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Bakgrund: Epiduralbedövning är idag en vanlig och effektiv smärtlindringsmetod som används vid nästan hälften av alla förlossningar i Sverige. Det är inte klargjort om epiduralbedövningen ingår i det normala förlossningsförloppet trots att forskning visar att den kan ha betydelse för förlossningsförloppets utfall.  Syfte: Att belysa barnmorskors erfarenheter av epiduralbedövning i samband med förlossningsarbetet. Metod: Studien genomfördes genom två fokusgruppsintervjuer med totalt tio barnmorskor där datamaterialet sedan analyserades med kvalitativ innehållsanalys. Resultat: Resultatet presenteras i tre huvudkategorier med tre underkategorier vardera. Huvudkategorierna är: Epiduralbedövningens betydelse för barnmorskans arbete, epiduralbedövningens betydelse för den födande kvinnan och epiduralbedövningens betydelse för förlossningsförloppet. Barnmorskorna upplevde att det både fanns för- och nackdelar med att använda en epiduralbedövning under förlossningen. Slutsats: Barnmorskor har en betydande och viktig roll i att kunna hjälpa och stötta den födande kvinnan och på så vis kunna bidra till en positiv förlossningsupplevelse. Fokus bör ligga på att främja en normal förlossning trots användning av epidural, tydligare riktlinjer hade kunnat hjälpa barnmorskor i deras handläggande. / Background: Epidural anesthesia is today a common and effective pain relief method used in almost half of all births in Sweden. It is not clear whether epidural anesthesia is part of the normal course of labor, despite research showing that the epidural may be important for the outcome of the course of labor. Aim: To describe midwives experiences of epidural anesthesia in connection with the birth process. Method: The study was conducted through two focus group interviews with a total of ten midwives where the data material was then analyzed with qualitative content analysis. Result: The results are presented in three main categories with three subcategories each: the importance of epidural anesthesia for the midwife's work, the importance of epidural anesthesia for the woman giving birth and the importance of epidural anesthesia for the birth process. The midwives experienced that there were both advantages and disadvantages to using an epidural anesthesia during childbirth. Conclusion: Midwives have a significant and important role in being able to help and support the woman giving birth and thus be able to contribute to a more positive birth experience. The focus should be on promoting a normal birth despite the use of an epidural, clearer guidelines could have helped midwives in their handling.

Den normala förlossningen är barnmorskans ansvarsområde. Frisättning av oxytocin är en förutsättning för ett normalt förlossningsförlopp och vårdmiljön har betydelse för detta. Utfallen av hemförlossningar är goda, vid lågriskgraviditet har det inte framkommit några ökade risker vare sig för kvinnor eller barn. I Sverige erbjuds inte hemförlossningar via det generella vårdutbudet. Det finns ett fåtal privata hembarnmorskor samt programmet ”Min Barnmorska” som tillhandahåller assistans vid hemförlossningar. Forskning kring kvinnors erfarenheter av att föda hemma visar på positiva upplevelser. Det finns begränsad kunskap om barnmorskors upplevelser av att bistå hemförlossningar. Syftet med studien var att beskriva barnmorskors upplevelser av att bistå planerade hemförlossningar. Metoden var en allmän litteraturöversikt med kvalitativ ansats och innefattade 15 artiklar. Resultatet sammanställdes i tre kategorier: Att arbeta i enlighet med sin ideologi, Med den födande i fokus och Baksidan med hemförlossning, med tillhörande subkategorier. Barnmorskorna hade en stark tilltro till den naturliga födelseprocessen och önskade arbeta med den födande i fokus. Det var viktigt att kvinnor tilläts göra informerade val gällande beslutet av födelseplats. Barnmorskorna uppskattade arbete i hemmiljö, det möjliggjorde för dem att arbeta utifrån sina sinnen och intuition. Hemmiljön främjande både de födande kvinnorna och barnmorskorna, då de tilläts arbeta i lugn och ro med en födande i taget. I hemmet tilläts förlossningsprocessen ta tid, det var viktigt att inte störa eller utföra onödiga interventioner. Relationen till familjen var en viktig del i att kunna ge adekvat stöd.Barnmorskorna önskade arbeta med kontinuerlig vård för att optimera relationen till familjen och de födandes förlossningsupplevelse. Att arbeta med hemförlossningar resulterade i olika svårigheter, exempelvis fientligt bemötande från annan vårdpersonal, bristfälligt stöd i arbetetoch påverkan på privatlivet. Slutsatsen är att hemförlossningar kan gynna barnmorskor. En arbetsmodell där barnmorskor får tillhandahålla kontinuerlig vård och kombinera arbete i hem- och sjukhusmiljö kan vara alternativ för de barnmorskor som vill arbeta med hemförlossningar. Det krävs mer stöd och resurser men möjliggör att fler barnmorskor får arbeta i enlighet med sin ideologi. / The normal birth is the midwife's area of responsibility. Release of oxytocin is a prerequisite for a normally developed birth process and the care environment has proven to be important for this. Home births have good outcomes, there have been no increased risks for either women or children with low-risk pregnancies. In Sweden, home births are not offered via the general range of care. There are a few private home midwives and the “Min Barnmorska”program that offers assistance during home births. Research on women's experiences of giving birth at home shows positive experiences. There is limited knowledge about midwives' experiences of assisting home births. The aim of the study was to describe midwives' experiences of assisting planned home births. The method was a general literature review with a qualitative approach and included 15 articles. The results were compiled in three categories: Working in accordance with theirideology, With the woman in focus and Disadvantages of home birth, with associated subcategories. The midwives had a strong belief in the natural birth process and wanted to work with the woman in focus. It was important that women were allowed to make informed choices regarding the decision on place of birth. The midwives appreciated working in a home environment, it enabled them to base their work on their senses and intuition. The home environment fostered both the women giving birth and the midwives, as they were allowed to work in peace and quiet with one woman at a time. At home, the delivery process was allowed to take time, it was important not to disturb or perform unnecessary interventions. The relationship with the family was an important part in being able to provide adequate support. The midwives wanted to work with continuous care in order to optimize the relationship with the family and the birth experience of the women giving birth. Working with home births resulted in various difficulties such as hostile treatment from other healthcare staff, inadequate support at work and impact on private life. The conclusion is that home births can benefit midwives. A work model where midwives are allowed to provide continuous care and combine work in a home and hospital environment can be an alternative for those midwives who wish to work with home births. More support and resources are required but it enables more midwives to work in accordance with their ideology.

