Orientadores: Maria Jose Duarte Osis, Jose Guilherme Cecatti / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-11-09T13:11:41Z (GMT). No. of bitstreams: 1 Carvalho_LuizEduardoCamposde_D.pdf: 1884973 bytes, checksum: 0dd23b132c19d4cdd493dad5c85f2eb0 (MD5) Previous issue date: 2007 / Resumo: O objetivo desta pesquisa foi investigar as condições em que está sendo atendida a demanda pela esterilização cirúrgica voluntária na rede pública de saúde dos dezenove municípios da Região Metropolitana de Campinas, e avaliar a opinião de gestores, provedores e usuárias quanto à adequação do atendimento à Lei de Planejamento Familiar. Foi realizado um estudo descritivo com dois componentes: quantitativo e qualitativo. No componente quantitativo foi realizado um estudo de corte transversal, com 398 mulheres residentes na RMC, entrevistadas em seus domicílios, selecionadas em ruas previamente sorteadas através de uma amostragem sistemática e eqüiprobabilística; 15 gestores municipais da área de planejamento familiar e 15 coordenadores de unidades básicas de saúde. Utilizaram-se questionários estruturados e pré-testados. Para a parte qualitativa foram escolhidos propositadamente quatro municípios da RMC. Foram realizadas 28 entrevistas semi-estruturadas com coordenadores (as) de centros de referência (CR) e/ou ambulatórios de planejamento familiar (APF), e com profissionais diretamente envolvidos no processo de atendimento às solicitações de esterilização. Os dados quantitativos foram duplamente digitados, por pessoas distintas, utilizando-se o software Sphinx Léxica. Quanto às entrevistas semi-estruturadas, foram transcritas, e o texto correspondente a cada entrevista inserido no computador utilizando-se o software The Ethnograph V. 5.0. Não houve diferenças significativas quanto às características das mulheres e homens esterilizados antes e depois da regulamentação legal. A partir de 1998, a maior parte das laqueaduras continuou a ser realizada no momento de uma cesárea; o pagamento ¿por fora¿ diminuiu, porém a diferença não foi significativa. O tempo mínimo de espera para a laqueadura foi de seis meses, entretanto, este foi o tempo máximo de espera para a vasectomia. Oito municípios referiram realizar a laqueadura e nove a vasectomia. A informação de cerca da metade dos municípios foi de seguir os critérios estabelecidos pela lei de planejamento familiar. Em três dos quatro municípios avaliados pela parte qualitativa, o atendimento era centralizado em CR/APF, onde se avaliava se eram atendidos os critérios legais para autorizar a cirurgia, ministravam-se atividades educativas e se providenciava o agendamento da cirurgia nos serviços credenciados. A principal crítica à atual legislação referiu-se à proibição de realizar a laqueadura no momento do parto, considerada como forma de penalização às mulheres que só têm partos vaginais. Havia demanda reprimida, gerada pelo tempo de espera para realizar as cirurgias, mas também pela dificuldade de agendamento de consultas nos CR/APF. Essas dificuldades foram atribuídas à falta de estrutura física e de recursos humanos para realizar ações em planejamento familiar, tanto nas Unidades Básicas de Saúde quanto nos CR/APF. Os resultados apontaram que, na RMC, as mudanças produzidas com a regulamentação da legislação específica sobre esterilização não ocorreram da forma esperada. Apesar de avanços, ainda existem várias distorções que ainda precisam ser corrigidas para que se tenha um adequado atendimento à demanda por esterilização cirúrgica / Abstract: The objective of this study was to evaluate the conditions under the demand for voluntary surgical sterilization is being addressed in the health public sector of the 19 municipalities in the Metropolitan Region of Campinas (MRC), and to evaluate the opinion of administrators, providers and users concerning the adequacy to the Law of Family Planning. A descriptive study was performed with two components: quantitative and qualitative. For the quantitative component, a cross sectional study was carried out with 398 women living in the MRC and interviewed in their households, selected in previously randomly identified streets through an equiprobabilistic and systematic sampling; 15 municipal health administrators in the field of family planning and 15 coordinators of primary health units. Structured and pre tested questionnaires were used. For the qualitative component, four municipalities of the MRC were purposely chosen. Twenty eight semi-structured interviews with coordinators of Referral Centers (RC) and/or family planning outpatient clinics (FPOC) were performed, and with professionals directly