<p>The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth. </p><p>The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports. </p><p>Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.</p>

Aim: The overall aim of this thesis was to illuminate, describe, and promote understanding of women’s experiences of prolonged labour. The thesis compromises four studies. Methods: Paper I describes a case-referent study that recruited women (n = 255) giving singleton live birth to their first child by spontaneous labour after more than 37 completed weeks’ pregnancy. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships, and childhood experiences. Paper II presented a cross-sectional study of 644 women who had been expecting their first child. Participants were asked to complete a questionnaire measuring psychosocial resources (social network and support), work-related psychosocial factors, control of daily life, and health characteristics. Papers III and IV presented interviews performed with 10 women, who, following prolonged labour, had given singleton live birth to their first children. Results: The risk of a negative birth experience was increased for women following prolonged labour. Both women experiencing prolonged and normal labours perceived the support given by their partners and midwives during labour to be very important, and felt pain relief to be a key issue. The suffering experienced during labour was more likely to mark the women for life if the labour was prolonged than if the experience of giving birth was positive and labour was normal. Both women, including those who had and those who had not experienced prolonged labour reported a high level of psychosocial resources, support, and sense of wellbeing in early pregnancy. The difficulties of prolonged labour were interpreted as an experience of being caught up in pain and fear: the women described how they had felt exhausted, powerless, and out of control. They described their dependency on others, and said that the caregiver’s decision to assist with the delivery was experienced as being relieved from pain. Prolonged labour could be understood as an experience of suddenly falling ill or of finding oneself in a life-threatening condition associated with an overwhelming fear of losing oneself and the child. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like “fumbling in the dark”. Women had experienced bodily fatigue accompanied by feelings of illness and detachment from the child. Meeting the child when in this condition entailed a struggle to become a mother. The negativity connected with prolonged labour and a struggle for motherhood may be comparable to the experience of illness and recovery. In spite of these experiences, reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged their interaction and relationship with the child, and contributed to their adaptation to motherhood. Conclusion: Women experiencing prolonged labour require advanced medical and obstetric care, which may limit their ability to participate in making decisions about their care. They have a special need for extra support and encouragement, as well as increased nursing and midwifery care during delivery.

The experience of pregnancy and childbirth is a central life event with special implications for women at high risk. This thesis describes the meaning of pregnancy, childbirth and midwifery care in four qualitative interview studies based on the lifeworld theory. Women were interviewed during pregnancy and within one week after childbirth. Midwives were interviewed concerning midwifery care for women at high risk. In an intervention study, childbirth experience as reported through a post partum questionnaire was compared between women receiving standard care and women who had formulated a birth plan preceded by a questionnaire on their expectations and feelings about childbirth. The findings emphasise that childbearing women at high risk live in an extremely vulnerable situation. The vulnerability is obvious in the use of an individual birth plan, where negative feelings become more frequent in women at high risk than in those with normal pregnancy and childbirth. During pregnancy the women feel a moral commitment towards the child, including feelings of objectification and of exaggerated responsibility. During an obstetrically complicated childbirth the essential meaning is the women’s desire to be recognised and affirmed as individual persons. Like women with normal pregnancy and childbirth, they need an emotionally present midwife who sees, give trust and supports. Good midwifery care of childbearing women at high risk is synthesised as "genuine caring in caring for the genuine". The ethos of caring constitutes the basis of caring. Women’s transition during pregnancy and childbirth is described as a genuinely natural process. Midwives have a special responsibility to encourage and preserve this process within women at high risk. The caring relationship is the core and the most essential tool in the care. Distinctive features in the midwifery care are embodied knowledge, physical as well as emotional presence, sensitivity, a mutual dialogue including shared control between midwife and woman, and confirmation and support of the genuine in each woman. The midwifery care is a struggle and a balance between natural and medical perspectives.

