Made available in DSpace on 2016-04-27T19:32:46Z (GMT). No. of bitstreams: 1 Aline da Silva Medeiros.pdf: 3024212 bytes, checksum: 458b0d298ee48a39a5353c38a8e7cde1 (MD5) Previous issue date: 2010-05-03 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present work intends to discuss the medical investments which had as target the woman s body, in the capital of Ceará, since the foundation, on March 1915, of the first city s maternity, the Maternity Dr. João Moreira. Divided between the hospital care service and the activities that made up the training of the midwives, the Maternity Dr. João Moreira constituted the productor and propagator center of new ways to understand and deal with the female body in childbirth, which in turn was significantly different from the previous methods of body reading carried by the traditional midwives, who then dominated the scene of the birth in Fortaleza city. The reviewed documentation, consisting of clinical cases, reports and statistical studies, also allowed the analysis of the gradual employment of technical procedures which surrounded the childbirth inside and outside of the Maternity Dr. João Moreira, with particular emphasis on the reorganization of the distances between nature and artifice, and its implications on the gestures professionals dedicated to the female body / Este trabalho pretende discutir os investimentos médicos que tiveram por alvo o corpo da mulher, na capital do Ceará, a partir da fundação, em março de 1915, da primeira maternidade da cidade, a Maternidade Dr. João Moreira. Dividida entre os atendimentos hospitalares e as atividades que compunham um curso de formação de parteiras, a Maternidade Dr. João Moreira constituiu núcleo produtor e propagador de novos modos de entender e lidar com o corpo feminino na hora do parto, modos estes, por sua vez, significativamente distintos das matrizes de leitura corporal carregadas pelas parteiras tradicionais, que então dominavam a cena do nascimento em Fortaleza. A documentação consultada, composta de casos clínicos, resenhas e estudos estatísticos, permitiu ainda a análise do emprego de procedimentos técnicos que cercaram algumas parturições dentro e fora da Maternidade Dr. João Moreira, com especial ênfase sobre as reorganizações das distâncias entre natureza e artifício, e suas implicações sobre o gestual médico dedicado ao corpo feminino por ocasião do parto

Childbirth can be associated with short and long-term psychological morbidity including depression, anxiety and trauma symptoms. Some previous studies have used psychological interventions to reduce postpartum distress but have primarily focussed on attempting to relieve symptoms of depression with little recognition of trauma symptoms. Furthermore, the intervention used in these studies has generally been poorly documented. The first aim of the present study was to develop a counselling framework, suitable for use by midwives, to address psychological trauma following childbirth. Multiple methods were used to develop the intervention including focus groups with women and midwives. Both the women and midwives gave unequivocal support for postpartum debriefing. Themes that emerged from the focus groups with women included the need for opportunities to talk about their birth experience, an explanation of events, an exploration of alternative courses of action that may have resulted in a different birth experience, talking about their feelings such as loss, fear, anger and self-blame, discussing social support, and discussing possible future childbearing. There was a high level of agreement between the women's and midwives' views. These themes were synthesized with contemporary literature describing counselling interventions to assist in reconciling a distressing birth experience and a model for understanding women's distressing birth experiences to develop a counselling framework. The counselling intervention was then tested using a randomised controlled study involving 400 women recruited from antenatal clinics of three public hospitals. When interviewed within seventy-two hours of birth, 103 women reported a distressing birth experience and were then randomised into either the treatment or control group. Women in the intervention group had the opportunity to debrief at the initial postpartum interview (< 72 hours postpartum) and at four to six weeks postpartum. The prevalence of posttraumatic stress disorder was quite high; 9.6% of participants meeting the diagnostic criteria for acute PTSD at four to six weeks postpartum. Fewer participants (3.5%) met the diagnostic criteria for chronic PTSD at three months postpartum. As with previous research relating to childbearing women, few demographic factors or antenatal psychological factors were associated with the development of a PTSD symptom profile following childbirth. The development of PTSD symptom profile was strongly associated with obstetric intervention and a perception of poor care in labour. This finding is also consistent with previous research. Emotional distress was reduced for women in the intervention group in relation to the number of PTSD symptoms [t (101) = 2.144, p = .035], depression [c2 (1) = 9.188, p = .002], stress [c2 (1) = 4.478, p = .029] and feelings of self-blame [t (101) = -12.424, p <.001]. Confidence about a future pregnancy was higher for these women [t (101) = -9.096, p <.001]. Although there was not a statistically significant difference in the number of women with a PTSD symptom profile at three months postpartum, fewer women in the intervention group (n=3) than in the control group (n=9) met PTSD criteria. Likewise, there were fewer women in the intervention group (n=1) with anxiety levels above mild than in the control group (n=6). Importantly, this study found that offering women who have had a traumatic birth the opportunity for counselling using the framework documented in this dissertation was not harmful. This finding is in contrast to previous findings of other studies. The intervention was well received by participants. All the women in the intervention group found the counselling sessions helped them come to terms with their birth experience. Maternity service providers need to be cognizant of the prevalence of this debilitating condition and be able to identify women at risk for early intervention and referral to a mental health practitioner if appropriate. This research offers further support for the compelling need to implement changes to the provision of maternity services that reduce rates of obstetric intervention and humanise service delivery as a means of primary prevention of birth-related PTSD.