involved in the process of answering sterilization requests. The quantitative data were double entered by different people using the software Sphinx Lexica. Regarding the semi-structured interviews, they were transcribed and the text correspondent to each interview was entered in a database using the software The Ethnograph V. 5.0. There were no significant differences concerning the characteristics of women and men sterilized before and after the legal regulamentation. From 1998 and upwards, the great majority of tubal ligations continued to be performed at the moment of a Cesarean section; the ¿extra¿ payment decreased, but the difference was not significant. The minimum waiting time for tubal ligation was six months, however this was the maximum waiting time for vasectomy. Eight municipalities reported to perform tubal ligation, while nine the vasectomy. Among them, around half referred to follow the criteria established by the Law of Family Planning. In three out four municipalities evaluated by the qualitative component, the care was centralized in RC/FPOC, where they evaluated whether the legal criteria were followed in order to allow the surgery, educational activities were ministered and the surgical procedure was scheduled in the services with credentials. The main criticism to the current legislation was concerned to the prohibition of performing tubal ligation at the moment of a delivery, what was considered as a kind of penalty to the women who have only vaginal births. There was a repressed demand generated by the waiting time to perform the surgery and also due to the difficulty in scheduling visits in the RC/FPOC. These difficulties were attributed to the lack of physical structure and human resources to accomplish with the family planning actions, not only in the primary health units but also in the RC/FPOC. The results indicated that in the MRC the changes produced with the regulamentation of the specific legislation for sterilization did not occur as expected. Although the improvements, there are still several distortions that need to be corrected in order to came to an adequate answer to the demand for surgical sterilization / Doutorado / Tocoginecologia / Doutor em Tocoginecologia

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Bakgrund: När en kvinna genomgår en graviditet och förlossning innebär det stora påfrestningar för hennes kropp. Vid en förlossning kan bristningar uppstå, vilket kan medföra besvär för kvinnan i olika utsträckning. Genom eftervårdsbesöket har barnmorskorna en möjlighet att identifiera problem som kan ha uppstått och upptäcka odiagnostiserade förlossningsskador. Syfte: Syftet var att beskriva barnmorskans erfarenheter av gynekologisk undersökning och att bedöma bäckenbottens strukturer vid eftervårdsbesök inom mödrahälsovården. Metod: Semistrukturerade intervjuer genomfördes med elva barnmorskor yrkesverksamma inom mödrahälsovården. Tematisk analys användes för att analysera materialet. Resultat: Ett huvudtema, tre organiserande teman samt tio basteman identifierades. Huvudtemat var: kvinnans behov i centrum. Organiserande teman var: att stödja genom sitt förhållningssätt; att verka hälsofrämjande och förbättringsområden. Basteman var: att vara lyhörd; att bekräfta; att se individuella behov; att motivera till undersökning; att motivera till egenvård; utbildning; struktur; dokumentation; tidsaspekten och uppföljning. Slutsats: Barnmorskor inom mödrahälsovården fyller en viktig funktion i att arbeta hälsofrämjande och arbetar med kvinnans behov i centrum. De försöker individanpassa varje besök och den information som ges ut men upplever att det kan finnas svårigheter att motivera kvinnor till gynekologisk undersökning. Mer utbildning, bättre och tydligare struktur för bedömning av bäckenbotten samt en förbättrad samtalsmetodik kring besvär som kan kvarstå efter förlossningen kan bidra till att kvinnor får den hjälp och vård de behöver. Klinisk tillämpbarhet: Studiens resultat belyser behov av mer kunskap, utbildning och struktur. Att detta uppmärksammas i denna studie kan leda till diskussion om vidareutveckling och att ämnet lyfts i den kliniska verksamheten. / Background: Undergoing pregnancy and childbirth, entails great strain on a woman’s body. When giving birth vaginally, tears may occur, which may cause problems for the woman to a different extent. Through the postpartum check-up, midwives have an opportunity to identify problems that may have occurred and detect undiagnosed perineal injuries. Aim: The aim was to describe the midwife’s experiences of pelvic examination and to assess pelvic floor structures at