Av de kvinnor som genomgår vaginalförlossning drabbas 85% av förlossningsbristningar, och följderna av dessa kan variera från lätta besvär till svåra komplikationer. En förutsättning för att kvinnan ska få rätt behandling är en korrekt diagnostik. Majoriteten av bristningarna handläggs av barnmorskor, och tidigare forskning har visat att kunskapen och kompetensen inom området varierar. Studiens syfte var att kartlägga svårigheter i barnmorskors arbete med att undersöka och bedöma vaginalbristningar efter förlossning. En enkätundersökning med barnmorskor som handlagt 72 förlossningar på en mellanstor förlossningsklinik vid ett svenskt sjukhus genomfördes under en period av 7 veckor. Resultatet visade att de vanligaste hindren vid granskning av bristningar var blödning och smärta hos patienten och de vanligaste svårigheterna var att identifiera strukturer och vävnader i bristningen. I en fjärdedel av fallen tog handläggande barnmorska stöd av kollega eller läkare, och några barnmorskor skattade sin kunskap och kompetens inom området som otillräcklig. Behovet av kollegialt stöd och av fortbildning och träning uttrycktes hos barnmorskor med både kort och lång erfarenhet. Det finns ett behov av fortsatt forskning om blödning som hinder för bedömning av förlossningsbristningar och av utvärdering av smärtlindringsmetoder. / Of all women undergoing vaginal birth, 85% sustain some form of perineal trauma and the consequences vary from smaller problems to severe complications. An accurate diagnosis of the trauma is necessary for it to be adequately treated. A majority of the perineal and vaginal ruptures are managed by midwives, and earlier research has shown that there is a considerable variation in midwives knowledge and skills concerning perineal trauma. The aim of this study was to explore difficulties in midwives examinations and assessments of perineal trauma following vaginal birth. A survey with midwives attending 72 births within a medium- sized Swedish birth-clinic, was conducted in a period of 7 weeks. The most common obstacles in assessing perineal ruptures, were the patient ́s bleeding and pain. The largest difficulties in assessment were identifying the structures and anatomy within the rupture. In one case out of four, peer support from midwife colleague or doctor was sought, and there were cases of midwives estimating their competence as non-sufficient. The need for peer support and continuous training and education was expressed in cases with midwives having short and long experience. There is a need for further research in the focus on bleeding as an obstacle in assessment of perineal trauma, and a need for further evaluation of the anaestethical methods used in management of them.

Bakgrund:Barnmorskor som arbetar på barnmorskemottagning [BMM] upplever sig ha bristande kunskap om hur professionellt stöd kan erbjudas till kvinnor med förlossningsrädsla under graviditet. Det är viktigt att gravida kvinnor med förlossningsrädsla erhåller professionellt stöd. Syfte:Syftet med studien är att belysa barnmorskor på barnmorskemottagningens erfarenheter av att erbjuda professionellt stöd till kvinnor med förlossningsrädsla under graviditet. Metod: En kvalitativ intervjustudie med induktiv ansats valdes i denna studie för att få en bredare uppfattning av barnmorskor på BMM erfarenhet. Sju barnmorskor blev intervjuade på två olika BMM i sydvästra Sverige. Resultat: I resultatet framkom det två huvudkategorier "Kvinnans förlossningsrädsla i fokus" och "Barnmorskors behov av resurser och kunskap kring förlossningsrädsla". Det tillkom även två underkategorier "Barnmorskors erfarenheter om kvinnors bristande kunskap kring förlossningsrädsla" och "Vägleda till rätt hjälpinsats för den förlossningsrädda kvinnan". Barnmorskor erbjuder professionellt stöd utifrån sina erfarenheter när kvinnan uttrycker förlossningsrädsla. Detta genom att barnmorskorna är lyhörda vid utredning av orsaker till kvinnans förlossningsrädsla. Slutsats:Barnmorskor på BMM behöver kontinuerlig utbildning om förlossningsrädsla för att kunna erbjuda gravida kvinnor professionellt stöd. Verksamhetschefer på BMM ska erbjuda dessa barnmorskor rätt förutsättningar för att de ska kunna känna sig trygga med att erbjuda professionellt stöd till förlossningsrädda kvinnor. / Background: Midwives working at maternal care center experience insufficient knowledge about how professional support can be offered to pregnant women. It´s important that pregnant women with tocophobia receive