Bakgrunden till denna litteraturöversikt är att kvinnor som utsatts för våld och övergrepp tillhör en skör grupp som kan ha extra behov av vård och stöd. Samtidigt upplever kvinnorna att det är både svårt och stigmatiserat att tala om det de utsatts för. Barnmorskans kompetensområde omfattar reproduktiv, perinatal och sexuell hälsa, vilket gör att hen kommer att möta kvinnor med olika bakgrund, ur alla samhällsklasser. Våld och övergrepp förekommer inom alla samhällsgrupper. Att leva i det, eller med minnen av det kan påverka hälsan både fysiskt och psykiskt. Den här litteraturöversikten fokuserar på kvinnor i graviditet och förlossning. Syftet med den här litteraturöversikten var att beskriva hur kvinnor som blivit utsatta för sexuellt våld upplever sin graviditet och förlossning. Metoden som användes var en litteraturöversikt med systematisk metod och integrerad analys. Sökningar i databaserna PubMed och Cinahl genererade kvalitativa och kvantitativa artiklar som kvalitetsgranskades för att garantera god vetenskaplig kvalitet. Resultatet visade att graviditet och förlossning reaktiverade minnet av sexuellt våld för dessa kvinnor. Nästan allt under graviditeten och förlossningen kunde väcka minnet av våldet och skapade negativa känslor. Ett återkommande fynd var känslan av att förlora kontrollen, speciellt vid fysiska undersökningar. Barnmorskan visade sig vara en nyckelfigur, där relationen och stödet som barnmorskan kunde erbjuda hade en avgörande roll för hur kvinnans upplevelse skulle bli genom graviditet och förlossning. Slutsatsen visar på att det är viktigt att barnmorskan har adekvat utbildning för att möta kvinnor som utsatts för sexuellt våld. Barnmorskan måste våga ställa frågan om våld och ha en handlingsplan för hur hen ska agera på svaret. Alla kvinnor vågar inte avslöja sitt förflutna och då är det viktigt att barnmorskan är lyhörd för tecken på att kvinnan varit utsatt. Många kvinnor känner sig tryggare när de har en barnmorska de etablerat en relation till / The background of this literature review is that women who have been subjected to violence and abuse belong to a fragile group who may have extra needs for care and support. At the same time the women feel that it is both difficult and stigmatizing to talk about what they have been exposed to. The midwife's area of competence includes reproductive, perinatal, and sexual health, which means that she will meet women from different backgrounds, from all social classes. Violence and abuse occur within all social groups. Living with it, or with memories of it, can affect health both physically and psychologically. This literature review focuses on women in pregnancy and childbirth. The aim of this literature review was to describe the experience of pregnancy and childbirth for women who were exposed to sexual violence. The method used was a literature review with a systematic method and integrated analysis. Searches in the PubMed and Cinahl databases generated qualitative and quantitative articles that were quality reviewed to ensure good scientific quality. The results showed that pregnancy and childbirth reactivated the memory of sexual violence for these women. Almost everything during pregnancy and childbirth could evoke the memory of the violence and create negative feelings. A recurring finding was the feeling of losing control, especially during physical examinations. The midwife proved to be a key figure, where the relationship and support the midwife could offer had a decisive role in how the woman's experience would be through pregnancy and childbirth. The conclusion shows that it is important that the midwife has adequate training to meet women who have been subjected to sexual violence. The midwife must dare to ask the question about violence and have an action plan for how to act on the answer. Not all women dare to reveal their past and then it is important that the midwife is sensitive to signs that the woman has been exposed. Many women feel safer when they have a midwife that they have an established relationship with.

