Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.

A quantitative, descriptive non-experimental design was used to identify the factors that influence clinical teaching of midwifery students in selected postnatal clinical settings in Tanzania. Structured questionnaires were used to collect data from midwifery tutors/preceptors. The major findings of the study showed that both the professional and educational qualification of tutors was low; tutors and preceptors were overworked due to shortage of staff; the school skills laboratory and postnatal wards lacked equipment and necessary supplies; there were no clinical accompaniment guidelines, and overcrowding of postnatal patients. Recommendations included developing the clinical teaching guidelines, employing more tutors, preceptors and clinical staff; improving the tutors'/ preceptors' educational and professional qualifications and updating the qualifications of ward supervisors and clinical facilitators. / Health Studies / M.A. (Health Studies)

This thesis deals with rituals connected with childbirth in Bohemia and Moravia since the 17th century to the present. The first chapter describes the word ritual, especially the transition ritual, which is understood as a necessary assumption enabling the transition from one stage of life to the other. The next chapter presents the family and its development across the centuries from the traditional conception until the modern one. The family also plays an important role in education and in the child's integration into society - this is discussed in the third chapter. The fourth chapter maps the rituals connected with childbirth adhered to in the past. The fifth chapter continues analyzing the situation about current rituals. The last chapter compares the situation about the implementation of rituals in the past with the situation nowadays. It is concluded with the authors own research, which was based on real data collection.

A descriptive quantitative study was undertaken in the Leribe and Butha-buthe northern districts of Lesotho. Thirty-six trained, twenty-four untrained TBAs and nine nurses involved in training TBAs were recruited. In line with research by Clarke and Lephoto (1989:3) the TBAs were elderly females who had children of their own. In contrast with the MOH (1993: 10) where TBAs were found to be illiterate, most (93%) of the TBAs in this study had at least a primary education. The art of primary midwifery was learned through assisting with a delivery and being taught by mothers or mothers-in-law. The public health nurses conduct formal training ofTBAs in Lesotho over a period of two weeks, where subjects like ante-natal care, delivery of the baby and post- natal care are addressed. The majority (78.8%) provide antenatal care at their homes or the home of the mother. This includes palpation, history taking, and abdominal massage and health education. An important role is identifying women at risk. During labour the progress of labour is monitored and care is given to the mother and baby post-natally. Trained TBAs could identify women at risk more readily than untrained TBAs. Cases referred most frequently were prolonged labour and retained placenta. Trained TBAs practiced hygiene more often and gave less herbs than untrained TBAs. The health care system is providing support to the TBAs through training and supervision, but was found to be inadequate. Community leaders are involved in the selection of TBAs for training. Regular meetings are held with the TB As to discuss problems. Communication is one of the problems the TB As have to face, because of the long distances from health care centres. A lack of infrastructure and supplies is also of concern. It can be concluded that TBAs play an important role in maternal health care in Lesotho and are supported to a lesser degree by the health care system, which causes problems for the TBAs in their practices. It is recommended that the ministry of health becomes more aware of the need for training TBAs and that a programme for training should be more appropriate, taking cultural practices into account. / Advanced Nursing Science / D.Lit. et Phil.

I initially explored historic figures of European accoucheur of the 17. and 18. century. Beyond this I focused on a period called "Pobělohorská" in Czech countries. I summarized the health conditions of the population during this period, and described medical professions, midwifery and emergency Christening ceremonies. One chapter discusses partnerships and considers women who hid their pregnancy to avoid the prospect of caring for their children in the future. For this reason I present questions relating to how women hid their pregnancy during the Early Modern period. In the next chapter I discuss aspects of the process of giving birth, the locations where women gave birth and the moments thereafter. I present the circumstances of the death of the baby and the possible causes of death. The process of investigation of the scene, an assessment of the body and the search for the mother of the baby (as a potential murderer) are all considered. The assessment of the body was in the hands of the regional physiciusurgeon and a midwife. In my work I describe how the body was assessed, how they judged the maturity of the newborn baby and if the baby was born dead or alive. Further chapters explain the treatment of the umbilical cord, the inquisition of the witnesses and the suspect, and the next steps of...