professional care from midwives during the entire pregnancy. Purpose: The aim of the study is to highlight maternal care midwives’ experiences providing professional support for pregnant women who fear of giving birth. Method: A qualitative interview study with inductive approach was chosen for this study to gain broader view of the BMM midwives' experiences. Seven midwives were interviewed at two BMM in southwestern Sweden. Results: There were two main categories "Women's fear of childbirth tokophobia". There were two subcategories "Midwife's experiences about women's lack of knowledge about fear of childbirth" and "Guide pregnant women to correct care effort". Midwives offer professional support from their own experience when women express fear of birth. This through midwives being responsive when incuayaring causes to tokophobia women. in focus" and "Midwife's need for resources and knowledge about women`s Conclusion: BMM midwives need continuous education about fear of childbirth in order to offer women prophetic support. BMM occupational managers should offer midwives right prerequisites for midwives to feel safe by providing care to women suffering from tokophobia.

Page 1 of 2 Abstract The diploma thesis deals with the topic of autonomy of the mother's will during childbirth. The main goal of the work is to analyze the legal regulation concerning the provision of healthcare in connection with childbirth and the limits of the autonomy of the patient's will in this situation. The aim of the thesis is to examine the issue of the autonomy of the patient's will according to the valid and effective legal regulation in the Czech Republic, with respect to gradual enforcement of the principle of patient and healthcare provider equality, this issue being related to a relatively specific area of childbirth. There is general legal regulation, relating to the position of the patient, healthcare provider and their mutual relationship outlined in this thesis. This legislation is then subsequently used for the provision of healthcare in relation to childbirths. The case law of both domestic courts and the European Court of Human Rights is then applied to specific problems in this area. One of the described problems is the legal nature of the delivery plan as one of the basic means of expressing the autonomy of the patient's will. In particular, the legal nature of the birth plan is handled as institute which is not regulated by law. Possible legal consequences of the delivery plan as...

No childbirth education (CE) programs are available in the public sectors in Jordan. Many studies from Jordan recommended that pregnant women be educated about their health needs during pregnancy and childbirth. From the literature, CE programs were found to have positive effects on pregnancy and childbirth outcomes. Four focus groups with pregnant women, midwives and physicians were conducted to examine the perceptions of pregnant women, midwives and physicians regarding the content, feasibility, and challenges of implementing a CE program in Jordan. The 4 focus groups, two with pregnant women (one group with 8 primiparous women and one group with 6 multiparous women), one with 8 midwives, and one with 6 physicians were presented with the content, timing, and a description of three existing CE programs. Findings indicated that pregnant women’s sources of knowledge about pregnancy and childbirth were mainly from other females and doctors but not from midwives. Younger pregnant women reported the Internet as an important source of pregnancy and childbirth knowledge. Findings showed that women were not sure of what they wanted to learn. Midwives and physicians wanted to include warning signs, physical exercises, psychological changes, vii nutrition, breast feeding, newborn heath, sexually transmitted diseases, pain management, postpartum physiology and care, family planning, and planning of pregnancy as content in a new CE program. All participants reported the need to include husbands in CE. However, husbands were considered a potential challenge to implementing a CE program. Other challenges were cost, staff, clients’ responses, and governmental policies. Midwives and physicians thought that CE should be included in free antenatal care. All participants reported support for a new CE program. Midwives and physicians suggested implementing the new program within the facilities of the Ministry of Health (MOH). This would decrease cost and the need for staffing for the new program. They suggested that the CE program could benefit from potential support from international sponsors that affiliate with the MOH. Potential benefits of CE could potentially help gain support from the MOH decision makers and the community in Jordan.