Men’s violence against women is a universal issue affecting health, human rights and gender-equality. In pregnancy, violence is a risk for both the mother and her unborn child. The overall aims were: to determine the prevalence of such violence in a Swedish pregnant population, to investigate pregnant women’s attitudes to questioning about exposure to violence, and to evaluate experience gained by antenatal care midwives having routinely questioned pregnant women regarding violence. All women registered for antenatal care in Uppsala, Sweden, during 6 months were assessed regarding acts of violence. The Abuse Assessment Screen (AAS) was used twice during pregnancy and again after delivery when the women were asked an open-ended written question regarding attitudes to questioning about violence. Midwives’ experiences regarding routine assessment were evaluated in focus group discussions. The AAS questions were answered by 93% (1,038) of those eligible. Physical abuse by a partner or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. Lifetime sexual abuse was reported by 8.1%. Repeated questioning increased the abuse detection rate. Abused women reported more previous ill-health, and women physically abused during pregnancy more pregnancy terminations than did non-abused women. Abuse assessment was found entirely acceptable by 80%, both acceptable and unacceptable/disagreeable by 5% and solely unacceptable/ disagreeable by 3%, while 12% were neural. Abused and non-abused women did not differ regarding disinclination to answer the abuse questions. According to the midwives the delicacy of the subject and the male partners’ presence were the most prominent remaining obstacles to routine determination of violence. Routines are required to make questioning about violence an integral part of antenatal care. This would necessitate a private appointment for the woman, knowledge among care providers about the nature of men’s violence, and awareness of referral options.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

In Sweden, there is currently no consensus addressing the screening, diagnostics and treatment of gestational diabetes mellitus (GDM). In addition, there is little knowledge on the impact of GDM on the daily life of pregnant women and the experiences of health care professionals providing maternal health care to women with GDM. Using different perspectives, this thesis examines the experiences of GDM and the performance of screening for GDM in a regional context in Sweden. The studies used qualitative and quantitative methods. In the qualitative studies, grounded theory was applied in two studies and qualitative content analysis in one study. In the quantitative study, a combination of questionnaire data and data from medical records of pregnancy and birth were processed. Surprisingly, screening for GDM was reduced despite local clinical guidelines stipulating the risk factors indicating an OGTT. Furthermore, the prevalence of the risk factors for GDM in the population investigated was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors for GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. The experiences of pregnant women with GDM revealed that being diagnosed with and living with GDM during pregnancy might be understood as a process ‘from stun to gradual balance’. The experience comprised both negative and positive dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to an altered lifestyle and finding their balance in daily life was ‘the prize’ the women ‘were willing to pay’ to secure optimal maternal and foetal health. The experiences of midwives comprised managing conflicting demands providing antenatal care to pregnant women diagnosed with GDM. Most midwives felt the obligation to control and monitor the complicated pregnancy, to initiate and motivate the recommended changes in life style together with providing an empowering and caring relation with the women. These assignments disclosed complex conflicting situations and the midwives appeared to choose strategy for managing the situation depending on their perception of the circumstances. The experiences of the obstetricians were understood as ‘dealing with ambiguity’. The ambiguity permeated all aspects of working as an obstetrician within the maternal health care counselling women with GDM: the role of the obstetrician, the context of the organization, balancing the multifaceted interests of the maternal and foetal conditions and the lack of consensus, recommendations and evidence-based knowledge.   The studies revealed the complexity of the situation for the affected pregnant women as well as for the health care professionals providing antenatal care to women diagnosed with GDM. Furthermore, the performance of screening of GDM in pregnant women with risk factors for GDM was insufficient in the investigated region. The findings in this thesis may be useful to increase knowledge of the experiences of pregnant women living with or managing GDM. The findings may also be useful when planning for improvements of maternal health care directed to pregnant women diagnosed with GDM during pregnancy.

Aim: The purpose of this study is to establish midwives’ perception of ethical and professional malpractices in labour units and to enhance the awareness of ethical behaviour and professional practice by midwives. Design: A qualitative, exploratory, descriptive and cross sectional design was followed to explore the midwives understanding of and experiences of ethical practice and professional malpractices in Labour Units of Tshwane, Gauteng Province. A non-probability purposive sampling was used to draw a sample from midwives with two or more years of experience working in Labour Units. Data collection: Individual in-depth interviews using open ended questions were used to collect data. Interviews were recorded using an audio tape recorder, which was later transcribed verbatim. Data collection was continuous until saturation was reached with the eight (n=8) participant. Findings: the results of the study revealed that midwives do understand the ethical code of conduct. However, due to challenges such as shortage of staff; shortage of material resources; non-compliance of midwives to policies and guidelines; fear of decision-making; and lack of management support, all this makes ethical conduct more challenging. It is hoped that the findings of this research will make contributions to midwifery training and practice. / Health Studies / M.A. (Health Studies)

