Orientador: Milena Temer Jamas / Resumo: Introdução: O enfermeiro tem reconhecimento mundial na mudança do modelo de assistência ao parto, resgatando o nascimento como um processo natural, no qual os sentimentos e preocupações da parturiente devem ser respeitados. Nesta perspectiva surge a preocupação com a formação acadêmica dos futuros enfermeiros. Entende-se que a forma como o profissional percebe o processo de nascimento pode influenciar a assistência. O medo e a interpretação desse período como sofrimento e dor podem estimular intervenções desnecessárias no intuito de abreviar vivências consideradas negativas. Considerando a inexistência de instrumento voltado para a população brasileira, capaz de avaliar o medo do parto antes da gestação, o objetivo do presente estudo foi realizar a adaptação transcultural e analisar as evidências de validade e confiabilidade da versão brasileira da Escala Childbirth Fear Prior to Pregnancy (CFPP). Método: Trata-se de estudo do tipo metodológico, aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de Botucatu, parecer nº 2.428.902, com amostra de conveniência composta por 146 alunos de graduação de enfermagem. A adaptação transcultural da Versão Brasileira da escala seguiu as etapas amplamente utilizadas na literatura: Avaliação por comitê de especialistas e Pré-teste com avaliação da população alvo. Participaram do estudo 146 graduandos de enfermagem da Faculdade de Medicina de Botucatu – FMB e do Centro Universitário Católico Salesiano Auxilium – UniSALESIANO.... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: The nurse has a world acknowledgement on changing birth assistance, recovering birth as a natural process as well as feelings and concerns from parturient being respected. Thus, an interest has been raised on nursing academic graduation. In addition, the meaning as a professional caring about the birthing process can influence the service. Fear, and the interpretation of this period as suffer and pain might stimulate unnecessary interventions as an intention of shorten considerable negative experiences. Furthermore, considering nonexistent tool related to Brazilian population, capable of measuring fear before pregnancy, the main objective of this paper was to make a transcultural adaptation and to analyze the evidences of efficacy and reliability for the brazilian version of the Childbirth Fear Prior to Pregnancy (CFPP). Methodology: This study has a methodological manner, approved by the Ethics in Research committee of Medical Science College of Botucatu, under number 2.428.902, with a convenience sample made of 146 nursing graduating students. The Brazilian version for the transcultural adaptation has followed the steps mentioned in the literature. Evaluation by a specialist committee and pre-test with assessment of the target audience. Nevertheless, 146 of nursing graduation students from Medical Science College of Botucatu – FMB and from the Salesians Catholic University Center - UniSALESIANO took part in this study. Data was collected from February to Augus... (Complete abstract click electronic access below) / Mestre

This thesis is a study of the prevalence, context, and experience of illegitimacy in Wales during the long eighteenth century, between approximately 1680 and 1800. It explores levels of illegitimacy across the Welsh counties of Montgomeryshire and Radnorshire, and investigates many of the underlying causes of childbirth outside of wedlock throughout eighteenth-century Wales. It is argued that Welsh illegitimacy was influenced by a combination of courtship-led marriage customs, a decline in traditional forms of social control, and worsening economic circumstances. In addition to exploring broader demographic trends, this study also examines the diverse individual identities, relationships and socioeconomic backgrounds of the mothers and fathers of illegitimate children in Wales, and the lived experience of conception, pregnancy and childbirth for unmarried mothers. The sexual encounters which resulted in the birth of an illegitimate child ranged from consensual sex which took place within the context of courtship, to sexual exploitation and rape. It is argued that these broad range of experiences are central to our understanding of illegitimacy. This thesis also examines infant and maternal survival chances, both in terms of overall risk of mortality in the days, weeks, and months after birth, and in terms of the ways in which fatal violence against illegitimate children and their mothers was contextualised in court records. These narratives reveal how the bodies of illegitimate infants and unmarried mothers often represented deviance, and served as the locus of anxieties surrounding unregulated reproduction. Finally, this study also analyses the provision of care for married and unmarried pauper women immediately before, during and after parturition. The skills, reputation, and availability of midwifery services in Wales are also explored. This thesis unites many disparate historical fields, including social and cultural history, historical demography, and the histories of crime, gender, sex, reproduction, and medicine, and analyses evidence from previously unstudied regions of Wales. It demonstrates that illegitimacy in eighteenth-century Wales was a deeply complex phenomenon governed by diverse regionally-specific social, cultural and economic influences.

