Normal birth, defined as birth without induction of labour, anaesthetic, instruments or caesarean section conveys significant maternal and neonatal benefits. Currently one-fifth of women in the United Kingdom are obese. There is increasing evidence of the detrimental effects obesity has on intrapartum outcomes. There is a lack of research on how to minimise the associated risks of obesity through non-medicalised interventions and how to support obese women to maximise their opportunity for normal birth. This thesis aims to provide evidence to address this gap and develop an evidence-based intervention to promote normal birth. Using a methodological approach aligned with pragmatism, this research was conducted in four parts and underpinned by the Medical Research Council framework for the development of complex interventions. Part one was a national survey involving 24 maternity units. Part two was a qualitative study of the experiences of 24 health professionals and part three involved 8 obese women. The final part was a multi-disciplinary workshop that used consensus decision-making to design the intervention. Collectively, the findings suggest that intrapartum care of obese women is medicalised. Health professionals face challenges when caring for obese women but many strive to optimise the potential for normal birth by challenging practice and utilising ‘interventions’ to promote normality. The findings also demonstrate that obese women have an intrinsic fear of pregnancy and birth, have a desire for normal birth and ‘obese pregnancy’ presents a window of opportunity for change. The intervention consists of three component parts; an educational aspect (e-learning package), a clinical aspect (intrapartum care pathway) and a leadership aspect (ward champions). Whilst acknowledging the importance of safety, increasing intervention during labour for obese women may further increase the risk of complications, with detrimental effects. Addressing intrapartum management of obese women through non-medicalised interventions is of paramount importance in order to promote normality, maximise the opportunity for normal birth and reduce the associated morbidities.

Abstract   Objective To study midwives' experiences of working with normal birth in multidisciplinary teams.
 Methods This was a qualitative study based on Semi-structured interviews in focusgroups with 20 midwives at four maternity wards in mid-Sweden. Results The interviews revealed a theme as The midwifery profession is both strong and torned at normal birth in hospital. The results describe that midwives are working independently and are responsible for the normal birth in multidisciplinary team. Hierarchies and relationships influence the independence of the midwives in their work with normal birth. The midwives were also using tools as risk evaluation and medical rounds to identify normal birth. There are no independent guidelines designed by midwives for the normal birth in maternity care. Heavy workload affects the midwives’ ability to work evidence-based and resulted in changes of practices in normal birth. Conclusion The midwives consider they sometimes share involuntary the responsibility in normal birth. A good cooperation and communication is important within a multidisciplinary team for the midwives to support normal birth. Keywords: collaboration, midwives, normal birth, professional responsibility / Sammanfattning                   Bakgrund Att arbeta som barnmorska i Sverige innebär att ansvara för kvinnans vård vid den normala förlossningen. När denna avviker vidtas adekvata åtgärder samt en bedömning av när samverkan krävs med andra professioner. Barnmorskans arbete och ansvar har förändrats över tid och tvärprofessionellt samarbete har växt fram som en rådande arbetsmodell inom förlossningsvården. Syfte: Att studera barnmorskors upplevelser av att handlägga normala förlossningar i tvärprofessionella arbetsgrupper. Metod: Semistrukturerade fokusgruppsintervjuer med 20 barnmorskor vid fyra olika förlossningsavdelningar i Mellansverige. Resultat: Ur fokusgruppsintervjuerna framkommer temat Barnmorskeprofessionen är både stark och söndrad vid normala sjukhusförlossningar. Resultatet visar att barnmorskorna är oftast självständigt ansvariga för den normala förlossningen i en tvärprofessionell arbetsgrupp. Hierarkier och relationer påverkar barnmorskornas självständighet vid handläggningen av den normala förlossningen. Barnmorskorna använder förutom sin professionella kunskap olika verktyg som riskevaluering och rond för att identifiera normala förlossningar. Det saknas självständigt utformade riktlinjer av barnmorskor för normal förlossning inom förlossningsvården. Hög arbetsbelastning påverkar barnmorskans möjligheter att arbeta från ett evidensbaserat perspektiv vilket resulterar i ett förändrat arbetssätt vid normal förlossning. Slutsats: Barnmorskor anser att de ibland har ett ofrivilligt delat ansvar vid normal förlossning. Ett gott samarbete och kommunikation har betydelse inom ett tvärprofessionellt team för att barnmorskan kan stödja kvinnans normala födande.   Nyckelord: barnmorskor normal förlossning, professionellt ansvar, samarbete

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.

In der Nutztierhaltung besitzt die Erkennung und Vermeidung von Geburtsstörungen beim Rind insbesondere aus ökonomischer Sicht einen hohen Stellenwert. Bei Hochleistungskühen können Schwergeburten eine erhöhte metabolische Belastung im peripartalen Zeitraum reflektieren. Besonders betroffen sind Färsen und Milchkühe mit einer negativen Energiebilanz. Hormon- und Stoffwechselfaktoren sind von zentraler Bedeutung für die Anpassung der Tiere an Veränderungen ihrer Körpermasse und -konstitution. Zur differenzierten Beurteilung metabolischer Belastungen bei Hochleistungskühen im peripartalen Zeitraum wurden mögliche Zusammenhänge zwischen Geburtsverlauf und den stoffwechselrelevanten Parametern Leptin, Insulin-like growth factor-1 (IGF-1) und freien Fettsäuren (FFS) untersucht. Die vorliegende Studie umfasste 28 adulte, hochträchtige (13 primipare, 15 pluripare) Kühe mit Normal- bzw. Schwergeburt. Die Kälber wurden analog zu ihren Müttern ebenfalls 4  Gruppen (Kuhkalb/Normalgeburt; Kuhkalb/Schwergeburt; Färsenkalb/Normalgeburt; Färsenkalb/Schwergeburt) zugeordnet. Die Analyse von Leptin, IGF-1 und FFS im Blutserum erfolgte zwischen dem 16./14. Tag ante partum (a. p.) und dem 14. Tag post partum (p. p.). Leptin und IGF-1 wurden zusätzlich bei den neugeborenen Kälbern ab der Geburt bis 14 Tage p. p. gemessen. Die Hormonkonzentrationen wurden mittels eines Enzymimmunoassays bestimmt. Die FFS-Analysen erfolgten im Labor der Medizinischen Tierklinik mit dem Labor-Automaten HITACHI 912 i (Roche