<p>The overall aim of this thesis was to study knowledge, attitudes and experience of emergency contraceptive pills among women and providers.</p><p>Both quantitative and qualitative methods were used. Focus-group interviews were conducted with teenage-girls (I) and with women who had purchased ECP without prescription (IV). Self-administered waiting-room questionnaires were administered to women presenting for induced abortion in three large hospitals (II, III), and after the deregulation of ECP, a postal questionnaire was sent to pharmacy staff and nurse-midwives in three counties in mid-Sweden (V). </p><p>Overall, women showed high basic awareness of ECP although specific knowledge such as the level of effectiveness, time-frames and how the method works was lacking. Approval of the method was high and most women were positive to use the method if they needed. Contradictory views as to whether ECP undermines contraceptive behavior were expressed. As many as 43% of women requesting induced abortion had a history of one or more previous abortions. Among the abortion applicants, one out of five, 22%, had previously used ECP and 3% had used it to prevent the current pregnancy. Media and friends were the two most common sources of information on ECP. Half of the women, 52%, were positive to having ECP prescription-free. Those women who had purchased ECP in a pharmacy without prescription, appreciated this possibility, and the major benefits expressed were time saving aspects. No severe side-effects were reported. The women's experiences of interaction with pharmacy staff were both positive and negative. The importance of up-to-date information about ECP and the OTC-availability from the health care providers was emphasized. Both pharmacy staff and nurse-midwives had positive attitudes towards ECP and the OTC availability. Of pharmacy staff, 38% reported that they referred women to nurse-midwives/gynecologists for further counseling and follow-ups. The need for increased communication and collaboration between pharmacies and local family planning clinics was reported by both study groups with suggestions of regular meetings for information and discussions.</p><p>The results suggest that ECP is still underused and that more factual information is needed before the method is becoming a known, accepted and integrated back-up method to the existing family planning repertoire. Longitudinal research to assess the long-term effects of ECP is needed. </p>

The overall aim of this thesis was to study knowledge, attitudes and experience of emergency contraceptive pills among women and providers. Both quantitative and qualitative methods were used. Focus-group interviews were conducted with teenage-girls (I) and with women who had purchased ECP without prescription (IV). Self-administered waiting-room questionnaires were administered to women presenting for induced abortion in three large hospitals (II, III), and after the deregulation of ECP, a postal questionnaire was sent to pharmacy staff and nurse-midwives in three counties in mid-Sweden (V). Overall, women showed high basic awareness of ECP although specific knowledge such as the level of effectiveness, time-frames and how the method works was lacking. Approval of the method was high and most women were positive to use the method if they needed. Contradictory views as to whether ECP undermines contraceptive behavior were expressed. As many as 43% of women requesting induced abortion had a history of one or more previous abortions. Among the abortion applicants, one out of five, 22%, had previously used ECP and 3% had used it to prevent the current pregnancy. Media and friends were the two most common sources of information on ECP. Half of the women, 52%, were positive to having ECP prescription-free. Those women who had purchased ECP in a pharmacy without prescription, appreciated this possibility, and the major benefits expressed were time saving aspects. No severe side-effects were reported. The women's experiences of interaction with pharmacy staff were both positive and negative. The importance of up-to-date information about ECP and the OTC-availability from the health care providers was emphasized. Both pharmacy staff and nurse-midwives had positive attitudes towards ECP and the OTC availability. Of pharmacy staff, 38% reported that they referred women to nurse-midwives/gynecologists for further counseling and follow-ups. The need for increased communication and collaboration between pharmacies and local family planning clinics was reported by both study groups with suggestions of regular meetings for information and discussions. The results suggest that ECP is still underused and that more factual information is needed before the method is becoming a known, accepted and integrated back-up method to the existing family planning repertoire. Longitudinal research to assess the long-term effects of ECP is needed.

The United States is ranked 27th in the world for maternal mortality, yet spends twice as much on maternity care services as countries with better maternal health indicators. Stuck in a technocratic and physician-dominated maternity care system, the U.S. depends on expensive technologies to control birth out of fear of pain and litigation, costing Americans billions of dollars and depriving women of the opportunity to have a transformative birth experience. Through an analysis of the medicalization of birth and the current biomedical model in birth, in conjunction with open-ended interviews with 5 hospital midwives and 3 homebirth midwives, the benefits and challenges of incorporating a midwifery model of care into our maternity services are explored. The midwifery model emphasizes that birth is not pathology and that psychosocial factors play a large role in birth outcomes. Basing their practice on collaboration, education, and support, midwives empower women, avoid unnecessary interventions, and offer a lower cost and higher quality care alternative. The current monopoly of women’s health services by physicians is unsustainable. Incorporating midwives into the maternity care team could provide a sustainable alternative with the caliber of maternity care services that U.S. women and families deserve.