the postpartum check-up. Method: Semi-structured interviews were conducted with eleven midwives working in maternal health care. Thematic analysis was used to analyze the material. Results: One global theme, three organizing themes and ten basic themes were identified. The global theme was: the woman´s needs. The organizing themes were: to support through the approach; to promote health and areas for improvement. The basic themes were: to be responsive; to confirm; to see individual needs; to motivate for examination; to motivate selfcare; education; structure; documentation; time aspect and follow-up. Conclusion: Midwives in maternal health care play an important role in health promotion and working with women's needs. They try to personalize each visit and adapt the information given, but their experience is that there are difficulties in motivating women to undergo a pelvic examination. More education, a better and clearer structure for assessing the pelvic floor and an improved way of addressing problems that may persist after childbirth may enable women getting the help and care they need. Clinical application: The study results highlight an existing need for more knowledge, education and structure. Attention to this can lead to discussion of further development and the subject can also be raised among other healthcare providers.

Bakgrund: Samhället ska värna sex- och samlevnadsundervisning, familjeplanering samt mödrahälsovård. Barnmorskan har en central roll att sprida kunskap inom området. Genom information till kvinnor och män om den prekonceptionella hälsans betydelse kan det skapas goda förutsättningar till familjebildning. Syfte: Att beskriva ungdomars kunskaper och inställningar om prekonceptionell hälsa samt vilken kunskap ungdomar efterfrågar angående detta. Metod: En kvalitativ intervjustudie med fokusgrupper genomfördes, varav en grupp med fem män i åldrarna 21-22 år samt en grupp med sju kvinnor som var 18 år. Datamaterialet analyserades med latent innehållsanalys.                                                                                                                         Resultat: Den kunskap ungdomarna hade om prekonceptionell hälsa var olika faktorers påverkan på fertiliteten. Fördelaktiga faktorer var varierad nyttig kost, träning och god sömn. Som negativ påverkan på fertilitet diskuterades tobak, alkohol, droger, mediciner, sjukdomar, ärftliga sjukdomar och cystor samt stress. Kunskap ungdomarna efterfrågade var att få information om prekonceptionell hälsa, vad de kunde påverka inför en eventuell framtida graviditet samt fakta om hur de olika faktorerna påverkade fertiliteten. Informationen ville de få av någon med  kunskap inom området. Slutsats: Information om prekonceptionell hälsa efterfrågades av ungdomarna, en ökad kunskap och medvetenhet om ämnet hos allmänheten skulle kunna generera positiva hälsoeffekter på individ- såväl som på samhällsnivå med en hälsosam befolkning som resultat. / Background: The society should be responsible for sexual education, family planning and maternal healthcare. The midwife has a central role when it comes to spreading knowledge within the area. By spreading information  to women and men about the importance of preconception health and care it could create good conditions to start a family.  Purpose: To describe young peoples knowledge and attitudes about preconception health and care and also about what kind of knowledge the youth asks about when it comes to it. Method: A qualitative interview study with focus groups was preformed which included a group of five men ages between 21-22 and a group of  seven women who all were 18 years old. The data was analyzed by latent content analysis. Results: The knowledge the young people had about preconceptional health and care were the effects of different factors on fertility. Beneficial factors were varied health diet, exercise and good sleep. As a negative influence on fertility, tobacco, alcohol, drugs, medicines, diseases, hereditary diseases and cysts were discussed as well as stress. Knowledge the young people asked for were information on preconceptional health and care, what could influence a possible future pregnancy and facts, how the various factors affected fertility. The youth wanted the information to be obtained from someone with knowledge within the field. Conclusion: Information on preconceptional health and care was asked about by the young people, increased awareness and awareness of the subject of  public could generate positive health effects at the individual- as well as at community level with a healthier population as a result.