Diagnostics GmbH, Mannheim). Unabhängig vom Geburtsverlauf konnten während des gesamten Untersuchungszeitraums bezüglich der Leptinkonzentrationen keine signifikanten Unterschiede zwischen Färsen und Milchkühen festgestellt werden. Vor allem zur Geburt besteht für alle Erstkalbinnen eine erhöhte metabolische Belastung, da deren IGF-1-Konzentrationen zu diesem Zeitpunkt niedriger (114 ±  40 vs. 158 ±  108 ng/ml) und deren FFS-Konzentrationen signifikant höher lagen (896 ±  273 vs. 705 ±  225 µmol/l, p = 0,05) als bei den Milchkühen. Im Vergleich zu den Kälbern von Milchkühen wiesen Kälber von Färsen 12 Stunden nach der Geburt signifikant höhere IGF-1-Werte (p = 0,05) auf. In Abhängigkeit vom Geburtsverlauf lagen die Leptinwerte bei allen Kühen mit Schwergeburt von Beginn der Untersuchungen bis einen Tag vor der Geburt niedriger als bei den Tiere mit Normalgeburt mit signifikanten Unterschieden am 13. bis 11. Tag a. p. (p = 0,009) und am 7. bis 5. Tag a. p. (p = 0,05). Während des gesamten Untersuchungszeitraums waren keine signifikanten Unterschiede in den Konzentrationen an IGF-1 und FFS zwischen allen Muttertieren mit einem normalen und einem erschwerten Geburtsverlauf festzustellen. Bei pluriparen Kühen mit Schwergeburt wurden im gesamten Untersuchungszeitraum niedrigere Leptinspiegel nachgewiesen als bei Tieren mit Normalgeburt, mit signifikanten Unterschieden a. p. und ab 3. Tag p. p. (p < 0,05 bzw. p < 0,01). Darüber hinaus fanden sich bei pluriparen Kühen mit Dystokie ab der Geburt höhere FFS-Konzentrationen mit signifikanten Unterschieden zur Kalbung (p = 0,05). Die Leptinkonzentrationen der Kälber lagen analog zu den dazugehörigen Muttertieren ab der Geburt bis 14. Tag p. p. bei allen Kälbern von pluriparen Kühen mit Schwergeburt niedriger als bei den normal geborenen Kälbern mit signifikanten Unterschieden am 7. Tag p. p. (p = 0,04). Im Vergleich zu den Färsen mit Normalgeburt hatten diejenigen mit Schwergeburt signifikant höhere Leptinwerte vom 3. bis 14. Tag p. p. (p = 0,004), signifikant niedrigere IGF-1-Konzentrationen am 10. bis 8. Tag a. p., zur Geburt und vom 3. Tag bis 14. Tag p. p. (jeweils p < 0,01) sowie postpartal niedrigere FFS-Konzentrationen mit signifikanten Unterschieden 12 Stunden p. p. (p = 0,008). Kälber von Färsen mit gestörtem Geburtsverlauf wiesen im Vergleich zu den Normalgeburtskälbern 12 Stunden nach der Geburt signifikant niedrigere IGF-1-Werte (p = 0,005) auf. Die vorliegende Studie verdeutlicht den Zusammenhang zwischen einem gestörten Geburtsablauf und veränderten Serumkonzentrationen an Leptin, IGF-1 und FFS. Damit konnte gezeigt werden, dass diese Parameter zur Interpretation von Stoffwechselstörungen bei Hochleistungskühen im peripartalen Zeitraum geeignet sind. / For livestock management, the identification and prevention of dystocia in cattle is of high significance, especially from an economic point of view. Dystocia in the high-yield cows may reflect an increased metabolic disorder during the peripartal period. Heifers and dairy cows with a negative energy balance are particularly affected. For the adaptation of animals to changes in their body mass and constitution, endocrine and metabolic factors are of central importance. To perform a differentiated assessment of metabolic disorders in high-yield cows during the peripartal period, possible relationships between calving and relevant parameters (leptin, insulin-like growth factor1 [IGF-1] and non-esterified fatty acids [NEFA]) were examined. The present study involved 28 adult high-pregnant (13 primiparous, 15 pluriparous) cows with normal birth and dystocia, respectively. Analogous to their mothers, the calves were likewise categorized into four groups (cow calve/ normal birth; cow calve/ dystocia; heifer calve/ normal birth; heifer calve/ dystocia). The analyses of leptin, IGF-1 and NEFA in blood serum were performed from 16/14 day ante-partum (a. p.) to day 14 post-partum (p. p.). Leptin and IGF-1 were additionally determined in all newborn calves from birth to 14 days p. p. Hormone concentrations were measured by enzyme immunoassay (EIA). Analyses of NEFA in dairy cows and heifers were carried out using HITACHI 912i device (Roche Diagnostics GmbH, Mannheim) at the laboratory of Large Animal Clinic for Internal Medicine. Independent of course of parturition, no significant differences between heifers and dairy cows were noticed concerning serum leptin during the entire examination period. Especially around calving time, all heifers were more intensively affected with metabolic disorders based on their lower IGF-1 values (114 ±  40 vs. 158 ±  108 ng/ml) as well as significantly higher NEFA (896 ±  273 vs. 705 ±  225 µmol/l, p = 0.05) compared to dairy cows. Calves of heifers had significantly higher IGF-1 values 12 hours after birth (p = 0.005) than calves of dairy cows. Dependent of course of parturition, all cows with dystocia displayed lower leptin concentrations from the beginning of the examination period to 1 day a. p compared to animals with normal calving with significant differences from day 13 to day 11 a. p. (p = 0.009) and from day 7 to day 5 a. p. (p = 0.05). During the entire examination period, no significant differences in the concentrations of IGF-1 and NEFA were found between all cows with a normal and difficult parturition. In pluriparous cows with difficult parturition lower leptin levels were detected during the entire examination period than in animals with normal calving with significant differences a. p. and from day 3 to day 14 p. p. (p < 0.05 and p < 0.01, respectively). Furthermore, higher NEFA concentrations were found from birth until 14 days p. p. in pluriparous cows with dystocia and significant differences at calving (p = 0.05). Calves of pluriparous cows with dystocia had p. p. lower leptin concentrations in comparison to those with normal births with significant differences on day 7 p. p. (p = 0.04). In comparison to heifers with normal birth, those with dystocia displayed significantly higher leptin levels in the period from day 3 to day 14 p. p. (p = 0.004), significantly lower IGF-1 concentrations (from day 10 to day 8 a. p., at birth and from day 3 to day 14 p. p.; each p < 0.01), as well as lower NEFA levels after birth with significant differences 12 hours p. p. (p = 0.008). Heifer calves with difficult parturition presented significantly lower IGF-1 values 12 hours p. p. (p = 0.005) in comparison to those with normal births. The present study underlines the relationship between dystocia and changed serum concentrations of leptin, IGF-1 and NEFA. In summary, it can be concluded that these parameters are suitable for interpretation of metabolic disorders in high-yielding cattle during peripartal period.