Bakgrund: Barnmorskor ska erbjuda rätt stöd som möjliggör säker och positiv förlossningsupplevelse. Metoden Föda utan rädsla kan hjälpa barnmorskor att bryta negativa känslor hos kvinnor och stödpersoner som kan försvåra födandet och leda till en försämrad upplevelse. Vidare kan metoden och barnmorskors kunskap bidra till ökad trygghet hos kvinnor och stödpersoner samt tilltro till det normala i födelseprocessen. Syfte: Att beskriva barnmorskors erfarenheter av att bistå kvinnor och stödpersoner under förlossning med metoden Föda utan rädsla. Metod: Arbetet genomfördes som en intervjustudie med kvalitativ design och analyserades med induktiv ansats. Data inhämtades genom tio intervjuer. Semistrukturerad intervjuteknik tillämpades. Resultat: Fem kategorier och elva subkategorier skapades. Barnmorskors närvaro skapade trygghet till kvinnor och stödpersoner under förlossning. Betydelsen av stödpersoner framkom tydligt. Vidare krävdes vissa förutsättningar för att metoden skulle ge bästa möjligheter att främja det naturliga. Barnmorskor behövde även tillräckligt och rätt stöd för att praktisera metoden på bästa sätt. Slutsatser: FUR bidrar till att barnmorskor blir mer engagerade och närvarande under förlossning vilket skapar goda förutsättningar att erbjuda en förlossningsfrämjande miljö och personcentrerad förlossningsvård för kvinnor och stödpersoner. Metoden skapar en ökad trygghet, tillit och delaktighet hos kvinnor och stödpersoner samt är viktig i vårdrelationen mellan barnmorskor, kvinnor och stödpersoner. / Background: Midwives should provide the right support that enables a safe and positive childbirth experience. The Confident Birth method can help midwives prevent negative feelings in women and birth partners, that could otherwise complicate childbirth and lead to a negative experience. The method and midwives' knowledge can furthermore contribute to increased sense of security in women and birth partners, as well as provide confidence in the normalcy of the birth process. Aim: To describe midwives' experiences of assisting women and birth partners during childbirth using The Confident Birth Method. Method: The work was conducted as an interview study with qualitative design and analyzed with an inductive approach. Data was collected through ten interviews. Semi-structured interview technique was applied. Results: Five categories and eleven subcategories were created. The presence of midwives created security for women and support persons during childbirth. The importance of birth partners was clearly evident. Furthermore, certain conditions were required for The Confident Birth method to provide the best opportunities to promote the natural process. Midwives also needed sufficient and appropriate support to practice the method effectively. Conclusions: The Confident Birth method contributes to midwives’ engagement and presence during childbirth, which creates good conditions to offer a childbirth-promoting environment and person-centered childbirth care for women and birth partners. The method creates increased security, trust, and participation among women and birth partners, and is important in the care relationship between midwives, women and birth partners.

Previous research has explored whether method of childbirth, such as home birth, hospital birth, or cesarean section, influences a woman's birth experience (Felming, Ruble, Anderson, & Flett, 1988). However, the influence of the child birth method on social perceptions of the mothers has yet to be explored. Social support for new mothers is an important factor in promoting postpartum adjustment (Collins, Dunkel Schetter, Lobel & Scrimshaw, 1993; Demyttenaere, Lenaerts, Nijs & Van Assche, 1995; Landy, Montgomery & Walsh, 1989). Yet it is possible that the amount of social support a new mother receives is affected by unseen biases regarding the method of childbirth. The current study explores whether mothers more negatively view other mothers who had a method of childbirth different from their own preferred method of childbirth. Participants were randomly assigned to one of three vignettes describing a new mother. One version describes a mother who had a hospital birth with an epidural, one describes a mother who had a home birth with a midwife, and one describes a mother who had a non-emergency scheduled cesarean section. Participants completed the Interpersonal Adjective Scale (IAS) and a Perception of Character Scale to assess their perceptions of the mother. Participants who preferred to have a home birth showed a high degree of variation in their ratings of the hypothetical mothers' dominance and submissiveness as a function of her birth method whereas participants who preferred to have their children in the hospital showed little variation in their ratings of the mothers' assurance and submissiveness. Participants who preferred to have their children in a hospital rated the hypothetical mother lower on perception of character than participants who preferred to have their children at home.

