Bakgrund: Det råder en global brist på barnmorskor vilket kan innebära ett hot för såväl födande kvinnors hälsa som den globala folkhälsan. Inom förlossningsvården har barnmorskan kompetens att självständigt handlägga normal förlossning. Bristen på barnmorskor inom den svenska förlossningsvården spås öka till följd av ett flertal olika faktorer däribland omfattande pensionsavgångar samt rekryteringsutmaningar. Mer forskning behövs kring faktorer som främjar en attraktiv och hållbar arbetsmiljö. Studiens syfte var att undersöka nyutexaminerade barnmorskors erfarenheter av att arbeta på förlossningsavdelning. Metod: Genom ett bekvämlighetsurval rekryterades tio nyutexaminerade barnmorskor till studien. Digitala intervjuer genomfördes baserade på en semistrukturerad intervjuguide. Intervjuerna transkriberades och datamaterialet låg till grund för en fenomenografisk analys. Resultat: Organisation och ledarskap har betydelse för en trygg start i yrkeslivet, känslan av delaktighet och en hanterbar arbetsbelastning. En tillåtande och stödjande miljö med möjlighet att vara ny är viktigt för trygghet och utveckling i yrkesrollen. Barnmorskorna växer in i en ny yrkesroll som uppges ge och ta energi. Konklusion: Nyutexaminerade barnmorskor behöver ges förutsättningar för att växa in i den nya yrkesrollen. Om förutsättningarna förbättras kan det bidra till möjligheten för barnmorskorna att fortsätta bistå förlossningar samt känna trygghet, glädje och yrkesstolthet, således en betydande del i att säkra framtidens förlossningsvård. / Background: There is a global shortage of midwives which can pose a threat to the health of women giving birth and the global public health in general. In maternity care the midwife has the competence to independently manage normal childbirth. The shortage of midwives within Swedish maternity care is predicted to increase as a result of multiple factors including extensive retirements and difficulties in recruitment. More research regarding factors that promote an attractive and sustainable work environment is needed. The aim of this study was to investigate newly graduated midwives' experiences of working in a maternity ward. Method: Through a convenience sample, ten midwives were recruited, and semi-structured interviews were conducted digitally. The data was analyzed with a phenomenographic approach. Result: Organization and leadership is important for a secure start into professional life as well as a sense of participation and manageable workload. A permissive and supportive environment is essential for safety and development in the professional role. The work in a maternity ward claims to give and take energy. Conclusion: Newly graduated midwives need to be given the proper conditions in order to develop within their profession. Improved conditions can enable the midwives continuing to assist childbirth with a sense of security, happiness and pride. Important aspects in securing future maternity care.

Bakgrund: Under graviditet genomgår kvinnan fysiologiska, psykologiska och hormonella förändringar. Att drabbas av psykisk ohälsa i samband med graviditet och tiden efter barnets födelse är inte annorlunda än att drabbas av psykisk ohälsa under andra perioder i livet men psykisk ohälsa under den perinatala perioden kan påverka bindningen till barnet och barnets anknytning till sin mamma. Psykisk ohälsa kan leda till att kvinnor ifrågasätter sin modersroll och barn till mödrar med psykisk ohälsa kan påverkas negativt genom emotionella-, kognitiva- och beteendemässiga svårigheter som kan bli långvariga. Barnmorskan har i uppgift att upptäcka och identifiera kvinnor med risk för psykisk ohälsa, tidiga insatser är av vikt. Barnmorskan kan remittera kvinnan till adekvat vård inom och utanför professionen. Det är av vikt att barnmorskan skapar förtroendefulla relationer, vården ska ges med värdighet och vara personcentrerad samt möjliggöra kontinuitet. Dock visar forskning att kvinnor upplevt att bemötande och vård inte tillgodoses vilket leder till att den psykiska ohälsan inte uppmärksammas. Syfte: Att, utifrån barnmorskors erfarenheter och upplevelser, belysa vad som påverkar bemötandet och vården gentemot kvinnor i relation till psykisk ohälsa i samband med graviditet och tiden närmast efter barnets födelse, så kallad perinatal psykisk ohälsa. Metod: Litteraturöversikt med kvalitativa och kvantitativa artiklar som analyserades med integrativ metod. Resultat: Barnmorskor ansåg att relationsskapandet var viktigt i avseendet att främja den psykiska hälsan och för att identifiera psykisk ohälsa. Barnmorskorna upplevde inte att stödet alltid räckte till, varken för att skapa förtroendefull relation eller för att erbjuda lämplig vård till kvinnor som drabbats av psykisk ohälsa. Helhetsperspektivet var bristande, en del barnmorskor ansåg att perinatal psykisk ohälsa var deras ansvar, medan ansvarsrollen upplevdes som otydlig av andra barnmorskor. Barnmorskor tillfrågade inte kvinnor om den psykisk hälsan under graviditeten och de kände sig mer bekväma att prata om fysiska besvär och frågor specifikt riktade mot graviditeten och dess fortskridande. Det framkom också negativa attityder och stigma kopplade till psykisk ohälsa, och att vården och bemötandet påverkades av tidsbrist. Barnmorskor upplevde kompetensbrist och otydlighet gällande remittering, vilket bidrog till osäkerhet och oro. Det visade sig att flertalet barnmorskor hade kunskapsbrister angående perinatal psykisk ohälsa. Slutsats: Bemötande och vård påverkas av förtroendefulla relationer, kontinuitet och kunskapsbrist. Genom att synliggöra betydelsen av förtroendefulla relationer skulle det möjliggöra att barnmorskor skulle kunna förebygga perinatal psykisk ohälsa och därmed kunna skydda, kanske den viktigaste relationen i livet, mammans bindning till sitt barn och barnets anknytning till sin mamma. / Background: During pregnancy, the woman undergoes physiological, psychological, and hormonal changes. Suffering from mental illness in context to pregnancy; before, during and the time after child’s birth, is no different than suffering from mental illness during other periods in life. But mental illness during the perinatal period can have a negative impact on the attachment to the child and the child´s attachment to the mother. Mental illness can lead to women´s questioning their role as mothers and children of mothers with mental illness can be negatively affected by emotional, cognitive, and behavioral difficulties that can be long-lasting. The midwife has the task of discovering and identifying women at risk of mental illness and early intervention is important. The midwife can refer the woman to adequate care within and outside the profession. It is important that the midwife creates trusting relationships, enable continuity and the care must be given with dignity and be person-centered. However, research shows that women have experienced that treatment and care are not provided, which leads to perinatal mental illness not being noticed.  Purpose: To, based on midwife’s view´s and experience, shed light on what affect the treatment and care towards women in relation to mental illness in connection with pregnancy and the time immediately after the child´s birth, so-called perinatal mental illness. Method: Literature review with qualitative and quantitative articles that were analyzed with an integrative method. Results: Midwives considered that building a relationship was important in promoting mental health and in identifying mental illness. The midwives did not feel that their support was always sufficient, neither to create a trusting relationship nor to offer appropriate care to women who have suffered from mental illness. The holistic perspective was lacking, some midwives considered that perinatal mental illness was their responsibility, while the role of responsibility was perceived as unclear by other midwives. Midwives did not ask women about their mental health during pregnancy, and midwives felt more comfortable talking about physical ailment and issues specifically related to pregnancy and its progression. There were also negative attitudes and stigmas associated with perinatal mental illness, and that care and treatment were affected negatively by lack of time. Midwives experienced a lack of skills and uncertainty regarding referral, which contributed to doubt and concern. It turned out that most midwives had a lack of knowledge regarding perinatal mental illness. Conclusion: Treatment and care are affected by trusting relationships, continuity, and lack of knowledge. By highlighting the importance of trusting relationships, it would enable midwives to prevent perinatal mental illness and thus protect, perhaps the most important relationship in life, the mother´s attachment to her child and the child´s attachment to the mother.