<p>Syftet med denna uppsats är att undersöka uppfattningar om risk inom mödrahälsovården. Den behandlar hur barnmorskor och deras patienter uppfattar risk i samband med och runt en graviditet och hur de hanterar denna. En av metoderna för att hantera risk är fosterdiagnostik, vilket syftar till att finna riskgraviditeter. Fokus har främst varit på barnmorskor med frågeställningar kring hur de informerar om risk och fosterdiagnostik, hur de ger råd och hur de uppfattar den inverkan detta har på deras patienter och hur dessa reagerar.</p> / <p>The purpose of this thesis is to explore perceptions of risk within the maternal health care. It deals with how midwives and their patients understand risks associated with and around a pregnancy and how they handle it. One of the methods to manage risk is to use prenatal diagnosis, which aim is to identify risk pregnancies. The focus has been primarily on midwives regarding how they transfer their knowledge about risk and prenatal diagnosis to their patients, how they give advice and how they perceive the impact it has on their patients and their reactions.</p>

<p>The aims of intrapartal care are a healthy mother and child and a positive birth experience for the woman. The aims should be achieved using the least possible number of interventions that is compatible with safety. The overall aim of this thesis was to develop an instrument based on the WHO’s recommendations for care in normal birth, to describe documented intrapartal care in a pre- and post-test following a quality improvement program and to elucidate women’s perceptions of received intrapartal care. The Delphi method was used to develop the instrument. Birth records were scrutinized in the pre-test (n=212) as well in the post-test (n=240). Women’s (n=138) perceptions were collected with a questionnaire.</p><p>An instrument with 69 questions and 24 follow-up questions was developed. The results from the pre-test showed that WHO’s recommendations were only partly followed. Intrapartal care for women at low-risk was similar to care for women at high-risk. Areas for improvement were identified and a quality improvement program was carried out during a two-year period. The post-test showed that the intrapartal care changed towards more adherence to WHO’s recommendations, especially for areas where guidelines were written and for women at low-risk. No statistically significant differences were found for the number of spontaneous vaginal deliveries, mother and child at low-risk after birth, active labour longer than 12 hours or second stage longer than one hour. The result from the women’s questionnaire showed that they to a great extent received care which encompassed practices that are demonstrably useful and should be encouraged. The women’s perceptions were that all received care was of great subjective importance.</p><p>The instrument developed from WHO’s recommendations can be used to examine intrapartal care. Midwives should carry out a risk assessment on the woman’s arrival at the maternity unit and plan the care together with the woman and significant others. Midwives’ documentation needs to change to incorporate interpersonal aspects. Women’s faith in intrapartal care shows the importance of continuous education for midwives in evidence-based care for normal birth. National evidence-based guidelines for intrapartal care need to be developed.</p> / <p>Målet med förlossningsvården är en frisk mor och ett friskt barn samt en för kvinnan positiv upplevelse av förlossningen. Dessa mål skall eftersträvas med minsta möjliga ingrepp i förlossningens förlopp men med bibehållen säkerhet för mor och barn. Det övergripande syftet med denna avhandling var att, utifrån WHO:s rekommendationer avseende vård vid normal förlossning, utveckla ett instrument för att kartlägga barnmorskors dokumenterade förlossningsvård före och efter ett kvalitetsutvecklingsprogram samt belysa kvinnors uppfattningar av förlossningsvård.</p><p>Instrumentutvecklingen genomfördes med Delfimetoden. Förlossningsjournaler granskades vid såväl föremätning (n= 212) som eftermätning (n=240). Kvinnors (n=138) uppfattningar insamlades med en enkät.</p><p>Ett instrument omfattande 69 frågor och 24 uppföljningsfrågor utvecklades. Resultatet av föremätningen visar att WHO:s rekommendationer bara delvis följdes. Vården skilde sig i liten utsträckning för kvinnor med låg- respektive högrisk. Förbättringsområden identifierades och ett kvalitetsutvecklingsprogram genomfördes under en tvåårsperiod. Eftermätningen visar att vården förändrades i riktning mot WHO:s rekommendationer, särskilt för de områden där riktlinjer utvecklats samt för kvinnor i lågriskgruppen. Inga statistiskt signifikanta skillnader noterades beträffande antalet spontana förlossningar, antalet mödrar och barn som var lågrisk efter förlossningen, antalet aktiva förlossningar över 12 timmar och antalet förlossningar med utdrivningsskede över 1 timma. Enkätstudien till kvinnorna visar att de i stor utsträckning erhöll vård enligt den praxis som är bra och bör uppmuntras. Kvinnorna uppfattade genomgående att erhållen vård var av stor subjektiv betydelse.</p><p>Instrumentet med utgångspunkt från WHO:s rekommendationer kan användas vid kartläggning av förlossningsvård. Barnmorskor bör göra en riskbedömning vid kvinnans ankomst till förlossningen och planera vården tillsammans med kvinnan och anhöriga utifrån denna. Barnmorskors dokumentation behöver förändras för att såväl omfatta medicinsk-tekniska som mellanmänskliga aspekter. Kvinnors tillit till förlossningsvården visar på vikten av att barnmorskor erhåller kontinuerlig fortbildning i evidensbaserad vård avseende normal förlossning. Evidensbaserade nationella riktlinjer för vård vid förlossning behöver utvecklas.</p>