Bakgrund: Alla friska gravida rekommenderas att vara fysiskt aktiva. Många gravida minskar sin träning under graviditeten. Barnmorskor har en hälsoupplysande och stöttande roll och hänvisar till viss del gravida med frågor till träningsinstruktörer. Syfte: Att undersöka träningsinstruktörers erfarenheter av att träna gravida och vilka träningsråd de ger. Metod: Studien har genomförts med intervjuer av tio träningsinstruktörer. Träningsinstruktörers erfarenhet och träningsråd delades in i två domäner och därefter analyserades materialet med kvalitativ innehållsanalys. Resultat: Innehållet i domänerna analyserades till fem kategorier; saknar kunskap, har kunskap, handläggning av gravida, generella träningsråd och individanpassade träningsråd. Några informanter ifrågasätter både sin egen och kollegors kompetens. När informanterna upplever sig ha kunskap känner de att de kan ge gravida korrekta träningsråd. Generellt rekommenderas det att gravida ska våga träna, men att de ska känna efter så det känns bra. All träning behöver individanpassas utifrån kvinnans träningserfarenhet och hur kvinnan mår i sin graviditet. Slutsats: Gravida önskar tydliga träningsråd, vilket är bra för både träningsinstruktörer och barnmorskor att ha i åtanke vid rådgivning. Med tydligare träningsråd skulle gravida kunna känna sig tryggare vilket förhoppningsvis leder till att fler tränar. / Abstract Background: Every healthy pregnant women are recommended to be physically active. Many pregnant women reduces their workouts during pregnancy. Midwives have a health-promoting and supportive role and sends some of the pregnant women with questions to personal trainers. Aim: The purpose of this study is to examine personal trainers experience of training pregnant women and what training advice they provide. Method: The study has been conducted by interviews with ten personal trainers. The personal trainers' experience and training advice were divided into two domains and then the material was analyzed with qualitative content analysis Results: The content of the domains has been divided into four categories; lack of knowledge, have knowledge, general training advice and personalized training advice. Some informants question both their own and colleagues' knowledge. When the informants feel that they have knowledge, they feel that they can give correct training advice to the pregnant women. In general should the pregnant woman dare to work out, but everything they do should feel okey. All training needs to be personalized based on the woman's training experience and how the woman feels in her pregnancy. Conclusion: Pregnant women wants more precise training advice, which is important for both personal trainers and midwives to keep in mind when consulting. With more precise training advice pregnant women could feel safer which hopefully leads to more people training.

Bakgrund: Förlossningsrädsla hos gravida kvinnor som väntar sitt första barn påverkar både den blivande modern och det ofödda barnet. Det är därför viktigt att barnmorskan i mödravården kan uppmärksamma rädsla inför förlossningen i tid för att kunna hjälpa kvinnan på bästa sätt. Förlossningsrädsla är ett ökande problem som kan leda till fler komplicerade förlossningar och kejsarsnitt, vilket även kostar samhället mer pengar.   Syfte: Syftet med denna studie var att belysa barnmorskors erfarenheter av att stödja och bemöta förstföderskor med förlossningsrädsla under graviditet samt studera vad som gett upphov till rädslan.   Metod: Arbetet innehåller en kvalitativ design som baseras på individuella semi-strukturerade intervjuer med 11 barnmorskor inom mödravården i mellansverige. Datan har analyserats genom kvalitativ innehållsanalys och manifest metod.   Resultat: Resultatet visade på fyra kategorier: Olika sätt att kommunicera rädsla, rädslans innehåll, inverkande faktorer samt att hjälpa och stötta kvinnor med förlossningsrädsla. Tretton subkategorier skapades och utgjorde kategorierna: Uttrycker rädslan med ord, sluter sig, katastroftankar, kontrollförlust, smärta, komplikationer, tidigare erfarenheter, övergrepp, psykisk ohälsa, yttre påverkan, svårt att nå kvinnan, en utmaning och stärka kvinnans självförtroende.   Slutsats: De flesta förstföderskor uttrycker sin förlossningsrädsla tidigt i graviditeten men det är inte alla som vågar prata om den. Att tappa kontrollen beskrivs vara det främsta motivet till rädslan. Den vanligaste bidragande faktorn till förlossningsrädsla idag beror på yttre faktorer så som media och influenser från vänner och familj. Även dagens pressade förlossningssituation påverkar kvinnornas rädsla inför förlossningen. Det kan upplevas vara en utmaning att kunna stödja och bemöta kvinnan på bästa sätt. / Background: Fear of childbirth in pregnant women waiting for their first child is affecting both mother and child. That is why it is important for the midwife’s in the antenatal care to pay attention to fear of childbirth in time and also to help the women in the best possible way. Fear of childbirth is a problem that increases which can result in complicated deliveries and sections which costs a lot of money for the community.   