Denna studie syftar till att undersöka nyblivna föräldrars upplevelser rörande användandet av förlossningsbrev. Föräldrar intervjuade till denna studie valde att skriva eller inte skriva ett förlossningsbrev. Blivande föräldrar som valde att inte skriva ett förlossningsbrev gjorde detta på grund av att de ansåg att brevet skulle styra in dem i en specifik riktning, samt att det inte hjälper att försöka kontrollera något som är utom deras kontroll. Föräldrar som valde att skriva ett förlossningsbrev gjorde detta eftersom de hade specifika önskemål som frångick den norm som styr förlossningen. Även kvinnor som utryckt någon form av förlossningsrädsla valde att skriva ett förlossningsbrev. Under studiens gång har fokus även riktats mot att undersöka andra förberedelser inför förlossningen. Studiens resultat bygger på att förlossningsbrevet bidrar till att kvinnor ska få en mindre passiv roll i sin förlossning samt att partnern blir mer delaktig i förlossningsskedet. Förlossningsbrevet upprätthåller och bekräftar normen kring den ”normala” vaginala födseln, men bidrar även till att föräldrarna ska få styra och planera sin förlossning. Därför kan förlossningsbrevet ses som en användbar metod för föräldrar som vill förbereda och planera förlossningen, då de får en större delaktighet i förlossningsskedet. Förlossningsbrevet kan därför vara en användbar metod för blivande föräldrar som vill ha större kontroll och delaktighet under graviditet och förlossning. / This Bachelor Thesis discusses expectant parents' experiences regarding the use of a birth plan. Prospective parents who chose not to write a birth plan did so because they felt that the letter would steer them in a specific direction, and moreover, that trying to control something that is beyond their control won't help. Parents who chose to write a birth plan did so because they had specific requests that were not consistent with standard Swedish hospital practices. Those women who expressed any sort of fear of childbirth also chose to write a birth plan. During the study, the focus has also been aimed at exploring other preparations for childbirth. The essay's conclusion is that birth plans aid women in playing a less passive role during the birth process, as well as the partner becoming more involved in the birth. Birth plans maintain and reaffirm the norms surrounding "normal" vaginal birth, but also help parents to gain more control and plan childbirth on their own terms. A birth plan may therefore be a useful method for parents who want more control and involvement during both pregnancy and childbirth.

Bakgrund: Sjuksköterskor ska i möjligaste mån främja patientens delaktighet och egna vilja, även när patienten ej kan uttrycka den själv. Få områden inom sjukvården använder patientbrev för att tydliggöra patientens förväntningar och önskningar. Tidigare studier har visat att förlossningsbrev både har positiva och negativa effekter på patienters känsla av omvårdnaden. Syfte: Syftet var att beskriva kvinnors upplevelser av hur förlossningsbrevet påverkade deras omvårdnad vid förlossningen relaterat till Kings omvårdnadsbegrepp i det mellanmänskliga mötet. Metod: En kvalitativ innehållsanalys av bloggar. Studien analyserade 25 stycken bloggar där kvinnor skrivit om sin upplevelse av förlossningsbrev. Resultat: Kvinnor som skrev förlossningsbrev upplevde en ökad trygghet, en känsla av kontroll, att de kände sig prioriterade, att det var en bra förberedelse inför vårdtillfället samt att det förbättrade kommunikationen och informationsbytet mellan sjuksköterska och patient samt att det ökade deras autonomi. Kvinnornas upplevde missnöje då förlossningsbrevet inte följdes. Några kvinnor upplevde en rädsla att förlossningsbrevet skulle begränsa dem. Slutsats: Det är mestadels positiva upplevelser av förlossningsbrevet. Användandet bör dock ske med vetskap om att ett brev som inte respekteras eller efterlevs ökar risken för missnöje med omvårdnaden. Klinisk betydelse: Studien tyder på att ett patientbrev kan öka patienters delaktighet, trygghet, autonomi och förbättra den personcentrerade vården. / Background: Nurses should increase patient participation, even when patients’ ability to communicate is reduced. Parts of the healthcare system use patient plans to clarify patients’ expectations and wishes. Previous studies show that patient plans both bring positive and negative features to the feeling of care. Aim: The aim was to describe women’s experiences of how the birth plan affected their care related to King’s concepts of the interpersonal system. Method: A qualitative concept analysis where 25 blogs were analyzed. Result: Women who wrote a birth plan felt an increased sense of safety, control and being prioritized. Women experienced that the birth plan was a good way to prepare and that it enhanced the communication. Some women felt unsatisfied with their care when the birth plan was not followed and some were afraid that it would limit their care. Conclusion: The outcome are almost exclusively positive. But the usage of patient plans should be done with the knowledge that a plan which is not followed might cause dissatisfaction. Clinical importance: This study indicates that a patient plan could increase patients’ feelings of participation, safety, autonomy and enhance the patient centered care.