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2016-04-25T18:52:17Z No. of bitstreams: 1 Maria Aparecida dos Santos Traverzim.pdf: 1790311 bytes, checksum: 7a6d20dee6a1d5d6bad8e90842729788 (MD5) / Made available in DSpace on 2016-04-25T18:52:17Z (GMT). No. of bitstreams: 1 Maria Aparecida dos Santos Traverzim.pdf: 1790311 bytes, checksum: 7a6d20dee6a1d5d6bad8e90842729788 (MD5) Previous issue date: 2015-11-25 / Patient safety is one of the dimensions of quality that has received increasing attention in recent years. The incident detection in patient safety aims to improve the quality of patient care. Incidents and adverse events (AEs) of patient safety should be reported spontaneously contributing for the apprenticeship and to create barriers so that they would not be repeated, but the fear of prosecution and punishment cause its underreporting. The objective of this study was to evaluate the incidence of patient safety incidents in the perinatal period with the use of an extended check list. This research used the inductive method, empirical approach with exploratory, descriptive, cross and as a strategy action research. Population sample was composed by admitted patients in the perinatal unit from June 25th to July 25th, 2015.We evaluated in maternal registry for proper completion of partogram, the patient chart and newborn data. We looked for: uterine rupture, changing the delivery type, returning to the operating room during hospitalization or after discharge, instrumental delivery, complications in the postpartum period, maternal death. In the newborn chart we collected information on neonatal trauma due to childbirth; research proper fetal vitality; Apgar score less than 7, and death of newborns weighing more than 2,500 g, and mother / newborn (NB). For both we looked for the detection of failure to follow the clinical protocol and blood components transfusion. We also evaluated whether these components of the check list were related to incidents or EAs in health care assistance. The total number of patients studied in the period was 249 patients, and we detected 97 AEs (38.9%). Of EAs, 27 (27.8%) were detected by traditional trigger points and 70 (72.8%) extended check list. The Apgar score less than 7 at the fifth minute was detected in 11 (11.3%) of all EAs and seven newborns (7.2% of events) had some type of trauma due to childbirth, 4 NB (4, 1%) were admitted to the ICU with less than 24 hours of birth. It was noted that two patients (2%) had to undergo to further surgery and one of them is still in outpatient treatment in the unit. Two patients (2%) had lacerations third / fourth degree and one patient (1%) uterine rupture diagnosed at the time of cesarean section. In the extended check list we detected failure in medicines in 20.6% of all AEs. In this study we observed a high incidence of clinical protocols violation (39.2%). Nine patients (9.3%) had complications in the postpartum period, two (2.1%) required liaison and one patient (1%) anesthetic complications. / A segurança do paciente é uma dimensão de qualidade que tem recebido atenção crescente nos últimos anos. A detecção de incidentes na área tem como objetivo melhorar a qualidade da assistência. Os incidentes e eventos adversos (EAs) deveriam ser relatados espontaneamente para que haja aprendizado e criação de barreiras para que não se repetam; porém, o receio de processos judiciais e punições leva a subnotificação. O objetivo deste estudo é avaliar sua incidência no período perinatal com o uso de um check list ampliado. A pesquisa utilizou o método indutivo, abordagem empírica com caráter exploratório, descritivo e transversal, e como estratégia a pesquisa-ação. Foram averiguados os atendimentos prestados a pacientes internadas na unidade de medicina perinatal, no período de 25 de junho a 25 de julho de 2015, quanto ao preenchimento adequado do partograma, dados do prontuário materno e do recém-nascido (RN). Também foi averiguado se a mãe apresentou, durante a internação na unidade: rotura uterina, alteração da via de parto durante o procedimento, retorno à sala cirúrgica durante a internação ou pós-alta hospitalar, parto instrumental, intercorrências no período puerperal ou morte materna. Entre os RNs, verificou-se