PhD (Health Sciences) / Department of Advanced Nursing Science / STRACT Background: The implementation of the World Health Organisation maternal health care guidelines in African countries has resulted in the reduction of maternal deaths by half since 1990. As a result, between 1990-2013, maternal mortality ratio declined by only 2.6% per year and this is far from the annual decline of 5.5% required to achieve the Sustainable Development Goals (SDGs). Ninety percent of women are dying from preventable maternal conditions and most of them are from the low and middle-income areas. The 2011-2013 Saving Mothers Report indicates that the Limpopo Province was ranked number three on the Maternal Mortality Rate in South Africa. Hence, this study sought to assess the implementation of maternal health care guidelines by professional nurses in Limpopo Province. Method: A convergent parallel mixed-methods design study was used. Phase 1 entailed parallel collection of qualitative and quantitative data. In this approach, self-administered questionnaires were used in the quantitative research method and an in-depth interview in qualitative research method. Data were collected from Maternal Health Care Managers, Professional Nurses and Operational Managers working in Primary Health Care Facilities of the Vhembe and Mopani Districts. Systematic methods to sample managers and midwives through the Slovan formula was used. Ethical clearance for the study was obtained from the University of Venda Research Ethics Committee and permission to conduct the study at the Primary Health Care facilities was obtained from the Limpopo Province Department of Health and Health District Offices. Data analyses were done separately using the Statistical Package for Social Sciences for quantitative data and Tesch’s open-coding methods for qualitative data. Validity, reliability and trustworthiness were ensured through a pilot study and by critical appraisal and peer review of the research instruments by experts in the field of maternal health. Results: The study revealed that midwives experienced difficulty when providing care to women presenting with postpartum haemorrhage and pre-eclampsia or eclampsia. Difficulty in the management was confirmed by 36% of respondents. Some participants lacked knowledge on the management of women with postpartum haemorrhage, Pre-eclampsia and eclampsia and this was also indicated by 30% of respondents. Shortage of staff led to work overload, especially if one midwife was left alone to provide care to patients in the facility. Furthermore, midwives experienced delayed ambulance services when in need of referring women who required urgent attention to the next level. Delayed ambulance was indicated also by 80,4% of respondents ad this contributed to the midwives’ frustrations hence poor maternal outcomes. High risk women failed to return to the hospital and others hide their previous history of complications and hence experienced abrupt postpartum haemorrhage leading to poor implementation of maternal health guidelines. Phase 2 dealt with the development of the strategy to facilitate implementation of maternal health guidelines in Limpopo Province using the Strengths, Weaknesses, Opportunities and Threats analysis, identified from the collected data. Phase 3 comprised the validation of the strategy, which was conducted using a quantitative research design. Meetings were held with Maternal Health Care Managers, Midwives and Operational Managers working at Primary Health Care Facilities of Vhembe and Mopani districts. Self-administered questionnaires were distributed for respondents to complete and data were analysed using descriptive analysis. Almost all respondents (95%) agreed that the developed strategy was suitable and applicable for midwifery practice. Maternal Health Care Managers, Midwives and Operational Managers made suggestions that will enhance the developed strategy. Recommendations: Continuous education and in-service training must be done in order to capacitate midwives with knowledge of the management of women with postpartum haemorrhage, pre-eclampsia and eclampsia. The curriculum for Midwifery training must be strengthened and must include enrolled nurses. Health education to women must be strengthened and they must be encouraged to give the correct history in order to reduce maternal mortality rate. / NRF

Mothers around the world experience preventable medical complications during labor and delivery that can lead to maternal and newborn mortality. In addition, some expectant mothers can experience abuse, neglect, and discrimination from attending midwives. This lack of quality care has more connection to maternal mortality than lack of access to health services itself, and it is shown that the most effective way to improve care is through training and continuous education of the midwife, the primary obstetric care-giver. Laerdal Global Health [LGH], was collaborated with in this thesis, a not-for-profit company whose work is dedicated to saving the lives of mothers and newborns in low income regions, through high-impact, low-cost solutions involving educational materials and training programs for midwives. The aim of the partnership with LGH was to support competency development for labor management, with a focus on continuous training and education for midwives in Tanzania, sub Saharan Africa. Continuous training is on-going education of midwives through various methods of training and learning, with the goal of keeping skill sets current and evolving with best practice knowledge. Around the world, as well as in in sub Saharan Africa, medical systems can be stressed by a range of factors, including lack of resources and lack experienced midwives, which leads to challenges to follow standardized obstetric guidelines and an over-burdening workload for the midwife. (LGH, 2019). There is also a high frequency of midwife turnover within clinics and hospitals, making it difficult to train a fluctuating staff of varying competencies and knowledge sets. (LGH, 2019). The net effect of these challenges and beyond, made it imperative to address how midwives could be supported in their efforts to engage in continuous education and training. To facilitate and support continuous education, a hybrid chat and professional education platform, Rio, was created, powered by social interaction, knowledge exchange, and democratization of information. This platform’s aim was to give form and body to existing digital and social behaviors, and midwives’ continuous education efforts, something that comes in many shapes and sizes, and levels of tangibility. A proposal in the digital space was determined to be optimal due to its ability to increase access to information, and its adaptability to user needs and environments. Rio also challenges the ubiquitous nature of WhatsApp in the medical context by addressing and rethinking the generation, use, and storage of patient data. In tandem, Rio maintains the successful social platform use patterns, while utilizing these traits to propel and facilitate professional education and knowledge exchange.