In der Nutztierhaltung besitzt die Erkennung und Vermeidung von Geburtsstörungen beim Rind insbesondere aus ökonomischer Sicht einen hohen Stellenwert. Bei Hochleistungskühen können Schwergeburten eine erhöhte metabolische Belastung im peripartalen Zeitraum reflektieren. Besonders betroffen sind Färsen und Milchkühe mit einer negativen Energiebilanz. Hormon- und Stoffwechselfaktoren sind von zentraler Bedeutung für die Anpassung der Tiere an Veränderungen ihrer Körpermasse und -konstitution. Zur differenzierten Beurteilung metabolischer Belastungen bei Hochleistungskühen im peripartalen Zeitraum wurden mögliche Zusammenhänge zwischen Geburtsverlauf und den stoffwechselrelevanten Parametern Leptin, Insulin-like growth factor-1 (IGF-1) und freien Fettsäuren (FFS) untersucht. Die vorliegende Studie umfasste 28 adulte, hochträchtige (13 primipare, 15 pluripare) Kühe mit Normal- bzw. Schwergeburt. Die Kälber wurden analog zu ihren Müttern ebenfalls 4  Gruppen (Kuhkalb/Normalgeburt; Kuhkalb/Schwergeburt; Färsenkalb/Normalgeburt; Färsenkalb/Schwergeburt) zugeordnet. Die Analyse von Leptin, IGF-1 und FFS im Blutserum erfolgte zwischen dem 16./14. Tag ante partum (a. p.) und dem 14. Tag post partum (p. p.). Leptin und IGF-1 wurden zusätzlich bei den neugeborenen Kälbern ab der Geburt bis 14 Tage p. p. gemessen. Die Hormonkonzentrationen wurden mittels eines Enzymimmunoassays bestimmt. Die FFS-Analysen erfolgten im Labor der Medizinischen Tierklinik mit dem Labor-Automaten HITACHI 912 i (Roche Diagnostics GmbH, Mannheim). Unabhängig vom Geburtsverlauf konnten während des gesamten Untersuchungszeitraums bezüglich der Leptinkonzentrationen keine signifikanten Unterschiede zwischen Färsen und Milchkühen festgestellt werden. Vor allem zur Geburt besteht für alle Erstkalbinnen eine erhöhte metabolische Belastung, da deren IGF-1-Konzentrationen zu diesem Zeitpunkt niedriger (114 ±  40 vs. 158 ± 108 ng/ml) und deren FFS-Konzentrationen signifikant höher lagen (896 ±  273 vs. 705 ±  225 µmol/l, p = 0,05) als bei den Milchkühen. Im Vergleich zu den Kälbern von Milchkühen wiesen Kälber von Färsen 12 Stunden nach der Geburt signifikant höhere IGF-1-Werte (p = 0,05) auf. In Abhängigkeit vom Geburtsverlauf lagen die Leptinwerte bei allen Kühen mit Schwergeburt von Beginn der Untersuchungen bis einen Tag vor der Geburt niedriger als bei den Tiere mit Normalgeburt mit signifikanten Unterschieden am 13. bis 11. Tag a. p. (p = 0,009) und am 7. bis 5. Tag a. p. (p = 0,05). Während des gesamten Untersuchungszeitraums waren keine signifikanten Unterschiede in den Konzentrationen an IGF-1 und FFS zwischen allen Muttertieren mit einem normalen und einem erschwerten Geburtsverlauf festzustellen. Bei pluriparen Kühen mit Schwergeburt wurden im gesamten Untersuchungszeitraum niedrigere Leptinspiegel nachgewiesen als bei Tieren mit Normalgeburt, mit signifikanten Unterschieden a. p. und ab 3. Tag p. p. (p < 0,05 bzw. p < 0,01). Darüber hinaus fanden sich bei pluriparen Kühen mit Dystokie ab der Geburt höhere FFS-Konzentrationen mit signifikanten Unterschieden zur Kalbung (p = 0,05). Die Leptinkonzentrationen der Kälber lagen analog zu den dazugehörigen Muttertieren ab der Geburt bis 14. Tag p. p. bei allen Kälbern von pluriparen Kühen mit Schwergeburt niedriger als bei den normal geborenen Kälbern mit signifikanten Unterschieden am 7. Tag p. p. (p = 0,04). Im Vergleich zu den Färsen mit Normalgeburt hatten diejenigen mit Schwergeburt signifikant höhere Leptinwerte vom 3. bis 14. Tag p. p. (p = 0,004), signifikant niedrigere IGF-1-Konzentrationen am 10. bis 8. Tag a. p., zur Geburt und vom 3. Tag bis 14. Tag p. p. (jeweils p < 0,01) sowie postpartal niedrigere FFS-Konzentrationen mit signifikanten Unterschieden 12 Stunden p. p. (p = 0,008). Kälber von Färsen mit gestörtem Geburtsverlauf wiesen im Vergleich zu den Normalgeburts-kälbern 12 Stunden nach der Geburt signifikant niedrigere IGF-1-Werte (p = 0,005) auf. Die vorliegende Studie verdeutlicht den Zusammenhang zwischen einem gestörten Geburtsablauf und veränderten Serumkonzentrationen an Leptin, IGF-1 und FFS. Damit konnte gezeigt werden, dass diese Parameter zur Interpretation von Stoff-wechselstörungen bei Hochleistungskühen im peripartalen Zeitraum geeignet sind. / For livestock management, the identification and prevention of dystocia in cattle is of high significance, especially from an economic point of view. Dystocia in the high-yield cows may reflect an increased metabolic disorder during the peripartal period. Heifers and dairy cows with a negative energy balance are particularly affected. For the adaptation of animals to changes in their body mass and constitution, endocrine and metabolic factors are of central importance. To perform a differentiated assessment of metabolic disorders in high-yield cows during the peripartal period, possible relationships between calving and relevant parameters (leptin, insulin-like growth factor1 [IGF-1] and non-esterified fatty acids [NEFA]) were examined. The present study involved 28 adult high-pregnant (13 primiparous, 15 pluriparous) cows with normal birth and dystocia, respectively. Analogous to their mothers, the calves were likewise categorized into four groups (cow calve/ normal birth; cow calve/ dystocia; heifer calve/ normal birth; heifer calve/ dystocia). The analyses of leptin, IGF-1 and NEFA in blood serum were performed from 16/14 day ante-partum (a. p.) to day 14 post-partum (p. p.). Leptin and IGF-1 were additionally determined in all newborn calves from birth to 14 days p. p. Hormone concentrations were measured by enzyme immunoassay (EIA). Analyses of NEFA in dairy cows and heifers were carried out using HITACHI 912i device (Roche Diagnostics GmbH, Mannheim) at the laboratory of Large Animal Clinic for Internal Medicine. Independent of course of parturition, no significant differences between heifers and dairy cows were noticed concerning serum leptin during the entire examination period. Especially around calving time, all heifers were more intensively affected with metabolic disorders based on their lower IGF-1 values (114 ± 40 vs. 158 ± 108 ng/ml) as well as significantly higher NEFA (896 ± 273 vs. 705 ± 225 µmol/l, p = 0.05) compared to dairy cows. Calves of heifers had significantly higher IGF-1 values 12 hours after birth (p = 0.005) than calves of dairy cows. Dependent of course of parturition, all cows with dystocia displayed lower leptin concentrations from the beginning of the examination period to 1 day a. p compared to animals with normal calving with significant differences from day 13 to day 11 a. p. (p = 0.009) and from day 7 to day 5 a. p. (p = 0.05). During the entire examination period, no significant differences in the concentrations of IGF-1 and NEFA were found between all cows with a normal and difficult parturition. In pluriparous cows with difficult parturition lower leptin levels were detected during the entire examination period than in animals with normal calving with significant differences a. p. and from day 3 to day 14 p. p. (p < 0.05 and p < 0.01, respectively). Furthermore, higher NEFA concentrations were found from birth until 14 days p. p. in pluriparous cows with dystocia and significant differences at calving (p = 0.05). Calves of pluriparous cows with dystocia had p. p. lower leptin concentrations in comparison to those with normal births with significant differences on day 7 p. p. (p = 0.04). In comparison to heifers with normal birth, those with dystocia displayed significantly higher leptin levels in the period from day 3 to day 14 p. p. (p = 0.004), significantly lower IGF-1 concentrations (from day 10 to day 8 a. p., at birth and from day 3 to day 14 p. p.; each p < 0.01), as well as lower NEFA levels after birth with significant differences 12 hours p. p. (p = 0.008). Heifer calves with difficult parturition presented significantly lower IGF-1 values 12 hours p. p. (p = 0.005) in comparison to those with normal births. The present study underlines the relationship between dystocia and changed serum concentrations of leptin, IGF-1 and NEFA. In summary, it can be concluded that these parameters are suitable for interpretation of metabolic disorders in high-yielding cattle during peripartal period.

