This research analyses the first paternal experience of childbirth and its affects on how men experience themselves as fathers. The study adopts a moral and philosophical standpoint, to ensure that the experiences of other key stakeholders in the childbirth realm are considered. This recognises that childbirth is women�s business, and how, as a male researcher, I have the potential to impose my views from a position of social dominance. Qualitative data were collected from twenty four participants who described their experiences of childbirth, in five focus groups. Participants were men whose first experience of childbirth occurred from as recently as one month to five years ago. Twelve participants were then involved in individual interviews to discuss, in depth, their experiences of fathering. An interview was also conducted with a midwife to illuminate her experiences of men and childbirth. Using interpretive interactionism as the chosen method for data analysis, I have identified the first paternal experience of childbirth as an epiphany in its major form. Epiphanies of which there are four types; the major, the cumulative, the minor illuminative and the relived, are those experiences that have the potential to transform and even radically alter peoples lives, and how they define themselves and their relations with others (Denzin,1989b:15). Data were phenomenologically analysed and six primary childbirth and fathering themes have been identified. Men�s first experience of childbirth entails emotions that range from fear and anger to awe and amazement. The reason that this life experience constitutes an epiphany for men, is that it affects how they experience themselves as fathers. The memory of their partner�s labour and birth pain is significant in how men construct their paternal identity. Important to men is the ability to biologically sire a child, and in particular a son, the need to create the child in men�s own likeness and responsibility for financial provision and discipline of the child.

The increasing rates of intervention in childbirth are an issue for women, their families, health professionals, and society across much of the Western World. This study is a response to these increasing rates of intervention, as reflected in the research question: 'What is shaping the practice of health professionals and the understanding of the public in relation to increasing intervention in childbirth?' The participants in the study were nine health professionals: midwives and obstetricians, who were interviewed individually, and thirty-three members of the public who took part in six focus groups. The research was carried out under the umbrella of critical hermeneutics, and the particular approach used was that of critical interpretation as formulated by Hans Kogler. This approach enabled a hermeneutical thematic analysis of that which is shaped (worldviews) and a critical structural analysis (discursive orders, social practices, relationships of power and structures of domination) of the shaping and shapers of practice and understanding. The research process facilitated by critical interpretation in identifying and describing the shaping and shapers of practice and understanding adds an important dimension to the statistical picture of increasing intervention that is of concern, both to health professionals and the public. The research revealed that the everyday world and its associated processes of socialisation in the 21st century - in particular pain, choice, and technology - shape the practice of health professionals and the understanding of the public in relation to increasing intervention. The study's findings were supported by the revelation that many of the social and cultural values, such as convenience, ease, and control, that underpin Western society in the 21st century, correlate with what intervention has to offer, which results in intervention being increasingly sought after and utilised. This milieu of intervention, which increasingly surrounds childbirth, is shown to be calling into question those things that have traditionally been at the heart of childbirth: the ability of the woman to birth and the clinical skills of the health professional. This research provides insight and awareness of those things that are shaping understanding and practice and birth itself and creating a milieu in which intervention is increasingly normalised.

In the past decade there has been growing recognition that a sexual abuse history may manifest during health care examinations. More recently, awareness has been raised about a possible link between a history of sexual abuse and traumatic labour and birth. It is theoretically likely that the intimacy of labour and birth for women with a history of sexual abuse may trigger post-traumatic stress symptomatology. In this cross sectional study, a survey method was used to establish prevalence of sexual abuse and to measure obstetric outcomes, birth experience and birth trauma in a cohort of women who have recently given birth and to test whether there are associations between sexual abuse and birth outcomes. Eighty-five women whose 3½ to 5 year old children attend kindergarten participated. Lifetime sexual abuse was found to be a common experience for study participants. One out of every three women disclosed an experience of sexual abuse in her lifetime. A history of sexual abuse was not associated with adverse labour and birth outcomes; however women with a positive sexual abuse history were more likely to report postnatal depression. A quarter of the women had PTSD symptoms but overall, women had positive birth experiences and felt well supported. Many women are able to overcome traumatic abuse experiences and successfully cope with birth, an event that may potentially replicate the dynamics of sexual abuse. Further research is needed to identify women who may be at high risk for traumatic birth experiences. Undertaking screening for sexual abuse in the antenatal period in a safe environment may provide reassurance for women and enable identification of those women at high risk for abuse related traumatic birth experiences.

