This study was carried out as part of efforts to better understand the factors that impinge on childbirth service delivery and to develop guidelines to help improve the quality and safety of childbirth services in Ghana. The objectives were to: assess the factors that influence client-centredness; explore women’s and health professional’s views of and experiences with client-centred childbirth services; and develop guidelines to assist improve client-centred childbirth services in hospitals. The fixed mixed methods design comprising both quantitative and qualitative methods was employed. Structured questionnaire and exit interviews were used to gather data from 754 women who delivered in the hospitals. Furthermore, in-depth interviews were used to examine the experiences of women, doctors and midwives. STATA MP Version 13 was used to analyse the data by generating frequencies, chi-square and binary logistic regression results. Qualitative data analysis was analysed through data reduction, data display and generation of themes and categories. The process of developing the guidelines comprised: drafting based on the findings of the study and additional literature review, and a number of reviews by senior health professionls to build consesnsus on the content. With a response rate of 97.8%, the results indicated average performance. A number of the items examined under demographic characteristics, ante-natal, labour and postnatal care were significantly associated with the experience of excellent client-centred care. These included: number of weeks pregnant before delivery; health professional who assisted with delivery; mode of delivery; labour pain management; and length of stay after delivery. On the whole, the findings of the quantitative study were support by that of the structured interviews. Most of the themes from in-depth interviews with women were had to do with the relationship between health care provider and clients. Issues of support during childbirth; decision-making and informed choice; and continuity were raised. Themes deduced from the doctors’ and midwives’ interviews demonstrated a fair understanding of principles of client-centred care and delineated relational as well as client, health care worker and organisational factors that facilitate or limit effective implementation of client-centred care. The findings of the studies were used to develop guidelines to help improve services. It is recommended that the Ministry of Health, Ghana adopt the guidelines and provide the enabling environment for its effective implementation. / Health Studies / D. Litt. et Phil. (Health Studies)

<p>Härtill 5 uppsatser.</p> / digitalisering@umu

I barnmorskans ansvarsområde ingår handläggning av normal förlossningen. Studier visar att förlossningsvården blir alltmer medikaliserad och att barnmorskor har svårt att främja den normala förlossningen eftersom tydliga gränser för vad som anses vara normalt saknas. Syftet med studien är att undersöka barnmorskors uppfattning kring normal förlossning. I studien används en kvalitativ metod med induktiv ansats. Totalt har tio barnmorskor deltagit i tre fokusgruppdiskussioner under våren 2015. Texten har analyserats enligt kvalitativ innehållsanalys. Analysen har resulterat i tre kategorier, med det övergripande temat Osäkerhet kring innebörden av begreppet normal förlossning. Kategorierna visar olika aspekter som bidrar till barnmorskors osäkerhet, dessa är; Olika synsätt på normal förlossning, Det som är vanligt blir normalt samt Barnmorskor känner sig styrda. Resultatet visar att barnmorskor har olika uppfattning av vad en normal förlossning innebär. De upplever också att läkare har ett annat synsätt på normal förlossning. Medicinska interventioner som är vanligt förekommande har normaliserats och uppfattas ingå i normal förlossning. Även förlossningsavdelningarnas organisation och riktlinjer påverkar synen och handläggningen av normal förlossning. I barnmorskans huvuduppgifter ingår det att främja normal förlossning och att stödja och stärka kvinnor i barnafödandet. Det är av stor vikt att barnmorskan har kunskap om den normala förlossningen så att rätt stöd och beslut om adekvata åtgärder vidtas för att främja den. / Normal childbirth is the midwife´s responsibility. Previous studies shows that the normal childbirth becomes more and more medicalised. Midwives have a hard time promoting normal birth, since there are no distinct boundaries. The aim for this study is to examine the midwives perceptions of the normal childbirth. The study was conducted with a qualitative inductive approach. A total of ten midwives participated in three focus groups discussions during spring 2015. The interviews were analyzed according to a qualitative content analysis. The analysis resulted in three categories, with a connecting theme Uncertainty about the concept of normal childbirth. The categories show different aspects that contribute to the midwives uncertainty, they are; Different approach to normal childbirth, What’s commonly used becomes normal and Midwives feels controlled. The result shows the midwives have different perceptions of what a normal birth entails. They also feel that doctors have a different approach to normal childbirth. Medical interventions that were commonly used become normalized and are now a part of normal childbirth. The organization and guidelines set by the ward also affected the perspective and management of normal birth. The midwife has a responsibility to promote normal childbirth but also to support and empower women during the delivery. It is therefore important that the midwife has knowledge of the normal childbirth so she can give the right support and make appropriate decisions to promote it.