Youth centres- A qualitative study of how midwives relate to the potential ethical dilemma between youths right to integrity and parents right to information 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.

The thesis describes the development and testing of a new computer based systematic observation instrument designed to facilitate the recording and measurement of the quantity and quality of midwifery intrapartum support. The content of the systematic observation instrument, the ‘SMILI’ (Supportive Midwifery in Labour Instrument), was based on a comprehensive review of the literature. The instrument was found to be valid and reliable in a series of studies. The feasibility and usability of the SMILI was extensively tested in the clinical setting in four maternity units in Scotland, UK. One hundred and five hours of direct observation of forty nine labour episodes were undertaken by four trained midwife observers. The clinical study demonstrated that the study and the instrument were feasible, usable and successful in measuring the quantity and quality of midwifery intrapartum support. The data collected has provided significant new information about the support given by midwives in the National Health Service of Scotland, UK. Continuous one to one support was the norm, with 92% of the observed midwives in the room for more than 80% of the observation period. Emotional support, including rapport building, encouragement and praise, was the most frequently recorded category of support.

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

Bakgrund: Sexualitet är viktigt i en människas liv. I samhället finns normer och förväntningar som vi alla förväntas anpassa oss till, dessa kan påverka sexualiteten och den sexuella hälsan. Genom att beskriva hur kvinnor förhåller sig till sin sexualitet, självbild och kropp utifrån ett heteronormativt samhälle kan barnmorskor få en djupare förståelse för kvinnors livsvillkor. Syfte: Att beskriva hur kvinnor förhåller sig till sin sexualitet, självbild och kropp utifrån samhällsnormer. Metod: Metasyntes baserat på 25 artiklar med kvalitativa data inkluderades i resultatet. Analysen gjordes genom metaetnografi. Resultat: Kvinnorna anpassade sig och var flexibla utifrån rådande samhällsnormer genom att de omfördelar makt i relationen, hanterar bristande utbildning och tabun, anpassar sig efter rådande könsroller samt strävar efter att uppfylla ideal. Dessa presenteras som de fyra huvudkategorierna i resultatet. Slutsats: Kvinnor formar sin sexualitet, självbild och kropp utifrån samhällsnormer och rådande maktstrukturer. De anpassar sig och är flexibla vilket påverkar deras självbild och sexuella hälsa. Självbilden och den sexuella hälsan utmärks av en begränsad makt att forma sitt eget liv. Kvinnor behöver medvetandegöras om denna situation för att få handlingskraft att värna om jämställdhet i sina egna liv och för att kunna verka för jämställdhet i samhället. Klinisk tillämpbarhet: Barnmorskor som yrkesgrupp kan stödja kvinnor i alla åldrar att bejaka sin sexualitet och se det fina i sina kroppar. Att inkludera barnmorskan och hens kompetens i skolans sexualundervisning; i samtal om lust, kroppsacceptans och samtycke, skulle kunna bidra till en förbättrad sexuell hälsa för unga kvinnor. Då barnmorskan i sitt arbete dagligen möter kvinnor som på olika sätt försöker förhålla sig till samhällsnormer och förväntningar kan denna metasyntes vara till hjälp i reflektion över barnmorskans värderingar kring jämställdhet och bemötande av kvinnor i olika livssituationer. / Background: Sexuality is important in a person's life. In our society there are norms and expectations that we all are expected to adapt to; these can affect sexuality and sexual health. To describe how women relate to their sexuality, self-image and body from a heteronormative society can give midwives a deeper understanding of women´s living conditions. Aim: To describe how women relate to their sexuality, self-image and body based on norms of society. Method: Meta-synthesis including qualitative data from 25 articles were included in the result. The analysis was done by meta-ethnography. Result: The women adapted and were flexible based on prevailing norms of society by redistributing power in the relationship, coping with lack of education and taboos, adapting to existing gender roles, and striving to fulfill ideals. These are presented as the four main categories in the result. Conclusion: Women shape their sexuality, self-image and body based on social norms and prevailing power structures. They adapt and are flexible, which affect their self-image and sexual health. The self-image and sexual health are characterized by a limited power to shape their own lives. Women need awareness of this situation in order to have the power to protect equality in their own lives and to promote equality in society. Clinical implication: Midwives as a professional group can support women of all ages to embrace their sexuality and see the beauty of their bodies. Inclusion of midwives in school sexual education; In conversation about lust, body acceptance and consent, could help improve sexual health for young women. When the midwife in her daily work meets women, who try to comply with social norms and expectations in different ways, this meta-synthesis can help in reflection on the midwifery's values about gender equality and the treatment of women in different life situations.