Amning innebär hälsofördelar för både mamma och barn både på kort och på lång sikt. World Health Organization rekommenderar helamning under barnets första halva levnadsår och delamning till barnet är minst två år gammalt. Barnmorskan har ett amningsfrämjande uppdrag och är ansvarig att ge adekvat information samt amningsstöd till föräldrar. Amningen är ett komplext fenomen som måste tränas, och det är vanligt med amningsproblem, framförallt i början av amningsperioden. Stress och oro kring amningen kan leda till att amningen försvåras och det är vanligt att kvinnan slutar amma tidigare än hon önskar. Stödet och uppmuntran från personer i kvinnans omgivning är avgörande för en lyckad amningsperiod, och av dessa är partnern det viktigaste stödet. Forskning har visat att en stöttande, amningspositiv och amningskunnig partner både påverkar initiering av amning samt amningslängd positivt. För att amningen ska kunna fungera behövs därför stöd- och utbildningsinsatser även för partnern. Det är på grund av detta viktigt att barnmorskan i sitt amningsfrämjande arbete har kunskap om partnerns perspektiv samt de faktorer som kan påverka partnerns förmåga att ge stöd.   Syftet med studien var att undersöka partners upplevelser av och förmåga till att ge stöd vid amningen, samt att beskriva hur partners ger detta amningsstöd.   Litteraturöversikt användes som metod för att svara på studiens syfte. Sexton studier valdes ut utifrån sökningar i PubMed och CINAHL Complete samt manuell sökning. Främst kvalitativ forskning valdes. Artiklarna kvalitetsgranskades och sammanställdes sedan genom integrerad analys.   Tre huvudteman kunde urskiljas i litteraturstudiens resultat: ”Faktorer som kan påverkar partners förmåga och möjlghet att ge stöd”, ”upplevelse av att vara stödperson” samt ”stödet partnern ger till den ammande kvinnan”. Partners var positiva till amning och önskade vara mer involverade i amningen. Faktorer som inställning till amning, kunskap, tradition, kultur, ekonomi och stöd från vården kunde påverka förmågan att ge stöd till kvinnan. Partners kunde uppleva rollen som stödperson som ett sätt att visa ansvarstagande för hem och familj. Att ge amningsstöd uppfattades också en form av ofrånkomligt utanförskap, som kunde upplevas som problematiskt. Det kunde vara svårt att ge stöd när kvinnan hade problem med amningen och känslor av maktlöshet var vanligt. Partners upplevde brist på relevant information om amning och amningsstöd från vården och uttryckte behov av mer konkreta och handfasta råd. Typer av stöd som gavs var av känslomässig och praktisk karaktär. Känslomässigt stöd innebar främst uppmuntring och att få kvinnan att känna sig mindre ensam, medan praktiskt stöd ofta bestod i att ta ansvar för hem och hushåll, samt att ge kvinnan service vid amningstillfällena.   Som slutsats dras att partnern har behov av att tydligare bli inkluderad av barnmorskan i det amningsfrämjande arbetet, för att bättre hantera de känslor av maktlöshet som kan uppstå av att vara den icke-ammande föräldern. Partnerns kunskap om amning samt kunskap om den ammande kvinnas individuella behov ger ökad förmåga att kunna ge stöd till kvinnan. / Breastfeeding entails short-term and long-term health benefits for both mother and child. The World Health Organization recommends exclusive breastfeeding for six months and partial breastfeeding is recommended at least until the child is two years old. Midwives have a mission of promoting breastfeeding as well as providing families with adequate breastfeeding information and support. Breastfeeding is a complex phenomenon that requires practice. Breastfeeding problems are common, especially in the early breastfeeding period. Stress and anxiety can make breastfeeding more difficult and it is common that women experience earlier than wanted cessation of breastfeeding. Kin support and encouragement is important for breastfeeding to become successful. The partner is the most important support person in the context of breastfeeding. Studies have shown that a supportive and educated partner that has a positive attitude towards breastfeeding, influence both breastfeeding initiation and duration in a positive direction. To make breastfeeding successful, the partner therefore has to receive support and breastfeeding education. Thus, it is important for midwives, in breastfeeding promotion, to gain knowledge of the partner’s perspective and the factors that can affect the ability to give breastfeeding support.   