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Yes / The Royal College of Midwives (RCM) reports that between 5–10% of newly qualified midwives (NQM) leave the profession in the UK within a year of registration, with similar losses reported internationally (RCM 2010). NQMs are in a position of vulnerability and are highly susceptible to workplace adversity that subsequently may affect their emotional well-being. This literature review explores the experiences of NQMs surrounding their emotional well-being within the first 12 months of transition. Following a thorough search and appraisal of the literature, four papers were reviewed. Two key themes were identified consisting of factors that challenge NQMs’ resilience causing negative emotional well-being, and factors that enhance resilience, promoting positive emotional well-being. The findings of this review demonstrate that there is a need for the consistent implementation of protective mechanisms such as structured preceptorship and supportive mentorship. Such interventions may improve physical and emotional well-being, increase retention and better prepare NQMs for the journey ahead; ultimately also improving quality of care for women and patient safety.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-07-02T12:17:07Z No. of bitstreams: 1 Thayane Cazallas do Nascimento_.pdf: 4720600 bytes, checksum: 8362f1bbda79cb5b987981b66e741a45 (MD5) / Made available in DSpace on 2018-07-02T12:17:07Z (GMT). No. of bitstreams: 1 Thayane Cazallas do Nascimento_.pdf: 4720600 bytes, checksum: 8362f1bbda79cb5b987981b66e741a45 (MD5) Previous issue date: 2018-02-28 / CNPQ – Conselho Nacional de Desenvolvimento Científico e Tecnológico / A tese objetiva compreender a construção de saberes envolvidos e desenvolvidos em uma cosmologia de parto/nascimento “na tradição”, presente em um espaço alternativo ao modelo médico-hospitalar predominante na sociedade contemporânea. A base empírica dessa tese embasou-se no acompanhamento das atividades desenvolvidas pela roda de casais e gestantes do espaço Flor da Vida, em Porto Alegre, Rio Grande do Sul. A proposta conhecida como parto “na tradição” envolve a realização de um parto/nascimento que considera tanto a experiência de quem pare quanto a de quem nasce como um evento espiritual. Sua definição como “na tradição” é uma referência ao modelo de ensinamentos e procedimentos a partir de uma parteira tradicional, que ensina seus conhecimentos, vinculados à prática de “ajudar a parir/nascer” a outras parteiras que seguem “na” sua tradição. Os resultados dessa trajetória investigativa estão organizados da seguinte forma: inicialmente apresento a discussão teórico conceitual que embasa as análise realizadas, especialmente a noção de cosmologia do parto/nascimento e apresento as categorias analíticas orientadoras da pesquisa: Intervencionismo, tecnicismo e medicalização do parto; as relações entre Ecofeminismo e Educação e a noção de empoderamento em perspectiva feminista. Na sequência, abordo a atuação do Centro Ativo de Integração do Ser/CAIS do Parto e da Escola de Saberes, Cultura e Tradição Ancestral/ESCTA, procurando analisar o impacto de seu ativismo na defesa da parteria tradicional e na formação inicial e continuada de parteiras e doulas “na tradição”. A seguir, apresento as considerações sobre o acompanhamento realizado no campo empírico, abordando a trajetória formativa de parteiras e doulas “na tradição” da ESCTA; a concepção de missão espiritual dessa parteria; as concepções e vivências dessa cosmologia e sua abrangência para além do parto; a organização da parteira tradicional no Rio Grande do Sul e finalizo procurando analisar os novos horizontes de outra cultura do parto e do nascimento em difusão no ambiente urbano contemporâneo. Conclui-se que o parto e o nascimento, assim como a gestação dentro das reflexões a partir da roda Flor da Vida ampliam as percepções dos pensamentos e das práticas da área da 8 Educação, mas que os seus saberes e conhecimentos educativos se encontram no fazer de um pensamento interdisciplinar que é também um saber pedagógico, considerando o olhar sobre a espiritualidade, e a inteireza do ser no momento do parto e do nascimento. / The thesis aims to understand the construction of knowledge involved and developed in a birth cosmology “in tradition”, present in an alternative space to the predominant medical-hospital model in contemporary society. The empirical basis of this thesis was based on the monitoring of the activities developed by the wheel of couples and pregnant women in the Flor da Vida space, in Porto Alegre, Rio Grande do Sul. The proposal known as childbirth "in tradition" involves the realization of a birth that considers both the experience of those of the gestate and the baby born as a spiritual event. Its definition as "in tradition" is a reference to the model of teachings and procedures from a traditional midwife who teaches her knowledge, linked to the practice of "helping to give birth" to other midwives who follow "in" their tradition. The results of this investigative trajectory are organized as follows: I first present the theoretical conceptual discussion that bases the analyzes performed, especially the notion of birth cosmology and present the analytical categories guiding the research: Interventionism, technicalism and medicalization of childbirth; the relationship between Ecofeminism and Education and the notion of empowerment in a feminist perspective. Following, I discuss the proceeding of the Center for the Integration of the Being/CAIS of Childbirth and the School of Knowledge, Culture and Ancestral Tradition/ESCTA, trying to analyze the impact of their activism in the defense of the traditional childbirth and in the initial and continued formation of midwives and doulas “in tradition”. Next I present the considerations about the accompaniment in the search location, approaching the formative trajectory of midwives and doulas "in tradition" of ESCTA; the conception of the spiritual mission of this birth; the conceptions and experiences of this cosmology and its reach beyond childbirth; the organization of the traditional midwife in Rio Grande do Sul and I finish trying to analyze the new horizons of another birth culture and diffusing traditional birth in the contemporary urban environment. As a conclusion, the study shows that childbirth and birth, as well as gestation within reflections from the Flor da Vida space, amplify the perceptions and the practices of the Education area. The knowledge about childbirth and birth and the educational knowledge are 10 interconnected in the development of an interdisciplinary thought that is also a pedagogical knowledge, taking into account the spirituality and the full presence of being at the time of childbirth and birth.

