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.

Breastfeeding offers numerous health benefits to both the mother and infant, yet it is not routinely practiced due to a number of internal and external factors that influence the mother's decision. Guided by the social ecological model, the purpose of this study was to examine the effect of required reporting to The Joint Commission on perinatal measures, a proxy measure for maternity care practices, and those professional effects on breastfeeding initiation and exclusivity for first-time mothers. The hypotheses were that the mandatory reporting, and thus an increase in maternity care practices, would increase the initiation of breastfeeding and exclusive breastfeeding on discharge in first-time mothers. This study was a quantitative retrospective study design that included data collected from the medical records of 1,000 mothers from Southeast Alabama Medical Center who gave birth between 2013 and 2014. The multiple logistic regression analysis indicated that the odds ratio for initiation of breastfeeding was greater among first-time mothers after implementation of mandatory reporting measures (OR = 2.07; p = 0.0007); however, the odds for exclusive breastfeeding on discharge did not show a statistically significant change (OR = 0.94; p = 0.7507). These findings may inform the work of healthcare providers at hospitals, community centers, and public health workers, guiding their maternity care practices to increase the number of first-time mothers who will breastfeed for longer periods of time and improving children's health outcomes.

With the loss or modification of natural roosting habitat afforded by caves, abandoned mines have assumed increased importance as surrogate roosting sites for Townsend's big-eared bats (Corynorhinus townsendii) and other chiropteran species. However, increasing concerns for human safety have led to accelerated programs for mine closure. In efforts to protect roosting sites in mines showing significant bat activity, "bat compatible" gates are installed, thus allowing continued access to mine workings. Aside from ensuring public safety, these structures afford protection from disturbance to roosting bats. To date few posting-gating studies have been conducted to obtain information on the effects of these structures on bat behavior and roost suitability. I evaluated the effects of gating on bat flight patterns at maternity colonies in two previously gated (reference) and two ungated mines, the latter (treatment) being gated with roundbar Manganal steel gates in the second year of the study. I also monitored four gated and three treatment mines to determine the potential effects of reclamation on internal microclimate. Overall circling activity increased > 6-fold at the portals of treatment mines following gating. Indices of crowding and frequency of bat-gate collisions were significantly higher in previously gated and increased substantially in treatment mines following reclamation. Gates appeared especially hazardous to subadults during initial-volancy periods. Increased activity of bats and collisions with gates at mine portals may amplify vulnerability to potential predators. Changes in internal mine microclimates, specifically increased ranges between minima and maxima in temperature and vapor pressure deficits following reclamation varied among treatment mines as a function of the number of mine openings. Generally, gated mines with multiple openings experienced greater changes in these parameters than those with single openings. Additional studies of bat-compatible gates are needed to elucidate possible long-term effects of these structures on Townsend's big-eared bats.

Orientador: Claudinei Magno Magre Mendes / Banca: Zélia Lopes da Silva / Banca: Beatriz Anselmo Olinto / Banca: Ivana Guilherme Simili / Banca: Tania Regina de Luca / Resumo: O presente trabalho busca analisar a construção de um modelo de assistência à infância e amparo à maternidade no Brasil entre os anos de 1927-1940. Pretende, também, examinar como foi o processo de elaboração que levou à centralização da assistência à infância aos cuidados da União, passando pelo debate entre juristas e médicos na Construção do Código de Menores e na Constituinte de 1934. Neste período, o saber médico-social prevaleceu, juntamente com o modelo de assistência que buscava dividir as responsabilidades de atendimento entre o público e o particular. Porém, manteria como responsabilidade do Estado a formulação de diretrizes e normatizações referentes ao assunto, criando para este fim um organismo nacional que foi o responsável por organizar, pesquisar, fiscalizar e divulgar as medidas que deveriam ser implementadas em relação à Assistência à Infância e o Amparo à Maternidade em todo o território nacional. / Abstract: The present work searches to analyse the construction of a model of assistance to infancy and support to the maternity in Brazil during the period of 1927-1940. It intends, also, to examine as it was the elaboration process that led to the centralization of the assistance to infancy to the cares of the Union, passing for the debate between jurists and doctors in the Construction of the Code of Minors and in the Constituent of 1934. In this period, doctor-social knowing would prevail together with the assistance model that it searched to divide the responsibilities of attendance between the public and the particular one. However, it would keep as responsibility of the State the referring building of the lines of direction and polices to the subject, creating for this end a national organism, called DNCr, that would be the responsible one for organizing, searching, finalising and publicising the measures that would have all to be implemented in relation to the Assistance to Infancy and the Support to the Maternity in the national territory. / Doutor