En graviditet och förlossning är i de allra flesta fall en normal livshändelse. De senaste decennierna har andelen instrumentella- och kejsarsnittsförlossningar ökat på bekostnad av den normala förlossningen. Trots fler interventioner ses ingen skillnad i den maternella och perinatala morbiditeten och mortaliteten. I barnmorskans arbetsområde ingår att handlägga den normala graviditeten och förlossningen. Syftet med studien var att beskriva hur barnmorskan kan främja en normal förlossning. Studien genomfördes som en litteraturstudie där 13 vetenskapliga artiklar, med både kvantitativ och kvalitativ ansats, analyserades. I resultatet framkom tre kategorier som beskriver hur barnmorskan främjar normal förlossning. Barnmorskan skapar genom närhet en god relation till kvinnan och ger vägledning. Genom att använda sig själv som kunskapskälla bidrar barnmorskans sinnen, erfarenheter av tidigare förlossningar och formell kunskap till att fatta korrekta beslut. Barnmorskan stödjer och bekräftar det normala individuellt efter kvinnans behov, vilket skapar en säker miljö runt kvinnan och förhindrar onödiga interventioner. Då det råder en medicinsk kultur inom förlossningsvården, behöver barnmorskans arbete kring normal förlossning stärkas. Forskning behövs på organisationsnivå, eftersom omgivande system inverkar på barnmorskans arbete med att främja den normala förlossningen. / Pregnancy and childbirth are in most cases a normal life event. Over the past decades the rate of instrumental birth and caesarean sections has increased at the expense of normal birth. Despite more interventions no difference is seen in the maternal or perinatal morbidity or mortality. The midwife’s work encompasses the normal pregnancy and labour. The aim of this study was to describe how the midwife can promote normal birth. The study was conducted as a literature study in which 13 scientific articles, with both quantitative and qualitative approach, were analyzed. Three categories emerged that explained how the midwife promotes normal birth. The midwife creates through closeness a positive relationship to the woman and gives guidance. By using herself as a source of knowledge, the midwife’s senses, experiences from previous labours and formal knowledge, contribute to make correct decisions. The midwife supports and confirms the normalcy, from the woman’s individual needs, and thereby creates a safe environment for the woman that prevents her from unnecessary interventions. As there is a medical culture within the maternity care, the midwife’s work with normal birth needs to be strengthened. Since the organization has an impact on the midwife’s promoting work, further research is needed in this area.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T16:58:54Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_CarineRibeiroBaldicera.pdf: 2189441 bytes, checksum: fb391fd70279593cfe59814921e9092f (MD5) / Made available in DSpace on 2018-08-22T16:58:54Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_CarineRibeiroBaldicera.pdf: 2189441 bytes, checksum: fb391fd70279593cfe59814921e9092f (MD5) Previous issue date: 2017-12-18 / Introduction: the experience of gestation and birth are important moments in the life of a woman, this event is part of the reproductive life and goes far beyond its physiological aspects. Health work practices can include several technologies, among them, videos, educational video can be an example of an instrument used as a technological didactic resource. Overall objective: to elucidate the experience of childbirth through the report of women who have recently experienced the birth of a child. Specific objectives: to give voice to women about their birth experiences; build and validate a video with reports of positive and negative experiences of childbirth. Methodologi: In order to meet the first specific objective, a qualitative descriptive exploratory study was carried out between April and August 2017 with eleven women who had a normal or cesarean birth in the central region of Rio Grande do Sul. The second specific objective was of a methodological research in the month of November of 2017 with twelve specialized judges in the maternal and child area. Results: of the research data organized and codified by the content analysis resulted in three thematic axes: Childbirth as experience; Labor pains; Protective factors and measures of comfort. From the methodological research, we obtained a return of twelve instrument of evaluation of the expert judges. The Likert Scale was adapted. The video was considered valid. Thus, a documentary video validated by expert judges of the area will be made available as a product of this research process to subsidize discussions about types of birth among professionals and academics. Final considerations: The initial goal was achieved, the documentary video, elucidating the report of women about their experience of delivery, was validated, after the analysis of 12 expert judges, was obtained 90% agreement. The empowerment of pregnant women is perceived in the direction of a conscious and non-fear-based decision-making, favoring experiences of dialogue between women and professionals. / Introdução: a vivência da gestação e do nascimento são momentos marcantes na vida de uma mulher. Esse evento faz parte da vida reprodutiva e vai muito além de seus aspectos fisiológicos. As práticas de trabalho em saúde podem incluir diversas tecnologias, entre elas, vídeos. O vídeo educativo pode ser um exemplo de instrumento utilizado como recurso didático tecnológico. Objetivo geral: elucidar a experiência de parto por meio do relato de mulheres que vivenciaram o nascimento de um(a) filho(a) recentemente. Objetivos específicos: dar voz para as mulheres sobre as suas experiências de parto; construir e validar um vídeo com relatos de experiências positivas e negativas de parto. Metodologia: para alcançar o primeiro objetivo específico, foi realizada uma pesquisa exploratório-descritiva de caráter qualitativo entre abril e agosto de 2017 com onze mulheres que viveram o parto normal ou cesáreo na região central do Rio Grande do Sul. O segundo objetivo específico foi atendido por meio de uma pesquisa metodológica no mês de novembro de 2017 com doze juízes especialistas na área materno-infantil. Resultados: dos dados de pesquisa organizados e codificados pela análise de conteúdo, resultaram três eixos temáticos: Parto como experiência; As dores do parto; Fatores de proteção e medidas de conforto. Da pesquisa metodológica, obteve-se retorno de doze instrumentos de avaliação dos juízes especialistas. Fez-se uma adaptação da Escala de Likert. O vídeo foi considerado válido. Assim, será disponibilizado como produto deste processo de pesquisa, um vídeo documentário validado por juízes especialistas da área, para subsidiar discussões sobre tipos de parto entre profissionais e acadêmicos. Considerações finais: O objetivo proposto inicialmente foi alcançado, o vídeo documentário, com o relato de mulheres sobre a sua experiência de parto foi validado após análise feita por 12 juízes especialistas e foi obtido um total de 90% de concordância. No vídeo, percebe-se, por meio dos relatos, o empoderamento das gestantes no sentido de uma tomada de decisão consciente, e não pautada no medo, sobre o parto e outras questões relacionadas. Além disso, o vídeo mostra experiências de diálogo entre a mulher e os profissionais, o que pode auxiliar outras gestantes no processo de vivência da gestação e do nascimento.