The aim of the study was to explore partners’ experiences and ability to provide breastfeeding support, and to describe how partners provide this breastfeeding support.   The methods used to answer the aim of the study was to conduct a literature review. Sixteen studies were chosen from literature searches in PubMed and CINAHL Complete, as well as manual literature search. The majority of studies chosen had a qualitative approach. They underwent quality screening and were synthesized using integrative analysis.   The result of the study showed three main themes: “Factors that may influence partners’ ability and to give breastfeeding support”, “Experience of being a support person” and “The support given to the breastfeeding woman”. Partners showed positive attitudes towards breastfeeding and wished to be more involved in the breastfeeding situation. Knowledge, tradition, culture, economy and support from caregivers were factors that could affect their ability of giving breastfeeding support. The support role could be experienced as a way of showing increased responsibility towards the home and the family. The role of the support person was also perceived as a form of inevitable alienation, that could be experienced as problematic. Giving breastfeeding support was difficult as the woman experienced breastfeeding problems, causing the partners to feel powerless. Partners expressed lack of relevant breastfeeding information and breastfeeding support from caregivers, as well as a desire to receive more hands-on, practical advice. Breastfeeding support given by partners was both emotional and practical. Emotional support consisted mostly of encouragement and making the woman feel less lonely, while practical support often meant taking on household chores and serve the woman while she breastfed.   Conclusions drawn from this study are that the partner has the need of being included in the breastfeeding promotion and support given by midwives, in order to obtain the ability to cope with feelings of powerlessness raised by being the non-breastfeeding parent. Furthermore, the partner’s breastfeeding knowledge and knowledge of the individual needs of the breastfeeding woman result in increased ability of giving breastfeeding support.

Pregnant immigrant women are a vulnerable population with respect to access and navigation of maternity care service. They have to deal with the challenges of  navigating a health system in a new country which in most cases is unknown to them while tackling issues such as communication, language, and an unfamiliar healthcare system. Conversely the healthcare professionals are confronted with managing these issues and  providing care within a health institution which was not designed to take on the challenges of providing healthcare to a diverse population.  Both parties continue to search and implement measures within and outside the general healthcare institution with the aspiration of bridging the existing gap.   As a result, the primary aim of this study is to examine immigrant women’s interpretation of maternity care in Sweden and the secondary aim is to explore the views of maternity healthcare professionals on given care to immigrant women. The purpose is to generate and explore new knowledge about an area with limited understanding thus, the research questions are Thus, the research questions are:  How do immigrant women describe their maternity care experience?. How do healthcare professionals describe their experience caring for immigrant women?. An inductive qualitative research was conducted to explore the research problem. Thus, the theory was grounded in data.  Data was collected using semi-structured interviews held with immigrant women who had accessed maternity care in Sweden, had a live birth in the last five years and from healthcare professionals (midwives and doulas).   The result of this study shows that the maternal health needs of immigrant women are compromised due to various factors which centres mainly around communication, language and the health system.  The healthcare professionals also highlighted these same factors and the lack of education and training for them as the most significant underlying systematic problem within health services.

