⁾; Labor and delivery in water⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Effective support of the companion⁽³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ⁾; Mobility of the woman⁽³³33 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27(6):842-7. doi: 10.1016/j.midw.2010.09.001 https://doi.org/10.1016/j.midw.2010.09.0... ^,⁴¹41 Bio E, Bittar RE, Zugaib M. Influência da mobilidade materna na duração da fase ativa do trabalho de parto. Rev Bras Ginecol Obstet. 2006;28(11):671-9. doi: 10.1590/S0100-72032006001100007 https://doi.org/10.1590/S0100-7203200600... ⁾; Adoption of upright positions⁽¹³13 Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012 May 16;(5):CD002006. doi: 10.1002/14651858.CD002006.pub3 https://doi.org/10.1002/14651858.CD00200... ^,³⁸38 Romano AM, Lothian JA. Promoting, protecting, and supporting normal birth: a look at the evidence. J Obstet Gynecol Neonatal Nurs. 2008;37(1):94-105. doi: 10.1111/j.1552-6909.2007.00210.x https://doi.org/10.1111/j.1552-6909.2007... ⁾; Use of the Swiss ball for greater permanence of the woman in the upright position⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ^,³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ⁾; Outcome of the normal delivery⁽¹¹11 Larkin P, Begley CM, Devane D. Women's preferences for childbirth experiences in the Republic of Ireland: a mixed methods study. BMC Pregnancy Childbirth. 2017;17(1):19. doi: 10.1186/s12884-016-1196-1 https://doi.org/10.1186/s12884-016-1196-... ^,¹⁶16 Borem P, Ferreira JBB, Silva UJ, Valério Jr J, Orlanda CMB. Increasing the percentage of vaginal birth in the private sector in Brazil through the redesign of care model. Rev Bras Ginecol Obstet. 2015;37(10):446-54. doi: 10.1590/SO100-720320150005264 https://doi.org/10.1590/SO100-7203201500... ^,³¹31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... ⁾.
Avoidance of early admission with effectiveness in meeting the needs of the woman, plus delivery and protagonism in labor, satisfaction, well-being and safety with feeling of relaxation and relief from anxiety
Avoidance of early admission⁽⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾; Effective meeting of the woman's needs⁽⁴⁰40 Walsh DJ. A birth centre's encounters with discourses of childbirth: how resistance led to innovation. Sociol Health Illn. 2007;29(2):216-32. doi: 10.1111/j.1467-9566.2007.00545.x https://doi.org/10.1111/j.1467-9566.2007... ⁾; Commitment to labor⁽³⁹39 Lundgren I, Berg M. Central concepts in the midwife-woman relationship. Scand J Caring Sci. 2007;21(2):220-8. doi: 10.1111/j.1471-6712.2007.00460.x https://doi.org/10.1111/j.1471-6712.2007... ⁾.
Subcategories	Codes and references
Protagonism	Aromatherapy⁽⁴²42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... ⁾; Favorable environment⁽²⁴24 Hammond A, Foureur M, Homer CSE. The hardware and software implications of hospital birth room design: a midwifery perspective. Midwifery. 2014;30(7):825-30. doi: 10.1016/j.midw.2013.07.013 https://doi.org/10.1016/j.midw.2013.07.0... ⁾.
Satisfaction and well-being	Welcoming reception⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Prioritization of care in case of emergency⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Presence and continuous support of the companion⁽¹⁴14 Happel-Parkins A, Azim KA. At pains to consent: a narrative inquiry into women's attempts of natural childbirth. Women Birth. 2016;29(4):310-20. doi: 10.1016/j.wombi.2015.11.004 https://doi.org/10.1016/j.wombi.2015.11.... ⁾; Specific guidance on labor and delivery⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Continued care by professionals⁽¹⁴14 Happel-Parkins A, Azim KA. At pains to consent: a narrative inquiry into women's attempts of natural childbirth. Women Birth. 2016;29(4):310-20. doi: 10.1016/j.wombi.2015.11.004 https://doi.org/10.1016/j.wombi.2015.11.... ^,²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Aromatherapy⁽⁴²42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... ⁾; Mobility of the woman⁽⁴⁴44 Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9(4):183-7. doi: 10.1155/2004/686913 https://doi.org/10.1155/2004/686913... ⁾; Ventilatory exercises⁽⁴⁴44 Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9(4):183-7. doi: 10.1155/2004/686913 https://doi.org/10.1155/2004/686913... ⁾; Bath⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Swiss ball⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Massages⁽⁴⁴44 Yildirim G, Sahin NH. The effect of breathing and skin stimulation techniques on labour pain perception of Turkish women. Pain Res Manag. 2004;9(4):183-7. doi: 10.1155/2004/686913 https://doi.org/10.1155/2004/686913... ⁾; No episiotomy⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾.
Safety	Presence of companion⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Continued care by professionals⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾; Staff and woman relationship⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾.
Relaxation and relief from anxiety	Swiss ball⁽³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ⁾; Aromatherapy⁽⁴²42 Mousley S. Audit of an aromatherapy service in a maternity unit. Complement Ther Clin Pract. 2005;11(3):205-10. doi: 10.1016/j.ctcp.2004.10.005 https://doi.org/10.1016/j.ctcp.2004.10.0... ⁾; Music therapy⁽³²32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... ^,³⁵35 Liu YH, Chang MY, Chen CH. Effects of music therapy on labour pain and anxiety in Taiwanese first-time mothers. J Clin Nurs. 2010;19(7-8):1065-72. doi: 10.1111/j.1365-2702.2009.03028.x https://doi.org/10.1111/j.1365-2702.2009... ⁾; Propitious environment⁽³²32 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27(5):582-7. doi: 10.1016/j.midw.2010.05.012 https://doi.org/10.1016/j.midw.2010.05.0... ⁾; Presence of the companion⁽²⁷27 Jamas MT, Hoga LAK, Reberte LM. Women's narratives on care received in a birthing center. Cad Saúde Pública. 2013;29(12):2436-46. doi: 10.1590/0102-311X00039713 https://doi.org/10.1590/0102-311X0003971... ⁾.