The study explored cultural perspectives of the Zimbabwean Ndebele on alternative modes of childbirth. A qualitative generic, exploratory and descriptive design guided the study. The problem is that alternative modes of birthing are not acceptable to the Zimbabwean Ndebele. Women who give birth through alternative modes of birthing, which include caesarean section (CS) instrumental deliveries (ID) and any other unnatural modes are stigmatised. Data were collected from purposively selected samples of women who had given birth through alternative modes of birthing, spouses, mothers-in-law, community elders, sangomas (traditional healers) and traditional birth attendants (TBAs) using individual unstructured in-depth interviews, structured interviews and focus group interviews (FGIs). Data were analysed through use of qualitative content analysis which involved verbatim transcripts. Interpretations of narrations of data and script reviewing were done while simultaneously listening to audio-tapes which were transcribed in the IsiNdebele the language that was used to collect data. Data were then translated into English to accommodate all readers. Accounts of all the informants that were interviewed point to effects of supernatural ancestral powers, infidelity and use of traditional and herbal medicines as cause for “tiedness” (labour complications), a concept that showed a strong thread throughout the study. Study findings illuminated that traditional practices are culture-bound and the desire is to perpetuate the valued culture. Recommendations made from the study are; cultural orientation of local and foreign health workers, cultural consultation and collaboration with sangomas (traditional healers) and particular recognition of the significance of the study as a cultural heritage of the Zimbabwean Ndebele society. Further research on how women and their spouses cope with the grieving process after experiencing the crisis and grief following CS is recommended. With all the recommended areas addressed, Zimbabwean Ndebele would find alternative modes of birthing acceptable. / Health Studies / D. Lit. et Phil. (Health Studies)

The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if: • the hospital/clinic fees were reduced or removed • transport would be available for women in labour to reach hospitals/clinics • shelters were built for pregnant women at hospitals/clinics • clinics were well equipped and had sufficient numbers of midwives • women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications • nurses/midwives would treat patients respectfully. Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health