Na assistência ao parto no Brasil, predominam intervenções desnecessárias em detrimento de valores como o cuidado. Algumas políticas públicas têm sido desenvolvidas com o intuito de alterar tal cenário, porém, com lentos resultados. Há também algumas estratégias e ferramentas desenvolvidas e difundidas entre as próprias mulheres. Uma destas é a construção do plano de parto, que objetiva informar e promover uma maior participação durante o parto. Apesar de mais difundida entre camadas médias, tal ferramenta tem sido utilizada em alguns serviços de atenção primária do país como a UBS Thérsio Ventura/São Paulo, campo de estágio para o curso de Obstetrícia EACH/USP. Este estudo objetivou descrever e analisar o uso de plano de parto entre usuárias do SUS e médicos/gestores. De metodologia qualitativa, os dados empíricos foram produzidos a partir de entrevistas com mulheres que vivenciaram a experiência de plano de parto no SUS; entrevistas com médicos/gestores; observação de uma consulta de orientação para o plano e parto; observação de dois grupos de apoio à gestação e ao parto realizados na UBS, e análise documental de material educativo, e de documentos referentes às políticas de saúde materna municipal e nacional. O material foi submetido à análise de conteúdo, da qual emergiram as seguintes categorias: (a) Não é uma incapacidade sua, e sim do sistema; (b) De coitada a poderosa; (c) Intervenção que era ajuda; (d) Resistência e negociação do encontro; (e) Plano de parto como mobilizador do cuidado como valor; (f) A segurança do bebê como chantagem; (g) Sobre comandantes, aviões e a necessidade de novas analogias; (h) Plano de parto como provocação: negligência e retaliação; (i) Limites para a decisão informada no SUS. O plano de parto funciona como uma ferramenta educativa que provoca rupturas simbólicas na relação hierárquica das mulheres com os profissionais. Como não há uma cultura que promova a tomada conjunta de decisões e porque há uma clara contradição entre o tipo de cuidado que as mulheres demandam e a atenção que os profissionais estão preparados e dispostos a oferecer, o plano de parto pode resultar em negligência e retaliação. Pode ser útil na construção de linhas de cuidado entre as instituições. Um modelo a ser discutido deveria garantir espaço para singularidades socioculturais, para a explicação dos momentos em que procedimentos podem ser necessários e também espaço para divulgação de locais de assistência mais amigáveis às mulheres e aos quais a mulher pode recorrer no caso de violação de direitos. / Birth care in Brazil is marked by strong predominance of unnecessary interventions at the expense of values such as care. Some policies have been developed in order to change such a scenario but with slow results. There are also some strategies and tools developed and disseminated among women themselves. One of those is the construction of the birth plan, which aims to inform and expand participation and decision making during childbirth. Widespread among middle class women, this tool has been used in some primary care services in the country such as UBS Thérsio Ventura/São Paulo, a training field for the course of Midwifery EACH/USP. This study aimed to understand and analyse the use of birth plan between women who use the public health system and doctors/managers. Using qualitative methodology, empirical data was produced from interviews with women who experienced birth plan in the public system; interviews with doctors/managers; observation of a guidance for the birth plan construction; observation of two support groups at the studied health center, and document analysis of educational materials and documents relating to municipal and national maternal health policies. The material was subjected to content analysis of which the following categories emerged: (a) It is not your disability, but the systems; (b) From poor thing to powerful; (c) Intervention that once was \'help\'; (d) Resistance and negotiation of the encounter; (e) Birth Plan as a mobilizer of care as a value; (e) The safety of the baby as blackmail; (f) About commanders, airplanes and the need for new analogies; (g) Birth plan as defiance: negligence and retaliation; (h) Limits for \'informed decision\' in the public health system. Birth plan functions as an educational tool that causes fissures in the symbolic hierarchical relationship of women in relation to professionals. As there isnt a culture that promotes joint decision-making and because there is a clear contradiction between the type of care women require and what professionals are ready and willing to offer, birth plan can end in neglect and retaliation. It could be useful in building protocols and care between the institutions. A model to be discussed should ensure space for socio-cultural singularities, to the explanation of times that procedures may be required and also space for disclosure of sites to which woman can turn in case of violation of rights.