The scourge of HIV and AIDS can no longer be underestimated. Its devastating effects have been translated into immeasurable monetary and human costs. Women and children, particularly among the rural communities, have borne most of the brunt accruing from the devastating socio-economic consequences of the disease. PURPOSE This study is intended to highlight the plight of rural communities who are constantly besieged by the demand and supply disequilibrium in the provision of primary health care and preventive interventions. OBJECTIVES To describe, compare and analyse HIV / AIDS health care services provided by fixed and mobile clinics in the Madibeng Sub-District of the North West Province. POPULATION The sampled participants were selected from a universal population among pregnant women. SAMPLING A sample of 100 pregnant women from the fixed and mobile clinics participated in answering the questionnaires during their antenatal care visits. RESEARCH SETTING The Madibeng Sub-District in the North West Province been selected as a suitable research site, as it met most of the selection criteria developed by the researcher's judgement sampling. RESEARCH DESIGN The data recorded on the questionnaires by the participants was used to compare and analyse the pregnant women's feelings about HIV / AIDS services of fixed and mobile clinics. Group discussions were also held prior self completion of questionnaires. Questionnaires were administered by the researcher and the two health promoters. FINDINGS It was found that participants in both mobile and fixed clinic have attended HIV / AIDS health care services. Fixed clinic and mobile clinic are respectively viewed as offering better health care services to pregnant women. CONCLUSIONS The research results from this study indicate that HIV / AIDS services provided at both the fixed clinic and mobile service points, including antenatal or prenatal care, are almost similar. RECOMMENDATIONS It is recommended for improving HIV / AIDS health care services that health care providers at Jericho mobile clinic and Jericho fixed clinic intervene by slowing the progression of HIV infection because it has a negative impact on the lives of women. The Jericho clinic and mobile clinic staff should be encouraged to adopt the perspective that HIV / AIDS is not a death sentence, but a preventable disease, not withstanding its deadly consequences on families and communities. The staff at these clinics is also to be motivated to adopt co-operative health care and psycho-social strategies, in which team work and the involvement and participation of all relevant stakeholders is viewed as an integral part of the struggle against HIV / AIDS and its devastating spread. / Health Studies / M.A. (Health Studies)

The purpose of the study was to describe the knowledge, attitudes and practices of nurse-midwives related to obstetric care at Thaba-Tseka, Lesotho. A quantitative, descriptive, cross-sectional research design was used. Data were collected using structured questionnaire from 45 nurse-midwives. The findings revealed that nurse-midwives had mean knowledge score of 10.5(80.7%) out of a possible 13(Standard Deviation (SD) 1.31) on obstetric care issues. However, the majority of nurse-midwives (n=28, 62.2%) did not have knowledge on the steps of the active management of third stage of labour according to the WHO. The mean scores on practice were 34.5(86.2%) against a possible 40(SD 5.43) for antenatal care, 39.2(89%) against a possible of 44(SD 4.66) and 22.4(93.3%) against a possible of 24(SD 2.18) for postnatal care. The study revealed that nurse-midwives had positive attitudes towards obstetric care practices with mean score for attitudes was 23.4(86.7%) against a possible score of 27(SD 3.02) / Health Studies / M.A. (Public Health)

Kvinnor har rätt till informerat samtycke och informerade val när det gäller undersökningar och behandlingar under graviditet och förlossning både utifrån FNs mänskliga rättigheter och utifrån svensk lagstiftning. Kvinnan har historiskt befunnit sig långt ned i den hierarkiska ordningen inom förlossningsvården. Det råder en riskkultur i det västerländska moderna samhället som även märks av i vården av gravida och födande kvinnor. Kvinnor genomgår många olika undersökningar och behandlingar under graviditet och förlossning av vilka några har oklar evidens. Barnmorskan har en viktig roll i att ge kvinnor möjlighet till informerat samtycke och informerade val när det gäller undersökningar och behandlingar under graviditet och förlossning. Det behövs mer kunskap om hur kvinnor i Sverige ges möjlighet till detta. Syftet med studien är att undersöka om kvinnor ges möjlighet till informerat samtycke och informerade val när det gäller undersökningar och behandlingar under graviditet och förlossning. Studien utfördes som en kvantitativ tvärsnittsstudie och datainsamlingen gjordes med hjälp av enkäter. Det insamlade materialet analyserades med både deskriptiv och analytisk statistik. Resultatet antyder att kvinnor inte ges möjlighet till informerat samtycke och informerade val utifrån begreppens rätta bemärkelse när det gäller ett flertal specifika undersökningar och behandlingar under graviditet och förlossning förutom när det gäller rutinultraljudsundersökningen. Kvinnor uppfattar dock att de ges möjlighet vara delaktiga i beslut rörande undersökningar och behandlingar överlag under graviditet och förlossning. Hierarkiska ordningar och riskkulturen som råder i förlossningsvården är tidigare påvisade faktorer som kan utgöra hinder för kvinnors möjligheter till informerat samtycke och informerade val under graviditet och förlossning. Med en vård baserad på ett patientperspektiv kan kvinnors ställning samt autonomi stärkas. För en hållbar utveckling är kvinnors möjligheter at t göra informerade val angående sin sexuella och reproduktiva hälsa avgörande. / Women have the right to informed consent and informed choice with regard to examinations and treatment during pregnancy and childbirth on the basis of the human rights conducted by The United Nations, and according to Swedish law. Women have historically been far down in the hierarchical order in the birthing care system. There is a risk culture in Western modern society that is also noticeable in the care of pregnant women and women giving birth. Women undergo a variety of examinations and treatments during pregnancy and childbirth, some of which have unclear evidence. The midwife has an important role to give women the opportunity for informed consent and informed choices regarding examinations and treatments during pregnancy and childbirth. There is a need for more knowledge about how women in Sweden are given the opportunity to do so. The aim of the study is to investigate whether women are given the opportunity for informed consent and informed choices with regard to examinations and treatments during pregnancy and childbirth. The study was conducted as a quantitative cross-sectional study and questionnaires were used for data collection. The collected data was analysed with both descriptive and analytical statistics. The results suggest that women are not given opportunities for informed consent and informed choices based on their true sense when it comes to several specific examinations and treatments during pregnancy and childbirth except for the routine ultrasound examination. Nevertheless do women perceive that they are given opportunities to participate in decision making regarding examinations and treatments in general during pregnancy and childbirth. Hierarchical schemes and risk culture that prevails in the birthing care system is earlier identified factors that may pose obstacles to women's opportunities for informed consent and informed choice during pregnancy and childbirth. Through a care based on a patient perspective, the status of women and women's autonomy would be strengthened. For sustainable development, women's opportunities to make informed choices about their sexual and reproductive health are crucial.

