Maternal deaths in Ethiopia are mainly due to complications of pregnancy and delivery. The socio-cultural contexts under which these pregnancies and deliveries occur that pave the way for these complications and mortality. In Ethiopia, the maternal mortality ratio had been 353/100,000 live births in 2015. Therefore, the purposes of this study were to examine, and describe the socio-cultural determinants and missed opportunities of maternal health care in Eastern Ethiopia. The study was conducted in selected districts of Grawa, Chelenko and Haramaya Woreda, East Hararghe, Oromia National Regional State, Ethiopia. A community-based survey involving pregnant women in their third trimester and women who gave birth in the last five years, husbands, mothers-in-law, sisters-in-law, health workers, religious and community leaders were conducted between September up to December 2017. A systematic sampling technique was used to get a total of 422 study participants for quantitative and 24 FGD participants to qualitative study were adopted using triangulation of data collection. Pre-tested and structured questionnaire was used to collect relevant data. The main instrument used for quantitative data collection was the structured questionnaire, specifically in-depth interview methods. Bivariate and Multivariate data analysis were performed using SPSS version 25.0 and focus group discussion (FGD) was used to collect qualitative information and the information was analysed using thematic analysis method based on Atlas.ti version 8.2 statistical software packages. The study revealed that among 359 (85%) pregnant women who planned for ANC visit, 16 (4.5%) received ANC four or more times during their last pregnancies, the respondents (81.3%) claimed that they were taken care of by skilled delivery attendant during delivery, 18.5% of them said that they delivered at home and 71.1% of them received medical care after delivery (missed opportunity). Women in the age group 15-24 years [AOR: 1.18, 95%CI: 1.18 (0.37, 3.74)], primary school [AOR: 4.09, 95%CI: 4.09(0.96, 15.50)], women intended their last pregnancy [AOR: 3.1, 95% CI: 0.32(0.11, 0.94)], and women living in urban residences [AOR: 1.2, 95%CI: 0.86(0.25, 2.95)] were significant predictors of unplanned home delivery. For optimal and effective interventions of maternal health services utilization, provisions should be made for better women‘s education, family planning, community-based health insurance, health facilities access, job opportunity and women empowerment; provisions should also be made for creating income generating activities to women. Strengthening village women‘s army wing, refreshing and enabling health extension workers and traditional birth attendants. What is more, optimal measures should be taken to discourage traditional practices such as female genital mutilation, polygamy, violence against women and teenage marriage. Finally, free maternal and child health services should be advocated for so that the gap in maternal healthcare services is bridged. / Health Studies / D. Litt. et Phil. (Health Studies)

Bakgrund: Kvinnors behov av modern familjeplanering är inte tillgodosett. Samhällsekonomiska vinster finns att hämta om fler använder långverkande reversibla preventivmedel (LARC), i stället för mindre effektiva kortverkande metoder. Det finns ett behov av förbättrade arbetssätt för att kvinnor genom ett välinformerat beslut ska kunna välja effektiva preventivmedel. Syfte: Att undersöka om reproduktiv anamnes och sociodemografiska faktorer har en inverkan på valet av LARC vid strukturerad respektive sedvanlig preventivmedelsrådgivning, bland ungdomar och unga vuxna (18–24 år) på ungdomsmottagningar i Stockholmsregionen. Metod: Kvantitativ ansats. Klusterrandomiserad studie och substudie av LOWE-studien. Resultat: Planerad användning av LARC innan besöket (OR 45.78, 95% CI 23,54–89,02) och strukturerad preventivmedelsrådgivning (intervention) (OR 3,67, 95% CI 2,24–5,97) var de variabler som visade sig vara påverka valet av LARC. Slutsats: En trolig anledning till att sociodemografiska faktorer och reproduktiv anamnes inte påverkar valet av LARC i denna studie kan vara att preventivmedelsanvändning är ett mer komplext område. Den information som ges vid preventivmedelsrådgivning har en inverkan på majoriteten av alla patienter, men rådande samhällsnormer styr valet av preventivmedel tillsammans med paradigmskiften inom SRHR. Klinisk tillämpbarhet: Resultatet var av klinisk signifikans för vårdpersonal på ungdomsmottagningar och kan kliniskt tillämpas för en fördjupad kunskap kring bidragande faktorer för valet av LARC. / Background: Women’s need for modern family planning is not met. Socioeconomic benefits can be obtained if less-safe methods are replaced by long-acting reversible contraceptives (LARC). There is a need for improvement within the work to enable women to choose effective contraceptives by a well-informed decision. Aim: To investigate if reproductive history and socioeconomic factors have an impact on the choice of LARC under the influence of customary and structured contraceptive counselling, among adolescents and young adults (18-24) at youth clinics in Stockholm, Sweden. Method: Quantitative method. Cluster randomized controlled intervention study, and a substudy of LOWE. Result: Planned use of LARC before the visit (OR 45.78, 95% CI 23,54–89,02) and structured contraceptive counselling (intervention) (OR 3,67, 95% CI 2,24–5,97) was the variables that influenced the choice of LARC. Conclusion: A likely reason why sociodemographic factors and reproductive history did not influence the choice of LARC, could be that contraceptive use is a part of a more complex context. The information provided in contraceptive counselling has an influence on the majority of all patients, but current societal norms control the choice of contraception, as well as paradigm shifts within SRHR. External validity: The result was of clinical significance for staff at youth clinics and can be clinically applied for in-depth knowledge of influencing factors for the choice of LARC.