The dissertation deals with the infant mortality decline in Iceland during the 19th and early 20th Century. It shows that despite its low degree of urbanization, pre-transitional Iceland displayed higher infant mortality rates than most other European countries. Levels are only comparable with a few areas in Europe, all of whom were known for a tradition of artificial feeding of newborns. In the Icelandic case, infants were either not breastfed at all or were weaned at a very young age. Another characteristic of infant mortality in Iceland were huge fluctuations during epidemics. Because of the isolation of the country, several diseases that had become endemie in other societies, such as measles, became dangerous epidemics in Iceland and affected all age groups. After 1850 the effects of epidemics declined and 20 years later there was a steep decline in infant mortality. By the beginning of the 20th Century infant mortality in Iceland was lower than in most other societies. Although epidemics often had important temporary consequences upon infant mortality level in pretransitional Iceland, being breastfed or not was without doubt the most important determinant of infant survival. There were huge differences in infant mortality levels between areas where breastfeeding was common and those where newborns were artificially fed. Towards the turn of the 20th Century significant changes occurred. Even though there were still differences in infant mortality between those babies who were breastfed and those who were not, infant survival had improved greatly and survival chances of Icelandic newborns that were fed artificially became in an international perspective relatively good. Midwives played a central role in the infant mortality decline in Iceland. Growing secularization during the second part of the 19th Century improved educational opportunities for women and also changed the content of education. Improved educational opportunities were reflected in changes in the education of midwives. At the same time there was growth in the publication of books that directly dealt with the issue of infant health. The increase in the number of educated midwives was a factor of central importance. The interaction between midwives and a literate population was most likely the key to infant survival in the Nordic countries. This study shows that that the custom to breastfeed spread earlier in areas with higher literacy. Not only is it plausible that the interest in changing prevailing traditions was directly related to literaey levels of individuai mothers, it is also shown that midwives had the best education in areas where literacy rates were high. On the other hand, the remarkable improvements in infant survival obtained towards the end of the 19th Century were scarcely linked to changes in the economic structure. Those factors only started to play an important role in the 20th Century. In its initial stages, changes in infant feeding and improvements in personal hygiene were more important / digitalisering@umu

Syftet med denna uppsats är att undersöka uppfattningar om risk inom mödrahälsovården. Den behandlar hur barnmorskor och deras patienter uppfattar risk i samband med och runt en graviditet och hur de hanterar denna. En av metoderna för att hantera risk är fosterdiagnostik, vilket syftar till att finna riskgraviditeter. Fokus har främst varit på barnmorskor med frågeställningar kring hur de informerar om risk och fosterdiagnostik, hur de ger råd och hur de uppfattar den inverkan detta har på deras patienter och hur dessa reagerar. / The purpose of this thesis is to explore perceptions of risk within the maternal health care. It deals with how midwives and their patients understand risks associated with and around a pregnancy and how they handle it. One of the methods to manage risk is to use prenatal diagnosis, which aim is to identify risk pregnancies. The focus has been primarily on midwives regarding how they transfer their knowledge about risk and prenatal diagnosis to their patients, how they give advice and how they perceive the impact it has on their patients and their reactions.

The aim of this study was to investigate how midwives at youth centres relate to the potential ethical dilemma between parents’ right to information that young people between 15-17 years share at the centre, vs. youths right to integrity. The study was based on qualitative interviews with six midwives in various youth centres in Stockholm County. We analysed our empirical material according to Blennbergers consequential ethical model and Bronfenbrenners ecological system model. The empirical data was categorized based on categories of information and integrity in relation to midwives' opinions and actions. The results show that midwives are careful to protect the integrity of young people and that parents’ right to information are neglected, unless there is a great risk that the youths will harm their lives or health. Often it is only when the midwives need to report to the social service that the parents are given right to information, which indicates that the ethical decisions that midwives make are based on their beliefs that the best consequence for the youths is for their integrity to be protected. It was revealed that the midwives experienced the decision as difficult, and sometimes even found it to be a dilemma.

