Bakgrund: Förekomsten av kvinnor som genomgår förlossningsinduktion i Sverige har ökat de senaste åren. Ämnet har diskuterats intensivt sedan hösten 2019 i samband med att doktorsavhandlingen "SWEPIS" publicerades. Delade meningar råder om när i graviditeten induktion bör ske. Tidigare beskrivningar av kvinnors upplevelser av förlossningsinduktion är att de generellt är sämre jämfört med spontan förlossningsstart. Syfte: Att utifrån kvinnors skrivna berättelser beskriva deras upplevelser av förlossningsinduktion som initierats av sjukvården efter beräknat förlossningsdatum. Metod: Kvalitativ innehållsanalys med induktiv ansats. Nio bloggar studerades och analyserades. Resultat: Analysen resulterade i ett tema: Induktion efter beräknat förlossningsdatum väcker mångfacetterade känslor hos kvinnor samt tre kategorier: Känslor relaterade till upplevelsen av induktion uppstår redan tiden före förlossningen, Behov av stöd under inducerad förlossning och Upplevelsen av förlossningsinduktion varierar både under och efter förlossningen. Konklusion: Kvinnor upplever ambivalenta känslor relaterat till förlossningsinduktion. Induktion präglas av tvivel och lång väntan men även rädsla, hopplöshet, smärta, förväntan och positiva känslor. Barnmorskor främjar en god upplevelse genom förståelse för kvinnors känslor inför, under och efter en förlossningsinduktion. / Background: The incidence of women undergoing labor induction in Sweden has increased during the past years. The topic has been loudly discussed since the fall of 2019 due to the doctoral thesis “SWEPIS”. There are divided opinions about when induction should take place during pregnancy. Previous descriptions of experiences of birth induction shows that it´s generally worse compared to the experience of childbirth that started spontaneously. Purpose: To describe, based on women's written stories, their experiences of induction initiated by healthcare after the estimated date of childbirth. Method: Qualitative content analysis with inductive approach. Nine blogs have been analyzed. Results: The analysis resulted in a theme: Induction after the estimated date of birth evokes multifaceted emotions in women and three categories: Emotions related to the experience of induction arises even before the start of the induction, Need for support during induced childbirth and the experience of birth induction varies both during and after childbirth. Conclusion: Women experience ambivalent emotions related to the induction of labor. Induction is characterized by doubt and long waits but also fear, hopelessness, pain, anticipation and positive emotions. Midwives can support good experiences by understanding women's feelings before, during and after the induction of labor.