The role of midwife has been an integral part of the culture of childbirth in Queensland throughout its history, but it is a role that has been modified and reshaped over time. This thesis explores the factors that underpinned a crucial aspect of that modification and reshaping. Specifically, the thesis examines the factors that contributed to the statutory regulation of midwives that began in 1912 and argues that it was that event that etched the development of midwifery practice for the remainder of the twentieth century. In 1859, when Queensland seceded from New South Wales, childbirth was very much a private event that took place predominantly in the home attended by a woman who acted as midwife. In the fifty-threeyears that followed, childbirth became a medical event that was the subject of scrutiny by the medical profession and the state. The thesis argues that, the year 1912 marks the point at which the practice of midwifery by midwives in Queensland began a transition from lay practice in the home to qualified status in the hospital. In 1912, through the combined efforts of the medical profession, senior nurses and the state, midwives in Queensland were brought under the jurisdiction of the Nurses' Registration Board as "midwifery nurses". The Nurses' Registration Board was established as part of the Health Act Amendment Act of 1911. The inclusion of midwives within a regulatory authority for nurses represented the beginning of the end of midwifery practice as a discrete occupational role and marked its redefinition as a nursing specialty. It was a redefinition that suited the three major stakeholders. The medical profession perceived lay midwives to be a disjointed and uncoordinated body of women whose practice contributed to needless loss of life in childbirth. Further, lay midwives inhibited the generalist medical practitioners' access to family practice. Trained nurses looked upon midwifery as an extension of nursing and one which offered them an area in which they might specialise in order to enhance their occupational status and career prospects. The state was keen to improve birth rates and to reduce infant mortality. It was prepared to accept that the regulation of midwives under the auspices of nursing was a reasonable and proper strategy and one that might assist it to meet its objectives. It was these separate, but complementary, agendas that prompted the medical profession and the state to debate the culture of childbirth, to examine the role of midwives within it, and to support the amalgamation of nursing and midwifery practice. This thesis argues that the medical profession was the most active and persistent protagonist in the moves to limit the scope of midwives and to claim midwifery practice as a medical specialty. Through a campaign to defame midwives and to reduce their credibility as birth attendants, the medical profession enlisted the help of senior nurses and the state in order to redefine midwifery practice as a nursing role and to cultivate the notion of the midwife as a subordinate to the medical practitioner. While this thesis contests the intervention of the medical profession in the reproductive lives of women and the occupational territory of midwives, it concedes that there was a need to initiate change. Drawing on evidence submitted at Inquests into deaths associated with childbirth, the thesis illuminates a childbirth culture that was characterised by anguish and suffering and it depicts the lay midwife as a further peril to an already hazardous event that helps to explain medical intervention in childbirth and, in part, to excuse it. The strategies developed by the medical profession and the state to bring about the occupational transition of midwives from lay to qualified were based upon a conceptual unity between the work of midwives and nurses. That conceptualisation was reinforced by a practical training schedule that deployed midwives within the institution of the lying-in hospital in order to receive the formal instruction that underpinned their entitlement to inclusion on the Register of Midwifery Nurses held by the Nurses' Registration Board. The structure that was put in place in Queensland in 1912 to control and monitor the practice of midwives was consistent with the policies of other Australian states at that time. It was an arrangement that gained acceptance and strength over time so that by the end of the twentieth century, throughout Australia, the practice of midwifery by midwives was, generally, consequent upon prior qualification as a Registered Nurse. In Queensland, in the opening years of the twenty-first century, the role of midwife remains tied to that of the nurse but the balance of power has shifted from the medical profession to the nursing profession. At this time, with the exception of a small number of midwives who have acquired their qualification in midwifery from an overseas country that recognises midwifery practice as a discipline independent of nursing, the vast majority of midwives practising in Queensland do so on the basis of their registration as a nurse. Methodology This thesis explores the factors that influenced the decision to regulate midwifery practice in Queensland in 1912 and the means by which that regulation was achieved. The historical approach underpins this research. The historical approach is an inductive process that is an appropriate method to employ for several reasons. First, it assists in identifying the origins of midwifery as a social role performed by women. Second, it presents a systematic way of analysing the evidence concerning the development of the midwifery role and the status of the midwife in society. Third, it highlights the political, social and economic influences which have impacted on midwifery in the past and which have had a bearing on subsequent midwifery practice in Queensland. Fourth, the historical approach exposes important chronological elements pertaining to the research question. Finally, it assists the exposure of themes in the sources that demonstrate the behaviour of key individuals and governing authorities and their connection to the transition of midwifery from lay to qualified. Consequently, through analysing the sources and collating the emerging evidence, a cogent account of interpretations of midwifery history in Queensland may be constructed. Data collection and analysis The data collection began with secondary source material in the formative stages of the research and this provided direction for the primary sources that were later accessed. The primary source material that is employed includes testimonies submitted at Inquests into maternal and neonatal deaths; parliamentary records; legislation, government gazettes, and medical journals. The data has been analysed through an inductive process and its presentation has combined exploration and narration to produce an accurate and plausible account. The story that unfolds is complex and confusing. Its primary focus lies in ascertaining why and how midwifery practice was regulated in Queensland. The thesis therefore explores the factors that influenced the decision to regulate midwifery practice in Queensland in 1912 and the means by which that regulation was achieved. Limitations of the study The limitations of the study relate to the documentary evidence and to the cultural group that form the basis of the study. It is acknowledged that historical accounts rely upon the integrity of the historian to select and interpret the data in a fair and plausible manner. In the case of this thesis, one of its limitations is that midwives did not speak for themselves but were, instead, spoken for by medical practitioners and parliamentarians. As a consequence, the coronial and magisterial testimonies that are employed constitute a limitation in that while they reveal the ways in which lay midwifery occurred, they relate only to those childbirth events that resulted in death. Thus, they may be said to represent the minority of cases involving the lay midwife rather than to offer a broader and perhaps more balanced picture. A second limitation is that the accounts are recorded by an official such as a member of the police or of the Coroner's Office and are sanctioned by the witness with a signature or, more often, a cross. It is therefore possible that the recorder has guided these accounts and that they are not the spontaneous evidence of the witness. Those witnesses and the culture they represent are drawn predominantly from non- Indigenous working class. Thus, a third limitation is that the principal ethnic group featured in this thesis has been women of European descent who were born in Queensland or other parts of Australia. This focus has originated from the data itself and has not been contrived. However, it does impose a restriction to the scope of the study.

