Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

Background: Occupational stress is a global and complex phenomenon, and workers in developing countries can be affected by it (International Labour Organisation 2001). Staff within maternity settings have been identified as being at risk of suffering from stress, resulting in adverse health outcomes (Evenden and Sharpe, 2002). However, MWAs’ perceptions of stress have not been captured and are not reflected in the literature. Purpose: The aim of this study was to explore MWAs’ perceptions of occupational stress, possible cause(s), the impact and support available and the coping methods they adopted within maternity care settings (hospital) in Nigeria. Methodology: This study adopted a qualitative methodology. Husserl’s (1962) phenomenological approach was chosen as it enabled the researcher to collect rich, in-depth, descriptive accounts of the MWAs’ perceptions of the phenomenon under study through the use of semi-structured interviews. Findings: The major sources of stress for MWAs included work overload, long working hours, staff shortages, work exploitation and intensification and lack of support from senior staff. The stress levels MWAs experienced impacted on their health and well-being and resulted in related behavioural and physical reactions. Conclusion: This study confirmed that MWAs were exposed to similar stress factors experienced by other health workers and reported in the research literature. Additionally, it demonstrated the need for more qualitative studies to explore the perceptions of occupational stress among under-represented groups of healthcare workers. Importantly, this study created an opportunity to explore the experience of dedicated women facing challenging employment practices in hospital settings in Nigeria. Equally, it gave a voice to these unrecognised, almost invisible women, who were the MWAs that played a key role within the maternity services.

In January this year, Region Västerbotten announced that the maternity ward in Lycksele would be closed until further notice. This paper is a case study of the closure of the maternity ward in Lycksele, located within the rural parts of northern Sweden. Previous research has focused on maternity ward closures in Canada and Australia whereas studies on maternity wards in northern Sweden is limited. Since large parts of northern Sweden consist of sparsely populated areas, the closure of Lycksele BB has resulted in women having to travel long distances to receive care. This paper seeks to provide a deeper understanding of the consequences of the closure of Lycksele BB by examining (1) what feelings women experience and how they manage these feelings, (2) the consequences of the maternity ward closure on women’s physical and mental health and (3) the consequences of the maternity ward closure in relation to the rural parts of northern Sweden. This study has been carried out by using a qualitative approach by conducting semi-structured interviews with two pregnant women, two mothers, and two midwives. The findings in this study show that women develop strategies to mitigate feelings of insecurity and anxiety. Both pregnant women and midwives create strategies to feel a stronger sense of control in an otherwise unpredictable situation. This contributes to major consequences for women’s mental and physical health as women are faced with new challenges, affecting their reproductive health and care. The findings also show that the closure of Lycksele BB is only a stepping stone for further welfare cuts which can result in people moving away from these sparsely populated areas. This study concludes that the issue goes beyond the closure of the maternity ward in Lycksele and raises bigger questions around the future of the rural parts of northern Sweden.