Indiana University-Purdue University Indianapolis (IUPUI) / Pregnant and postpartum women with substance use disorders (SUDs) are likely to experience adverse health care encounters that contribute to poor health outcomes for them and their infants. The purpose of this dissertation is to describe the health care encounters of pregnant and postpartum women with SUDs. This dissertation includes two studies. The first study is a metasynthesis of published qualitative studies using a metasummary approach to classify the types of health care encounters experienced by pregnant and postpartum women with SUDs. A taxonomy of health care encounters was developed. Five types of adverse encounters were identified and labeled as (a) judgmental, (b) disparaging, (c) scrutinizing, (d) disempowering, and (e) deficient care. Three types of beneficial encounters were identified and labeled as (a) recovery-based, (b) accepting, and (c) effective care. The second study was a qualitative descriptive study conducted to describe factors that influence the formation of trusting relationships between maternity nurses and pregnant and postpartum women with SUDs. Interviews with 15 maternity nurses and 10 pregnant and postpartum women with SUDs were conducted. Content analysis of the participant narratives revealed a number of characteristics of maternity nurses and pregnant and postpartum women with SUDs that helped or hindered trusting relationships. Six characteristics of maternity nurses were identified and labeled as (a) rapport-building with women, (b) demeanor toward women, (c) provision of care, (d) provision of information, (e) attitude toward substance use, and (f) addiction expertise. Five characteristics of the women were identified and labeled as (a) engagement with nurses, (b) demeanor toward nurses, (c) acceptance of care, (d) investment in recovery, and (e) bonding with infant. Adverse encounters were often associated with provider stigma related to substance use during pregnancy and limited provider knowledge related to addiction. The findings will contribute to the development of strategies to improve the health care encounters of this population by promoting stigma awareness and communication skills training.

This study examines the moral regulation of the Swedish-speaking Martha Organization in Finland during the 1930’s, from two aspects; the construction of the ideal female citizen and the mobilization of minority nationalistic identity. The ideal female citizen was supposed to develop traits such as work ethics, piety, compassion, motherly care and peacefulness. The ideal female citizen should also encourage temperance, thus the sobriety of men was viewed as a womanly responsibility. Due to mothers’ decisive impact on the moral health of the youth, the Martha Organization aimed at shaping the attitudes of the members. Women’s roles as mothers and housewives prepared them for citizenship, since women had the same duties in society as they had in the household. During the 1930’s Finland was marked by the pragmatic gender order of the agrarian society, even though the modern gender order of industrial society gradually grew in importance. The Martha Organization aimed at mobilizing minority nationalistic identity, as well as encouraging binational Finnish patriotism amongst its members. This survey analyses the mobilization of the Swedish-speaking minority nationalistic identity in general, as well as the particular minority nationalistic identity of Åland. These mobilization processes took place in relation to each other, accordingly they were similar in nature. The public sphere was understood as a continuation of the private one in the Martha ideology. Consequently, the love of the home and the fatherland were important values for both these minorities. The Swedish-speaking minorities shared the love of freedom, Western rationality and mother tongue, as well as the notion of being a national elite. The minority nationalistic identity of Åland resembled that of Swedish-speaking Finland. Even so, minority nationalism on Åland was built around a self-image of being an unique ethnicity, while underlining the close cultural connections to Sweden. Apart from the years around the implementation of Åland’s autonomous status in 1922, the minority nationalistic identity of Åland has been neglected in previous research. The Finnish 1930’s were marked by conflicts between the Finnish-speaking majority and the Swedish-speaking minority, clashes that never reached Åland. The language question was practical in nature — especially on Åland, where the population hardly spoke Finnish — but even so, it was framed in ideological terms. Thanks to the Martha ideology, gaps between the Finnish-speaking members and their Swedish-speaking counterparts could be bridged, as well as those between Åland and the rest of Swedish-speaking Finland.

A new concept of maternity hospital creates a place, where future mother is not stressed and where she feels free. A place, where birth is perceived as a common part of everyday life. It searches a compromise between birth at classical hospital environment on one side and birth at home on the other. Both aforementioned possibilities bring certain risks that are intended to be minimized using this concept. The idea is based on practice from birth facilities from Germany and creates new concept of so called „birth houses“ that is consistent with law in the Czech Republic. Design of maternity hospital should not be based solely on meeting technical requirements of a bulding, but first of all comfort of mothers should be taken into account to make them feel home.