Pregnancy and childbirth are critical life events and women and their families require physical as well as emotional support and care. The concepts continuity of care, choice and a sense of control are prominent in the literature on women’s satisfaction with as well as outcomes of care. Midwives have globally been identified as important role players in women-centred care for low risk pregnant women. To be able to offer their women safe, supportive care they need not only a certain degree of autonomy, but also the support of other health care professionals such as obstetricians to whom they can refer women with risk factors or complications. Maternity care has become “medicalised” and the overuse of interventions such as caesarean section is prevalent in many countries. South African women make use of either the public or private health sector for care during pregnancy and birth. The public sector is overburdened and women do not have a high level of continuity of care. The private sector is mainly obstetrician-led and intervention-driven, even for low risk women. The estimated caesarean section rate is higher than 70%. Private midwife-led care is available in South Africa, but is concentrated in the major cities. Private midwives practise at hospitals, birth centres, “active birth units” and women’s homes. No evidence could be found on the outcomes of private midwife-led care in South Africa. The objectives of this study were to explore and describe the outcomes of births attended by private midwives in Gauteng over a two year period and to compare these outcomes with the latest Cochrane review on midwife-led care. A retrospective cohort design was chosen to audit the birth registers of private midwives in Gauteng and conduct quantitative analyses. Gauteng midwives’ patients, when compared with the Cochrane review that juxtaposes midwife-led care with other models of care, had a significantly lower percentage of interventions such as induction of labour (9.6% versus 18.6%) but caesarean sections were performed significantly more frequently (19.3% for the women in Gauteng versus 12.5% for the women in the review). Women in Gauteng also made significantly less use of medications in labour. Maternal and neonatal outcomes were reassuring. Significantly more Gauteng women had intact perineums (53.4% versus 31.4%). A higher percentage of postpartum haemorrhage was found in the Gauteng sample (7.9% versus 6.2%). The difference is significant, although, only three women were admitted to high care units as a result of postpartum haemorrhage. Overall foetal loss (4.3% versus 6.7%) and neonatal ICU admissions (0.3% versus 2.9%) occurred significantly less frequently in the Gauteng sample. The study findings indicate that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of intervention rates and outcomes. / MCur, North-West University, Potchefstroom Campus, 2015

Continuous support during intrapartum is undeniably beneficial. It increases the mother‟s chance of giving spontaneous vaginal birth, which is not physically traumatic.This indicates the effectiveness of continuous support during intrapartum. According to a Cochrane review conducted such support has no identified adverse effects (Hodnett et al., 2009:2). It is important that implementation of continuous intrapartum support should be promoted by the midwives in order to improve the quality of care given to labouring women. The objective of the study is to explore and describe the challenges in implementing continuous intrapartum support in public hospitals in the North West Province. The findings of this study will contribute to the formulation of recommendations to promote continuous intrapartum support in public hospitals in the North West Province. Focus group interviews were conducted to collect data from 33 (thirty-three) registered midwives who have worked in labour rooms for 2 years or more who are able to give in-depth and rich expressions of opinion. The focus group interviews were conducted in a natural setting in the labour unit to avoid inconvenience. An explorative, descriptive and contextual qualitative approach using a non-experimental research design was used in order to reach the aim of the study, being to promote continuous support during intrapartum in public hospitals in the North West Province. The study revealed that midwives have an understanding of the benefits of continuous intrapartum support, but its implementation is hindered by challenges. Recommendations are made to inform the different stakeholders involved in curbing the challenges in order for the implementation of continuous intrapartum support to be a success. These recommendations are directed at the nursing practice, nursing (midwifery) education, nursing research and policy. / MCur, North-West University, Potchefstroom Campus, 2014