The aims of this study were to describe the childbirth preferences of nulliparous women in early pregnancy and to develop a model of the predictors of those preferences. Participants were recruited with Facebook advertisements and data were collected from 344 women via online survey. Predictors were measured using the Utah Test for the Childbearing Year. Predictors of childbirth preferences (type of birth care provider, birth setting, mode of delivery, and use/avoidance of pain medication) were tested using structural equation modeling. Conventional content analysis was employed to analyze women’s reasons for selecting the type of provider and setting they expected for their delivery. Although the majority of respondents preferred physicians and hospital birth, the proportions of women who preferred midwifery care and planned home birth were higher than currently access those types of care in the U.S. More respondents preferred to use pain medication than to avoid it. Over 95% of respondents preferred vaginal delivery. Women who had an internal locus of control and perceived their childbearing role to be one of active participation were more likely than women who saw their role as a passive one to prefer midwifery care, home birth, vaginal delivery, and to avoid pain medication. Women who saw the provider’s role as dominant to their own were more likely to prefer physicians and hospital birth than those who viewed the provider’s role as a collaborative one. The more fearful/painful women expected birth to be, the more likely they were to prefer cesarean delivery.

Postpartum depression is by definition a major depression with an onset during the first weeks after delivery. In practice, however, the term, postpartum depression is used to characterize all kinds of depressive symptoms after childbirth. The aims of this thesis were to investigate the prevalence of depressive symptoms during late pregnancy, in the puerperium and four years after delivery, and to analyze the mothers’ estimation of personal health and their children’s behavior at the age of four. Additional goals were to test the predictive power of potential associated factors of postpartum depression during pregnancy and the puerperium and finally, to elucidate possible genetic or neuropeptidergic explanatory variables behind the development of postpartum depression. A population-based sample of 1489 women was screened with the Edinburgh Postnatal Depression Scale and the prevalence of depressive symptoms was 17% in late pregnancy and 13% postpartum. Antenatal depressed mood was related to postpartum depression. In a cross-sectional study we later found that postpartum depression was associated with subsequent depressive symptoms and current health problems four years after childbirth. Four-year-old boys of postpartum depressed mothers and children of mothers with a subsequent depressive status had more behavior problems than children of non-symptomatic mothers did, according to the mothers’ opinion. The strongest associated factors for postpartum depression, in a case-control study, were sick leave during pregnancy mainly due to pregnancy complications, e.g. hyperemesis and premature contractions and a high number of visits to the antenatal care clinic. There was no association between delivery complications or complications in the perinatal period and postpartum depression. The theory that depressive symptoms in late pregnancy or postpartum are connected with CYP2D6 genotype could not be confirmed. In a rat model, we found that pregnancy and parturition influence the concentrations of neuropeptide Y, cholecystokinin, substance P and galanin in the rat brain. This result supports the hypothesis that neuropeptidergic systems in the brain influence the mood changes around childbirth. In conclusion, postpartum depression is a common feature with influence on both maternal and child well being. / Pages 26 and 57 containing illustrations are removed from the electronic version. On the day of the public defence the status of article IV was: Accepted for publication.

The expectations of a successful outcome are great during childbirth. The overall objective of prenatal care and birth care is that midwives contribute in creating the most positive experience of pregnancy, child birth and infancy as possible. During the past 30 years there has been a significant increase in sectiofrequency both in Sweden and the rest of the Western world. More parents feel an overall insecurity when it comes to child labour. The purpose of this study was to describe how midwives experience the work of creating a sense of security and good nursing when meeting the expectant parents. A phenomenological approach was chosen with the use of eleven qualitative interviews that were analyzed with Giorgis' method of analysis. The result revealed three themes: organizational - professional conditions, the communicative ability and the reflective - emotional competence. Trusting your inner sensibility and intuition was something that characterized all the interviews and was the essence of the results. The way work was lead and organized, as well as the utilization of competence effected the midwives’ possibility of contributing to a sense of security and good care. When the communication was based on sensibility, midwives’ could create a good and trustful relationship with the expectant parents. The emotional involvement was an essential requirement for carrying out the work in a satisfying way. A question for the future is how inner knowledge based on practical experience can benefit new personnel and how the organization and education for healthcare givers can utilize the specialist knowledge of midwives with experience. / Förväntningarna i samband med barnafödande är stora på att en graviditet ska sluta lyckligt. Det övergripande målet inom mödrahälsovård och förlossningsvård är för barnmorskor att medverka till en så positiv upplevelse av graviditet, förlossning och spädbarnstid som möjligt. De sista trettio åren har sectiofrekvensen ökat betydligt både i Sverige och västvärlden. Fler föräldrapar upplever idag en allmän otrygghet i samband med barnafödande. Syftet med denna studie var att beskriva barnmorskors upplevelser av att förmedla trygghet och en god omvårdnad i mötet med det blivande föräldraparet. Fenomenologisk ansats valdes med elva kvalitativa intervjuer som analyserades enligt Giorgis analysmetod. Resultatet visade tre teman: Organisatoriska - professionella förutsättningar, den kommunikativa förmågan och den reflektiva - emotionella kompetensen. Att lita på sin inre känsla och intuition var en upplevelse som genomsyrade hela intervjumaterialet och blev resultatets essens. Hur arbetet leds och organiseras och hur kompetens tillvaratas påverkade i hög grad barnmorskors möjligheter att förmedla trygghet och en god omvårdnad. Genom att vara lyhörd i sitt sätt att kommunicera kunde en god och förtroendefull relation skapas mellan barnmorskor och det blivande föräldraparet. Det känslomässiga engagemanget var en nödvändig förutsättning för att utföra ett bra jobb. En fråga inför framtiden är på vilket sätt den erfarenhetsbaserade inre kunskapen kan komma ny personal tillgodo och hur omvårdnadsarbetets organisation och vårdutbildningar kan ta tillvara det expertmässiga kunnandet hos erfarna barnmorskor.