Reduced use of oxytocin, epidural analgesia and analgesics, with decrease in the occurrence of episiotomy and promotion of perineal integrity, supported by therapeutic communication and staff satisfaction.
Subcategories	Codes and references
Therapeutic communication	Commitment⁽³³33 Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27(6):842-7. doi: 10.1016/j.midw.2010.09.001 https://doi.org/10.1016/j.midw.2010.09.0... ⁾.
Staff integration	Gratification⁽⁴³43 Hoga LAK. Motivação de enfermeiras obstétricas para o desenvolvimento de seu trabalho em uma casa de parto. Rev Min Enferm [Internet]. 2004 [cited 2018 Jul 02];8(3):369-73. Available from: http://www.reme.org.br/artigo/detalhes/725 http://www.reme.org.br/artigo/detalhes/7... ⁾; Satisfaction⁽²⁴24 Hammond A, Foureur M, Homer CSE. The hardware and software implications of hospital birth room design: a midwifery perspective. Midwifery. 2014;30(7):825-30. doi: 10.1016/j.midw.2013.07.013 https://doi.org/10.1016/j.midw.2013.07.0... ^,⁴³43 Hoga LAK. Motivação de enfermeiras obstétricas para o desenvolvimento de seu trabalho em uma casa de parto. Rev Min Enferm [Internet]. 2004 [cited 2018 Jul 02];8(3):369-73. Available from: http://www.reme.org.br/artigo/detalhes/725 http://www.reme.org.br/artigo/detalhes/7... ⁾; Facilitation of the staff performance⁽²⁴24 Hammond A, Foureur M, Homer CSE. The hardware and software implications of hospital birth room design: a midwifery perspective. Midwifery. 2014;30(7):825-30. doi: 10.1016/j.midw.2013.07.013 https://doi.org/10.1016/j.midw.2013.07.0... ⁾.
Reduced use of oxytocin	Admission assessment of the woman⁽⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾; Propitious institutional setting⁽³¹31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... ⁾.
Normal delivery without epidural analgesia	Admission assessment of the woman⁽⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾; Propitious institutional setting⁽⁴⁵45 Lauzon L, Hodnett E. Labour assessment programs to delay admission to labour wards. Cochrane Database Syst Rev. 2001;(3):CD000936. doi: 10.1002/14651858.CD000936 https://doi.org/10.1002/14651858.CD00093... ⁾; Mobility of the woman⁽⁴¹41 Bio E, Bittar RE, Zugaib M. Influência da mobilidade materna na duração da fase ativa do trabalho de parto. Rev Bras Ginecol Obstet. 2006;28(11):671-9. doi: 10.1590/S0100-72032006001100007 https://doi.org/10.1590/S0100-7203200600... ⁾; Upright position⁽²⁹29 Lawrence A, Lewis L, Hofmeyr GJ, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(2):CD003934. doi: 10.1002/14651858.CD003934.pub4 https://doi.org/10.1002/14651858.CD00393... ⁾; Labor and delivery in water⁽²⁶26 Nutter E, Meyer S, Shaw-Battista J, Marowitz A. Waterbirth: an integrative analysis of peer-reviewed literature. J Midwifery Womens Health. 2014;59(3):286-319. doi: 10.1111/jmwh.12194 https://doi.org/10.1111/jmwh.12194... ⁾.
Reduced use of analgesics	Mobility of the woman⁽⁴¹41 Bio E, Bittar RE, Zugaib M. Influência da mobilidade materna na duração da fase ativa do trabalho de parto. Rev Bras Ginecol Obstet. 2006;28(11):671-9. doi: 10.1590/S0100-72032006001100007 https://doi.org/10.1590/S0100-7203200600... ⁾.
Promotion of perineal integrity	Swiss Ball Effect assisting in the exercise of the perineal region⁽³⁴34 Mota e Silva L, Oliveira SMJV, Silva FMB, Alvarenga MB. Using the Swiss ball in labor. Acta Paul Enferm. 2011;24(5):656-62. doi: 10.1590/S0103-21002011000500010 https://doi.org/10.1590/S0103-2100201100... ⁾; Labor and delivery in water promoting the perineal integrity⁽²⁶26 Nutter E, Meyer S, Shaw-Battista J, Marowitz A. Waterbirth: an integrative analysis of peer-reviewed literature. J Midwifery Womens Health. 2014;59(3):286-319. doi: 10.1111/jmwh.12194 https://doi.org/10.1111/jmwh.12194... ⁾.
Decrease in the occurrence of episiotomy	Propitious institutional setting⁽³¹31 Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012;(8):CD000012. doi: 10.1002/14651858.CD000012.pub4 https://doi.org/10.1002/14651858.CD00001... ⁾; Labor and delivery in water⁽²⁶26 Nutter E, Meyer S, Shaw-Battista J, Marowitz A. Waterbirth: an integrative analysis of peer-reviewed literature. J Midwifery Womens Health. 2014;59(3):286-319. doi: 10.1111/jmwh.12194 https://doi.org/10.1111/jmwh.12194... ⁾; Upright position⁽¹³13 Gupta JK, Sood A, Hofmeyr GJ, Vogel JP. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012 May 16;(5):CD002006. doi: 10.1002/14651858.CD002006.pub3 https://doi.org/10.1002/14651858.CD00200... ⁾.