Programa Internacional de Becas da FundaÃÃo Ford / FundaÃÃo Carlos Chagas Filho de Amparo a Pesquisa do Estado do Rio de Janeiro / Pegando Vida nas MÃos: um olhar etnogrÃfico sobre saberes e prÃticas das parteiras tradicionais nos circuitos do Amapà em mudanÃas à fruto do percurso de investigaÃÃo, trilhado no sentido de descortinar um universo de significados dos saberes e das prÃticas das parteiras tradicionais de MazagÃo/AmapÃ. Esta investigaÃÃo situa-se no Ãmbito das ciÃncias sociais, configurando um estudo etnogrÃfico, numa Ãrea de fronteira entre a Sociologia e a Antropologia. De fato, busquei construir um olhar sociolÃgico sobre a teia de relaÃÃes que circunscrevem o ofÃcio das parteiras tradicionais, valendo-me do instrumental metodolÃgico da etnografia. Nesta aventura etnogrÃfica, tomei como pressuposto fundante, a tese de que o trabalho de partejar implica um processo de interaÃÃes âparteira-parturienteâ que envolve cumplicidade, solidariedade feminina, disputa de poder, respeito e lideranÃa, conferindo a esta relaÃÃo uma complexidade de sentidos na da partilha de vida e de cultura. Minha anÃlise situa os saberes e prÃticas das parteiras tradicionais de MazagÃo no interior das formas peculiares de sociabilidade nas comunidades tradicionais amazÃnicas, apreendendo as mÃltiplas convergÃncias gestadas nos saberes e fazeres das mulheres desta regiÃo. Nesta investigaÃÃo, busquei desvendar as redes de significados que envolvem a prÃtica tradicional das parteiras de MazagÃo no contexto da dinÃmica contraditÃria de (re)significaÃÃes de seus saberes/fazeres, compreendendo que em contextos polÃticos especÃficos, essas prÃticas e as redes que as articulam experimentam mudanÃas e adequaÃÃes em funÃÃo de programas de intervenÃÃo do Estado que, algumas vezes, tÃm carÃter pontual e temporÃrio, causando impacto nas redes informais. / Hand Delivering: An Ethnographic Outlook on Changing Knowledge and Practices of Traditional Midwives (âPegando Vida nas MÃosâ: um olhar etnogrÃfico sobre saberes e prÃticas das parteiras tradicionais nos circuitos do Amapà em mudanÃas) is the upshot of an investigative trail followed in the pursuit of unveiling the world of knowledge and practices of traditional midwives from Mazagao/Amapa. The investigation is set within the realm of the Social Sciences shaping up an ethnographic study that encompasses a frontier area between Sociology and Anthropology. Indeed, I tried to develop a sociological approach about a web of relations that define the profession of traditional midwives resorting to a methodological tool from ethnography. To set out on this ethnographic adventure I took as a basic assumption the thesis that the job of helping delivery implies an interaction process of âmidwife and parturientâ that includes partnership, female solidarity, power struggle, respect and leadership that add to this relation a complex web of feelings for the sharing of life and culture. My analysis posts knowledge and practices, as seen by the performance of traditional midwives from Mazagao, within peculiar sociability forms in traditional communities in the Amazon basin in order to grasp the meaning of multiple converging elements produced by knowledge and practices of women from the region. In this investigation I tried to unveil the web of meanings that involves the traditional practice of midwives from Mazagao within conflicting dynamics of meanings found in their knowledge/practices considering that within a given political context those practices and the web that they form go through changes and adjustments according to intervention programs of the State that sometimes have punctual and temporary aspects that impact the informal webs.