Bakgrund: Att genomgå förlossning och bli förälder för första gången är en av de största händelserna i livet och förlossningsupplevelsen påverkas av flera faktorer. Mer kunskap behövs om sambandet mellan föräldrars förlossningsupplevelser, uppfattat socialt stöd samt deras känsla av sammanhang ett år efter förlossning. Syfte: Syftet med studien är att utforska samband mellan förstföderskors samt partners förlossningsupplevelser ett år efter förlossning och deras uppfattning om socialt stöd samt deras känsla av sammanhang. Metod: Kvantitativ longitudinell kohortstudie med 380 förstföderskor och 266 partners. Datainsamlingen genomfördes med upprepade enkätutskick mellan en vecka och ett år efter förlossning. Dataanalys genomfördes genom deskriptiv samt analyserande statistik med logistisk binär- och multipel regressionsanalys. Resultat: Den multipla regressionsanalysen påvisade att mer positiv förlossningsupplevelse ett år efter förlossning visade samband med: högre skattad betydelse av positiv förlossningsupplevelse, uppfattad normal förlossning, känsla av trygghet och kontroll under förlossning, vid olika mättillfällen i studien. Utöver ovan beskriva samband i den multipla regressionsanalysen visade det sig i den binära regressionsanalysen att uppfattat socialt stöd spelar en betydande roll för förstföderskors förlossningsupplevelse. Studien visar även att en högre skattad känsla av sammanhang hos förstföderskor samt partners står i samband med en mer positiv förlossningsupplevelse ett år efter förlossning. Konklusion: Betydelsen av en positiv förlossning, uppfattad normal förlossning samt känsla av trygghet och kontroll under förlossning påvisar samband med en mer positiv förlossningsupplevelse ett år efter förlossning. / Background: Childbirth and becoming a parent for the first time is one of the biggest events in life and the birth experience is affected by several factors. More knowledge is needed about the relationship between parent’s birth experiences, perceived social support and their sense of coherence one year after childbirth. Objective: The purpose of the study is to explore the relationship between first-time-mothers and partners birth experiences one year after childbirth and their perception of social support and their sense of coherence Method: Quantitative longitudinal cohort study with 380 first-time-mothers and 266 partners. The data collection was carried out with repeated questionnaires between one week and one year after delivery. Data analysis was performed through descriptive and analytical statistics with logistic binary and multiple regression analysis. Results: The multiple regression analysis showed that more positively perceived childbirth experience one year after childbirth was significantly associated with: higher estimated importance of perceiving positive childbirth experience, perceived normal childbirth, feeling of security and control during childbirth, at various measurement occasions in the study. In addition to the above described, it was found in the binary regression analysis that perceived social support plays a significant role in the childbirth experience of first-time-mothers. The study also shows that a higher valued sense of coherence within first-time-mothers and partners is associated with a more positive birth experience one year after childbirth. Conclusion: The importance of a positive birth, perceived normal birth and a feeling of security and control during childbirth demonstrates a connection with a more positive birth experience one year after childbirth.

Background: Ruptures in the pelvic floor muscles is the most common childbirth injury. It affects 70 – 85 percent of the Swedish women who gives birth every year. Childbirth injuries can cause lack of motor control of the pelvic floor muscles, decreased participation and activity in the womens every day life. It also can affect the qualilty of life. The physiotherapists role in care for these patients is to examine and treat the patients problems in a biopsychosocial way to work for health benefits and provide further injuries. Purpose: The purpose is to examine physiotherapists experience of examination and rehabilitation of women with ruptures in the pelvic floor muscles caused by childbirth injuries. Method: In a qualitative descriptive interview study with a appropriate selection, interviews was done with six physiotherapists who is operative in womens health. A semi structured interview guide was used and then a manifest qualitative analysis was done with an inductive approach. Result: The analysis process showed five main categories in terms of the physiotherapists experience of examine and treat women with muscle ruptures in the pevic floor caused by childbirth injuries: ’Examination and treatment in body structure and body function level’, ’to build trust between therapist and patient’, ’work with the patients fear-avoidance behaviour’, ’work in team with other professionals’ and ’inform the patient about the injury in early state’. Two of the five main categories were divided into under categories associated to the main categories. Conclusion: The informants in the study experienced that there is a necessity to examine and rehabilitate patients out of their individual needs. They experienced that it was important to talk about the worry a lot of the patients with injuries in the pelvic floor feel and to build trust to avoid catastrophizing and fear-avoidance behaviour. / Bakgrund: Bristningar i bäckenbotten till följd av förlossning drabbar 70 - 85% av kvinnorna som föder barn i Sverige varje år. En förlossningsskada kan leda till försämrad motorisk bäckenbottenkontroll, nedsatt aktivitets- och delaktighetsförmåga samt sänkt livskvalité. Fysioterapeutens roll är att undersöka och behandla patienterna med ett biopsykosocialt synsätt för att verka hälsofrämjande och skadeförebyggande. Syfte: Att undersöka fysioterapeuters erfarenheter av undersökning och behandling av kvinnor med förlossningsskada i bäckenbotten. Metod: I en kvalitativ beskrivande intervjustudie med ändamålsenligt bekvämlighetsurval intervjuades sex fysioterapeuter/sjukgymnaster verksamma inom området kvinnohälsa utifrån en semistrukturerad intervjuguide. En manifest kvalitativ dataanalys med induktiv ansats genomfördes. Resultat: I analysprocessen framkom fem huvudkategorier om informanternas erfarenheter av undersökning och behandling vid förlossningsskador i bäckenbottenmuskulaturen: undersökning och behandling på kroppsstruktur- och kroppsfunktionsnivå, att bygga förtroende mellan fysioterapeut och patient, arbeta med rädsla och undvikandebeteende hos patienten, samarbete med andra professioner och informera om skadan i ett tidigt skede. Två av de fem huvudkategorierna delades in i underkategorier. Slutsats: Utifrån studiens resultat visade informanternas samlade erfarenheter att behovet är stort att undersöka, individanpassa behandling och bemöta oro hos den berörda patientgruppen som drabbas av bäckenbottenskada. Även att bygga förtroende för att undvika katastroftankar och eliminera rädsla-och undvikande beteende hos patienterna.