Pregnancy and childbirth are critical life events and women and their families require physical as well as emotional support and care. The concepts continuity of care, choice and a sense of control are prominent in the literature on women’s satisfaction with as well as outcomes of care. Midwives have globally been identified as important role players in women-centred care for low risk pregnant women. To be able to offer their women safe, supportive care they need not only a certain degree of autonomy, but also the support of other health care professionals such as obstetricians to whom they can refer women with risk factors or complications. Maternity care has become “medicalised” and the overuse of interventions such as caesarean section is prevalent in many countries. South African women make use of either the public or private health sector for care during pregnancy and birth. The public sector is overburdened and women do not have a high level of continuity of care. The private sector is mainly obstetrician-led and intervention-driven, even for low risk women. The estimated caesarean section rate is higher than 70%. Private midwife-led care is available in South Africa, but is concentrated in the major cities. Private midwives practise at hospitals, birth centres, “active birth units” and women’s homes. No evidence could be found on the outcomes of private midwife-led care in South Africa. The objectives of this study were to explore and describe the outcomes of births attended by private midwives in Gauteng over a two year period and to compare these outcomes with the latest Cochrane review on midwife-led care. A retrospective cohort design was chosen to audit the birth registers of private midwives in Gauteng and conduct quantitative analyses. Gauteng midwives’ patients, when compared with the Cochrane review that juxtaposes midwife-led care with other models of care, had a significantly lower percentage of interventions such as induction of labour (9.6% versus 18.6%) but caesarean sections were performed significantly more frequently (19.3% for the women in Gauteng versus 12.5% for the women in the review). Women in Gauteng also made significantly less use of medications in labour. Maternal and neonatal outcomes were reassuring. Significantly more Gauteng women had intact perineums (53.4% versus 31.4%). A higher percentage of postpartum haemorrhage was found in the Gauteng sample (7.9% versus 6.2%). The difference is significant, although, only three women were admitted to high care units as a result of postpartum haemorrhage. Overall foetal loss (4.3% versus 6.7%) and neonatal ICU admissions (0.3% versus 2.9%) occurred significantly less frequently in the Gauteng sample. The study findings indicate that private midwife-led care in Gauteng compared well with that in the rest of the world in terms of intervention rates and outcomes. / MCur, North-West University, Potchefstroom Campus, 2015

Continuous support during intrapartum is undeniably beneficial. It increases the mother‟s chance of giving spontaneous vaginal birth, which is not physically traumatic.This indicates the effectiveness of continuous support during intrapartum. According to a Cochrane review conducted such support has no identified adverse effects (Hodnett et al., 2009:2). It is important that implementation of continuous intrapartum support should be promoted by the midwives in order to improve the quality of care given to labouring women. The objective of the study is to explore and describe the challenges in implementing continuous intrapartum support in public hospitals in the North West Province. The findings of this study will contribute to the formulation of recommendations to promote continuous intrapartum support in public hospitals in the North West Province. Focus group interviews were conducted to collect data from 33 (thirty-three) registered midwives who have worked in labour rooms for 2 years or more who are able to give in-depth and rich expressions of opinion. The focus group interviews were conducted in a natural setting in the labour unit to avoid inconvenience. An explorative, descriptive and contextual qualitative approach using a non-experimental research design was used in order to reach the aim of the study, being to promote continuous support during intrapartum in public hospitals in the North West Province. The study revealed that midwives have an understanding of the benefits of continuous intrapartum support, but its implementation is hindered by challenges. Recommendations are made to inform the different stakeholders involved in curbing the challenges in order for the implementation of continuous intrapartum support to be a success. These recommendations are directed at the nursing practice, nursing (midwifery) education, nursing research and policy. / MCur, North-West University, Potchefstroom Campus, 2014