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.

O parto cesariano tem sido usado de forma abusiva no Brasil. Fatores socioeconômicos, culturais e de organização dos serviços de saúde colaboram para a grande proporção de partos cirúrgicos, muitas vezes sem indicação médica que a justifique. Objetivo: avaliar a associação independente de variáveis socioeconômicas e demográficas maternas, características da assistência à gestação e parto e características do parto com o tipo de parto (vaginal e cirúrgico) e também com a causa da cesariana, classificada como terapêutica (doença ou condição materna ou fetal) e eletiva (sem causa médica expressa), em comparação ao parto vaginal. Método: Foram utilizados dados coletados de todas as puérperas do município de Ribeirão Preto, SP, em 2010, 7568 mães de recém-nascidos vivos de parto único. Na análise descritiva utilizou-se o teste de qui-quadrado e a associação dos fatores descritos com tipo de parto (vaginal e cirúrgico) foi testada por análise de Poisson com ajuste robusto da variância. A associação entre cesariana terapêutica ou eletiva e parto vaginal com as variáveis de interesse foi testada em análise de regressão logística multinomial. Resultados: Cesárea ocorreu em 58,4% dos partos, dos quais 58,3% foram terapêuticas e 41,7% eletivas; de todos os partos, 33,8% foram cesáreas terapêuticas e 24,3% foram eletivas. Após ajuste, cesárea foi mais frequente que parto vaginal nas gestações terminadas antes de 39 semanas, em mães adolescentes, com 9 a 11 anos de estudo, que realizaram partos no setor privado, depois de 12 horas decorridas entre internação e parto e internaram sem trabalho de parto; foi menos frequente de madrugada, às sextas-feiras, sábados e domingos, entre três e cinco horas da internação, em mães não brancas, que não realizaram pré-natal e parto com o mesmo médico e primíparas. Cesárea terapêutica foi mais frequente que o parto vaginal em gestações terminadas prematuramente; foi menos frequente que o parto vaginal de quinta-feira a domingo, entre três e 11 horas de internação, em gravidez não planejada e em multíparas. Cesáreas eletivas foram mais frequentes nas gestações entre 37-38 semanas, entre mães com 5 a 11 anos de estudo e multíparas com 2 a 4 partos; foram menos frequentes em mães idosas, nas classes menos favorecidas e com tempo de internação até o parto maior que três horas. Tanto as terapêuticas como eletivas foram mais frequentes do que parto vaginal em mães adolescentes, parto ocorrido no setor privado e fora do trabalho de parto. Ambas foram menos frequentes do que parto vaginal em mães, não brancas, partos realizados de madrugada e de quinta-feira a domingo e quando não foi o mesmo médico do pré- natal e parto. Conclusão: A taxa de cesárea em Ribeirão Preto apresentou valores expressivos, sendo 1/4 deles eletivos. Cesárea foi associada a características socioeconômicas da população estudada e também a fatores não clínicos, como assistência privada ao parto, dia e hora do nascimento. Algumas dessas características são comuns à cesárea terapêutica e eletiva, sugerindo que, mesmo com razões biológicas definindo a cesárea como terapêutica, fatores não clínicos podem ser mais importantes para decidir sobre a realização da cirurgia. / The caesarean section has been overused in Brazil. Socioeconomic, cultural and organization of health services factors contribute to the high proportion of surgical deliveries, often without medical indication to justify it. To assess the independent association of socioeconomic and maternal demographic variables, assistance features to pregnancy and labor and delivery characteristics of the type of delivery (vaginal and surgical) and also to the cause of cesarean section, classified as therapy (disease or maternal condition or fetal) and elective (without medical cause expressed) compared to vaginal delivery. We used data collected from all the mothers of Ribeirão Preto, SP, in 2010, 7568 mothers of live births of single birth. In the descriptive analysis was performed using the chi-square test and the combination