Bakgrund: Förlossningssmärta är en av de mest intensiva formerna av smärta. Det finns både farmakologiska och icke farmakologiska metoder för att lindra förlossningssmärta. En icke farmakologisk smärtlindringsmetod är sterilvatteninjektioner. Sterilt vatten injiceras intrakutant eller subkutant. Smärtlindrande effekten kommer snabbt, oftast inom 10 min och kan sitta kvar i upp till två timmar. Enda bieffekt injektionerna ger är en brännande känsla när det sterila vattnet injiceras. Syfte: Att analysera betydelsen av den smärta som uppstår vid behandling med sterilvatteninjektioner. Metod: Kvalitativ metod i enlighet med hybridmodellen har använts. Hybridmodellen är uppdelad i tre faser. I den första, teoretiska fasen, gjordes artikelsökningar. I den andra, empiriska fasen, intervjuades åtta kvinnor och fyra barnmorskor. I den tredje fasen sker en sammanfattande analys. Resultat: Sticksmärtan har betydelse i kvinnans val att använda sterilvatteninjektioner. När barnmorskorna informerar kvinnorna om sterilvatteninjektioner får de information om att de kommer uppleva en smärta i samband med injektionen. Efter erhållen sterilvatteninjektion uttrycker kvinnorna att det gjorde ont att få injektionerna. Konklusion: Smärta uppkommer när kvinnor erhåller sterilvatteninjektioner. När barnmorskan upplyser om sterilvatteninjektionernas effekt vill kvinnorna ändå testa. De kvinnor som erhöll en god smärtlindring av injektionerna kände att smärtan var överkomlig och kunde då rekommendera metoden till andra. / Background: Labor pain is one of the most intensive forms of pain. Sterile water injected intradermal or subcutaneously is a non-pharmacological pain-relief method. The analgesic effect comes quickly and can remain for up to two hours. The only side-effect is a burning pain during injection. Aim: To analyze the importance of the pain that occurs during treatment with sterile water injections. Method: A qualitative method in accordance with the hybrid model has been used. The hybrid model is divided into three phases. In the first, theoretical phase, search of scientific articles was made. In the second, empirical phase, interviews were conducted with eight women and four midwives. In the third phase a summary analysis takes place. Results: Injection pain is of importance in the woman's choice of the use of sterile water injections. Midwives inform women of sterile water injections, they informed that they will experience a pain associated with the injection. After the women received sterile water injection they expressed that it hurts to get the injection. Conclusion: Pain arises when obtaining sterile water injections. Women who received a good pain relief from the injections felt that the pain was affordable and could then recommend the method to others.

The study sought to describe Mozambican women's experience of labour pain. The study sought to determine the manner in which labour pain is perceived and to determine the culturally acceptable behaviour of Mozambican women as they experience labour pain. The preferred pain relief measures and cultural practices and beliefs pertaining to labour pain by this cultural group were also studied. The major inferences drawn from this study are that during labour, Mozambican women mainly respond stoically to the experience of labour. They also exhibited different kinds of behaviour in response to labour pain, such as rubbing the painful site, tossing about in bed, and verbalisation. The implication of the study is that Swazi nurse-midwives should render culture congruent maternity care to the women during labour. / Health Studies / M.A. (Health Studies)

This thesis deals with the topic of childbirth and birth delivery in Eastern Africa. The theoretical part tackles mostly the high birth rates, midwifery and hygiene habits and rituals, health system, alternative approaches in midwifery care and traditional healing methods, post-natal care as well as high maternal and infant mortality rates. It uncovers the taboo topic of female circumcision and the impact that it has on giving birth. It furthermore describes a case of an especially complicated labour of a Ugandan girl called Fatima Mirembe who gave birth in a prison hospital. The practical part of this paper consists of a research survey that, using questionnaires, aims to find out what the women from the Ugandan Nyakyera Village and the communities nearby experience during and after the delivery and what the quality of local post-natal care is. It also describes the abortion rate in the area and common causes of abortions and it also describes the knowledge of the true story of Fatima Mirembe. Keywords African women, Fatima Mirembe, childbirth, birthrate, Uganda, East Africa, health care, female circumcision