University, Diss.--Chicago, 2006. / Introduction-The scope of this book-Definitions of metaphor-The approach to metaphor in this book-Birth as event and metaphor in the ancient Near East-The sources-The experience of birth-The experience of birth becomes a metaphor-Birth as event and metaphor in the Hebrew Bible-Birth as an event in the Hebrew Bible-Birth as a metaphor in the Bebrew Bible-The biblical birth metaphor for cases of local crisis-War imagery and bad news-War imagery-Divine punishment imagery-The biblical birth metaphor for cases of universal crisis-Texts-The biblical birth metaphor for cases of personal crisis-Engulfment imagery-War imagery-Prophetic vision imagery-1QH XI, 1-18: the birth metaphor at Qumran-1QH XI, 1-18 within the corpus of the Hodayot-The identity of the mothers and the children in 1QH XI, 1-18-Interpreting 1QG XI, 1-18 in light of the birth metaphor-1QH XI, 1-18: personal and universal crisis.

The study attempted to identify factors influencing women’s preference for home births in the Mutare District, Zimbabwe. A quantitative, descriptive, exploratory, cross sectional survey, gathering data by conducting structured interviews with 150 women, was used. All 150 women attended antenatal clinics but did not deliver their babies at health care facilities. The research results indicated that home deliveries might decline if: • the hospital/clinic fees were reduced or removed • transport would be available for women in labour to reach hospitals/clinics • shelters were built for pregnant women at hospitals/clinics • clinics were well equipped and had sufficient numbers of midwives • women had received more effective health education on the advantages of institutional deliveries and on the danger signs of pregnancy/labour complications • nurses/midwives would treat patients respectfully. Unless these factors are addressed, the number of home deliveries might not decline, and the high maternal/infant mortality and morbidity rates in this district will persist. / Health Studies / M. Public Health

The study explored cultural perspectives of the Zimbabwean Ndebele on alternative modes of childbirth. A qualitative generic, exploratory and descriptive design guided the study. The problem is that alternative modes of birthing are not acceptable to the Zimbabwean Ndebele. Women who give birth through alternative modes of birthing, which include caesarean section (CS) instrumental deliveries (ID) and any other unnatural modes are stigmatised. Data were collected from purposively selected samples of women who had given birth through alternative modes of birthing, spouses, mothers-in-law, community elders, sangomas (traditional healers) and traditional birth attendants (TBAs) using individual unstructured in-depth interviews, structured interviews and focus group interviews (FGIs). Data were analysed through use of qualitative content analysis which involved verbatim transcripts. Interpretations of narrations of data and script reviewing were done while simultaneously listening to audio-tapes which were transcribed in the IsiNdebele the language that was used to collect data. Data were then translated into English to accommodate all readers. Accounts of all the informants that were interviewed point to effects of supernatural ancestral powers, infidelity and use of traditional and herbal medicines as cause for “tiedness” (labour complications), a concept that showed a strong thread throughout the study. Study findings illuminated that traditional practices are culture-bound and the desire is to perpetuate the valued culture. Recommendations made from the study are; cultural orientation of local and foreign health workers, cultural consultation and collaboration with sangomas (traditional healers) and particular recognition of the significance of the study as a cultural heritage of the Zimbabwean Ndebele society. Further research on how women and their spouses cope with the grieving process after experiencing the crisis and grief following CS is recommended. With all the recommended areas addressed, Zimbabwean Ndebele would find alternative modes of birthing acceptable. / Health Studies / D. Lit. et Phil. (Health Studies)

MPH / Department of Public Health / See the attached abstract below