of the factors described in the type of delivery was tested by Poisson analysis with robust adjustment of the variance. The association between therapeutic or elective cesarean section and vaginal delivery with the variables of interest was tested in multinomial logistic regression analysis. Cesarean occurred in 58.4% of births, of which 58.3% were therapeutic and 41.7% elective; of all births, 33.8% were therapeutic cesarean and 24.3% were elective. After adjustment, cesarean sections were more frequent than vaginal birth pregnancies ending before 39 weeks in teenage mothers, with 9 to 11 years of study, who underwent births in the private sector after 12h elapsed between admission and delivery and interned without labour; It was less frequent at dawn on Fridays, Saturdays and Sundays, between three and five hours of hospitalization in non-white mothers, who did not undergo prenatal and delivery with the same doctor and gilts. Cesarean therapy was more common than vaginal delivery in prematurely terminated pregnancies; It was less frequent than vaginal delivery Thursday to Sunday from 3 to 11 hours of hospitalization in unplanned pregnancies and multiparous. Elective cesareans were more common in pregnancies between 37- 38 weeks between mothers with 5 to 11 years of study and multiparous with 2-4 deliveries; They were less common in older mothers in the lower classes and length of stay to the higher birth than three hours. Both therapeutic and electives were more common than vaginal delivery in teenage mothers, birth occurred in the private sector and outside labor. Both were less frequent than vaginal delivery in mothers, not white, carried out early morning deliveries and from Thursday to Sunday and when it was not the same doctor\'s prenatal care and childbirth. The rate of cesarean delivery in Ribeirão Preto presented significant values, and 1/4 of them elected. Cesarean section was associated with socioeconomic characteristics of the population studied and also the non-clinical factors, such as private delivery care, day and time of birth. Some of these features are common to therapy and elective caesarean section, suggesting that even with biological reasons defining cesareans as a therapeutic, nonclinical factors may be more important to decide on the surgery.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-05-09T20:02:20Z No. of bitstreams: 1 OlivaniGuarda.pdf: 1436445 bytes, checksum: 999fb8a8ae64b0f9111e85cc447406c0 (MD5) / Made available in DSpace on 2017-05-09T20:02:20Z (GMT). No. of bitstreams: 1 OlivaniGuarda.pdf: 1436445 bytes, checksum: 999fb8a8ae64b0f9111e85cc447406c0 (MD5) Previous issue date: 2017-02-23 / Maternal mortality is a serious public health problem in Brazil, especially in the Northeast region and most significantly in the State of Maranhão. This study aimed to characterize maternal mortality in Maranhão between 2010 and 2014. This is a descriptive, retrospective study of all maternal deaths declared in the SIM between 2010 and 2014 of women residing in the State, by Regional Health. It was based In data collected in SIM, SINASC and in the Deputy Secretary of Health Surveillance of the Government of the State of Maranhão. Sociodemographic variables focused on age, race / color, schooling and marital status. The variables related to the deaths focused on the moment of death, place of occurrence and type of obstetric cause. There were 516 maternal deaths and 472 were submitted to spatial analysis. The following results were observed: MMR in the State presented very high and high values, according to WHO classification, in most of the Health Region in the years studied. The highest spatial density of deaths occurred in the Regional of São Luis. Predominant direct obstetric causes in brown women, between 20 and 29 years, with no partner and with little schooling, which portrays the expression of social inequity and evidences the need to improve prenatal care, delivery and puerperium in the State of Maranhão / A mortalidade materna é um grave problema de saúde pública no Brasil, principalmente