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T17:54:35Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AlexandreRodriguesSevero.pdf: 2176832 bytes, checksum: cb83fa1d94c7a57e1f88035744527c66 (MD5) / Made available in DSpace on 2018-08-22T17:54:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_AlexandreRodriguesSevero.pdf: 2176832 bytes, checksum: cb83fa1d94c7a57e1f88035744527c66 (MD5) Previous issue date: 2018-07-13 / The gestational period can represent a special moment in the woman's life, in which she experiences anatomical, physiological, biochemical, social and cultural changes and readaptations, as well as a process of preparation for changes and new responsibilities. However, changes caused by cesarean delivery or normal delivery may lead to tissue-level repercussions in the pelvic floor and impairment of pelvic mobility in women. Thus, Manuscript 1 aimed to perform a search in the literature on articles that deal with the relationship between natural delivery and cesarean delivery with urinary incontinence, fecal incontinence, strength and mobility of the pelvic floor. Articles published and indexed in the LILACS, Medline, PubMed, Scopus and PEDro databases were evaluated in the last ten years. Four articles were found. Two of them present a relationship between the type of delivery and the probable predisposition to the development of changes such as urinary and fecal incontinence. The other two studies report the predisposition to poor counseling on the contraction performed during the time of delivery. It is concluded that the articles presented suggest the relationship between the birth and muscle strength, pelvic floor mobility and the development of changes such as urinary and fecal incontinence. Manuscript 2 aimed to evaluate the perineal strength and pelvic mobility of primiparous women and to report them to characteristics of gestation and the way of delivery. The sample consisted of twenty-four primiparous women, over 18 years of age, who underwent cesarean delivery or normal delivery with and without episiotomy or forceps and were evaluated in the period from three to six months after gestation. The evaluations were done through evaluation form, perineometry and flexion test sitting and standing. The evaluation of muscle strength, time of contraction and pelvic mobility and their relationship with gestational and clinical variables showed that the women presented a reduction in strength and time of contraction and alteration of pelvic mobility, regardless of the way of delivery; that some clinical and gestational characteristics seem to be related to the pelvic floor musculature and pelvic mobility. It was concluded that there was a reduction in strength and time of contraction and alteration of pelvic mobility, regardless of the way of delivery. In general, some clinical and gestational characteristics seem to influence pelvic strength and mobility. Thus, early evaluation to more accurately identify the repercussions of such pathways may avoid pelvic symptoms. The product generated from the dissertation was a folder entitled: Natural Childbirth, Cesarean Delivery, repercussions on the organism, containing information pertinent to possible changes from gestation and delivery, training for perineal strengthening and postural care for prophylaxis of complications generated during childbirth, as well the puerperium. / O período gestacional pode representar um momento especial na vida da mulher, no qual ela vivencia alterações e readaptações anatômicas, fisiológicas, bioquímicas, sociais e culturais, além de um processo de preparação para as mudanças e novas responsabilidades. No entanto alterações geradas pela cesariana ou pelo parto normal podem levar a repercussões em nível tecidual no assoalho pélvico e prejudicar a mobilidade pélvica das mulheres. Assim, o estudo objetivou buscar a relação entre os tipos de vias de parto e sua influência sobre a musculatura e mobilidade pélvica de primíparas. O Manuscrito 1 teve como objetivo realizar uma busca na literatura sobre artigos que tratam da relação entre o parto natural e cesariana com incontinência urinária, incontinência anal, força e mobilidade do assoalho pélvico. Foram avaliados artigos publicados e indexados nos bancos de dados LILACS, Medline, PubMed, Scopus e PEDro, nos últimos dez anos. Como resultados foram encontrados quatro artigos. Dois deles apresentam uma relação entre o tipo de parto e a provável predisposição ao desenvolvimento de alterações como incontinência urinária e fecal. Os outros dois estudos relacionam a predisposição à uma má orientação sobre a contração realizada durante o momento do parto. Conclui-se que os artigos apresentados sugerem uma relação entre a via de parto e força muscular, mobilidade do assoalho pélvico e o desenvolvimento de alterações como incontinência urinária e fecal. O Manuscrito 2 objetivou avaliar a força perineal e a mobilidade pélvica de mulheres primíparas e relacionar com características da gestação e via de parto. A amostra foi composta por vinte e quatro mulheres primíparas, maiores de 18 anos, as quais foram submetidas a cesariana ou parto normal com/sem episiotomia ou fórceps e avaliadas no período de três a seis meses após o parto. As avaliações se deram por meio de ficha de avaliação, perineometria e teste de flexão sentado e em pé. A avaliação da força muscular, tempo de contração e mobilidade pélvica e suas relações com variáveis gestacionais e clínicas mostrou que as mulheres apresentaram redução da força e tempo de contração e alteração da mobilidade pélvica, independente da via de parto e; que algumas características clínicas e da gestação parecem estar relacionadas com a musculatura de assoalho pélvico e a mobilidade pélvica. Conclui-se que houve redução da força e tempo de contração e alteração da mobilidade pélvica, independente da via de parto. De maneira geral, algumas características clínicas e da gestação parecem influenciar a força e a mobilidade pélvica. Dessa forma, a revisão de literatura referente ao Manuscrito 1, e os dados apurados no Manuscrito 2 deram subsídios para elaboração de um produto. O produto gerado a partir da dissertação foi um folder intitulado: Parto Natural, Cesariana, repercussões sobre o organismo, contendo informações pertinentes às possíveis alterações oriundas da gestação e do parto, treino para fortalecimento perineal e para profilaxia de complicações geradas durante o parto, bem como puerpério.