Bakgrund: Kvinnlig könsstympning är en sed som utförs i flera länder i Afrika, längs ekvatorn och delar av Mellanöstern. Invandringen till Sverige från områden där kvinnlig könsstympning utförs ökar. Det innebär att svenska barnmorskor kommer att möta könsstympade kvinnor allt oftare. Riktlinjer och mer och bättre utbildning har efterfrågats för att kunna bemöta kvinnan på ett professionellt sätt. Syfte: Att belysa barnmorskors erfarenheter av möten med kvinnor på ungdomsmottagning som kommer från områden där kvinnlig könsstympning är vanligt förekommande. Metod: Studien genomfördes med kvalitativ metod och en induktiv ansats. Åtta semistrukturerade intervjuer utfördes med barnmorskor på ungdomsmottagningar. Materialet analyserades med konventionell innehållsanalys enligt Hsieh och Shannon. Resultat: Ämnet visade sig beröra barnmorskorna känslomässigt och en oförståelse för traditionen beskrevs. Barnmorskorna framhöll vikten av att inte acceptera traditionen, men underströk betydelsen av att respektera kvinnan och hennes kulturella arv. Ett varsam och lyhört förhållningssätt i mötet betonades, där ett felaktigt förhållningssätt antogs kunna leda till att kvinnan kände sig kränkt.  Konklusion: Möten med könsstympade kvinnor på ungdomsmottagningarna förekom sällan. Barnmorskorna upplevde därför att deras kunskaper var bristfälliga. I dagsläget ansågs inte behovet av riktlinjer vara stort, men en gemensam uppfattning fanns att behovet inom en nära framtid kommer att öka. / Background: Genital mutilation of woman is a custom practiced in several African countries, along the equator and parts of the Middle-East. Immigration from areas where this custom is common is on the rise. Midwives in Sweden are increasingly visited by women who have been victims of genital mutilation.  Guidelines and more and better education have been requested in order to approach the women in a professional way. Purpose: To highlight midwives experiences of meetings at the youth health center with women who come from areas where the practice of genital mutilation is common.  Method: A qualitative approach was chosen. Eight interviews were conducted with midwives at youth health center. Content analysis according to Hsieh and Shannon were used to analyze the material.  Results: The topic affected midwives emotionally. Midwives stressed the importance of not accepting the tradition, but felt it to be important to respect the woman and her cultural heritage. It is considered important to be gentle and responsive during the meeting and to show a good attitude towards the woman where an incorrect approach is perceived to lead to the woman feeling offended. Conclusion: Meetings with genitally mutilated women at youth health center were something that rarely occurred. Midwives knowledge of the subject was incomplete due to the lack of experience. In the current situation guidelines are not needed, but the common perception was that they will be in the future.

Fysisk aktivitet är viktigt för att främja hälsa och förebygga ohälsa och bör även rekommenderas till kvinnor under graviditeten. Barnmorskan har en central roll i det hälsofrämjande arbetet då hon ibland är den enda hälso- och sjukvårdspersonal som träffar kvinnan under graviditeten. Det finns rekommendationer för hur mycket den gravida kvinnan bör träna men studier visar att det är få som följer dessa. Barnmorskan upplever det svårt att ge råd och det finns ett behov av att hitta strategier som kan användas i arbetet med att främja fysisk aktivitet. Syftet med denna studie var att beskriva barnmorskors strategier för att främja fysisk aktivitet under graviditeten. Studien utfördes enligt kvalitativ metod där semistrukturerade intervjuer användes för insamling av data som sedan analyserades utifrån tematisk analys. I studien framkom ett flertal olika strategier som barnmorskorna använde för att främja fysisk aktivitet under graviditeten; Att ge råd, Att motivera, Att söka stöd i omgivningen, Att individualisera, Att vårda relationen och Att utveckla. Studien visade också att barnmorskorna upplevde arbetet med att främja fysisk aktivitet som viktigt men svårt. Författarna anser att strategierna är användbara, inte bara av barnmorskan utan även av annan personal inom hälso- och sjukvården som arbetar med att främja fysisk aktivitet under graviditeten. / Physical activity should be recommended to all women during pregnancy. Midwives have an important role in the health promotion practice. There are recommendations about physical activity during pregnancy, although studies show that few pregnant women actually follow them. The midwife experience difficulties in counselling and there is a need to find strategies that can be used to promote physical activity. The aim of this study was to describe the midwives strategies to promote physical activity during pregnancy. The study was conducted by qualitative method and semistructured interviews were used to collect data. The data was analysed by thematic analysis. Several strategies emerged that the midwives used to promote physical activity during pregnancy; To advice, To motivate, To seek support in the surroundings, To individualize, To take care of the relationship and To elaborate. Another finding in the study was that promotion of physical activity was perceived as important but difficult by the midwives. These strategies can be used by midwives and other healthcare providers to promote physical activity during pregnancy.

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