I Sverige föds ungefär 440 barn döda varje år. Intrauterin fosterdöd kan beskrivas som en stilla födsel och definieras som framfödande av barn som saknar livstecken efter 22 fullgångna graviditetsveckor. En förlossning av ett dödfött barn sker på liknande sätt som en förlossning med ett levande barn. Skillnaden är att fosterhjärtljuden inte behöver övervakas eller registreras. Modern som genomgår förlossningen kan då istället få all uppmärksamhet. Att få ett dödfött barn tillhör inte en vanlig livserfarenhet och innebär en chock för föräldrarna. Intrauterin fosterdöd kan orsaka kraftiga psykiska besvär hos modern. En majoritet har planerat månader och ibland år i förväg för hur livet med ett barn kommer att bli och när barnet sedan dör intrauterint rasar hela deras värld. Sorgen efter ett barn som får en stilla födsel beskrivs som långvarig och djup, speciellt för modern som bär barnet i sin kropp.   Syftet med föreliggande litteraturöversikt var att belysa moderns psykiska hälsa efter att hon mist sitt barn intrauterint.   För att på lämpligt sätt besvara föreliggande studies syfte valdes en litteraturöversikt som metod. Databassökningar gjordes via PubMed, CINAHL och PsychINFO. Resultatet av sökningarna medförde att 18 vetenskapliga artiklar inkluderades. Artiklarna var publicerade från år 2008 till och med år 2018 och både artiklar med kvalitativ och kvantitativ ansats inkluderades i studien. Vetenskaplig kvalitetsgranskning och klassificering genomfördes utifrån Sophiahemmet Högskolas utarbetade bedömningsunderlag. Resultatet framtogs genom integrerad analys av innehåll.   I resultatet framkom det att modern kan drabbas av olika psykiska besvär med varierande svårighetsgrad efter att hon mist sitt barn intrauterint. Ångest, depression, oro, tvångstankar, posttraumatiskt stressyndrom och självmordstankar förekommer. Besvären kan finnas kvar lång tid efter dödfödseln. Känslor av tomhet, olust och skuld beskrevs hos ett flertal mödrar samt skillnader i hur samhället betraktade dem på grund av socioekonomisk och kulturell status. Genom att få stöd från sjukvården och barnmorskor kunde symtomen och besvären minska. Att samla minnen, hålla i barnet, utföra ritualer, mindfulness, stödsamtal eller psykoterapi ledde till att besvären kunde minska.   Slutsatsen som framkommit från föreliggande litteraturöversikt är att den psykiska hälsan hos modern kunde påverkas negativt av den kris som en intrauterin fosterdöd innebär. Hur svåra och långvariga besvären blev var beroende av tillgängligheten och kvaliteten på generellt stöd samt vårdinsatser. / In Sweden, approximately 440 children are stillborn every year. Intrauterine fetal death is sometimes described as a still birth and is defined as the birth of a child who has shown no sign of life after 22 completed pregnancy weeks. The birth of a stillborn child is similar to the birth of a living child. The difference is that the fetal heartbeat does not need to be monitored or recorded. Full attention can be directed at the mother giving birth. Giving birth to a stillborn child is not a normal life experience and is a shock for the parents. Intrauterine fetal death can cause the mother severe mental disorders. A majority has planned months and sometimes years in advance for how life with a child will be and when the child then dies their entire world crumbles. Grieving for a child who is stillborn is described as long lasting and deep, especially for the mother who carried the child in her body.   The aim of this literature review was to illuminate the mother's mental health after she has lost her baby intrauterine.      In order to adequately respond to the purpose of the study, a literature review was chosen as a method. Database searches were made through PubMed, CINAHL and PsychINFO. The result of the searches led to the inclusion of 18 scientific articles. The articles were published from year 2008 to 2018 and both qualitative and quantitative articles were included in the study. Scientific quality review and classification was implemented in the foundation of the Sophiahemmet University Hospital. The result was developed through integrated content analysis.   From the result it emerged that the mother could suffer from various mental disorders with varying degrees of difficulties after she has lost her child intrauterine. Anxiety, depression, worrying, obsessive thoughts, post-traumatic stress disorder and suicidal thoughts occur. The discomfort can last long after the birth of a stillborn child. Feelings of emptiness, unrest and guilt were shown by a number of mothers as well as differences in how society saw them based on their socio-economic and cultural status. By receiving support from health care staff and midwives, the symptoms and disorders could be reduced. Collecting memories, holding the child, performing rituals, mindfulness, counseling or psychotherapy could also lead to reduced symptoms.   The conclusion from the literature review is that the mental health of the mother was adversely affected by the crisis that an intrauterine fetal death implies. How severe and long-lasting problems became, depended on availability and quality of general support and efforts from the healthcare system.