Aim: The aim of this study was to investigate midwife’s experience of supporting and responding to fear of childbirth in nulliparous women and to study what has caused the fear.   Method: We conducted a qualitative interview study with 11 midwives working at antenatal clinics in mid Sweden. The interviews were analyzed with manifest content analysis.   Result: Four categories were found: Different ways to communicate fear, the content of the fear, influence factor and to help and support women with fear of childbirth.  Thirteen subcategories were created and formed the categories: Expresses the fear with words, no words, thoughts about disaster, control loss, pain, complications, past experiences, abuse, mental illness, external impact, difficult to reach the woman, a challenge and strengthening the woman's self-esteem.   Conclusion: Most nulliparous women express their fear of childbirth early in pregnancy, but not everyone dares to talk about it. Controll loss is described as the main motive for fear. The most common cause of fear of childbirth today is due to external factors such as media and influences from friends and family. Also today's situation of maternity ward affects women's fear of childbirth. It could be a challenge to be able to support and respond to the woman in the best way.

Bakgrund: Förlossningssmärta är ett begrepp som används inom barnmorskeutbildningen och hälso- och sjukvård där kvinnor vårdas under graviditet och på förlossningsavdelningar. Begreppet är odefinierat i litteraturen och hur och vad som innefattas av begreppet är brett. Förlossningssmärta har stor plats inom mödrahälsovården men just som begrepp finns lite information. Syfte: Syftet var att beskriva begreppet förlossningssmärta genom en begreppsanalys. Metod: En begreppsanalys med kvalitativ design. Först utfördes en litteratursökning, den teoretiska fasen, och sedan blev fem barnmorskor identifierade genom ett bekvämlighetsurval och intervjuades i fältstudiefasen. Resultatet från fältstudiefasen sammanställdes med resultatet från den teoretiska fasen. Resultat: Analysen av begreppet förlossningssmärta mynnade ut i ett resultat med flera dimensioner där den unika upplevelsen är konklusionen. De tre huvuddimensionerna är sensorisk, affektiv och kognitiv upplevelse av förlossningssmärta. Där det sensoriska står för fysiologin, det affektiva för det vi bär med oss in i smärtupplevelsen och det kognitiva för hur vi tänker kring smärtupplevelsen. Referens-ramen för begreppet bestäms av dess förutsättningar och konsekvenser. Förlossningssmärtan är en unik upplevelse och endast den födande kvinnan vet hur den känns. Förlossningssmärta är en upplevelse som tolkas olika och uttrycket är individuellt. Slutsats: Förlossningssmärta kan ses som ett komplext begrepp som anpassas till varje gravid utifrån de definierade dimensionerna. Klinisk tillämpbarhet: Begreppet förlossningssmärta är viktigt att klargöra för barnmorskestudenter under utbildning. / Background: Labor pain is a term used in education and healthcare, where women are cared for during pregnancy and in maternity wards. How the concept is defined is described in literature and how and what is covered by the concept is wide. Labor pain has great location within maternity care but as a concept it is relatively undefined. Aim: The aim was to describe the concept of labor pain through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed; earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: After the analysis of the concept of labor pain the main results is that it is truly one unique experience of labour pain. Defined three dimensions sensory, affective and cognitive. The sensory dimension stands for physiology, the affective dimension for earlier experiences and the cognitive dimension for how a person thinks about pain and the experience of it. Pain in labour is a unique experience. Only the woman in labour knows how it feels like. Pain during labour is an individual experience and just like all other experience it has its unique and individual interpretation for the person involved. Conclusion: Labor pain can be identified as a complex concept adapted to each pregnancy based on the defined dimensions. Clinical applicability: Clarification of the concept is important in education of midwifery students.