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Bakgrund: Förlossningen kan upplevas som en positiv livshändelse och har betydelse för framtida hälsa, välbefinnande och relation till partner. Förlossningsupplevelsen påverkas av de blivande föräldrarnas förberedelser inför förlossningen och föräldraskapet. Parrelationen är central under förlossningen där stöd från partnern är viktigt. I nuläget finns dock begränsad forskning kring hur förlossningsupplevelsen påverkas av kvinnors och partners kvalitet i parrelation samt deras tankar och känslor inför förlossningen och föräldraskapet i ett longitudinellt perspektiv, varför det finns behov av att studera detta. Syfte: Syftet med studien är att undersöka faktorer relaterade till förstföderskor och partners förlossningsupplevelse sex månader efter förlossning. Metod: Studien är en kvantitativ longitudinell kohortstudie. Datainsamlingen genomfördes via webbaserade enkäter vid tre tillfällen under graviditet och de första sex månaderna efter förlossning. Enkäterna innehöll frågor kring studiedeltagarnas bakgrund, förlossningsupplevelse (QPP), kvalitet i parrelation (QDR36) och känslor inför förlossning och föräldraskap. Analys av data har skett i SPSS där deskriptiv statistik och multipel logistisk regressionsanalys har genomförts. Resultat: Följande faktorer hade ett samband med en mer positivt skattad förlossningsupplevelse sex månader efter förlossning; Upplevelse av normal förlossning (QPP 5), förstföderska (p=0.001), partner (p=0.003); Upplevelse av kontroll vid förlossning (QPP9), förstföderska (p=0.024); Högre uppfattad kvalitet i parrelation (QDR36-index), partner (p=&lt;0.001). Konklusion: Förlossningsupplevelsen påverkas av upplevelsen av förlossningen som normal, upplevelsen av kontroll under förlossningen samt högre uppfattad kvalitet i parrelation. / Background: Childbirth can be perceived as a positive life event and has a significance for future health, well-being, and relationship with partner. The childbirth experience is influenced by the prospective parent´s preparations for childbirth and parenthood. The couple relationship is central during childbirth where support from the partner is important. At present, however, there is limited research on how the childbirth experience is affected by the quality of couple relationship, as well as thoughts and feelings about childbirth and parenthood, in a longitudinal perspective, why there is a need to study this further. Purpose: The aim of the study is to examine factors related to first-time mothers and partners' childbirth experience six months after childbirth. Method: The study is a quantitative longitudinal cohort study. Data collection was conducted via web-based surveys on three occasions during pregnancy and the first six months after childbirth. The questionnaires contained questions about the study participants' background, childbirth experience (QPP), quality of couple relationship (QDR36) and feelings about childbirth and parenting. Data has been analyzed in SPSS where descriptive statistics and multiple logistic regression analysis have been performed. Results: Following factors were associated with a more positive childbirth experience six months after childbirth; Experience of normal childbirth (QPP 5), first-time mother (p=0.001), partner (p=0.003); Experience of control during childbirth (QPP 9), first-time mother (p=0.024); Higher perceived quality of couple relationship (QDR36 index), partner (p=&lt;0.001). Conclusion: The childbirth experience is affected by the experience of a normal childbirth, feeling of control during childbirth and higher perceived quality of couple relationship.

This thesis deals with the issue of biopsychosocial factors in childbirth. It aims to map factors and their possible relationships that contribute to a positive birth experience. The study used a mixed methods research design. A questionnaire was used for the quantitative part of the research. Respondents completed a set of online questionnaires about pregnancy and childbirth, followed by a questionnaire on childbirth experience, stress management strategies (SVF-78), and the Psychosocial Climate of the Maternity Hospital (KLI-P). For the qualitative part, semi-structured interviews were used. The research sample for the quantitative part consisted of 81 first-time mothers, from which five respondents who scored above average on the birth experience questionnaire were subsequently interviewed. The results showed that the absence of obstetric complications, perceived low pain intensity, delivering without pain relief medication, a pleasant psychosocial climate of the maternity hospital and stress avoidance coping strategies significantly contributed to a positive birth experience. The qualitative analysis results showed that a close person, especially a partner, who assists with their passive presence or practical help, also plays an important role. Women with positive birth experiences in the...

Objective The present study aimed to explore women's perceptions and experiences of childbirth by unplanned Caesarean section. Background New motherhood is characterised as a profound change, and research suggests that the psychological effects of childbirth can be significant and far–reaching for some women. The processes occurring during a traumatic birth experience could affect a woman's emotional and psychological state, and she may experience considerable adjustment difficulties in adapting to unfulfilled expectations of delivering her baby naturally. Methods In–depth interviews explored 10 women's lived experiences of childbirth, after which thematic content analysis was used to synthesise data. The elements of phenomenological theory served as a broad framework for the structuring, organizing and categorizing of data, with interpretation aimed at gaining a greater understanding of women's internalised childbirth accounts. Findings Women described their contact with medical personnel, as well as the physical, environmental, and emotional aspects of their unplanned Caesarean sections, as distressing and traumatic. A sense of loss of control was the most significant contributor to women's negative childbirth experiences. Feelings of failure and disappointment were primarily related to unmet expectations and a lack of preparedness. Negative experiences were mediated by attentive caregiving, inclusion in decision–making, and support from loved ones. / Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2011.