No description available.

Bakgrund: Antalet induktioner ökar ständigt och i dagsläget sker de vanligen på sjukhus. På senare tid har intresset ökat för att induceras i hemmet, vilket flera andra länder har som etablerat arbetssätt. Flera kliniker i Sverige kan idag erbjuda kvinnor heminduktion. Detta är ett relativt nytt arbetssätt för barnmorskor i Sverige, där begränsat med kunskap om deras erfarenheter och inställning till heminduktioner saknas. Syfte: Att beskriva barnmorskors erfarenhet och inställning till heminduktion. Metod: Kvalitativ design med induktiv ansats baserad på nio enskilda intervjuer. En kvalitativ innehållsanalys valdes som analysmetod. Resultat: Analysen frambringade fyra kategorier med tre till fyra underkategorier vardera. Kategorierna är; Framgångsfaktorer vid heminduktion, Främja det normala vid heminduktion, Barnmorskors erfarenhet av hur heminduktion kan gynna den födande kvinnan och Utmaningar med heminduktion. Resultatet visade att barnmorskorna ansåg att heminduktion bör erbjudas som standardmetod vid normal graviditet då det kan främja det normala. Heminduktioner kan bidra till färre interventioner än vid induktion på sjukhus och stärker kvinnors egenmakt. Barnmorskorna menar att ett nytt arbetssätt kan vara utmanande, men att erfarenhet ger trygghet på sikt. Slutsats: När en kvinna med lågriskgraviditet behöver induceras är heminduktion, i samråd med kvinnan, att föredra. Genom heminduktion kan det normala bevaras med kvinnocentrerad vård i fokus. Det nya arbetssättet är samtidigt en utmaning där det skapar osäkerhet och kan vara en påfrestning organisatoriskt. Heminduktion kan vara bra för flera, men inte för alla. / Background: The number of inductions is constantly increasing and nowadays they usually take place in hospitals. In recent times interest has increased in being induced at home, which several other countries have as an established working method. Several clinics in Sweden can today offer women outpatient induction of labour, which is a relatively new way of working for midwives in Sweden and there is a lack of sufficient knowledge about their experiences and attitudes towards outpatient induction of labour. Purpose: To describe midwives' experience and attitude towards outpatient induction of labour. Method: A qualitative design with an inductive approach based on nine interviews. A qualitative content analysis was chosen as the analysis method. Result: The analysis produced four categories with three to four subcategories each. The categories are; Success factors in outpatient induction of labour, Promoting normality in home induction, Midwives' experience of how outpatient induction of labour can benefit the laboring woman and Challenges in outpatient induction of labour. The results of the study showed that the midwives believed that outpatient induction of labour should be offered as a standard method in normal pregnancy because it can promote the normal. Outpatient induction of labour can contribute to fewer interventions and strengthen women's empowerment. Midwives believe that a new way of working can create challenges, but that experience provides security in the long term. Conclusion: When a woman with a low-risk pregnancy needs to be induced, outpatient induction of labour is preferred, in consultation with the woman. Through outpatient induction of labour, the normal can be preserved with women-centered care in focus. At the same time, the new way of working is a challenge as it creates uncertainty and can be an organizational strain. Outpatient induction of labour is good for some, but not for all.