Caesarean section is a common major surgical procedure and long-term complications have not been fully investigated. By longitudinal population based register studies, based on National health registers and medical data records, maternal complications after caesarean delivery at subsequent labour (N=7 683), among extremely preterm births (N=406), and at remote gynaecologic surgery (N=25 354) were explored. In Paper I, uterine closure was investigated in respect to uterine rupture in a subsequent delivery after caesarean section. Uterine rupture occurred in 1.3 % of women with a previous caesarean section. There was no increased risk of uterine rupture with single compared with double layers for closure of the uterus (adjusted Odds Ratio 1.17, 95 % CI 0.78-1.70). Modifiable risk factors of uterine rupture in a trial of labour after caesarean section included induction of labour and use of epidural analgesia. In Paper II, maternal outcomes and surgical aspects of caesarean section in the extremely preterm period were assessed. Maternal complications were more frequently reported in extremely preterm- compared with term caesarean delivery. No increase in short-term morbidity was observed at 22-24 compared with 25-27 gestational weeks, but uterine corporal incisions were performed more frequently (18.1 % vs. 9.6 %, p=0.02). Furthermore, risk factors for abdominal adhesions after caesarean section and organ injury in remote gynaecologic surgery were analysed (Paper III and IV). Numbers of prior caesarean sections were the most important factor for formation of adhesions. Advanced maternal age, obesity, infection and delivery year 1997-2013 were factors associated with adhesions in conjunction with caesarean section. Organ injury occurred in 2.2 % of women undergoing benign hysterectomy. A history of caesarean section increased the risk (adjusted Odds Ratio 1.74, 95 % CI 1.41-2.15), but was only partly explained by the presence of adhesions. The organ affected depended on medical history; prior caesarean predisposed for bladder injury, prior bowel/pelvic surgery for bowel injury and endometriosis was associated with ureter injury at time of hysterectomy. In conclusion; data from National health registers indicates that caesarean delivery is associated with long-term complications, although the absolute risk of severe complications for the woman is low.

Bakgrund: Episiotomi är ett klipp som läggs i vagina och perineum under förlossningen, som utförs exempelvis för att skynda på förlossningen. Ingreppet utfördes tidigare rutinmässigt men har på senare år kritiserats, eftersom ingreppet orsakar många gånger onödiga problem för kvinnorna. Syfte: Syftet med studien var att undersöka kvinnors upplevelser av episiotomi eftersom det visat sig finnas sparsamt med forskning kring detta, särskilt i Sverige. Metod: En kvalitativ intervjustudie med semistrukturerade intervjuer har genomförts med fenomenologisk metod och induktiv ansats. Informanter eftersöktes genom bekvämlighetsurval, via en grupp på sociala medier. Resultat: Resultatet som framkommit visar att kvinnorna har upplevt episiotomin samt omständigheterna runt omkring som mycket negativa. Kvinnorna understryker framförallt hur de upplevde att bristande kommunikation och information från personalen ledde till en känsla av att vara i en utsatt position samt att de inte upplevde sig vara delaktiga i beslutet rörande episiotomin. Konklusion: Kvinnorna upplevde många negativa känslor kring ingreppet och hade ingen delaktighet när beslut om episiotomi togs. Det faktum att kvinnorna inte fick någon chans att lämna sitt samtycke till ingreppet har gjort att de i efterhand har haft svårt att bearbeta händelsen. / Background: Episiotomy is a cut through the vagina and perineum during childbirth, which is performed, for example, to speed up labor. The procedure was previously performed routinely but has in recent years been criticized, because the procedure often causes unnecessary problems for the women. Aim: The aim of the study was to investigate women's experiences of episiotomy since there is little research on this, especially in Sweden. Method: A qualitative interview study with semi-structured interviews was conducted with a phenomenological method and an inductive approach. Informants were sought through convenience selection, via a group on social media. Results: The results show that the women have experienced the episiotomy and the surrounding circumstances as very negative. The women emphasize that a lack of information from the staff led to a feeling of being in a vulnerable position and not being involved in the decision regarding the episiotomy. Conclusion: The women experienced many negative feelings about the procedure and had no participation when the decision on episiotomy was made. Since the women did not get a chance to give their consent to the procedure it has been difficult for them to process the incident afterwards.