Pregnant immigrant women are a vulnerable population with respect to access and navigation of maternity care service. They have to deal with the challenges of  navigating a health system in a new country which in most cases is unknown to them while tackling issues such as communication, language, and an unfamiliar healthcare system. Conversely the healthcare professionals are confronted with managing these issues and  providing care within a health institution which was not designed to take on the challenges of providing healthcare to a diverse population.  Both parties continue to search and implement measures within and outside the general healthcare institution with the aspiration of bridging the existing gap.   As a result, the primary aim of this study is to examine immigrant women’s interpretation of maternity care in Sweden and the secondary aim is to explore the views of maternity healthcare professionals on given care to immigrant women. The purpose is to generate and explore new knowledge about an area with limited understanding thus, the research questions are Thus, the research questions are:  How do immigrant women describe their maternity care experience?. How do healthcare professionals describe their experience caring for immigrant women?. An inductive qualitative research was conducted to explore the research problem. Thus, the theory was grounded in data.  Data was collected using semi-structured interviews held with immigrant women who had accessed maternity care in Sweden, had a live birth in the last five years and from healthcare professionals (midwives and doulas).   The result of this study shows that the maternal health needs of immigrant women are compromised due to various factors which centres mainly around communication, language and the health system.  The healthcare professionals also highlighted these same factors and the lack of education and training for them as the most significant underlying systematic problem within health services.