In der Nutztierhaltung besitzt die Erkennung und Vermeidung von Geburtsstörungen beim Rind insbesondere aus ökonomischer Sicht einen hohen Stellenwert. Bei Hochleistungskühen können Schwergeburten eine erhöhte metabolische Belastung im peripartalen Zeitraum reflektieren. Besonders betroffen sind Färsen und Milchkühe mit einer negativen Energiebilanz. Hormon- und Stoffwechselfaktoren sind von zentraler Bedeutung für die Anpassung der Tiere an Veränderungen ihrer Körpermasse und -konstitution. Zur differenzierten Beurteilung metabolischer Belastungen bei Hochleistungskühen im peripartalen Zeitraum wurden mögliche Zusammenhänge zwischen Geburtsverlauf und den stoffwechselrelevanten Parametern Leptin, Insulin-like growth factor-1 (IGF-1) und freien Fettsäuren (FFS) untersucht. Die vorliegende Studie umfasste 28 adulte, hochträchtige (13 primipare, 15 pluripare) Kühe mit Normal- bzw. Schwergeburt. Die Kälber wurden analog zu ihren Müttern ebenfalls 4  Gruppen (Kuhkalb/Normalgeburt; Kuhkalb/Schwergeburt; Färsenkalb/Normalgeburt; Färsenkalb/Schwergeburt) zugeordnet. Die Analyse von Leptin, IGF-1 und FFS im Blutserum erfolgte zwischen dem 16./14. Tag ante partum (a. p.) und dem 14. Tag post partum (p. p.). Leptin und IGF-1 wurden zusätzlich bei den neugeborenen Kälbern ab der Geburt bis 14 Tage p. p. gemessen. Die Hormonkonzentrationen wurden mittels eines Enzymimmunoassays bestimmt. Die FFS-Analysen erfolgten im Labor der Medizinischen Tierklinik mit dem Labor-Automaten HITACHI 912 i (Roche Diagnostics GmbH, Mannheim). Unabhängig vom Geburtsverlauf konnten während des gesamten Untersuchungszeitraums bezüglich der Leptinkonzentrationen keine signifikanten Unterschiede zwischen Färsen und Milchkühen festgestellt werden. Vor allem zur Geburt besteht für alle Erstkalbinnen eine erhöhte metabolische Belastung, da deren IGF-1-Konzentrationen zu diesem Zeitpunkt niedriger (114 ±  40 vs. 158 ±  108 ng/ml) und deren FFS-Konzentrationen signifikant höher lagen (896 ±  273 vs. 705 ±  225 µmol/l, p = 0,05) als bei den Milchkühen. Im Vergleich zu den Kälbern von Milchkühen wiesen Kälber von Färsen 12 Stunden nach der Geburt signifikant höhere IGF-1-Werte (p = 0,05) auf. In Abhängigkeit vom Geburtsverlauf lagen die Leptinwerte bei allen Kühen mit Schwergeburt von Beginn der Untersuchungen bis einen Tag vor der Geburt niedriger als bei den Tiere mit Normalgeburt mit signifikanten Unterschieden am 13. bis 11. Tag a. p. (p = 0,009) und am 7. bis 5. Tag a. p. (p = 0,05). Während des gesamten Untersuchungszeitraums waren keine signifikanten Unterschiede in den Konzentrationen an IGF-1 und FFS zwischen allen Muttertieren mit einem normalen und einem erschwerten Geburtsverlauf festzustellen. Bei pluriparen Kühen mit Schwergeburt wurden im gesamten Untersuchungszeitraum niedrigere Leptinspiegel nachgewiesen als bei Tieren mit Normalgeburt, mit signifikanten Unterschieden a. p. und ab 3. Tag p. p. (p < 0,05 bzw. p < 0,01). Darüber hinaus fanden sich bei pluriparen Kühen mit Dystokie ab der Geburt höhere FFS-Konzentrationen mit signifikanten Unterschieden zur Kalbung (p = 0,05). Die Leptinkonzentrationen der Kälber lagen analog zu den dazugehörigen Muttertieren ab der Geburt bis 14. Tag p. p. bei allen Kälbern von pluriparen Kühen mit Schwergeburt niedriger als bei den normal geborenen Kälbern mit signifikanten Unterschieden am 7. Tag p. p. (p = 0,04). Im Vergleich zu den Färsen mit Normalgeburt hatten diejenigen mit Schwergeburt signifikant höhere Leptinwerte vom 3. bis 14. Tag p. p. (p = 0,004), signifikant niedrigere IGF-1-Konzentrationen am 10. bis 8. Tag a. p., zur Geburt und vom 3. Tag bis 14. Tag p. p. (jeweils p < 0,01) sowie postpartal niedrigere FFS-Konzentrationen mit signifikanten Unterschieden 12 Stunden p. p. (p = 0,008). Kälber von Färsen mit gestörtem Geburtsverlauf wiesen im Vergleich zu den Normalgeburtskälbern 12 Stunden nach der Geburt signifikant niedrigere IGF-1-Werte (p = 0,005) auf. Die vorliegende Studie verdeutlicht den Zusammenhang zwischen einem gestörten Geburtsablauf und veränderten Serumkonzentrationen an Leptin, IGF-1 und FFS. Damit konnte gezeigt werden, dass diese Parameter zur Interpretation von Stoffwechselstörungen bei Hochleistungskühen im peripartalen Zeitraum geeignet sind. / For livestock management, the identification and prevention of dystocia in cattle is of high significance, especially from an economic point of view. Dystocia in the high-yield cows may reflect an increased metabolic disorder during the peripartal period. Heifers and dairy cows with a negative energy balance are particularly affected. For the adaptation of animals to changes in their body mass and constitution, endocrine and metabolic factors are of central importance. To perform a differentiated assessment of metabolic disorders in high-yield cows during the peripartal period, possible relationships between calving and relevant parameters (leptin, insulin-like growth factor1 [IGF-1] and non-esterified fatty acids [NEFA]) were examined. The present study involved 28 adult high-pregnant (13 primiparous, 15 pluriparous) cows with normal birth and dystocia, respectively. Analogous to their mothers, the calves were likewise categorized into four groups (cow calve/ normal birth; cow calve/ dystocia; heifer calve/ normal birth; heifer calve/ dystocia). The analyses of leptin, IGF-1 and NEFA in blood serum were performed from 16/14 day ante-partum (a. p.) to day 14 post-partum (p. p.). Leptin and IGF-1 were additionally determined in all