Bakgrund: Att genomgå en förlossning kan vara skrämmande och outforskat för den födande kvinnan. För att erhålla en positiv förlossningsupplevelse krävs det att kvinnan känner säkerhet och besitter kontroll under förlossningsprocessen. Ett alternativ som visat sig ha medicinska fördelar för kvinna och barn under förlossning är när kvinnan ligger nedsjunken i vatten under förlossningsarbetet. Syfte: Syftet var att undersöka kvinnors upplevelser av att befinna sig nedsjunken i vatten i samband med förlossningsarbete. Metod: Kvalitativ metasyntes med metaetnografisk analysmetod. Datainsamling har genom sökning i relevanta databaser genererat i 15 artiklar som ligger till grund för resultatet. Resultat: I resultatet identifierades fyra huvudteman: En tro på det naturliga som innefattade en önskan om naturlig förlossning och en medicinsk misstro. En tilltalande förlossning som berörde vattnets välgörande effekter, stärkande flytkraft, hemlik miljö och ett effektivt förlopp. I En stärkande upplevelse framgick att metoden innebar en känsla av kontroll och tillfredsställelse och att stödet från andra ansågs viktigt. Försvårande omständigheter beskrev olika hinder för en god förlossningsupplevelse, det handlade om poolen, negativa inställningar hos vårdpersonal och anhöriga men också en oro eller rädsla hos kvinnan. Slutsats: Förlossningsarbete i vatten innebär möjligheter för kvinnan till positiv förlossningsupplevelse där hon erhåller kontroll och tillfredsställelse. Ökad kunskap behövs hos barnmorskan och annan relevant vårdpersonal för att kunna stödja och erbjuda kvinnan vård efter hennes önskemål och behov. Klinisk tillämpbarhet: Metasyntesens resultat kan användas av barnmorskor och annan vårdpersonal som möter gravida kvinnor. Dels för att informera och stödja kvinnan, dels för vidare implementering av vattenförlossning på kliniker. / Background: Giving birth can be an intimidating and unexplored experience for women. In order to obtain a positive birth experience, it is required that women feel safe and in control during the birthing process. Water immersion has been shown to have medical benefits during labor and childbirth.Aim: The aim was to investigate women’s experiences of immersion in water in connection with labor and birth.Method: A qualitative metasynthesis with metaethnographic analysis was used. Searching the relevant databases generated in 15 articles and results are based on this data.Results: In the results, four main themes were identified: A belief in the natural that included desire for a natural childbirth and a medical mistrust. An appealing birth that included the beneficial effects of the water as strengthening buoyancy, homely environment and an efficient process. A strengthening experience showed that the method entailed a feeling of control and satisfaction and that the support from others was considered as important. Aggravating circumstances described obstacles for a good experience. It was about the pool, negative attitudes among care staff and relatives but also a worry or fear for the woman.Conclusion: Water immersion during childbirth means a possibility for the women to have a positive childbirth experience where she can feel in control and satisfaction. Increased knowledge is needed for the midwife and other relevant health care professionals to be able to support and offer the woman care according to her wishes and needs.Clinical applicability: The results of metasynthesis can be used by midwives and other healthcare professionals who meet pregnant women. Partly to inform the woman, to be able to support the woman but also for further implementation of waterbirths in clinics.