Våld i nära relationer är ett folkhälso- och samhällsproblem som kräver insatser från flera verksamheter. Studiens syfte var att undersöka hur personal inom socialtjänst respektive hälso- och sjukvård upplever arbetet med kvinnor som blivit utsatta för våld i en nära relation. Syftet var att genom en kvalitativ metod bidra med kunskap ur perspektivet från de yrkesgrupper som har ett ansvar att upptäcka våld samt stödja våldsutsatta kvinnor. Den empiriska datan samlades in genom intervjuer med sju respondenter och analyserades därefter utifrån en innehållsanalys. Respondenterna bestod av två socialsekreterare, två barnmorskor samt tre kuratorer inom den psykiatriska öppenvården. Resultatet tolkades genom systemteori och begreppen makt, normalisering och handlingsutrymme. Det framkommer i resultatet att vissa professionella tillfrågar alla klienter om våld i nära relationer, medan andra endast tillfrågar vid misstanke om våld. Det finns delade meningar om huruvida frågan om våld ska ställas direkt eller om man ska närma sig ämnet varsamt. Att ställa frågan om en kvinna är utsatt för våld upplevs vara svårt, på grund av en osäkerhet gällande hur de ska hantera svaret. Det upplevs finnas brister i det långsiktiga och det förebyggande stödet. De professionella upplever att våld i nära relationer är ett tabubelagt ämne i samhället, men att utbildning och samverkan anses främja arbetet. / Intimate partner violence is a public health- and social problem, which requires support from several organisations. The aim of our study was to examine how employees in social services and healthcare experience the work of detecting and supporting women who have been subjected to violence in an intimate relationship. The ambition was to contribute with knowledge, from the perspective of the professions that have a responsibility to detect domestic violence and support battered women, through a qualitative study. The empirical data was collected by interviews with seven respondents and analysed through a content analysis. The respondents were two social workers, two midwives and three counsellors within psychiatric outpatient care. System theory and the perspectives of power, normalization and discretion were used to analyse the result. The result shows that some professionals ask all clients about intimate partner violence, while others only ask if they suspect that a woman is being abused. The professionals’ opinions differ as to whether the question should be asked upfront or being approached more carefully. Some professionals state that asking a woman if she has suffered abuse is difficult, because of an insecurity regarding how they should proceed when they find out about the violence. There are perceived shortcomings in long-term and preventive support. The professionals find that violence in close relationships is a taboo subject in society, but that education and cooperation between organisations are considered to facilitate their work.

Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being. Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling. Methods: Study I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy. Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden. Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.

No description available.

Bakgrund: Efter förlossningen kan familjen få fortsatt vård och stöd på en BB-avdelning. Ett gott stöd efter förlossningen är av stor vikt för nyblivna föräldrar och är något som främjar föräldrablivandet. Dock drabbades världen av ett nytt virus, covid-19 i slutet av året 2019. Viruset medförde restriktioner på BB-avdelningarna, vilket innebar skyddsutrustning för personalen samt att partnern ej fick närvara på avdelningen. Nya rutiner samt okunskapen av Covid-19 har medfört att stödet förhindrats till viss del. Detta ämne är relativt outforskat och det finns ytterst få studier som berör Covid-19 pandemins inverkan på svensk BB-vård. Syfte: Att undersöka hur barnmorskan inom svensk BBvård upplever att ge stöd till föräldrar under pågående pandemi. Metod: Genom elvaindividuella intervjuer samlades datamaterial som analyserats utifrån kvalitativ innehållsanalys med en induktiv ansats. Resultat: Resultatet bestod av temat -Skyddsutrustning och besöksrutiner kräver uppfinningsrikedom och påverkar barnmorskors professionella stöd på BB och huvudkategorierna - Barnmorskan behöver anpassa sitt professionella stöd utefter pandemirestriktioner & Pandemin påverkar förutsättningar att ge stöd negativt. Konklusion: Barnmorskor har under Covid-19 pandemin fått utöka stöd till mödrar samt vara uppfinningsrika för att nå hela familjen. Barnmorskor upplever att stödet har varit otillräckligt, begränsat av hög arbetsbelastning och den skyddsutrustning som används. / Background: After giving birth, the new family can receive care and support in a maternity-ward. Parenting is encouraged through support from the maternity-ward after the birth. By the end of the year 2019, the world was affected by Covid-19. Virus entailed restrictions at the maternity-ward, which resulted in protective equipment and partner restrictions. Covid-19´s restrictions have prevented the support. This topic is relatively unexplored and there are few studies in the field. Aim: To explore how midwives in Swedish maternity-ward experience to support parents during the ongoing pandemic. Method: The method is a qualitative content analysis with an inductive approach. Eleven midwives were interviewed individually. Result: The theme that emerged was: Protective equipment and visiting restrictions requires ingenuity and affects midwives professional support at maternity-ward. The results presented in two categories: The midwifes needs to adapt professional support according to the Covid-19 pandemic restrictions & how the Covid-19 Pandemic affects the conditions for providing support negatively. Conclusion: Midwives have had to increase their support to the mothers in various ways and be inventive in reaching the whole family. Midwives have also experienced the support as insufficient and limited by high workload and the use of protective equipment.