The World Health Organization (WHO) recommends that of all the live births per year no more than 10-15% of these should be delivered by caesarean section. Despite this recommendation there has been a global increase in the percentage of caesarean section deliveries over the past few decades. In South Africa the percentage is as high as 70% in certain health care institutions which is of concern to midwives. Caesarean section deliveries are needed when the life of the baby, mother or both are at stake. However, this method of delivery bears more disadvantages than advantages to the baby and mother. Despite these disadvantages, some women request a caesarean section in their birth plans while others are influenced by health professionals to request a caesarean section. Therefore, there is a need for labouring women to be guided where possible to have vaginal birth because of its many advantages. This study sought to explore and describe the perceptions of the midwives regarding their role in facilitating the choice of delivery mode for labouring women in public hospitals and midwifery obstetric units (MOUs) of the Nelson Mandela Bay and Sarah Baartman districts. Based on the results of the study, guidelines for midwives in this role were developed. Maputle’sWoman-Centred Childbirth Model (2010) was used as the theoretical lens through which this study was viewed. The researcher selected a quantitative survey design using an explorative, descriptive and contextual research approach. The population consisted of midwives who were working in labour wards at public hospitals and midwife-led MOUs. A non-probability convenience sample was used to collect data using a structured, self-administered questionnaire. The reliability and validity of the data collection instrument were ensured by using various means including a pre-test and an expert panel. Altogether, 300 questionnaires were distributed and 288 were returned. This number excluded the pilot study. Data was collected over a period of three months using the assistance of two fieldworkers. Data was captured and analysed under the supervision of the statistician and supervisors. Analysis was done by means of descriptive analyses that involved the production of frequencies and presented using charts, figures and tables. The major findings of the study are: -The midwives perceived themselves as the main facilitators of a suitable decision by the labouring woman for a safe delivery method - The midwives emphasised the importance of the delivery position preferred by the labouring woman -The midwives indicated that a collaboration between doctors, senior midwives, midwives and midwives in management positions could assist with a decision for a suitable delivery mode option. -The midwives agreed that the culture of the labouring woman should be considered when deciding on a delivery mode and therefore midwifery curriculum should include lessons about cultural diversity. Three principal guidelines were developed, namely: 1. Create an environment that promotes acceptance of a woman’s choice of a delivery mode. 2. Create an environment promoting a collaborative health care relationship 3. Create an environment that is sensitive to cultural needs in the maternity unit Ethical considerations in this study were upheld by maintaining the principles of beneficence, maleficence, autonomy and justice.

During the spring of 2014 two midwives in Sweden were denied work because they refused to perform abortion on the grounds of their religious beliefs. Shortly after the health authorities were sued for discrimination. The purpose of this study is to examine whether there should be room for exemptions based on one’s conscience in a neutral liberal state. This essay applies Cécile Labordes theory of individual exceptions and liberal justices on the midwives’ case in Sweden to perform this purpose. Should, or could, they have been exempted from performing abortion and thus be allowed to work as midwives? This essay’s analysis demonstrates that the current case is not compatible with justice and there is thus no room for exemptions on a national level. However, there should be space for exemptions for cases that are compatible with justice, in order for all citizens in a pluralistic society to live in accordance with their own conception of the good.

A deductive, descriptive, quanitative study was undertaken at Nyangabgwe Hospital, Francistown, Botswana, situated in the north east of the country. Its focus was on the use of partogram by midwives. The population consisted of 395 obstetric records for the period of one month. A sample of 303 obstetrics records was drawn. Data were collected through auditing the bed letters of delivered mothers and interviews with and observation of midwives using the partogram in practice. The Statistical Package for Social Sciences (SPSS) program was used to analyse the data. The findings indicate that there are problems regarding, and factors that can have a negative influence on the use of the partogram by midwives. It is suggested that a supportive teaching programme for the midwives should be designed, that will support the system of supervision in the labour ward that already exists, in the use of the partogram throughout the labour process. / Health Studies / M.A. (Advanced Nursing Sciences)