Det emotionella arbetet vid intrauterin fosterdöd - barnmorskors erfarenheter av att bistå föräldrar under hela förlossningsprocessen Abstrakt Bakgrund: Intrauterin fosterdöd (IUFD) förekommer runt om i hela världen och närmare två miljoner barn föds fram döda varje år. Rökning, högt BMI samt tillväxthämning hos barnet är några av de kända riskfaktorerna kopplat till IUFD och prevalensen av dödfödda barn är högre i låginkomstländer jämfört med höginkomstländer. Barnmorskor bär en viktig roll i mötet med IUFD där deras uppgift dels är att stötta och tillgodose föräldrarnas behov, vilket ställer stora krav på deras emotionella arbete.   Motiv: Att möta föräldrar vars barn har dött intrauterint kan vara ett av de tuffaste möten en barnmorska ställs inför. Det finns få studier i Sverige om barnmorskors erfarenheter i mötet med IUFD, därför är det relevant att fördjupa kunskapen inom ämnet. Syfte: Syftet var att belysa barnmorskors känslor och erfarenheter av att bistå föräldrar innan, under samt efter förlossningen vid intrauterin fosterdöd. Metod: En kvalitativ metod med semistrukturerade intervjuer tillämpades för att besvara syftet med studien. Sju barnmorskor intervjuades och intervjuerna transkriberades ordagrant och analyserades med inspiration av klassisk grundad teori.    Resultat: Det teoretiska perspektivet emotionellt arbete bidrog till framväxten av kärnkategorin: Barnmorskors emotionella arbete i interaktionen med föräldrar vid intrauterin fosterdöd, tre kategorier: Att vara fyren i stormen; En känslomässig berg-och-dalbana; Kunskap och stöd – intrauterin fosterdöd, en del av professionen, samt åtta underkategorier.  Konklusion: Barnmorskors emotionella arbete i interaktionen med föräldrar vid IUFD belyser det känslomässiga engagemanget som krävs från barnmorskorna, vilket resulterar i att många känner sig emotionellt dränerade. I denna studie tydliggörs förståelsen för den känslomässiga påfrestning och behovet av professionellt stöd som barnmorskor upplever vid IUFD. / The emotional work of intrauterin fetal death - midwives' experiences of assisting parents throughout the birth process Abstract Background: Intrauterin fetal death (IUFD) occurs all around the world and approximately two million babies are stillborn every year. Smoking, high Body Mass Index (BMI) and fetal growth retardation are some of the well-known risk factors associated with stillbirth and the prevalence of stillborn babies are higher in low-income countries compared to high-income countries. Midwives play an important role when meeting IUFD, where their tasks are partly to support and meet the parents’ needs, which places great demands on their emotional work.  Motive: Meeting parents whose babies have died in the uterus can be one of the toughest encounters a midwife faces. There are few studies in Sweden about midwives' experiences in meeting with IUFD, therefore it is relevant to deepen the knowledge about the topic. Aim: The aim was to explore midwives' emotions and experiences of assisting parents before, during and after childbirth in case of intrauterine fetal death. Methods: A qualitative method with semi-structured interviews was applied to answer the purpose of the study. Seven midwives were interviewed and the interviews were transcribed verbatim and analyzed with inspiration from classical grounded theory. Result: The theoretical perspective of emotional labor contributed to the emergence of the core category: Midwives' emotional labor in the interaction with parents at intrauterine fetal death, three categories: Being the lighthouse in the storm; An emotional roller coaster; Knowledge and support – intrauterine fetal death, a part of the profession, as well as eight subcategories. Conclusion: Midwives' emotional labor in interacting with parents at IUFD highlights the emotional commitment required from midwives, resulting in many feeling emotionally drained. This study clarifies the understanding of the emotional strain and the need of professional support for midwives who have taken care of parents experiencing an IUFD.