newborn calves from birth to 14 days p. p. Hormone concentrations were measured by enzyme immunoassay (EIA). Analyses of NEFA in dairy cows and heifers were carried out using HITACHI 912i device (Roche Diagnostics GmbH, Mannheim) at the laboratory of Large Animal Clinic for Internal Medicine. Independent of course of parturition, no significant differences between heifers and dairy cows were noticed concerning serum leptin during the entire examination period. Especially around calving time, all heifers were more intensively affected with metabolic disorders based on their lower IGF-1 values (114 ±  40 vs. 158 ±  108 ng/ml) as well as significantly higher NEFA (896 ±  273 vs. 705 ±  225 µmol/l, p = 0.05) compared to dairy cows. Calves of heifers had significantly higher IGF-1 values 12 hours after birth (p = 0.005) than calves of dairy cows. Dependent of course of parturition, all cows with dystocia displayed lower leptin concentrations from the beginning of the examination period to 1 day a. p compared to animals with normal calving with significant differences from day 13 to day 11 a. p. (p = 0.009) and from day 7 to day 5 a. p. (p = 0.05). During the entire examination period, no significant differences in the concentrations of IGF-1 and NEFA were found between all cows with a normal and difficult parturition. In pluriparous cows with difficult parturition lower leptin levels were detected during the entire examination period than in animals with normal calving with significant differences a. p. and from day 3 to day 14 p. p. (p < 0.05 and p < 0.01, respectively). Furthermore, higher NEFA concentrations were found from birth until 14 days p. p. in pluriparous cows with dystocia and significant differences at calving (p = 0.05). Calves of pluriparous cows with dystocia had p. p. lower leptin concentrations in comparison to those with normal births with significant differences on day 7 p. p. (p = 0.04). In comparison to heifers with normal birth, those with dystocia displayed significantly higher leptin levels in the period from day 3 to day 14 p. p. (p = 0.004), significantly lower IGF-1 concentrations (from day 10 to day 8 a. p., at birth and from day 3 to day 14 p. p.; each p < 0.01), as well as lower NEFA levels after birth with significant differences 12 hours p. p. (p = 0.008). Heifer calves with difficult parturition presented significantly lower IGF-1 values 12 hours p. p. (p = 0.005) in comparison to those with normal births. The present study underlines the relationship between dystocia and changed serum concentrations of leptin, IGF-1 and NEFA. In summary, it can be concluded that these parameters are suitable for interpretation of metabolic disorders in high-yielding cattle during peripartal period.

In der Nutztierhaltung besitzt die Erkennung und Vermeidung von Geburtsstörungen beim Rind insbesondere aus ökonomischer Sicht einen hohen Stellenwert. Bei Hochleistungskühen können Schwergeburten eine erhöhte metabolische Belastung im peripartalen Zeitraum reflektieren. Besonders betroffen sind Färsen und Milchkühe mit einer negativen Energiebilanz. Hormon- und Stoffwechselfaktoren sind von zentraler Bedeutung für die Anpassung der Tiere an Veränderungen ihrer Körpermasse und -konstitution. Zur differenzierten Beurteilung metabolischer Belastungen bei Hochleistungskühen im peripartalen Zeitraum wurden mögliche Zusammenhänge zwischen Geburtsverlauf und den stoffwechselrelevanten Parametern Leptin, Insulin-like growth factor-1 (IGF-1) und freien Fettsäuren (FFS) untersucht. Die vorliegende Studie umfasste 28 adulte, hochträchtige (13 primipare, 15 pluripare) Kühe mit Normal- bzw. Schwergeburt. Die Kälber wurden analog zu ihren Müttern ebenfalls 4  Gruppen (Kuhkalb/Normalgeburt; Kuhkalb/Schwergeburt; Färsenkalb/Normalgeburt; Färsenkalb/Schwergeburt) zugeordnet. Die Analyse von Leptin, IGF-1 und FFS im Blutserum erfolgte zwischen dem 16./14. Tag ante partum (a. p.) und dem 14. Tag post partum (p. p.). Leptin und IGF-1 wurden zusätzlich bei den neugeborenen Kälbern ab der Geburt bis 14 Tage p. p. gemessen. Die Hormonkonzentrationen wurden mittels eines Enzymimmunoassays bestimmt. Die FFS-Analysen erfolgten im Labor der Medizinischen Tierklinik mit dem Labor-Automaten HITACHI 912 i (Roche Diagnostics GmbH, Mannheim). Unabhängig vom Geburtsverlauf konnten während des gesamten Untersuchungszeitraums bezüglich der Leptinkonzentrationen keine signifikanten Unterschiede zwischen Färsen und Milchkühen festgestellt werden. Vor allem zur Geburt besteht für alle Erstkalbinnen eine erhöhte metabolische Belastung, da deren IGF-1-Konzentrationen zu diesem Zeitpunkt niedriger (114 ±  40 vs. 158 ± 108 ng/ml) und deren FFS-Konzentrationen signifikant höher lagen (896 ±  273 vs. 705 ±  225 µmol/l, p = 0,05) als bei den Milchkühen. Im Vergleich zu den Kälbern von Milchkühen wiesen Kälber von Färsen 12 Stunden nach der Geburt signifikant höhere IGF-1-Werte (p = 0,05) auf. In Abhängigkeit vom Geburtsverlauf lagen die Leptinwerte bei allen Kühen mit Schwergeburt von Beginn der Untersuchungen bis einen Tag vor der Geburt niedriger als bei den Tiere mit Normalgeburt mit signifikanten Unterschieden am 13. bis 11. Tag a. p. (p = 0,009) und am 7. bis 5. Tag a. p. (p = 0,05). Während des gesamten Untersuchungszeitraums waren keine signifikanten Unterschiede in den Konzentrationen an IGF-1 und FFS zwischen allen Muttertieren mit einem normalen und einem erschwerten Geburtsverlauf festzustellen. Bei pluriparen Kühen mit Schwergeburt wurden