Na assistência ao parto no Brasil, predominam intervenções desnecessárias em detrimento de valores como o cuidado. Algumas políticas públicas têm sido desenvolvidas com o intuito de alterar tal cenário, porém, com lentos resultados. Há também algumas estratégias e ferramentas desenvolvidas e difundidas entre as próprias mulheres. Uma destas é a construção do plano de parto, que objetiva informar e promover uma maior participação durante o parto. Apesar de mais difundida entre camadas médias, tal ferramenta tem sido utilizada em alguns serviços de atenção primária do país como a UBS Thérsio Ventura/São Paulo, campo de estágio para o curso de Obstetrícia EACH/USP. Este estudo objetivou descrever e analisar o uso de plano de parto entre usuárias do SUS e médicos/gestores. De metodologia qualitativa, os dados empíricos foram produzidos a partir de entrevistas com mulheres que vivenciaram a experiência de plano de parto no SUS; entrevistas com médicos/gestores; observação de uma consulta de orientação para o plano e parto; observação de dois grupos de apoio à gestação e ao parto realizados na UBS, e análise documental de material educativo, e de documentos referentes às políticas de saúde materna municipal e nacional. O material foi submetido à análise de conteúdo, da qual emergiram as seguintes categorias: (a) Não é uma incapacidade sua, e sim do sistema; (b) De coitada a poderosa; (c) Intervenção que era ajuda; (d) Resistência e negociação do encontro; (e) Plano de parto como mobilizador do cuidado como valor; (f) A segurança do bebê como chantagem; (g) Sobre comandantes, aviões e a necessidade de novas analogias; (h) Plano de parto como provocação: negligência e retaliação; (i) Limites para a decisão informada no SUS. O plano de parto funciona como uma ferramenta educativa que provoca rupturas simbólicas na relação hierárquica das mulheres com os profissionais. Como não há uma cultura que promova a tomada conjunta de decisões e porque há uma clara contradição entre o tipo de cuidado que as mulheres demandam e a atenção que os profissionais estão preparados e dispostos a oferecer, o plano de parto pode resultar em negligência e retaliação. Pode ser útil na construção de linhas de cuidado entre as instituições. Um modelo a ser discutido deveria garantir espaço para singularidades socioculturais, para a explicação dos momentos em que procedimentos podem ser necessários e também espaço para divulgação de locais de assistência mais amigáveis às mulheres e aos quais a mulher pode recorrer no caso de violação de direitos. / Birth care in Brazil is marked by strong predominance of unnecessary interventions at the expense of values such as care. Some policies have been developed in order to change such a scenario but with slow results. There are also some strategies and tools developed and disseminated among women themselves. One of those is the construction of the birth plan, which aims to inform and expand participation and decision making during childbirth. Widespread among middle class women, this tool has been used in some primary care services in the country such as UBS Thérsio Ventura/São Paulo, a training field for the course of Midwifery EACH/USP. This study aimed to understand and analyse the use of birth plan between women who use the public health system and doctors/managers. Using qualitative methodology, empirical data was produced from interviews with women who experienced birth plan in the public system; interviews with doctors/managers; observation of a guidance for the birth plan construction; observation of two support groups at the studied health center, and document analysis of educational materials and documents relating to municipal and national maternal health policies. The material was subjected to content analysis of which the following categories emerged: (a) It is not your disability, but the systems; (b) From poor thing to powerful; (c) Intervention that once was \'help\'; (d) Resistance and negotiation of the encounter; (e) Birth Plan as a mobilizer of care as a value; (e) The safety of the baby as blackmail; (f) About commanders, airplanes and the need for new analogies; (g) Birth plan as defiance: negligence and retaliation; (h) Limits for \'informed decision\' in the public health system. Birth plan functions as an educational tool that causes fissures in the symbolic hierarchical relationship of women in relation to professionals. As there isnt a culture that promotes joint decision-making and because there is a clear contradiction between the type of care women require and what professionals are ready and willing to offer, birth plan can end in neglect and retaliation. It could be useful in building protocols and care between the institutions. A model to be discussed should ensure space for socio-cultural singularities, to the explanation of times that procedures may be required and also space for disclosure of sites to which woman can turn in case of violation of rights.