Objective The present study aimed to explore women's perceptions and experiences of childbirth by unplanned Caesarean section. Background New motherhood is characterised as a profound change, and research suggests that the psychological effects of childbirth can be significant and far–reaching for some women. The processes occurring during a traumatic birth experience could affect a woman's emotional and psychological state, and she may experience considerable adjustment difficulties in adapting to unfulfilled expectations of delivering her baby naturally. Methods In–depth interviews explored 10 women's lived experiences of childbirth, after which thematic content analysis was used to synthesise data. The elements of phenomenological theory served as a broad framework for the structuring, organizing and categorizing of data, with interpretation aimed at gaining a greater understanding of women's internalised childbirth accounts. Findings Women described their contact with medical personnel, as well as the physical, environmental, and emotional aspects of their unplanned Caesarean sections, as distressing and traumatic. A sense of loss of control was the most significant contributor to women's negative childbirth experiences. Feelings of failure and disappointment were primarily related to unmet expectations and a lack of preparedness. Negative experiences were mediated by attentive caregiving, inclusion in decision–making, and support from loved ones. / Thesis (M.Sc. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2011.

Denna studie ämnar undersöka hur inlägg på Instagram som presenterar en nyfödd bebis utformas språkligt och visuellt. Avsikten är att se om det finns vissa språkliga mönster som är återkommande och därmed kan utgöra en egen genre. Studien utgår från tre forskningsfrågor vilka är: Hur presenteras den nyfödda bebisen i Instagraminläggen, och hur skiljer sig inläggen åt vad gäller presentationen av flickor och pojkar? Hur beskriver Instagramanvändaren förlossningsupplevelsen i presentationen? Resultatet av de första frågorna leder sedan in på studiens sista fråga vilken är: Vilka genredrag i inläggen kan ses som obligatoriska? Materialet som ligger till grund för studien är 110 Instagraminlägg som alla innehåller en presentation av en nyfödd bebis samt en beskrivning av förlossningsupplevelsen. Eftersom det är Instagraminlägg som materialet bygger på, analyseras både skrift och bild för att se hur dessa samverkar och tillsammans skapar betydelse. Studiens teori och metod utgår från socialkonstruktivismen, den kritiska diskursanalysen och genreanalys tillsammans med språkvetenskapliga metoder för skrift och bildanalys.  Resultatet visar att inläggen, både vad gäller skrift och bild, följer fler språkliga mönster som går att koppla till en egen genre. Många av dessa språkliga drag går även att dra historiska kopplingar till vad gäller hur födelseannonser i dagstidningar utformats. Den komponent som har visat sig vara allra vanligast är att avslöja barnets kön i presentationen, vilket sker både genom pronomen och av kvinnligt och manligt könade benämningar. När det kommer till hur  förlossningsupplevelsen beskrivs kan det konstateras att vara intim och privat är en viktig komponent vilket studien kopplar är ett nytt språkligt drag som har med den digitala presentationen att göra.

Objective: To explore the longitudinal associations between prepartum fear of childbirth (FOC), birth experience, and postpartum mother-child-bonding, and the potential mediator role of the birth experience. Design: Women from the prospective cohort study DREAM completed questionnaires during pregnancy, 8 weeks, and 14 months after the birth. Participants: A community sample of n = 645 pregnant women from a large city in Eastern Germany participated in the study. Results: In a regression analysis, FOC predicted negative birth experience (β = 0.208, p < 0.001) which in turn predicted poorer mother-child-bonding both at 8 weeks (β = 0.312, p < 0.001) and 14 months postpartum (β = 0.200, p < 0.001). FOC also predicted mother-child-bonding at 14 months postpartum (β = 0.098, p < 0.05). Of note, this association was mediated by birth experience both at 8 weeks, indirect effect ab = 0.065, 95% CI [0.036, 0.098], and 14 months postpartum, indirect effect ab = 0.043, 95% CI [0.023, 0.067]. These effects remained stable even when adjusting for potential confounders. Key Conclusions: This study suggests that the association between FOC and mother-child-bonding is mediated by birth experience, pointing to the importance of a woman's positive subjective experience. Implications for Practice: Findings reveal two targets for peripartum interventions for women at risk for poor mother-child-bonding, namely the implementation of FOC screenings during pregnancy, and birth experience as mediating factor between FOC and mother-child-bonding. Focusing on the mother's subjective birth experience could aid to identify women at risk for impaired bonding who might need additional support.