a ocorrência de trauma neonatal devido ao parto, Apgar menor que 7 e morte com peso superior a 2.500g, além de investigação da vitalidade fetal adequada. Para mãe e recem-nascido, verificou-se se foi seguido o protocolo clínico da instituição e transfusão de heomcomponentes. Também avaliamos se esses componentes do check list, quando presentes, estavam relacionados a incidentes ou EAs no atendimento. O total de pacientes estudadas no período foi de 249, sendo detectados 97 EAs (38,9%). Destes, 27 (27,8%) foram detectados pelos trigger points tradicionais e 70 (72,8%) pelo check list ampliado. O índice de Apgar menor que 7 no quinto minuto foi detectado em 11 (11,3%) do total de EAs e 7 RNs (7,2% dos eventos) apresentaram algum tipo de trauma devido ao parto. 4 RNs (4,1%) foram admitidos na UTI com menos de 24h de nascimento. Observou-se que duas pacientes (2%) tiveram que ser submetidas a nova intervenção cirúrgica e que uma delas ainda continua em tratamento ambulatorial na unidade. Duas (2%) apresentaram lacerações de terceiro/quarto grau e uma (1%), rotura uterina diagnosticada no momento da cesárea. No check list ampliado detectamos falhas de medicamentos como causa de 20,6% de todos os EAs. O número de inobservância de protocolos clínicos da instituição também se mostrou com elevada incidência (39,2%). Nove pacientes (9,3%) apresentaram intercorrências no puerpério, duas (2,1%) necessitaram de interconsulta e uma (1%) de intercorrência anestésica.

Bakgrund: Sedan december 2019 har ett nytt virus, som orsakar sjukdomen Covid-19, spridits världen över och för att minska smittspridning har restriktioner införts i samhället och vården. Detta innebär att partners inte får delta vid exempelvis besök på barnmorskemottagningar, ultraljud eller närvara på BB efter förlossningen. Partners delaktighet är viktig under graviditet och barnafödande för att främja föräldratransitionen och anknytningen till barnet, vilket försvårats under pandemin. Det är därför av vikt att undersöka partners upplevelse under Covid-19-pandemin. Syfte: Syftet var att belysa partners upplevelse av graviditet och barnafödande under Covid-19-pandemin. Metod: Studien genomfördes med kvalitativ innehållsanalys med induktiv ansats, där åtta partners intervjuades. Resultat: I resultatet framkom fyra kategorier som sedan mynnade ut i ett tema. Samtliga partners uppgav bristande delaktighet. Förstagångsföräldrarna upplevde en stark negativ påverkan av den bristande delaktigheten vilket resulterade i känslor av utanförskap och en svårighet att förverkliga graviditeten. Andragångsföräldrar upplevde en större trygghet i föräldraskapet vilket ökade förmågan att hantera den bristande delaktigheten. Konklusion: Beslutsfattare bör väga smittorisken mot de negativa effekterna som uppstår av restriktionerna. Det krävs förändringar för att främja partnerns delaktighet och motverka långsiktiga negativa konsekvenser på hälsan för partners och deras familjer. / Background: Since December 2019, a new virus, which causes Covid-19 disease, has spread around the world and to reduce the spread of infection, restrictions have been introduced in society and healthcare. This entails that partners are not allowed to participate in, for example; visits to midwife clinics, ultrasounds or attend BB postpartum. Partner participation during pregnancy and childbirth is important to promote the transition to parenthood and connection to the child, which is made more difficult during the pandemic. It is therefore important to examine partners' experiences during the Covid-19 pandemic. Aim: The aim was to illustrate the partners' experience of pregnancy and childbirth during the Covid-19 pandemic. Method: The study was conducted with a qualitative content analysis with an inductive approach. Eight partners were interviewed. Results: The results revealed four categories which then culminated in a theme. All partners stated a lack of participation. The first-time parents experienced a strong negative impact of the lack of participation, which resulted in feelings of exclusion and a difficulty in actualizing the pregnancy. Second-time parents experienced greater security in parenthood, which increased the ability to handle the lack of participation. Conclusion: Decision-makers should consider weigh the risk of infection against the negative effects of restrictions. Changes are needed to promote partner participation and counteract long-term negative health consequences for partners and their families.