Bakgrunn: Norskehelsemyndigheter anbefaler i tråd med WHO / UNICEF at spedbarn bør få morsmelk som eneste næring i de første seks levemånedene. Ammingen bør opprettholdes gjennom hele det første leveåret samtidig med at fast føde introduseres. Rutiner ved føde-/ barselavdelingene har stor innvirkning på etablering og varighet av ammingen. Bruk av tilleggsnæring uten medisinsk grunnkan føretil at færre mødre fullammer og at de har en kortere ammeperiode. Mål: Studere endring av rutiner som fremmer amming ved norske fødeenheter med et spesielt fokus på perioden1991-2009, rett før og etter lanseringen av Mor-barn-vennlig initiativ (MBVI). Beskrive situasjonen med den fortløpende registreringen av amming og spedbarn som får tilleggsnæring ved landets fødeenheter. Metode: Ammeundersøkelsen som er gjennomført hvert 9. år, er en deskriptiv tverrsnitt studie. Fødeenhetene besvarte et tilsendt spørreskjema med spørsmål om avdelingens ammerutiner for det forutgående år, retrospektivt. En fortløpende registreringpå tilsendt registreringsskjema, av amming og bruk av tillegg til 20 friske, fullbårne barn ved hver fødeenhet, tilsammen 984 barn, ble gjort prospektivt. Resultat: Fødeenhetenes rutinerhar i hovedsak endret seg i tråd med helsemyndighetenes anbefalinger, bortsett frapraksis med å gi tilleggsnæring til friske, fullbårne barn som skal ammes. Registreringen av amming og bruk av tilleggbekrefter svarene fra Ammeundersøkelsen. 30 % av de registrerte barna fikk tilleggsnæring minst en gang under barseloppholdet, og de fleste fikk det av en ikke medisinsk grunn. Konklusjon: Unødig bruk av tilleggsnæring er en indikator på at avdelingens ammepraksis ikke fungerer tilfredsstilende. / Background: In concurrence with the World Health Organization and UNICEF, Norwegian health authorities recommend exclusive breastfeeding for infants during the first six months of life. Thereafter, recommendations suggest the continuance of breastfeeding for the first year of life, while introducing complementary food. Routines in maternity wards have a huge impact on the establishment and duration of breastfeeding. Consequently, supplemental nutrition that lacks medical justification may reduce exclusive breastfeeding, and associates with early termination of breastfeeding. Objective: This study aimed to examine changes in maternity ward routines with regard to breastfeeding, focusing particularly on the period between 1991 and 2009, immediately before and after Norway launched the Baby-Friendly Hospital Initiative. In addition we examined the continuous registration of breastfeeding and the provision of breast-milk substitutes in the maternity units. Methods: Norway conducts a descriptive and cross-sectional National Breastfeeding Survey (Ammeundersøkelsen) every 9th year. The 53 head midwifes responded retrospectively to a questionnaire about their units’ breastfeeding practices the preceding year. In addition each unit registered breastfeeding and the use of breast milk substitutes for 20 healthy term infants, a total of 984 infants, prospectively. Results: Except for non-medical use of breast-milk substitutes, changes in breastfeeding routines mostly adhered to health authority recommendations. The registration of breastfeeding and breast-milk substitutes confirms our findings. Thirty percent of registered babies received breast-milk substitutes at least once during their stay in the maternity ward, and most received a substitute due to a non-medical reason. Conclusion: The use of breast-milk substitutes for non-medical reasons indicates that hospitals’ breastfeeding routines are not satisfactory. / <p>ISBN 978-91-86739-97-3</p>

Bakgrund: Det är vanligt att kvinnor under en vaginal förlossning drabbas av grad II-bristning. I barnmorskans ansvarsområde ingår att handlägga dessa bristningar. Forskning visar att det finns begränsat med rutiner kring dessa bristningar och att fokus ofta ligger på grad III- och grad IV-bristningar trots att även grad II-bristningar kan ge långtidskomplikationer. Syfte: Syftet var att beskriva barnmorskans erfarenhet av handläggning vid uppkommen grad II-bristning. Metod: Semistrukturerade individuella intervjuer genomfördes med åtta barnmorskor verksamma vid en mellanstor förlossningsavdelning i Mellansverige. Kvalitativ innehållsanalys användes för att analysera materialet. Resultat: Fyra kategorier och två underkategorier identifierades. Kategorierna var Information, Kollegialt stöd, Behov av uppföljning och Undersökning och underkategorierna Strategier för återkoppling och Dokumentation. Slutsats: Det framkom en osäkerhet hos barnmorskorna gällande diagnostisering och suturering av grad II-bristning. Detta gällde främst de barnmorskor med minst yrkeserfarenhet. Barnmorskorna uttryckte också en önskan om bättre återkoppling på de bristningar de suturerat samt en bättre uppföljning för de kvinnor som fått en grad II-bristning. Resultatet visade även att barnmorskorna informerar kvinnorna på olika sätt gällande deras bristning. Inga tydliga rutiner finns gällande vilken information som ska ges eller på vilket sätt. Klinisk tillämpbarhet: Studiens resultat syftar till att skapa ökad kunskap och riktlinjer kring grad II-bristningar. Ytterligare forskning skulle kunna beröra information i samband med bristningen och när den är bäst att ge. / Background: Many women sustain a second-degree tear when giving birth vaginally. The work field of a midwife includes managing these injuries. There is limited research regarding this field and the focus tend to be on third- and fourth-degree tears, even though second-degree tears may also result in long-term complications. Aim: The aim was to investigate the midwife’s experience of managing second-degree tears. Method: Eight semi-structured individual interviews were conducted with midwives working at a medium large maternity ward located in the middle of Sweden. Qualitative content analysis was used to analyze the material. Results: Four categories and two subcategories were identified. The categories were: Information, The support of colleagues, The need for follow-ups and Physical examination and the subcategories were: Feedback strategies and Documentation. Conclusion: The result show that midwives feel insecure when managing second-degree tears, especially the midwives with less experience. The midwives also requested more feedback from the women they sutured regarding their second-degree tears and the midwives also wished for a better follow-up for the women with second-degree tears. The result also showed that the midwives give different information to women regarding their tears. No pronounced routines were found regarding what information to give and in what way. Clinical application: The results of the study aim to increase the knowledge and to develop routines regarding second-degree tears. More knowledge is needed about information given about the tear and when it is the best time to give information.