im gesamten Untersuchungszeitraum niedrigere Leptinspiegel nachgewiesen als bei Tieren mit Normalgeburt, mit signifikanten Unterschieden a. p. und ab 3. Tag p. p. (p < 0,05 bzw. p < 0,01). Darüber hinaus fanden sich bei pluriparen Kühen mit Dystokie ab der Geburt höhere FFS-Konzentrationen mit signifikanten Unterschieden zur Kalbung (p = 0,05). Die Leptinkonzentrationen der Kälber lagen analog zu den dazugehörigen Muttertieren ab der Geburt bis 14. Tag p. p. bei allen Kälbern von pluriparen Kühen mit Schwergeburt niedriger als bei den normal geborenen Kälbern mit signifikanten Unterschieden am 7. Tag p. p. (p = 0,04). Im Vergleich zu den Färsen mit Normalgeburt hatten diejenigen mit Schwergeburt signifikant höhere Leptinwerte vom 3. bis 14. Tag p. p. (p = 0,004), signifikant niedrigere IGF-1-Konzentrationen am 10. bis 8. Tag a. p., zur Geburt und vom 3. Tag bis 14. Tag p. p. (jeweils p < 0,01) sowie postpartal niedrigere FFS-Konzentrationen mit signifikanten Unterschieden 12 Stunden p. p. (p = 0,008). Kälber von Färsen mit gestörtem Geburtsverlauf wiesen im Vergleich zu den Normalgeburts-kälbern 12 Stunden nach der Geburt signifikant niedrigere IGF-1-Werte (p = 0,005) auf. Die vorliegende Studie verdeutlicht den Zusammenhang zwischen einem gestörten Geburtsablauf und veränderten Serumkonzentrationen an Leptin, IGF-1 und FFS. Damit konnte gezeigt werden, dass diese Parameter zur Interpretation von Stoff-wechselstörungen bei Hochleistungskühen im peripartalen Zeitraum geeignet sind. / For livestock management, the identification and prevention of dystocia in cattle is of high significance, especially from an economic point of view. Dystocia in the high-yield cows may reflect an increased metabolic disorder during the peripartal period. Heifers and dairy cows with a negative energy balance are particularly affected. For the adaptation of animals to changes in their body mass and constitution, endocrine and metabolic factors are of central importance. To perform a differentiated assessment of metabolic disorders in high-yield cows during the peripartal period, possible relationships between calving and relevant parameters (leptin, insulin-like growth factor1 [IGF-1] and non-esterified fatty acids [NEFA]) were examined. The present study involved 28 adult high-pregnant (13 primiparous, 15 pluriparous) cows with normal birth and dystocia, respectively. Analogous to their mothers, the calves were likewise categorized into four groups (cow calve/ normal birth; cow calve/ dystocia; heifer calve/ normal birth; heifer calve/ dystocia). The analyses of leptin, IGF-1 and NEFA in blood serum were performed from 16/14 day ante-partum (a. p.) to day 14 post-partum (p. p.). Leptin and IGF-1 were additionally determined in all newborn calves from birth to 14 days p. p. Hormone concentrations were measured by enzyme immunoassay (EIA). Analyses of NEFA in dairy cows and heifers were carried out using HITACHI 912i device (Roche Diagnostics GmbH, Mannheim) at the laboratory of Large Animal Clinic for Internal Medicine. Independent of course of parturition, no significant differences between heifers and dairy cows were noticed concerning serum leptin during the entire examination period. Especially around calving time, all heifers were more intensively affected with metabolic disorders based on their lower IGF-1 values (114 ± 40 vs. 158 ± 108 ng/ml) as well as significantly higher NEFA (896 ± 273 vs. 705 ± 225 µmol/l, p = 0.05) compared to dairy cows. Calves of heifers had significantly higher IGF-1 values 12 hours after birth (p = 0.005) than calves of dairy cows. Dependent of course of parturition, all cows with dystocia displayed lower leptin concentrations from the beginning of the examination period to 1 day a. p compared to animals with normal calving with significant differences from day 13 to day 11 a. p. (p = 0.009) and from day 7 to day 5 a. p. (p = 0.05). During the entire examination period, no significant differences in the concentrations of IGF-1 and NEFA were found between all cows with a normal and difficult parturition. In pluriparous cows with difficult parturition lower leptin levels were detected during the entire examination period than in animals with normal calving with significant differences a. p. and from day 3 to day 14 p. p. (p < 0.05 and p < 0.01, respectively). Furthermore, higher NEFA concentrations were found from birth until 14 days p. p. in pluriparous cows with dystocia and significant differences at calving (p = 0.05). Calves of pluriparous cows with dystocia had p. p. lower leptin concentrations in comparison to those with normal births with significant differences on day 7 p. p. (p = 0.04). In comparison to heifers with normal birth, those with dystocia displayed significantly higher leptin levels in the period from day 3 to day 14 p. p. (p = 0.004), significantly lower IGF-1 concentrations (from day 10 to day 8 a. p., at birth and from day 3 to day 14 p. p.; each p < 0.01), as well as lower NEFA levels after birth with significant differences 12 hours p. p. (p = 0.008). Heifer calves with difficult parturition presented significantly lower IGF-1 values 12 hours p. p. (p = 0.005) in comparison to those with normal births. The present study underlines the relationship between dystocia and changed serum concentrations of leptin, IGF-1 and NEFA. In summary, it can be concluded that these parameters are suitable for interpretation of metabolic disorders in high-yielding cattle during peripartal period.