Title: Psychosocial aspects of intrapartum and postpartum care Author: Mgr. Lea Takács Department: Department of Psychology Supervisor: PhDr. Simona Hoskovcová, Ph.D. Consultant: MUDr. PhDr. Pavel Čepický, CSc. Abstract Background: Satisfaction with perinatal care is largely a result of psychosocial aspects of the care provided. However, despite a considerable body of research, the concept of satisfaction with perinatal care is not sufficiently defined and understood, being often confused with other concepts, particularly with that of satisfaction with childbirth experience. The lack of knowledge concerns especially the psychosocial dimensions and determinants of the care, most importantly for different groups of women, and the level of importance of psychosocial factors for satisfaction compared to biomedical variables. Objective: The aim of the present dissertation is to contribute to the theory of satisfaction by investigating the psychosocial and biomedical factors that affect satisfaction with perinatal care and satisfaction with childbirth experience in different groups of women depending on the mode of delivery (vaginal delivery, emergency caesarean section or elective caesarean section). Method: Ordinal logistic regression was used to identify the key predictors of satisfaction. The data were...

Inledning: Att föda barn är något som kvinnor har gjort i urminnes tider och är vanligen förknippat med glädje och kärlek. Men ibland inträffar oförutsägbara händelser som lämnar de nyblivna föräldrarna med en känsla av att förlossningen upplevdes som traumatisk. Syfte: Syftet med denna litteraturöversikt var att beskriva kvinnornas psykiska ohälsa efter en förlossning samt hur detta kan påverka kvinnan och hennes partners framtida psykisk hälsa. Metod: Val av metod till denna studie var litteraturöversikt. Tio vetenskapliga artiklar söktes via de vetenskapliga databaserna PubMed och CINAHL för att svara på studiens syfte. Tematisk analys användes för att analysera artiklarna och de teman som skapades var perinatal PTSD, lågt socialt stöd och traumatisk förlossning. Resultat: Resultatet visade att en traumatisk förlossning var en riskfaktor för att drabbas av perinatal depression, ångest samt perinatal PTSD. Vidare var lågt socialt stöd från vårdgivare, historik av traumatiska händelser samt instrumentella förlossningar riskfaktorer för att de nyblivna föräldrarna skulle uppfatta förlossningen som traumatisk. Slutsats: En negativ eller traumatisk förlossningsupplevelse kan leda till att de nyblivna föräldrarna får psykisk ohälsa. Det finns ett behov av ökad förståelse kring traumatiska förlossningsupplevelser för att minska prevalensen av perinatal psykisk ohälsa. Resultaten i denna studie är viktigt då den skapar förståelse för kvinnan och hennes partners utsatthet vid en negativ eller traumatisk förlossning samt vilka skyddsfaktorer som mer fokus borde läggas på av hälso-och sjukvården. / Introduction: Giving birth is something that women have done for many years and is usually associated with joy and love. But sometimes unpredictable events occur that leaves the new parents with a feeling that the birth was experienced as traumatic. Aim: The purpose of this literature review was to describe women's mental illness after childbirth and how this may affect the future mental health of the woman and her partner. Method: Choice of method for this study was literature review. Ten scientific articles were searched via the scientific databases PubMed and CINAHL to answer the purpose of the study. Thematic analysis was used to analyze the articles and the themes that were developed were perinatal PTSD, low social support and traumatic birth.Results: The results showed that a traumatic birth was a risk factor for suffering from perinatal depression, anxiety and perinatal PTSD. Furthermore, low social support from caregivers, history of traumatic events and instrumental births were risk factors for the new parents to perceive the birth as traumatic.Conclusion: A negative or traumatic birth experience can lead to that the new parents get mental illness. There is a need for increased understanding of risk factors correlated to traumatic birth experiences to reduce the prevalence of mental