Bakgrund: Epiduralbedövning är idag en vanlig och effektiv smärtlindringsmetod som används vid nästan hälften av alla förlossningar i Sverige. Det är inte klargjort om epiduralbedövningen ingår i det normala förlossningsförloppet trots att forskning visar att den kan ha betydelse för förlossningsförloppets utfall.  Syfte: Att belysa barnmorskors erfarenheter av epiduralbedövning i samband med förlossningsarbetet. Metod: Studien genomfördes genom två fokusgruppsintervjuer med totalt tio barnmorskor där datamaterialet sedan analyserades med kvalitativ innehållsanalys. Resultat: Resultatet presenteras i tre huvudkategorier med tre underkategorier vardera. Huvudkategorierna är: Epiduralbedövningens betydelse för barnmorskans arbete, epiduralbedövningens betydelse för den födande kvinnan och epiduralbedövningens betydelse för förlossningsförloppet. Barnmorskorna upplevde att det både fanns för- och nackdelar med att använda en epiduralbedövning under förlossningen. Slutsats: Barnmorskor har en betydande och viktig roll i att kunna hjälpa och stötta den födande kvinnan och på så vis kunna bidra till en positiv förlossningsupplevelse. Fokus bör ligga på att främja en normal förlossning trots användning av epidural, tydligare riktlinjer hade kunnat hjälpa barnmorskor i deras handläggande. / Background: Epidural anesthesia is today a common and effective pain relief method used in almost half of all births in Sweden. It is not clear whether epidural anesthesia is part of the normal course of labor, despite research showing that the epidural may be important for the outcome of the course of labor. Aim: To describe midwives experiences of epidural anesthesia in connection with the birth process. Method: The study was conducted through two focus group interviews with a total of ten midwives where the data material was then analyzed with qualitative content analysis. Result: The results are presented in three main categories with three subcategories each: the importance of epidural anesthesia for the midwife's work, the importance of epidural anesthesia for the woman giving birth and the importance of epidural anesthesia for the birth process. The midwives experienced that there were both advantages and disadvantages to using an epidural anesthesia during childbirth. Conclusion: Midwives have a significant and important role in being able to help and support the woman giving birth and thus be able to contribute to a more positive birth experience. The focus should be on promoting a normal birth despite the use of an epidural, clearer guidelines could have helped midwives in their handling.

Fostrets rörelser kan vara en indikator på den intrauterina miljön, där avtagande fosterrörelser kan tyda på att moderkakan inte fungerar optimalt. När fostret får för lite syre och näring spar fostret energi genom att röra sig mindre. Det finns olika räknemetoder för att registrera fosterrörelser. Metoderna har utvecklats för att identifiera ett foster som är under risk, där förlossningen måste tidigareläggas för att rädda barnets liv. Evidens för räknemetodernas effektivitet diskuteras i en pågående internationell diskurs. Mindfetalness är en ny metod för att observera fostrets rörelser, där fokus är att registrera rörelsernas styrka, kvalité och karaktär utan att räkna varje enskild rörelse.   Syftet var att undersöka barnmorskors upplevelse av att arbeta med Mindfetalness på barnmorskemottagning.   I december 2017 genomfördes en datainsamling, med hjälp av ett webb-baserat frågeformulär, till barnmorskor som arbetar på en mottagning som lottats att dela ut en broschyr till gravida kvinnor. Svaren analyserades med hjälp av en innehållsanalys med induktiv ansats.   Majoriteten av barnmorskorna upplevde att broschyren var lätthanterlig, stödjande och den kompletterade deras muntliga information om fosterrörelser. Barnmorskorna upplevde att kvinnorna var nöjda och kände sig trygga med att få broschyren. I några få fall upplevde barnmorskorna att kvinnorna blev oroliga. Barnmorskorna förmedlade att informationen om Mindfetalness underlättade kvinnornas anknytning till sitt ofödda barn. Att informera om fosterrörelser var enligt barnmorskorna svårt men samtidigt viktigt och betydelsefullt.   Mindfetalness kan vara en lämplig metod för barnmorskor att använda då de informerar och samtalar om fostrets rörelser med gravida kvinnor. Fler studier behövs om metodens effektivitet avseende att identifiera foster under risk. / Fetal movements can be an indicator of the intrauterine environment, where reduced fetal movements may interpret a placenta deficiency. When a shortage of oxygen and nutrition occurs the fetus saves energy by moving less frequently. There are a variety of methods for recording fetal movements. The methods have been created to identify a fetus at risk and the delivery might be put in advance to save the fetus’s life. There is an on-going international discussion whether the counting methods carries enough evidence. Mindfetalness is a new method to observe fetal movements, where the main focus is to record the strength, quality and characteristic of the movements without counting each and every movement.   The purpose was to observe midwives experience working with Mindfetalness at midwifery clinics.   In December 2017 data collection was conducted via a web-based questionnaire including midwives practicing at antenatal clinics, which were randomized to hand out brochures to pregnant women. The responses were analysed based on a content analysis with inductive approaches.   A majority of the midwives experienced the brochure manageable, supporting and complemented the verbal information about fetal movements. The midwives experienced that the women perceived satisfaction and felt secure receiving the brochure. A few women experienced anxiety according to the midwives. The midwives conveyed the information of Mindfetalness facilitate the women’s attachment to their unborn child. To inform about fetal movements was according to the midwives difficult but at same time important and meaningful.   Mindfetalness can be an appropriate method for midwives when informing and talking about fetal movements to pregnant women. Further research focused on the methods efficacy to identify a fetus at risk is necessary.