na região Nordeste e mais expressivamente no Estado do Maranhão. Este estudo objetivou caracterizar a mortalidade materna no Maranhão no período de 2010 a 2014. Trata-se de um estudo descritivo, retrospectivo de todos os óbitos maternos declarados no SIM entre 2010 a 2014 de mulheres residentes no Estado, por Regional de Saúde. Foi baseado em dados coletados no SIM, SINASC e na Secretaria Adjunta de Vigilância em Saúde do Governo do Estado do Maranhão. As variáveis sociodemográficas enfocaram a faixa etária, raça/cor, escolaridade e situação conjugal. As variáveis relacionadas aos óbitos enfocaram o momento de ocorrência do óbito, local de ocorrência e o tipo de causa obstétrica. Foram encontrados 516 óbitos maternos e destes, 472 foram submetidos à análise espacial. Observaram-se os seguintes resultados: A RMM no Estado apresentou valores muito altos e altos, conforme classificação da OMS, na maioria das Regionais de Saúde nos anos estudados. A maior densidade espacial de óbitos ocorreu na Regional de São Luís. Predominaram as causas obstétricas diretas em mulheres pardas, entre 20 a 29 anos, sem companheiro e com pouca escolaridade, o que retrata a expressão da iniquidade social e evidencia a necessidade de melhorar a assistência ao pré-natal, parto e puerpério no Estado do Maranhão.

Bakgrund: Under 2016 var det 7,9 % av förlossningarna i Sverige som avslutades med ett oplanerat kejsarsnitt. Inte bara kvinnan påverkas av ett akut kejsarsnitt, utan även pappan som blir försatt i en överväldigande situation som gör att han kan känna oro både för sin partner och sitt ofödda barn. Forskning har gjorts på den födande kvinnans upplevelser vid akut kejsarsnitt men endast lite har forskats om hur hennes partner upplever dessa händelser. Syfte: Syftet med studien var att belysa pappors upplevelse i samband med ett oplanerat kejsarsnitt. Metod: Semistrukturerad intervjustudie som analyserats med kvalitativ innehållsanalys Resultat: Utifrån analysen skapades fyra huvudkategorier. Föräldraförberedelser inför förlossning, försöka finna sin roll, personalens påverkan och betydelse, konsekvenser för parrelationen. Slutsats: Pappor behöver stöd och uppmuntran för att medges tillträde och delaktighet vid ett oplanerat kejsarsnitt. Även om pappan inte är patient bör han uppmärksammas av vårdpersonal för att kunna ge kvinnan stöd men också för att underlätta för honom under förlossningen och även underlätta i hans nya roll att bli förälder. Barnmorskan spelar en betydande roll i detta arbete inte bara under förlossningen utan också under graviditeten. / Background: During 2016 in Sweden 7,9% of the childbirths was conducted by emergency ceasarian section. Not only the woman are affected by a emergency ceasasrian section, also the father that is put in a overwealming situation that bring worries not only for his partner but also for their unborn child. Research has been done of the woman in labour that ends with an unplanned ceasarian section but little is known of the fathers perspective of these events. Aim: To explore fathers experience of childbirth when their baby is being born by an unplanned ceasarian section. Method: Seven semi-structured interviews were conducted and analysed with qualitative content analysis. Findings: Fathers prepare for childbirth in many different ways. The behavior of the staff have great impact on the fathers. Fathers feels demands on supporting the women during labour. When a childbirth ends with a emergency ceasarian section fathers are faced with different emotions. Fathers experience diffuculties sharing the experience with the women and this affects their relationship even after the birth. Conclusion: There is a need to support and encourage the fathers so that their access and participation strengthens. Even though the father isn´t the patient he should be noted by health care staff so that he can support the woman but also to facilitate him during labour and strengthen him in his role of becoming a father. Midwifes has a large part in this not only during labour but also throughout pregnancy.