Bakgrund: Yoga under graviditet har blivit allt mer populärt i Sverige och västvärlden på senare tid. Tidigare studier föreslår att yoga för gravida kan ge ökat välmående under graviditet, minska förlossningsrädsla och öka prenatal anknytning. Idag finns yoga för gravida att tillgå på privata yoga- och träningscenter, samt på vissa mödravårdscentraler. Det verkar dock finnas en kunskapslucka i forskningen angående barnmorskors upplevelse av att arbeta med yoga för gravida. Syfte: Beskriva barnmorskors upplevelse av att arbeta med yoga för gravida. Metod: Åtta semistrukturerade intervjuer genomfördes med barnmorskor som har erfarenhet av att leda klasser i yoga för gravida. Kvalitativ innehållsanalys användes för analys av materialet. Resultat: Fyra kategorier identifierades. Kategorierna var Förlossningsförberedelse, Välmående under graviditet, Prenatal anknytning samt Avrådan eller Anpassning. Vidare framträdde 11 underkategorier och ett övergripande tema: Trygghet och Tillit. Slutsats: Barnmorskorna upplever att yoga under graviditet kan bidra till ökat välmående både psykiskt och fysiskt, skapar möjlighet till prenatal anknytning samt förbereder de gravida inför förlossningen. Barnmorskorna betonar att deras erfarenheter från barnmorskeprofessionen ger en djupare dimension i yogaklasserna och gör att de kan leda yoga för gravida på ett säkert sätt. Klinisk tillämpbarhet: Studien kan inspirera barnmorskor till att arbeta med, eller rekommendera yoga för gravida samt inspirera till vidare studier. / Background: Yoga during pregnancy has become increasingly popular in Sweden and the western world in recent years. Earlier studies suggest that yoga for pregnant women may increase well-being during pregnancy, reduce fear for giving birth and increase prenatal attachment. Today, yoga for pregnant women is available at private yoga and fitness centres and at certain maternity clinics. However, there seems to be a gap of knowledge about midwifes experiences of working with yoga for pregnant women. Aim: Describe midwives experiences of working with prenatal yoga. Method: Eight semistructured interviews were conducted with midwives who have experience instructing yoga classes during pregnancy. Qualitative content analysis was used for analysis of the material. Result: Four main categories were identified. The categories were Birth Preparation, Well-being during Pregnancy, Prenatal attachment, and Contraindication or Adjustment. Furthermore, there were 11 subcategories and an overall theme: Sense of security and Trust. Conclusion: The midwives experience that yoga during pregnancy can contribute to increased well-being, both mentally and physically, establish prenatal attachment and prepare the pregnant women for childbirth. The midwives emphasize that their professional experiences in midwifery contributes to a deeper dimension in the yoga classes, enabling a safe practise during pregnancy. Clinical application: The study can inspire midwives to work with, or recommend prenatal yoga and inspire to further studies.

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The purpose of the study was to explore and describe the experiences of male community service officers during midwifery clinical training. A qualitative, explorative, descriptive and contextual design was used in order to achieve the study objectives. Data was collected by means of semi-structured interviews. Data analysis elucidated analogous themes and categories which translated into the overall experiences of the participants. The study found that whilst the experience was described as beneficial, there were overwhelming challenges in providing intimate care to female clients, dealing with ethno-cultural aspects, meeting clinical practice requirements and the right to choose to be part of midwifery clinical training. Recommendations to nurse educators, clinical midwives and midwifery clinical supervisors with regard to better support for male nurses during midwifery clinical training emanated from the study findings / Health Studies / M.A. (Health Studies)