The thesis examines the importance of psychological support from a supplementary person provided to mothers during their pregnancy and mainly during the process of childbirth. Such person may be a partner, relative, midwife, doula, doctor, etc. The aim of this thesis is to find out why the mother chooses to give birth in the presence of the specific person, how important is the psychological (and sometimes also physical) support from an accompanying person for such woman during delivery, or what specific action the mother considers psychologically supportive during the pregnancy and childbirth. Theoretical part describes a psyche of the mum-to-be and her need for psychological support during the pregnancy and the delivery and names the types of support in relation to a person, who is supporting. Practical part will be based on qualitative research carried out as half-structured interviews with mothers, who delivered a baby with accompaniment. The interpretative content analysis will be used to evaluate the interviews. Key words: woman, mother, motherhood, pregnancy, delivery, childbirth, psychological support, partner, doula, midwife

Determination of Parenthood The topic of my thesis is Determination of parenthood. The reason why I chose this topic is because it combines legal, historical, social and ethical aspects. Goal of my thesis is to analyse legal institute and raise awareness about its problems. The thesis is concerned with determination of maternity, determination of paternity and denying of paternity. Diploma thesis is divided into five chapters. First chapter is Introduction, in which I determine the extent of the thesis. Second chapter deals with historical development of legal regulation of determination of parenthood. This chapter comprises of three subchapters. First is concerned with determination of parenthood in ancient Rome. Second explains determination of parenthood in ABGB. Third explains the Czech legal regulation between 1948 and 2014. Third chapter is about contemporary legal regulation. Chapter is divided in three subchapters. First deals with determination of maternity. Second deals with determination of paternity. Third deals with denying of paternity. Fourth chapter reports on decisions of European Court of Human Rights. It outlines concrete cases a tries to summarise, how the court decides in question of determination of parenthood. Last chapter summarises the whole thesis with conclusion that...

Establishing parentage The subject of this master thesis is the issue of establishing parentage. The thesis targets areas of establishing parenthood, issues of three legal presumptions and last but not least, parenthood denial. The question of establishing maternity is examined mainly from perspectives including surrogate maternity, assisted reproduction method and secret and anonymous delivery. All matters are reviewed based on the valid amendment to Act No. 89/2012 Coll., the Civil Code that has come into effect on 1.1.2014. The goal of the thesis is it to introduce, describe and analyze the new amendment to the Family Act. Further, it aims to compare individual institutions with respect to changes made to the Family Act in the past and those made as a part of the new amendment. The thesis consists of eight key chapters. The initial chapter targets relationships among parents and their children, protection of children's legal rights as well as a child's right to know its biological origin. Following, the second and the third chapters concentrate in depth on legislation of the paternity establishment per se. While the second chapter covers the historical development of the legislation from the ancient Rome era until present, the latter chapter intends to introduce the legislation from domestic,...

Determination of Parenthood Determination of parenthood is very actual topic due to the constant changes of the traditional understanding of the family and family relationships. It is primarily the development of modern medical science, biology or genetics that has brought new concepts into the issue of determination of parenthood. For example surrogacy, assisted reproduction or baby boxes. The legislation must responds to these changes in order to stabilized family relationships and to ensure their protection. The aim of this thesis is to describe and to analyze Czech legal regulation of determination of parenthood and to compare it with not only European but also global legislation. The analyse of valid legal regulation highlights questionable passages that may cause difficulties in its interpretation or practical application. The thesis is composed of nine chapters, each of them dealing with different aspects of determination of parenthood. Opening chapter introduces the historical development of relationships between parents and children in Roman and European law. It focuses on legal standards applicable in our country during the period of time from the establishment of the Czechoslovak Republic to the present times. Chapter Three is devoted to determination of maternity. It focuses on concealed birth,...