O parto cesariano tem sido usado de forma abusiva no Brasil. Fatores socioeconômicos, culturais e de organização dos serviços de saúde colaboram para a grande proporção de partos cirúrgicos, muitas vezes sem indicação médica que a justifique. Objetivo: avaliar a associação independente de variáveis socioeconômicas e demográficas maternas, características da assistência à gestação e parto e características do parto com o tipo de parto (vaginal e cirúrgico) e também com a causa da cesariana, classificada como terapêutica (doença ou condição materna ou fetal) e eletiva (sem causa médica expressa), em comparação ao parto vaginal. Método: Foram utilizados dados coletados de todas as puérperas do município de Ribeirão Preto, SP, em 2010, 7568 mães de recém-nascidos vivos de parto único. Na análise descritiva utilizou-se o teste de qui-quadrado e a associação dos fatores descritos com tipo de parto (vaginal e cirúrgico) foi testada por análise de Poisson com ajuste robusto da variância. A associação entre cesariana terapêutica ou eletiva e parto vaginal com as variáveis de interesse foi testada em análise de regressão logística multinomial. Resultados: Cesárea ocorreu em 58,4% dos partos, dos quais 58,3% foram terapêuticas e 41,7% eletivas; de todos os partos, 33,8% foram cesáreas terapêuticas e 24,3% foram eletivas. Após ajuste, cesárea foi mais frequente que parto vaginal nas gestações terminadas antes de 39 semanas, em mães adolescentes, com 9 a 11 anos de estudo, que realizaram partos no setor privado, depois de 12 horas decorridas entre internação e parto e internaram sem trabalho de parto; foi menos frequente de madrugada, às sextas-feiras, sábados e domingos, entre três e cinco horas da internação, em mães não brancas, que não realizaram pré-natal e parto com o mesmo médico e primíparas. Cesárea terapêutica foi mais frequente que o parto vaginal em gestações terminadas prematuramente; foi menos frequente que o parto vaginal de quinta-feira a domingo, entre três e 11 horas de internação, em gravidez não planejada e em multíparas. Cesáreas eletivas foram mais frequentes nas gestações entre 37-38 semanas, entre mães com 5 a 11 anos de estudo e multíparas com 2 a 4 partos; foram menos frequentes em mães idosas, nas classes menos favorecidas e com tempo de internação até o parto maior que três horas. Tanto as terapêuticas como eletivas foram mais frequentes do que parto vaginal em mães adolescentes, parto ocorrido no setor privado e fora do trabalho de parto. Ambas foram menos frequentes do que parto vaginal em mães, não brancas, partos realizados de madrugada e de quinta-feira a domingo e quando não foi o mesmo médico do pré- natal e parto. Conclusão: A taxa de cesárea em Ribeirão Preto apresentou valores expressivos, sendo 1/4 deles eletivos. Cesárea foi associada a características socioeconômicas da população estudada e também a fatores não clínicos, como assistência privada ao parto, dia e hora do nascimento. Algumas dessas características são comuns à cesárea terapêutica e eletiva, sugerindo que, mesmo com razões biológicas definindo a cesárea como terapêutica, fatores não clínicos podem ser mais importantes para decidir sobre a realização da cirurgia. / The caesarean section has been overused in Brazil. Socioeconomic, cultural and organization of health services factors contribute to the high proportion of surgical deliveries, often without medical indication to justify it. To assess the independent association of socioeconomic and maternal demographic variables, assistance features to pregnancy and labor and delivery characteristics of the type of delivery (vaginal and surgical) and also to the cause of cesarean section, classified as therapy (disease or maternal condition or fetal) and elective (without medical cause expressed) compared to vaginal delivery. We used data collected from all the mothers of Ribeirão Preto, SP, in 2010, 7568 mothers of live births of single birth. In the descriptive analysis was performed using the chi-square test and the combination of the factors described in the type of delivery was tested by Poisson analysis with robust adjustment of the variance. The association between therapeutic or elective cesarean section and vaginal delivery with the variables of interest was tested in multinomial logistic regression analysis. Cesarean occurred in 58.4% of births, of which 58.3% were therapeutic and 41.7% elective; of all births, 33.8% were therapeutic cesarean and 24.3% were elective. After adjustment, cesarean sections were more frequent than vaginal birth pregnancies ending before 39 weeks in teenage mothers, with 9 to 11 years of study, who underwent births in the private sector after 12h elapsed between admission and delivery and interned without labour; It was less frequent at dawn on Fridays, Saturdays and Sundays, between three and five hours of