Cette thèse en cotutelle vise à analyser le processus d'institutionnalisation des accouchements par césarienne au Brésil et en France selon une démarche socio-clinique institutionnelle. Le cadre théorique et méthodologique, dans son caractère dialectique entre institué et instituant, permet d’approcher le processus d'institutionnalisation. Par conséquent, la naissance est comprise comme un analyseur des institutions de « santé maternelle et infantile » et d’« éducation en santé ». La présente recherche est issue d'une étude plus vaste sur la naissance au Canada, en France et au Brésil. Les données sur lesquelles s’appuient cette thèse ont été produites entre 2016 et 2019, au Brésil et en France. Ceci lors de groupes de discussion de parents et de professionnels, d'entretiens individuels avec des professionnels de la santé maternelle et infantile et des participants à un Comité de surveillance des décès maternels et infantiles), ainsi qu’avec des mères et des pères ayant vécu l'accouchement. Un journal de recherche a également été tenu tout au long de la recherche. Les groupes de discussion étaient composés de professionnels des services traditionnels et alternatifs, de parents issus de milieux sociaux différents. Chaque groupe s’est réuni trois fois, ceci pour un total de 12 réunions qui ont été transcrites. Les aspects éthiques de la recherche avec des êtres humains ont été respectés. Une analyse croisée a été effectuée entre les différents types de données, entre les services, entre les groupes et entre les pays, ceci de façon continue, à partir des matériaux produits. Trois axes d’analyse ont été retenus : 1) Naissance par césarienne: un analyseur - de la condition féminine face à la médicalisation, 2) des pratiques professionnelles et des discours, et 3) de l'institutionnalisation de la naissance. Les transcriptions ont fait l’objet d’une analyse thématique. Des synthèses transversales des entrevues ont été réalisées pour chacun des groupes interviewés. L'analyse a également été produite lors de restitutions aux participants. De façon générales, la démarche d’analyse des matériaux était basée sur l'approche d'analyse thématique des auteurs Mucchielli et Paillé. Le Brésil et la France suivent des processus distincts concernant l’institutionnalisation de la césarienne. Le Brésil est le champion des accouchements chirurgicaux sans indication. La France, en revanche, présente une autre réalité, où les naissances sont essentiellement vaginales. Chacun des pays étudiés a sa propre structure sanitaire et éducative mais les deux sont imprégnés par une construction socio-historique et économique marquée par le patriarcat et la soumission féminine. La Nouvelle Gestion Publique influe sur les deux contextes nationaux, précarisant l’offre sanitaire dans un discours ou prédomine les impératifs économiques. En termes d'éducation et de santé, dans tous les pays, la grossesse est essentiellement comprise comme un processus physiologique et donne lieu à de nombreuses interventions sur le corps féminin. Les dimensions techniques et organisationnelles prédominent en soulignant la division intellectuelle et sociale du travail et des connaissances en santé. Les pratiques et les discours des professionnels (dans le processus de travail) influencent le choix (ou non) de pratiquer la césarienne. La progression ou la régression de ce phénomène est liée au degré de mise en œuvre des actions médicales dans les actions de santé. Au moment de la réalisation de cette recherche doctorale, au Brésil, il y a une lutte entre l'institutionnalisation de l'accouchement par césarienne et sa désinstitutionnalisation. En France, en ce qui concerne les césariennes, une discussion sur la «césarienne active» apparait. Celle-ci exprime-t-elle le mouvement d'institutionnalisation de l'accouchement par césarienne dans ce pays ?Mots-clés: césarienne ; accouchement ; éducation à la santé; santé ; éducation, analyse institutionnelle / This is a double titled thesis that aims to analyze the process of institutionalization of cesarean deliveries in Brazil and France from the perspective of institutional social-clinical. The theoretical-methodological framework, in its dialectical character between institute and instituinte, unfolds in the process of institutionalization. Therefore, birth is understood as an analyzer of "maternal and child health" and "health education" institutions. The present research comes from a larger study on births in Canada, France and Brazil. In this thesis, data were produced between 2016 and 2019, in Brazil and France, through focus groups, individual interviews with maternal and child health professionals (and the Brazilian Maternal and Child Death Surveillance Committee), with mothers and fathers who lived the experience of childbirth and the research journal. The focus groups were composed of professionals from traditional and alternative services, parents from different social backgrounds. There were 3 meetings making a total of 12 meetings. The ethical aspects regarding research with human beings were respected. A cross-analysis was carried out between the different types of data, between services, between groups and between countries, on a continuous basis, based on the materials produced. The polished thematic axes were: Birth by cesarean section: an analyzer of the female condition in face of medicalization, of professional practices and discourses, and of the institutionalization of birth. These were arranged in analytical frameworks and organized by group of interviewees and scenarios studied. Afterwards, horizontal summaries of the interviews were carried out, by groups interviewed. The analysis was also produced during the time of restitution to the participants and was based on the thematic analysis approach of the authors Mucchielli and Paillé. Brazil and France demarcate distinct processes. Brazil is the champion in surgical deliveries without indication. France, on the other hand, presents another reality, in which births are mostly vaginal. It was possible to learn that although each of the countries studied has its peculiar sanitary and educational structure, they are marked by a sociohistorical-economic construction outlined by the patriarchy and female subjugation. The marks of New Public Management are present in both contexts and reveal a precariousness of offers and actions supported by a discourse of economic fragility. In terms of education and health, in any of the countries, pregnancy is understood as a physiological process and developed with numerous interventions on the female body. There is an appreciation of the technical and organizational dimensions pointed out by an intellectual and social division of work and knowledge in health. The practices and discourses of professionals (in their work process) influence the occurrence (or not) of cesarean delivery. The progression or regression of this is related to the degree of implementation of medical actions in health actions. In this way, in Brazil there is a struggle between the institutionalization of cesarean delivery in comparison with its deinstitutionalization. In France, in relation to cesarean sections, there is a discussion on "active cesarean section". Would this be the movement of institutionalization of cesarean delivery in this country?Keywords: cesarean section; childbirth; health education; health; education