Philosophiae Doctor - PhD / Literature has shown that Malawi is experiencing a shortage of qualified healthcare providers, with the greatest burden on maternal and neonatal health. The majority of health service providers are Nurse-Midwife Technicians (NMT), contributing to 87% of the nursing and midwifery workforce. However, research has shown that the NMTs lack the ability to transfer skills into different clinical settings. It was not known what competencies were taught in Christian Health Association of Malawi colleges to equip the NMTs with clinical competence in neonatal nursing practice and how the clinical teachers assisted these NMTs to acquire the competencies. Furthermore, there was no documentation on the availability of a clinical competency-based assessment tool to validate the NMTs’ achievement of clinical competence in neonatal nursing. The purpose of this study was to develop a neonatal nursing care clinical competency-based assessment tool to validate NMTs’ achievement of clinical competence in CHAM nursing colleges. The competency, outcomes and performance assessment (COPA) model and the skills acquisition model were the conceptual frameworks used as the foundation of the study. The study adopted a sequential mixed method approach in which both qualitative and quantitative methods were utilized. Data collection was conducted using focus group discussions, document review and cross-sectional survey. The design and development model developed by Reeves (2006) and steps to development of assessment tools identified by the Department of Training and Workforce Development (2012) guided the study and development of the competency-based assessment tool. The study was conducted in eight CHAM nursing colleges. The researcher employed purposive, convenient and proportional stratified sampling to select the participants. Ethics clearance was obtained from the University of Western Cape and the National Health Sciences Ethical Research Committee in Malawi, prior to data collection. The data collection involved 31 midwifery clinical teachers and 140 third year students for the FGD and 48 midwifery clinical teachers and 195 third year students for the cross section survey. Document analysis was conducted at all the eight nursing colleges. The qualitative data was analysed using content analysis with Atlas.ti 7 and the quantitative data was analysed using descriptive analysis with SPSS 22. The research findings showed that the NMTs were taught basic nursing skills to enable them provide basic care to the health newborn baby. However, there were inadequate clinical assessments done to validate the NMT’s achievement of clinical competence in this setting. In addition, the clinical teachers used skills checklists to evaluate the NMTs clinical performance on specific procedures. The outcome of this study was the establishment of neonatal nursing clinical competencies, and development of a neonatal nursing care clinical competency-based assessment tool for the validation of NMT’s achievement of clinical competence. The tool provides a framework for neonatal nursing clinical teaching and assessments as well as tracking of the NMT’s clinical performance in this setting. It is recommended that training institutions should reinforce mechanisms to track the students’ clinical experience and performance assessments using this tool to ensure quality student outcomes. Furthermore, the clinical teachers should be oriented on the use of the developed assessment tool for familiarisation; thereby enhancing consistency and objectivity in the students’ performance assessments. / ICAP-NEPI Project Malawi

Bakgrund: Det är vanligt att kvinnor under en vaginal förlossning drabbas av grad II-bristning. I barnmorskans ansvarsområde ingår att handlägga dessa bristningar. Forskning visar att det finns begränsat med rutiner kring dessa bristningar och att fokus ofta ligger på grad III- och grad IV-bristningar trots att även grad II-bristningar kan ge långtidskomplikationer. Syfte: Syftet var att beskriva barnmorskans erfarenhet av handläggning vid uppkommen grad II-bristning. Metod: Semistrukturerade individuella intervjuer genomfördes med åtta barnmorskor verksamma vid en mellanstor förlossningsavdelning i Mellansverige. Kvalitativ innehållsanalys användes för att analysera materialet. Resultat: Fyra kategorier och två underkategorier identifierades. Kategorierna var Information, Kollegialt stöd, Behov av uppföljning och Undersökning och underkategorierna Strategier för återkoppling och Dokumentation. Slutsats: Det framkom en osäkerhet hos barnmorskorna gällande diagnostisering och suturering av grad II-bristning. Detta gällde främst de barnmorskor med minst yrkeserfarenhet. Barnmorskorna uttryckte också en önskan om bättre återkoppling på de bristningar de suturerat samt en bättre uppföljning för de kvinnor som fått en grad II-bristning. Resultatet visade även att barnmorskorna informerar kvinnorna på olika sätt gällande deras bristning. Inga tydliga rutiner finns gällande vilken information som ska ges eller på vilket sätt. Klinisk tillämpbarhet: Studiens resultat syftar till att skapa ökad kunskap och riktlinjer kring grad II-bristningar. Ytterligare forskning skulle kunna beröra information i samband med bristningen och när den är bäst att ge. / Background: Many women sustain a second-degree tear when giving birth vaginally. The work field of a midwife includes managing these injuries. There is limited research regarding this field and the focus tend to be on third- and fourth-degree tears, even though second-degree tears may also result in long-term complications. Aim: The aim was to investigate the midwife’s experience of managing second-degree tears. Method: Eight semi-structured individual interviews were conducted with midwives working at a medium large maternity ward located in the middle of Sweden. Qualitative content analysis was used to analyze the material. Results: Four categories and two subcategories were identified. The categories were: Information, The support of colleagues, The need for follow-ups and Physical examination and the subcategories were: Feedback strategies and Documentation. Conclusion: The result show that midwives feel insecure when managing second-degree tears, especially the midwives with less experience. The midwives also requested more feedback from the women they sutured regarding their second-degree tears and the midwives also wished for a better follow-up for the women with second-degree tears. The result also showed that the midwives give different information to women regarding their tears. No pronounced routines were found regarding what information to give and in what way. Clinical application: The results of the study aim to increase the knowledge and to develop routines regarding second-degree tears. More knowledge is needed about information given about the tear and when it is the best time to give information.