In January this year, Region Västerbotten announced that the maternity ward in Lycksele would be closed until further notice. This paper is a case study of the closure of the maternity ward in Lycksele, located within the rural parts of northern Sweden. Previous research has focused on maternity ward closures in Canada and Australia whereas studies on maternity wards in northern Sweden is limited. Since large parts of northern Sweden consist of sparsely populated areas, the closure of Lycksele BB has resulted in women having to travel long distances to receive care. This paper seeks to provide a deeper understanding of the consequences of the closure of Lycksele BB by examining (1) what feelings women experience and how they manage these feelings, (2) the consequences of the maternity ward closure on women’s physical and mental health and (3) the consequences of the maternity ward closure in relation to the rural parts of northern Sweden. This study has been carried out by using a qualitative approach by conducting semi-structured interviews with two pregnant women, two mothers, and two midwives. The findings in this study show that women develop strategies to mitigate feelings of insecurity and anxiety. Both pregnant women and midwives create strategies to feel a stronger sense of control in an otherwise unpredictable situation. This contributes to major consequences for women’s mental and physical health as women are faced with new challenges, affecting their reproductive health and care. The findings also show that the closure of Lycksele BB is only a stepping stone for further welfare cuts which can result in people moving away from these sparsely populated areas. This study concludes that the issue goes beyond the closure of the maternity ward in Lycksele and raises bigger questions around the future of the rural parts of northern Sweden.

Bakgrund: De stora medicinska framstegen som åstadkommits inom förlossningsvården genom historien har varit revolutionerande för kvinnor och barn vilket bidragit till en minskad mödra- och barnadödlighet. Barnmorskan är expert på normal graviditet och födsel, och har både förr och nu en avgörande roll för folkhälsans positiva utveckling. Trots denna utveckling minskar antalet normala födslar och parallellt ses en ökning av onödiga interventioner inklusive en ökad andel kejsarsnitt. Syfte: Att klargöra vad som främjar en normal födsel från barnmorskans och kvinnans perspektiv. Metod: Litteraturöversikt med systematisk ansats utfördes genom databassökning i PubMed och CINAHL. Artiklarna kvalitetgranskades genom Caldwells kvalitetsgranskningsmall och dataanalysen utfördes genom en integrerad analys av fem kvantitativa respektive 11 kvalitativa artiklar som svarade på studiens syfte och frågeställningar. Resultat: Studiens resultat klargjorde vad som främjar normal födsel och redovisades genom fyra huvudkategorier. Kategorin stöd identifierade hur kontinuerlig närvaro, empowerment och mödravårdens förlossningsförberedelse främjade det normala. Kategorin omgivning redovisade hur vårdorganisationen och födelserummet antingen kunde främja eller hämma den normala födelseprocessen. Kategorin barnmorskans betydelse redovisades genom hur barnmorskans kompetens, handläggande och egenskaper kunde påverka förloppet. Slutligen visade kategorin kvinnans individuella förutsättningar hur medicinska faktorer, den egna förberedelsen samt copingstrategier underlättade eller hindrade en normal födsel. Slutsats: För att främja normal födsel krävs en genuin tro på den normala födelseprocessen av både barnmorskan och kvinnan. Studien visar på hur barnmorskan självständigt kan främja processen genom sitt förhållningssätt där stöd är avgörande. Ytterligare huvudfynd visar dock på hur vårdorganisationen kan ha en hämmande inverkan. Kontinuitetsmodeller är den mest framgångsrika vårdformen för att främja normal födsel och trots detta är denna vårdform högst begränsad i Sverige. Istället visar studier på hur obstetrikerledda förlossningsenheter med utbredd riskkultur dominerar. Detta är problematisk då studier inklusive denna litteraturöversikt visar hur onödiga interventioner samt kejsarsnitt minskar med kontinuitetsmodeller. / Background: Medical advances throughout history have been revolutionary contributing to a reduction in maternal and child mortality. Midwives are experts in normal pregnancy and birth, having a decisive role in the positive development of public health. Despite this development, the number of normal births are decreasing while there is an increase in unnecessary interventions, including caesarean sections. Aim: To clarify what promotes a normal birth from a midwife and woman's perspective. Method: Literature review with a systematic approach was carried out by database search in PubMed and CINAHL. The articles were quality reviewed using the Caldwell quality framework. The data analysis was performed through an integrated analysis of five quantitative and 11 qualitative articles that answered the aim of the study. Results: The findings clarified factors promoting normal birth and were presented through four main categories: Support identified how continuous presence, empowerment and maternity care's birth preparation promoted normality. Environment reported how care organizations and delivery rooms could either inhibit or promote normal birth. Midwife's importance was reported through how midwife's experience, competence, handling and characteristics could influence the process. Finally woman's individual conditions showed how medical factors, own preparation and coping strategies facilitated or hindered normal birth. Conclusion: To promote normal birth, a genuine belief in normal birth is required by midwives and women. Findings show how midwives independently can promote normal birth through her approach where support was crucial. However, further findings show how care organizations could have an inhibiting impact. Continuity of care models has proven to be the most successful care in promoting normal birth. Despite this, these models are highly limited in Sweden. Instead, studies show how obstetrician-led delivery units with a widespread culture of risk are dominant. This is problematic as studies show how unnecessary interventions and cesarean sections are reduced with continuity of care models.

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