hospitalization in non-white mothers, who did not undergo prenatal and delivery with the same doctor and gilts. Cesarean therapy was more common than vaginal delivery in prematurely terminated pregnancies; It was less frequent than vaginal delivery Thursday to Sunday from 3 to 11 hours of hospitalization in unplanned pregnancies and multiparous. Elective cesareans were more common in pregnancies between 37- 38 weeks between mothers with 5 to 11 years of study and multiparous with 2-4 deliveries; They were less common in older mothers in the lower classes and length of stay to the higher birth than three hours. Both therapeutic and electives were more common than vaginal delivery in teenage mothers, birth occurred in the private sector and outside labor. Both were less frequent than vaginal delivery in mothers, not white, carried out early morning deliveries and from Thursday to Sunday and when it was not the same doctor\'s prenatal care and childbirth. The rate of cesarean delivery in Ribeirão Preto presented significant values, and 1/4 of them elected. Cesarean section was associated with socioeconomic characteristics of the population studied and also the non-clinical factors, such as private delivery care, day and time of birth. Some of these features are common to therapy and elective caesarean section, suggesting that even with biological reasons defining cesareans as a therapeutic, nonclinical factors may be more important to decide on the surgery.

Thesis (MPH.) --University of Limpopo, 2018 / Background: When pregnant women deliver fresh stillbirths, their expectations and happiness are heartlessly substituted by mourning for their loss. The consequences are psychosocial and physiological. Mothers begin to search for answers while feeling guilt and shame; some accept blame for their babies‟ death. Their experiences are determined by the care they received from healthcare workers during delivery and grieving period. They complain that doctors and nurses care about the fact that the baby has been delivered and do not care about the emotional trauma that the mother is experiencing. Objectives: To identify, explore and describe experiences of women who delivered fresh stillbirths at a public hospital. Methods: A qualitative and descriptive phenomenological study was conducted using an in-depth phenomenological interview technique to collect data. Due to data saturation, nine purposively selected mothers participated. Interviews were conducted in the local language, and field notes were also collected. Interview recordings were transcribed and translated and analysed using open coding thematic analysis. Results: Some women experienced feelings of guilt, sadness, hurt, sense of failure, shock and self-blame. Some needed counselling whereas others were doing fine without it. Some experienced lack of sympathy from healthcare workers. Conclusions: Giving birth to a stillborn baby is a painful experience for women and their families. Healthcare workers should care for such mothers after delivery. Keywords: Stillbirth; postnatal care, phenomenological study design, field notes / AMREF

Postpartum Depression (PPD) affects 15% of women after childbirth. Its etiology includes psychoneuroimmunologic factors with long-lasting postpartum stressors that lead to allostatic overload. Using mindfulness-based stress reduction (MBSR) for PPD has not yet been studied. Addressing this literature gap, the potential benefits of including an 8-week MBSR component based on Beck's theory of PPD at support groups were examined in this phenomenological study based on a sample of 10 women and 2 group facilitators. Purposes of the study included describing the experience of PPD and the MBSR program, identifying the stage of behavioral change of the participants, and describing the population of women attending the PPD support groups. These assessments were carried out using coding and constant comparison, guided by the tenets of the transtheoretical model. Data triangulation safeguarded study validity and rigor. Results pointed to the value of utilizing the MBSR program in PPD support groups. Data analysis concluded in the identification of 9 stages and 5 themes of the PPD experience of which 2 constructs, unexpected experience and feeling dismissed, emerged as original contributions of the study. Positive impact on social change was evidenced at the individual level by women's report of high satisfaction with the support groups and the MBSR program; improved problem-solving and coping with anxiety, panic, and intrusive thoughts; and by positive behavioral change at Week 8. The updated knowledge about these women's experiences, along with the availability of a new tool for professionals to treat PPD, contribute to positive social change at a societal level by improving mothers' health and children's development.