Bakgrund: Sexuell och reproduktiv hälsa är en mänsklig rättighet och innefattar rätten att ta beslut gällande sin egen kropp och sin vård. Barnmorskan träffar och vårdar mestadels kvinnor i sitt arbete och har en viktig roll i att värna och främja kvinnors rätt. Sverige ses som ett av världens mest jämställda länder, men det kan finnas strukturer och faktorer även i det svenska samhället som påverkar kvinnors möjligheter till självbestämmande negativt. Syfte: Att undersöka vilka barriärer barnmorskan upplever och uppfattar hindrar kvinnors rätt att bestämma över sin kropp utifrån professionella, sociokulturella och hälsoekonomiska perspektiv. Metod: Kvalitativ innehållsanalys med deduktiv ansats. Data från åtta semistrukturerade intervjuer utförda 2016, med legitimerade barnmorskor inom olika verksamhetsområden analyserades utifrån ramverket "What Prevents Quality Midwifery Care". Resultat: De professionella barriärer barnmorskorna uppfattade resulterade i tre subkategorier: "Lagar, riktlinjer och vårdprogram", "Kunskap, utbildning och profession" och "Personalens personliga åsikter, förutfattade mening och engagemang". Sociokulturella barriärer kategoriserades som: "Politik, jämställdhet och samhällets ideal", "Kultur, religion och familjeförhållanden", "Språk" samt "Personliga förutsättningar". Hälsoekonomiska barriärer delades in i: "Personal och tidsbrist" och "Kostnader och resurser". Slutsats och klinisk tillämpbarhet Studien visar att barnmorskor uppfattar att det finns professionella, sociokulturella och hälsoekonomiska barriärer för kvinnans självbestämmande gällande sin egen kropp i det svenska samhället. Studien kan bidra till att olika yrkeskategorier inom vården kan öka sin förståelse och kompetens i mötet med kvinnor och kan då hjälpa kvinnan att stärka sin position, personligen och samhälleligt. Studien kan ge en bättre förståelse för barnmorskans roll när det gäller att hjälpa individer i en utsatt situation, genom att stärka deras autonomi och känsla av självbestämmande. Studien kan även få vårdpersonal att tänka kritiskt kring att de själva är en del av en kulturell kontext med en förförståelse för andra individer. / Background: Sexual and reproductive health is a human right and involves the right to make decisions concerning your own body and care. The midwife mostly meets and care for women and have an important role in defending and advocating women’s rights. Today there are global political influences that restricts women’s rights even though Sweden is considered to be one of the world’s most equal countries, there can be structures and factors in the Swedish society that affects women’s ability to make decisions about their own bodies in a negative way. The aim: To investigate midwives perceptions and experiences concerning professional, sociocultural and health economic barriers for women regarding decisions about their own bodies. Method: A qualitative content analysis with a deductive approach. Data from eight semi structured interviews with Swedish registered midwifes, active in different areas of the midwife profession, was analyzed based on the framework "What Prevents Quality Midwifery Care". Result: The professional barriers that the midwives perceived resulted in three subcategories: "Laws, clinical guidelines and policies", "Knowledge, education and profession" and "Caretakers personal opinions and commitment". Sociocultural barriers were categorized in: "Politics, equality and the society’s ideals", "Culture, religion and family relations", "Language" and "Personal abilities". The health economic barriers were divided in to: "Lack of time and staff" and "Costs and resources". Conclusion and clinical applicability: This study shows that there are professional, sociocultural, and health economic barriers that affects women’s autonomy in the Swedish society according to the midwives’ perceptions. The study can help caretakers increase their understanding and competence in meeting with women in care and help them strengthening their position in the society as well as on a personal level. This study can give a greater understanding for the midwife’s role when it comes to helping individuals in an exposed situation, by strengthen the women’s autonomy and sense of control. The study can also help caretakers to increase critical thinking regarding themselves in their own cultural context and preunderstanding for other individuals.

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

Ce mémoire explore le concept de la sagefemme-sorcière dans le contexte de la masculinisation et la médicalisation du processus de l'accouchement. En m'appuyant sur le roman The Birth House, par Ami McKay, je développerai trois chapitres qui traitent de l'histoire du domaine obstétrique, la chasse aux sorcières, ainsi que l'historique de l'archétype de la sorcière dans un contexte féministe afin d'illuminer la caractérisation de Dora et Miss Babineau en tant que des véritables sorcières, malgré qu'elle ne pratiquent pas de magie dans l'histoire. De plus, ce mémoire examinera les implications féministes de l'adoption littéraire de l'archétype de la sorcière en ce qui concerne la culture populaire et le climat politique actuel en Amérique du Nord grâce à l'adoption d'une perspective historique afin d'illustrer l'importance culturelle non seulement du roman, mais des personnages qui y habitent. / In this paper, I explore the notion of the midwife-witch and how it relates to the medicalization and masculinization of birth as portrayed in The Birth House by Ami McKay. This subject is divided in three chapters that give historical context to the emergence of obstetrics and the prosecution of midwives, the history of the archetype of the witch and how it is explored in the characterization of Dora and Miss Babineau, as well as the feminist implications of the figure of the midwife-witch and how it is relevant to the current political and cultural climate. I argue that McKay's novel fictionalizes the question of how witchcraft influenced the process of excluding women from medicine as well as reinforces the overall patriarchal subjugation of women. In turn, the text suggests that the key to transcending gender-based oppression lies in embracing the magick of womanhood: the power to create life. This thesis draws a timeline in the history of women's medicine, witch hunts, and feminism to show how these three elements interact in McKay's novel, which serves as a feminist retelling of the real-world implications and power of negotiating and claiming identity.