<p>The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth. </p><p>The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports. </p><p>Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.</p>

<p>The experience of childbirth is an important life event for women, which may follow them throughout life. The overall aim of this thesis has been to describe and analyse these experiences from the women's perspective as well as the encounter between the woman and the midwife, and the possibility that a birth plan might improve women's experience of childbirth. The setting has been the ABC-centre (Alternative Birth Care), antenatal clinics and Sahlgrenska University hospital in Göteborg, and Karolinska hospital in Stockholm, Sweden. The studies have used both qualitative (phenomenological and hermeneutic) and quantitative approaches. The essential structure of the experiences of pregnancy and childbirth may be conceptualised under the heading ‘releasing and relieving encounters’, which for the woman constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as being in the moment; exemplified as presence and being one's body. Change is expressed as transition; to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person that listens to and follows the woman through the process of childbirth. To be anchored is to be the person that in the transition process respects the limits of the woman's ability as well as her own professional limits. The releasing and relieving encounter is not improved for women by a birth plan. Instead, in some aspects the relationship between the woman and her midwife during childbirth is reported as less satisfactory if preceded by a birth plan although some experiences of fear, pain and concerns for the child might be improved. </p>

The experience of childbirth is an important life event for women, which may follow them throughout life. The overall aim of this thesis has been to describe and analyse these experiences from the women's perspective as well as the encounter between the woman and the midwife, and the possibility that a birth plan might improve women's experience of childbirth. The setting has been the ABC-centre (Alternative Birth Care), antenatal clinics and Sahlgrenska University hospital in Göteborg, and Karolinska hospital in Stockholm, Sweden. The studies have used both qualitative (phenomenological and hermeneutic) and quantitative approaches. The essential structure of the experiences of pregnancy and childbirth may be conceptualised under the heading ‘releasing and relieving encounters’, which for the woman constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as being in the moment; exemplified as presence and being one's body. Change is expressed as transition; to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person that listens to and follows the woman through the process of childbirth. To be anchored is to be the person that in the transition process respects the limits of the woman's ability as well as her own professional limits. The releasing and relieving encounter is not improved for women by a birth plan. Instead, in some aspects the relationship between the woman and her midwife during childbirth is reported as less satisfactory if preceded by a birth plan although some experiences of fear, pain and concerns for the child might be improved.

The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth. The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports. Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.