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.

An emergency reaction is required in Africa because HIVIAIDS is a reality which may be regarded as a developing crisis and a catastrophe. Approximately a third of all women in the North-West Province are HIV positive. Because of their vulnerability against HIVIAIDS there arose a need for health service provision to the HIV positive woman to focus specifically on the reduction of the transmission of HIVIAIDS from mother to child. Mother to child transmission is the biggest cause of HIV infection among children. Almost all HIV positive children are infected during pregnancy, labour, childbirth or breastfeeding. Without the necessary preventative measures as many as 25-35% of the children of HIV positive mothers may be infected. The biggest percentage of infections, however, takes place during labour and the birth process. In first world countries the mother has access to choices and facilities to make an informed decision about antiretroviral therapy, as well as the method of birth. In the North-West Province not all these options and facilities are available, and therefore the knowledge and skills of midwives must be deployed to reduce vertical transmission of HIV during the intrapartum practice. It is important that midwives have the necessary knowledge about intrapartum practices and vertical transmission of HIV, in order to distinguish between risky and safe intrapartum practices. The purpose of this research was to determine whether midwives in the Southern region of the North-West Province have sufficient knowledge of intrapartum practices to reduce vertical transmission of HIV, as well as to determine the intrapartum practices in the Southern region of the North-West Province. The ultimate goals, then, were to determine how the national policy should be adapted and implemented in the Southern region of the North-West Province to reduce HIV transmission during intrapartum practices. A quantitive survey design was used. For the data collection a questionnaire and a control list were used. The questionnaire and the control list, which are adapted and based on literature, were submitted to research and subject specialists, after which they were adapted. Permission was obtained for this research from the Department of Health in the North-West Province, the ethics committee of the PU for CHE as well as each provincial hospital in the Southern region in the North-West Province to conduct the research. A purposeful availability sample of midwives working in the Southern region of the North-West Province was used and a random sample was used for auditing the obstetric records. A total of 31 midwives participated as respondents, and 401 obstetrical records were audited. Data analysis was performed by means of a frequency analysis, effect sizes and cross reference. Based on these findings it was concluded that the midwives do have basic knowledge regarding vertical transmission of HIV, but that this knowledge is not reflected in the intrapartum practice. There is uncertainty about certain aspects where the latest research about intrapartum practices are not implemented in practice. Recommendations were accordingly formulated for nursing education, research and practice. This research particularly focused on improving midwives' knowledge about intrapartum practices to reduce the vertical transmission of HIV, so that this knowledge may result in improved intrapartum practice. Recommendations are also made as to how the national policy may be adapted and implemented in the Southern region of the North-West Province. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2004.