A study was conducted to investigate the claim made by proponents of the natural childbirth method that attendance in the program results in a decrease of the anxiety commonly associated with pregnancy and delivery. Seventy-two pregnant women filled out the A-State and A-Trait forms of the STAI twice in their obstetricians' offices at points which approximated 6.5 and 8.5 months along in their pregnancies. Subjects who elected not to attend natural childbirth classes evidenced significantly higher state and trait scores as compared to those scores of subjects who did attend classes. Implications for dealing with these differences are discussed in terms of the natural childbirth program.

This study addresses the preparenthood period of family life, that period from conception to six weeks after the infant is born. This period was of great interest because in nine years of social work practice I have recognized that families resist change after their particular family system process, even destructive process, is established. I also believe that the order, or disorder, of society depends upon the order of the institution of the family. Other institutions of society depend upon the family for their existence.

Indiana University-Purdue University Indianapolis (IUPUI) / This thesis project aims to address the following question: How do women who were planning a vaginal birth with limited medical intervention experience an unplanned c-section? Specifically, this research project involved: completing in-depth interviews with 15 women who planned a vaginal birth with limited medical intervention but instead experienced an unplanned c-section between six months and two years ago; discovering and describing the nature of the birth the mothers originally envisioned for their child; exploring the women’s experiences with, and feelings about, the birth itself and how it might differ from what they envisioned; developing a better understanding of how these experiences and feelings affected the women during the first two years following the birth; describing any challenges they faced and how, if at all, they managed such challenges; and identifying strategies that could be used to improve the experience of women recovering from an unplanned c-section who envisioned a vaginal birth with limited medical intervention.

About 4 % women in general population and up to 19 % women in at-risk population suffer from PTSD related to childbirth. The main risk factors for postpartum PTSD are negative birth experience and obstetric emergencies. However, the findings about risk factors and prevalence rates vary across studies, which is mainly due to the inconsistency in the diagnostics of postpartum PTSD. Researchers use various PTSD measures that differ in the number and type of symptoms monitored and many of these measures do not cover all DSM criteria for PTSD. Furthermore, the PTSD diagnostic criteria have been significantly modified in the new DSM-5 and the existing instruments need to be revised. The first part of the thesis presents the concept of PTSD related to childbirth. Special attention is paid to the risk factors identified in previous research and to the analysis of PTSD diagnostic and screening measures used in the postpartum context. The aim of the second part of the thesis is to evaluate the psychometric properties of the unpublished Childbirth-Related PTSD Questionnaire on a sample of 620 Czech women. The factor validity of the scale, the internal consistency of the total scale and the subscales resulting from the factor analysis; and the criterion validity of the instrument are verified. With regard to...

The purpose of this study was to explore the childbirth narratives of first-time mothers in order to understand and describe the ways in which experiencing birth for the first time shaped their personal identities and identities as women. The study was guided by a qualitative postmodern research approach and involved conducting in-depth interviews with eight South African first-time mothers. The narrative accounts of these mothers were then analysed in two stages in order to present the findings. Firstly, using a holistic-content narrative analysis approach, significant themes that emerged from the data analysis were contextualised and organised in relation to the holistic accounts and interpretations of participants’ experiences in order to present how their personal identities were shaped through the experience of giving birth for the first time. Secondly, by conducting a qualitative thematic content analysis, shared common themes emerging from participant’s narratives were presented to understand in what ways individual elements interrelated to all participants’ identities in general, with a focus on female-gender identity. The findings reinforce the message that women’s personal and shared social identities are indeed significantly shaped by their first time childbirth experiences. These findings lend voice to women’s experiences and may serve to deepen insight for individuals and professionals working with perinatal women.