Bakgrund: Teamarbete anses nödvändigt i hälso- och sjukvården. Barnmorskan och undersköterskan ska kunna samarbeta i team tillsammans med andra barnmorskor, undersköterskor samt med andra professioner. Syfte: Syftet med studien var att beskriva barnmorskors och undersköterskors upplevelser av teamarbete på ett BB. Metod: En kvalitativ metod används i genomförandet av studien. Tio telefonintervjuer, med fem barnmorskor och fem undersköterskor, utfördes. Datamaterialet analyserades med hjälp av Graneheim och Lundmans innehållsanalys. Resultat: Resultatet sammanställdes i sex kategorier: Att arbeta mot samma mål, Att kommunicera, Att stödja varandra i arbetet, Att ha förståelse för varandra inom teamen, Att känna trygghet i teamet samt Att hantera stress. Två av kategorierna genererade i underkategorier. Slutsats: Det är grundläggande att ha ett effektivt teamarbete för att skapa en god vård. För att skapa ett effektivt teamarbete krävs det att teammedlemmarna stödjer varandra och arbetar mot samma mål. Det är även viktigt att ha en god kommunikation med varandra och ha förståelse för varandras professioner. / Background: Teamwork is considered necessary in health care. The midwife and the assistant nurse must be able to work in teams together with other midwives, assistant nurses and other professions.  Purpose: To describe midwives and assistant nurses experience of teamwork in postnatal care. Method: A qualitative method was used. The data collection was conducted using semi structured interviews. Interview material was analyzed using a qualitative content analysis by Graneheim och Lundman. Result: The results were compiled in six categories: To work towards the same goal, To communicate, To support each other in the work, To have an understanding of each other in the teams, To feel secure in the team and To manage stress. Two of the categories generated in subcategories. Conclusion: It is fundamental to have effective teamwork to create good care. To create effective teamwork, team members need to support each other and work towards the same goal. It is also important to have good communication with each other and have an understanding of each other's professions.

The dissertation aims at the issue of transcultural care in the practice of midwives with a specific focus on Mongolian women, who currently represent the fifth largest group in terms of the number of births of foreigners in the Czech Republic. The theoretical framework of the text consists of chapters on nursing with subsequent differentiation of the field with regard to specialized care in the field of gynecology-obstetrics, as well as the divided subdiscipline of transcultural nursing care. An integral part of the theoretical part of the work are the basic general information about Mongolia and the Mongols. The practical part of the work is represented by my own qualitative and quantitative research. Qualitative research was carried out in the field through in-depth interviews with Mongolian women living in the Czech Republic and having experience with their own childbirth in a Czech maternity hospital. The aim of the research was to uncover possible peculiarities and requirements that a midwife may encounter from Mongolian women in the provision of transcultural care related to pregnancy, childbirth and the postnatal period. Additional quantitative research was conducted in the form of a questionnaire survey among Prague midwives and was focused on finding out the awareness, previous experience...

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

Philosophiae Doctor - PhD / In this thesis, I use gender and human rights approaches to examine and analyse the major causes of maternal mortality, which result from delay in seeking maternity care and failure to attend maternity care during pregnancy. A gender approach was used to identify and analyse inequalities that arise from belonging to one sex or from unequal power relations between sexes and how these impact on women accessing maternity care. The Human Rights approach was used to identify and analyse health system related factors that led women to delay seeking care and also failing to attend maternity care. A qualitative multiple case study methodology was followed with data analysed thematically. Findings were interpreted in the context of the International Bill of Rights, the South African Bill of Rights and International Human Rights treatises. Maternity women are unable to access maternity care because of their unmet gender equity needs, and because of maternity services that are not respecting, protecting and fulfilling their human right to access health care. A Gender-Human rights model of accessibility to quality maternity care is developed to assist health care providers in promoting availability of maternity services to health consumers. The model propositions are based on the major concepts which are: Gender equity, Women empowerment, Human rights to quality health care, Evidence Based Health Care, and Support during labour.