The association between pain and depression is well documented across various populations, but not in puerperal women. This study examined the association of childbirth pain with postpartum depression (PPD) in a nationally representative sample of Canadian women. Data from the Canadian Maternity Experiences Survey (n=6421) was used. Multivariate logistic regressions and partial proportional odds models were fitted and included socio-demographic, obstetric, health, psychological, and psychosocial factors. Chronic pain sufferers at mean 7.3 months postpartum had adjusted odds of PPD of 2.4 (95% CI: 1.6, 3.6) compared to women without pain. Adjusted odds of PPD increased with the number of areas of chronic pain, reaching 4.2 (95% C.I.: 0.7, 25.0) for 3 or more areas. Immigration, obesity, cesarean section and social support increased the strength of the association while smoking and the use of pain relief were protective effect modifiers. Persistent postpartum pain is a major risk factor for PPD.

This thesis supported the hypothesis that preoperative verbalization enhances the birth experience in primary emergency cesarean delivered women. A T-test was utilized to compare the two groups' responses on each item of a 29 point questionnaire. The questionnaire measured perception of birth in 28 participants who verbalized their feelings preoperatively and 22 participants who did not verbalize preoperatively. The total mean score for all 29 items indicated a favorable perception for the former group. In addition, six specific items were significantly favorable for the group who verbalized. The T-test revealed questionnaire items of significance in the following subgroups: age, duration and intensity of labor, and parity.Ball State UniversityMuncie, IN 47306

The purpose of this study was to describe relationships between husband attendance during cesarean birth and parental perceptions of the cesarean birth and of the neonate. The independent variable was husband attendance during cesarean birth. Dependent variables were parental perceptions as measured by the Parental Perceptions of Cesarean Birth and Neonate Questionnaire. Thirty-five married couples who delivered healthy neonates by cesarean section with regional anesthesia constituted the study and control groups. The 60 parents in the study group were together during cesarean delivery; the 10 parents in the control group were not. Seventy subjects responded to 19 items on a Lilert-type questionnaire and 53 wrote comments about their birth experiences. ANOVA and repeated measures were used to examine data. Both research hypotheses, which were tested at the .05 level off significance, were supported: there was a significant relationship between husband attendance and positive perceptions of both the birth and of the neonate. Presence of the father in surgery had significant effects on perceptions of cesarean birth (p <.01), perceptions of the neonate (p<.01), and perceptions of the time that the neonate was first seen and held by parents (p <.01). Level of education of mother was significantly related to perceptions of the neonate (p <.05). Level of education of father had a significant effect on reported fear for self during cesarean delivery (p <.05). Adequate preparation was significantly related to positive perceptions of cesarean birth (p <.01). The majority of parents of both groups found their birth experiences satisfying, but some would have liked more time together, more contact with infant, more preparation and more comfort for mother. Study results supported the practice of family-centered cesarean birth.Ball State UniversityMuncie, IN 47306

The association between pain and depression is well documented across various populations, but not in puerperal women. This study examined the association of childbirth pain with postpartum depression (PPD) in a nationally representative sample of Canadian women. Data from the Canadian Maternity Experiences Survey (n=6421) was used. Multivariate logistic regressions and partial proportional odds models were fitted and included socio-demographic, obstetric, health, psychological, and psychosocial factors. Chronic pain sufferers at mean 7.3 months postpartum had adjusted odds of PPD of 2.4 (95% CI: 1.6, 3.6) compared to women without pain. Adjusted odds of PPD increased with the number of areas of chronic pain, reaching 4.2 (95% C.I.: 0.7, 25.0) for 3 or more areas. Immigration, obesity, cesarean section and social support increased the strength of the association while smoking and the use of pain relief were protective effect modifiers. Persistent postpartum pain is a major risk factor for PPD.