Aim: Inform of the experiences of midwives in providing care for women undergoing second-trimester abortions. Method: A qualitative approach was employed, utilizing a web-based survey distributed within Facebook-groups dedicated to midwifery. This survey comprised of multiple-choice questions, dictum questions and with open ended questions. Participants were also given the opportunity to provide detailed responses following each question. Data analysis was conducted using qualitative content analysis. Results: Findings underscore the critical role of midwives in providing essential support throughout the abortion process, highlighting abortion as a fundamental human right. Midwives emphasize the importance of respecting women’s decisions and providing personalized care despite challenges such as limited resources and societal stigma. Improvements in abortion care are needed, including access to pain relief and post-abortion support. Midwives advocate for enhanced education and resources to reduce stigma and ensure every woman receives the care she deserves. Conclusion: Engaging in abortion care as a midwife is viewed positively, offering purpose and empowerment. Challenges such as resource limitations and difficulty in managing pain can lead to feelings of inadequacy. There’s a call for prioritizing these patients and improving abortion care through better pain relief, education, and practical changes. / Syfte: Belysa barnmorskors erfarenheter av att vårda kvinnor som genomgår abort i andra trimestern. Metod: Kvalitativ metod med induktiv ansats. Webbaserad enkät distribuerades inom Facebook-grupper dedikerade barnmorskeprofessionen. Enkäten bestod av flervalsfrågor, dikotoma frågor och öppna frågor. Deltagarna gavs möjlighet att ge ett mer utförligt svar efter varje fråga. Resultat: Framhäver barnmorskans avgörande roll i att tillhandahålla väsentligt stöd genom hela abortprocessen och barnmorskorna understryker abort som en grundläggande mänsklig rättighet. Barnmorskor betonar vikten av att respektera kvinnors beslut och tillhandahålla individanpassad vård trots utmaningar såsom begränsade resurser och samhällets stigmatisering. Förbättringar inom abortvården behövs, som bättre smärtlindring och stöd efter aborten. Barnmorskor förespråkar ökad utbildning och mer resurser, och minskad stigmatisering för att säkerställa att varje kvinna erhåller den vård som behövs. Slutsats: Att vara engagerad i abortvård som barnmorska ses som positivt och ger en känsla av att vara behövd och göra skillnad. Utmaningar ses som resursbegränsningar och svårighet till optimal smärtlindring, vilket kan leda till känslor av otillräcklighet.

The purpose of midwifery nursing education is to prepare midwives who are fully qualified to provide high-quality, evidence-based mother and child health care services. A quantitative descriptive explorative design was used to identify and explore midwifery students’ experiences of clinical teaching at Sovenga Campus, (Limpopo College of Nursing), Limpopo province. Structured questionnaires were used to collect data. The research sample consisted of fifty (50) midwifery students from Sovenga Campus. Ethical principles were adhered to. Validity and reliability were maintained. The findings showed that learning opportunities are being utilised and clinical accompaniment by tutors has improved. The findings indicated that clinical teaching in midwifery units does not include implementation of the maternity guidelines and protocols’ being used .A recommendation was that tutors be included in student orientation and the planning of monthly unit in-service programmes. / Health Studies / M.A. (Nursing Science)

In Uganda, there are an estimated 200,000 women suffering from obstetric fistula, with 1,900 new cases expected annually. These figures, combined with a persistently high maternal mortality rate, have led to an international discourse that claims the solution to improving maternal health outcomes is facility-based delivery with a skilled birth attendant. In accord with this discourse, the Ugandan government criminalized traditional birth attendants in 2010. In this study, I examine the lived experience of traditional birth attendants and women who have suffered from an obstetric fistula in eastern Uganda. Using data collected from open-ended, semi-structured interviews, focus groups, and participant-observation, I describe the biocultural determinants of obstetric fistula. Based on findings, I argue that although emergency obstetric care is critical to prevent obstetric fistula in cases of obstructed labor, the criminalization of the locally constructed system of care, TBAs, serves as yet another layer of structural violence in the lives of rural, poor women. Results demonstrate how political-economic and cultural determinants of obstetric fistula are minimized in favor of a Western prescribed, bio-medical solution, which is heavily resource dependent. This solution is promoted through a political economy of hope fueled by the obstetric imaginary, or the enthusiastic belief in Western-style biomedical obstetric care’s ability to deliver positive health outcomes for women and infants regardless of local context and constraints. Recommendations include increased obstetric fistula treatment facilities with improved communication from medical staff, decriminalization of traditional birth attendants and renewed training programs, and engaging local populations in maternal health discourse to ensure culturally competent programs. / Graduation date: 2013

Midwifery is the backbone of women and child healthcare. The shortage of staff in maternity units is a crisis faced by many countries worldwide, including South Africa. This study aims to investigate and explore the perceptions of midwives on the shortage and retention of staff in a public institution. An explorative, descriptive generic qualitative design method was followed. Non-probability, purposive sampling technique was used. The study was conducted at one tertiary hospital in the district of Tshwane, Gauteng Province. A total of 11 midwives were interviewed. Thematic coding analysis was followed in analysing data. Midwives are passionate about their job, despite the hurdles related to their day-to-day work environment. They are demoralised by a chronic shortage of staff, and feel overworked. Staff involvement in decision-making processes is a motivational factor for midwives to stay in the profession. / Health Studies / M.A. (Public Health)