Bakgrund: Barnmorskor upplever att rotationsarbete och kontinuitet i arbetet leder till en god vård, bredare kunskap samt att det uppskattas av patienter. Barnmorskorna känner sig mer välmående i sin arbetssituation. Det leder även till en dubbel kompetens hos barnmorskorna. Syfte: Syftet med studien var att beskriva barnmorskors upplevelse av att arbeta roterande mellan mödrahälsovård och förlossningsvård. Metod: En kvalitativ intervjustudie där semistrukturerade intervjuer med åtta deltagande barnmorskor arbetande i mellansverige utfördes. En kvalitativ innehållsanalys utfördes vilken resulterade i fyra kategorier samt nio subkategorier. Resultat: Barnmorskornas upplevelser av att arbeta roterande beskrevs som ett omväxlande och givande arbete som gav glädje och tillfredsställelse, trots att det var arbetsamt. Samtidigt var det en utmanande uppgift då de behövde hålla sig uppdaterade på två arbetsplatser, få ihop tidboken på barnmorskemottagningen och bibehålla kompetensen på förlossningsavdelningen. Arbetsplatserna skiljde sig åt vilket var med fördelar och nackdelar. En viktig grundsten i arbetet var kollegialt stöd, och att ha en hemarbetsplats istället för två upplevdes positivt. Rotationsarbete ur patientsynvinkel ansåg barnmorskorna vara uteslutande positivt då de kunde ge ett utökat stöd till de födande vilket var en vinst för både barnmorskan och patienten. Slutsats: Trots att det kräver extra arbete från barnmorskorna är upplevelserna av att arbeta roterande övervägande positiva både ur barnmorskans eget perspektiv samt deras beskrivning av respons från patienterna. Det finns relevans för att genomföra ytterligare forskning inom området genom att intervjua en större grupp med barnmorskor. / Background: Midwives experience that working rotationally and with continuity leads to a quality of good care, bigger knowledge and the care is valued by patients. This also leads to a double competency for the midwives. Aim: The aim of the study was to describe midwives’ experience of working rotation between antenatal care and perinatal care. Method: A qualitative interview study with semi structured interviews were conducted, with eight participating midwives working in the central Sweden. An analysis was conducted, resulting in four categories and nine subcategories. Result: The midwives’ experiences of working rotationally were described as a varied and rewarding job that brought joy and satisfaction, even though the work was trying. The work was a challenging task, they needed to be updated at two workplaces, make sure the patients were being cared for at the maternity clinic and maintain the expertise at the maternity ward. The workplaces differed, which was advantageous and disadvantageous. An important cornerstone for the work was collegiate support and having one instead of two working places. From the patients’ point of view the rotationally work by the midwives was positive as they could provide increased support for childbearing women, which was beneficial for the midwives and the patient. Conclusion: Although it requires extra work from the midwives, the experience of working with rotation is mostly positive both from the midwife’s own perspective as well as their description of the patient’s response. There is relevance for conducting further research in the field by interviewing a larger group of midwives.