illness. The results of this study are important as it creates an understanding of the woman and her partner's vulnerability in the event of a negative or traumatic birth as well as which protective factors more focus should be placed on by the healthcare.joy and love. But sometimes unpredictable events occur that leaves the new parents with a feeling that the birth was experienced as traumatic.Aim: The purpose of this literature review was to describe women's mental illness after childbirth and how this may affect the future mental health of the woman and her partner.Method: Choice of method for this study was literature review. Ten scientific articles were searched via the scientific databases PubMed and CINAHL to answer the purpose of the study. Thematic analysis was used to analyze the articles and the themes that were developed were perinatal PTSD, low social support and traumatic birth.Results: The results showed that a traumatic birth was a risk factor for suffering from perinatal depression, anxiety and perinatal PTSD. Furthermore, low social support from caregivers, history of traumatic events and instrumental births were risk factors for the new parents to perceive the birth as traumatic.Conclusion: A negative or traumatic birth experience can lead to that the new parents get mental illness. There is a need for increased understanding of risk factors correlated to traumatic birth experiences to reduce the prevalence of mental illness. The results of this study are important as it creates an understanding of the woman and her partner's vulnerability in the event of a negative or traumatic birth as well as which protective factors more focus should be placed on by the healthcare.

The childbirth in the medical discourse is still viewed as a proces of high risk. The birth at home is then in such a discourse considered to be hazardous practice which can threaten the life of the unborn child. This paper tries to contribute to the discussions about the freedom of choice of the place of birth. The birth is then viewed from the perspective of gender as a constructed phenomenon culturaly and socialy biased. The main focus is on the research of the experience of women who gave birth at home. Their experience is to be considered as constructed as well, therefore I investigate the leverages that influence their interpretation of the birth experience. I am also interested in researching how their experience influenced their futher life and what meaning they asign to it in the context of their life experience as such. Further interest of this paper is to research the knowledge that the women, who gave birth at home, used during the proces of childbirth. The main focus is to elicit the auhoritative knowledge based on which they make decisions and how this knowledge is constituted.

Bakgrund: Forskning visar att den sexuella hälsan hos kvinnor minskar under barnafödandet och kvinnans relation till partnern förändras. Kvinnan har behov av närhet och intimitet men mindre fokus på sexuell aktivitet. Kvinnor upplever att barnmorskor saknar tid och intresse att fokusera på deras sexuella hälsa vid besöken på kvinnohälsovården. Barnmorskor upplever att de har en kunskapsbrist och känner osäkerhet kring hur frågorna ska ställas i mötet med kvinnorna. Syfte: Att beskriva barnmorskors erfarenheter av att stödja kvinnors sexuella hälsa under barnafödande. Metod: Kvalitativ innehållsanalys användes för att analysera intervjuer med åtta barnmorskor från kvinnohälsovården. Resultat: Fyra kategorier framkom: Anpassa samtalet till situationen, Stödja den fysiska processen, Stärka parets relation och Hinder som försvårar. Barnmorskors erfarenhet är att deras professionella kunskap bidrar till öppna samtal och att de stödjer genom att informera om de psykiska och fysiska förändringar som sker hos kvinnan och genom att stärka parets relation. Hinder för stödjande kan vara tidsbrist, kunskapsbrist, kvinnans fokusering på förlossningen eller att kvinnor förväntas ta egenansvar att inhämta information. Konklusion: För att förbättra stödet av kvinnors sexuella hälsa behövs mer utbildning till barnmorskor och eventuellt omorganisering av besöken för att kunna fånga upp kvinnan en längre tid efter barnafödandet.