Background: Domestic violence is a major social problem both nationally and internationally. Around the world 35% of the women say that they have experienced physical and/or sexual violence. In most cases it is the woman's partner who subjected her to violence. Every year, 12,000 -14,000 women in Sweden seek medical help as a result of injury incurred of domestic violence. The healthcare in Sweden has a responsibility when it comes to detecting, treating and documenting, but also to prevent violence and its consequences. Aim: To examine the extent to which nurses and midwives asking women about domestic violence, barriers for asking the question and making visible steps to increase the ability to ask the question. Method: A literature review, were included articles reviewed and quality determined. Articles results were then analyzed and presented in three main themes and related sub-categories. Main results: The literature review is based on 13 pieces of scientific articles from Sweden, USA, England, Northern Ireland, Belgium, Turkey, Israel and Canada. Of the analyzed results three main themes were derived, "To question," "Obstacle" and "Opportunities". Both nurses and midwives underestimate the prevalence of domestic violence and only 50% of nurses and midwives routinely ask the question of domestic violence. However, it is common that the question is asked at times when suspicion of violence is at hand. Obstacles to not ask the question describe as lack of time, lack of knowledge and training, lack of privacy and present partners. Opportunities for routine screening of domestic violence are described to be further education and knowledge, clear policies and procedures from employers. Conclusion: The literature study results show that both nurses and midwives need to be better at routinely ask about domestic violence. This is due to more cases of violence against women coming to light and enable more people to have the opportunity to support and help. It also suggests that the greatest obstacles to ask the question are lack of knowledge, training, time and privacy. By giving healthcare professionals access to education and training in domestic violence and how to ask the question and handle the response, the authors believe that several of these obstacles can be rectified in the future. / Bakgrund: Våld i nära relation är ett stort samhällsproblem både nationellt och internationellt. Av kvinnorna runt om i världen så uppger 35 % att de någon gång har utsatts för fysiskt och/eller sexuellt våld. I de flesta fall så är det kvinnans partner som utsatt henne för våldet. Varje år tvingas 12 000 -14 000 kvinnor i Sverige att uppsöka sjukvård till följd av skador som uppstått när de utsatts för våld i nära relation. Hälso- och sjukvården har ett ansvar vad det gäller att upptäcka, behandla och dokumentera, men även att förebygga våld och dess konsekvenser.   Syfte: Att undersöka i vilken utsträckning sjuksköterskor och barnmorskor frågar kvinnor om våld i nära relation, hinder till att ställa frågan samt att synliggöra åtgärder för att öka möjligheten att ställa frågan. Metod: En litteraturstudie där inkluderade artiklar granskats och kvalitetsbestämts. Artiklarnas resultat har sedan analyserats och presenterats i 3 huvudteman med tillhörande underteman. Huvudresultat: Litteraturstudien grundar sig på 13 vetenskapliga artiklar från Sverige, USA, England, Nord Irland, Belgien, Turkiet, Israel och Kanada. Av resultatet analyserades tre huvudteman fram, “Att fråga”, “Hinder” och “Möjligheter”. Både sjuksköterskor och barnmorskor tenderar att underskatta förekomsten av våld i nära relation och cirka 50 % av sjuksköterskorna och barnmorskorna ställer rutinmässigt frågan om våld i nära relation. Det är dock vanligare att frågan ställs vid tillfällen då misstanke om våld finns. Hinder till att inte ställa frågan beskriv vara tidsbrist, bristande kunskap och utbildning, brist på avskildhet samt närvarande partner. Möjligheter till rutinmässig screening om våld i nära relation beskrivs vara vidare utbildning samt mer kunskap, tydliga riktlinjer och rutiner från arbetsgivarna. Slutsats: Litteraturstudiens resultat visar samstämmigt på att både sjuksköterskor och barnmorskor kan bli bättre på att rutinmässigt ställa frågan om våld i nära relation. Detta på grund av att fler fall av våld mot kvinnor ska uppdagas och att fler ska kunna ges möjlighet till stöd och hjälp. Det framkommer även att de största hindren till att ställa frågan är brist på kunskap, utbildning, tid och avskildhet. Genom att ge vårdpersonal möjlighet till utbildning och träning inom våld i nära relation samt hur man ställer frågan och hanterar svaret, tror författarna att flera av dessa hinder kan avhjälpas.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 5 uppsatser.