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.

Bakgrund: De stora medicinska framstegen som åstadkommits inom förlossningsvården genom historien har varit revolutionerande för kvinnor och barn vilket bidragit till en minskad mödra- och barnadödlighet. Barnmorskan är expert på normal graviditet och födsel, och har både förr och nu en avgörande roll för folkhälsans positiva utveckling. Trots denna utveckling minskar antalet normala födslar och parallellt ses en ökning av onödiga interventioner inklusive en ökad andel kejsarsnitt. Syfte: Att klargöra vad som främjar en normal födsel från barnmorskans och kvinnans perspektiv. Metod: Litteraturöversikt med systematisk ansats utfördes genom databassökning i PubMed och CINAHL. Artiklarna kvalitetgranskades genom Caldwells kvalitetsgranskningsmall och dataanalysen utfördes genom en integrerad analys av fem kvantitativa respektive 11 kvalitativa artiklar som svarade på studiens syfte och frågeställningar. Resultat: Studiens resultat klargjorde vad som främjar normal födsel och redovisades genom fyra huvudkategorier. Kategorin stöd identifierade hur kontinuerlig närvaro, empowerment och mödravårdens förlossningsförberedelse främjade det normala. Kategorin omgivning redovisade hur vårdorganisationen och födelserummet antingen kunde främja eller hämma den normala födelseprocessen. Kategorin barnmorskans betydelse redovisades genom hur barnmorskans kompetens, handläggande och egenskaper kunde påverka förloppet. Slutligen visade kategorin kvinnans individuella förutsättningar hur medicinska faktorer, den egna förberedelsen samt copingstrategier underlättade eller hindrade en normal födsel. Slutsats: För att främja normal födsel krävs en genuin tro på den normala födelseprocessen av både barnmorskan och kvinnan. Studien visar på hur barnmorskan självständigt kan främja processen genom sitt förhållningssätt där stöd är avgörande. Ytterligare huvudfynd visar dock på hur vårdorganisationen kan ha en hämmande inverkan. Kontinuitetsmodeller är den mest framgångsrika vårdformen för att främja normal födsel och trots detta är denna vårdform högst begränsad i Sverige. Istället visar studier på hur obstetrikerledda förlossningsenheter med utbredd riskkultur dominerar. Detta är problematisk då studier inklusive denna litteraturöversikt visar hur onödiga interventioner samt kejsarsnitt minskar med kontinuitetsmodeller. / Background: Medical advances throughout history have been revolutionary contributing to a reduction in maternal and child mortality. Midwives are experts in normal pregnancy and birth, having a decisive role in the positive development of public health. Despite this development, the number of normal births are decreasing while there is an increase in unnecessary interventions, including caesarean sections. Aim: To clarify what promotes a normal birth from a midwife and woman's perspective. Method: Literature review with a systematic approach was carried out by database search in PubMed and CINAHL. The articles were quality reviewed using the Caldwell quality framework. The data analysis was performed through an integrated analysis of five quantitative and 11 qualitative articles that answered the aim of the study. Results: The findings clarified factors promoting normal birth and were presented through four main categories: Support identified how continuous presence, empowerment and maternity care's birth preparation promoted normality. Environment reported how care organizations and delivery rooms could either inhibit or promote normal birth. Midwife's importance was reported through how midwife's experience, competence, handling and characteristics could influence the process. Finally woman's individual conditions showed how medical factors, own preparation and coping strategies facilitated or hindered normal birth. Conclusion: To promote normal birth, a genuine belief in normal birth is required by midwives and women. Findings show how midwives independently can promote normal birth through her approach where support was crucial. However, further findings show how care organizations could have an inhibiting impact. Continuity of care models has proven to be the most successful care in promoting normal birth. Despite this, these models are highly limited in Sweden. Instead, studies show how obstetrician-led delivery units with a widespread culture of risk are dominant. This is problematic as studies show how unnecessary interventions and cesarean sections are reduced with continuity of care models.