Bakgrund: Förlossningsrädsla klassificeras som lätt rädsla eller oro, måttlig rädsla samt svår eller intensiv förlossningsrädsla. Prevalensen av svår förlossningsrädsla hos gravida kvinnor uppskattas till 14 procent ur ett globalt perspektiv. Förlossningsrädsla kan ge konsekvenser i form av att kvinnor väljer att inte föda fler barn och eller att det går ofrivilligt lång tid mellan graviditeterna samt att kvinnorna kan uppleva mer smärta under en förlossning. Syfte: Syftet med den här metasyntesen är att beskriva upplevelser och rädslor hos förlossningsrädda kvinnor under graviditet och förlossning. Metod: Kvalitativ metasyntes med meta-ethnografi som analysmetod. Datainsamling har utförts i databaserna PubMed, Cinahl, Web of Science och PsycINFO. Totalt ingår 15 artiklar i metasyntesens resultat och dessa valdes ut efter kvalitetsgranskning. Resultat: Fyra huvudteman identifierades, Beskrivning av förlossningsrädsla, Rädsla för sin egen hälsa och det okontrollerbara, Rädslor i samband med möten i vården och Rädslor för barnets hälsa. Även sex underteman identifierades, Det oförutsägbara, Att inte ha kontroll, Den fysiska hälsan, Smärta, Möten med barnmorska och annan vårdpersonal och Interventioner. Slutsats: Resultatet visar att de vanligaste rädslorna som förlossningsrädda kvinnor har under graviditet och förlossning är rädsla för bristningar, smärta och att barnet ska skadas. De förlossningsrädda kvinnorna uppger även att de är rädda för att inte erhålla tillräckligt med stöd från barnmorskan. Klinisk tillämpbarhet: Den här metasyntesen visar att det är av stor vikt att identifiera och hjälpa förlossningsrädda kvinnor i ett tidigt stadie under graviditet för att kunna främja deras hälsa och förebygga förlossningsrädsla. För att hjälpa dessa kvinnor kan barnmorskan förslagsvis erbjuda föräldrautbildning för kvinnor som känner oro eller rädsla inför sin förlossning. Denna utbildning skulle kunna innehålla studiebesök på en förlossningsavdelning samt information om de vanligaste rädslorna och åtgärder som vidtas om komplikationer skulle uppstå. / Background: Fear of childbirth can be classified as low fear or worry, moderate fear and severe fear of childbirth. The prevalence of severe fear of childbirth among pregnant women is estimated to be 14 percent globally. Consequences of fear of childbirth is not wanting to have another child, involuntarily long time between pregnancies and more pain during labour. Method: Qualitative meta- synthesis with meta-ethnographic analysis method. Databases that was used to find the articles were PubMed, Cinahl, Web of Science and PsycINFO. Totally 15 articles are included in the meta-synthesis after a quality review. Results: Four main themes were identified Description of fear of childbirth, Fear of their own health and the uncontrollable, Fear associated with meetings with healthcare and Fear of the health of the child. Also six subtopics were identified, The unpredictable, Not having control, The physical health, Pain, Encounters with midwives and other healthcare professionals and interventions. Conclusion: The results showed that the most common fear among pregnant women with fear of childbirth were fear of tearing, pain and the health of the baby. The women with fear of childbirth is also afraid of encounter a midwife who would give inadequate support. Clinical implications: This meta-synthesis shows it is of huge importance to identify fear of childbirth in early pregnancy to promote health and reduce fear of childbirth. To help these women, the midwife may propose parental education for women who feel anxious or afraid of childbirth. This training could include study visits to a maternity ward as well as information on the most common fears and measures taken if complications should occur.