No description available.

No description available.

The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units. / Health Studies / M. A. (Social Behaviour Studies in HIV/AIDS)

Studier har visat att hud-mot-hud har flera positiva effekter för modern och det nyfödda barnet. Trots detta upplever barnmorskor hinder för kontinuerlig hud-mot-hud under föräldraparens BB-vistelse.  Syftet med arbetet var att beskriva barnmorskors tankar kring hinder och möjligheter för kontinuerlig hud-mot-hud på barnbördshus (BB). Forskning finns om hud-mot-hud men inga specifika studier om barnmorskors tankar kring vilka hinder och möjligheter som finns för kontinuerlig hud-mot-hud under BB-vistelsen.  En intervjustudie utfördes och materialet bearbetades med kvalitativ innehållsanalys för att lyfta fram de viktigaste aspekterna. Resultatet som framkom belyser barnmorskors tankar om hinder och möjligheter vid implementering av kontinuerlig hud-mot-hud under barnets första dygn på BB. Resultatet av studien visade att barnmorskorna största hinder var brist på riktlinjer, förekomsten av barnsängar, bristande föräldrainformation, platsbrist, samt föräldrarnas kulturella bakgrund och personalens attityder. De möjligheter som lyftes fram var enkelrum, bärhjälpmedel såsom tubtopp eller bärsjal, samt att utbilda föräldrarna under graviditeten. Vårdhandlingen införlivas lättast om de blivande föräldrar deltar i förberedande föräldrakurser under graviditeten, samt att personalen är välutbildade och uppmuntrar till hud-mot-hud. / Studies have shown that skin-to-skin care has several positive effects for both the mother and the newborn. Despite this, midwifes experience that it can be difficult to get parents to implement the skin-to-skin care continuously during its stay the maternity ward.  The aim of the thesis is to describe midwives’ thoughts on the obstacles and opportunities for continuous skin-to-skin care at the maternity ward. There are studies on skin-to-skin care but no specific studies regarding midwives’ thoughts on the obstacles and opportunities for continuous skin-to-skin care during maternity stay. An interview study was conducted, and the material was processed using qualitative content analysis to highlight the main points. The result highlighted midwives’ thoughts on the obstacles and opportunities in the implementation of continuous skin-to-skin contact during the child's first days in the maternity ward. The results of the study showed that midwives biggest obstacles are the hospital baby beds, as well as lack of guidelines, parental information, private rooms, and the parents' cultural background and the staff attitudes. The opportunities that arouse were private rooms, aids such as tube tops or slings, and prenatal parental training during pregnancy. Skin-to-skin care can most easily be implemented when parents participate in preparatory parenting training, and when the staff is well trained and encourage implementing skin-to-skin care.

The study reports on the perceptions of the midwives and pregnant women of the PMTCT of HIV programme at the antenatal care and maternity ward at the Johan Heyns Community Health Centre. A qualitative approach was adopted to conduct the study. Purposive sampling was used to select participants and was informed by social behavioural theories. Data was collected using interviews and analysed using thematic categorisation. The findings show that at the first PMTCT encounter participants had little to no knowledge of the PMTCT programme, generally displayed a lack of interest, experienced emotional distress, and fear at the thought of having to disclosing their HIV-positive status to their partners/family and had certain trepidations about participating in the PMTCT programme. The participants’ perception on their roles was that their roles were interlinked, midwife needs the recipients (pregnant woman) and pregnant woman needs the provider (midwife) therefore one cannot do PMTCT without the other. The study recommends that the capacity building of pregnant women be optimised, that PMTCT awareness campaigns for women of childbearing age should be a priority and PMTCT skills to be prerequisite for midwives deployed to ANC clinics and maternity ward units. / Health Studies / M.A. (Social Behaviour Studies in HIV/AIDS)