Bakgrund: Barnmorskans arbetsfält omfattar idag sexuell-, reproduktiv- och perinatal hälsa och det centrala i yrkesutövningen är att främja hälsa. Barnmorskan ska ha kunskaper om, kunna ge information och undervisa om sexualitet och samlevnad utifrån ett genus- och livscykelperspektiv. Uppdraget på ungdomsmottagning är att arbeta med sexualitet och hälsa samt att förebygga oönskade graviditeter och STI. Syfte: Syftet var att beskriva barnmorskors erfarenheter av preventivmedelsrådgivning på ungdomsmottagning. Metod: Individuella intervjuer genomfordes med nio barnmorskor på ungdomsmottagningar. Vid intervjutillfället användes en frågeguide och semistrukturerade frågor ställdes. Som analysmetod användes kvalitativ innehållsanalys. Resultat: Fyra kategorier och 15 subkategorier identifierades. Kategorierna var enligt följande: Erfarenheten och kunskapens betydelse, Det kliniska arbetssättet, Modererande faktorer och Utmaningar. Slutsats: Barnmorskor uppgav god kunskap och goda erfarenheter av ungdomar och preventivmedelsrådgivning på ungdomsmottagning men menade att det är ett dynamiskt arbete som bidrar till ständig utveckling. Vid möten med preventivmedelssökande ungdomar på ungdomsmottagning fanns önskan att mötet skulle ske på individnivå. Erfarenheter av modererande faktorer för barnmorskan, utmaningar för preventivmedelsrådgivningen och följsamheten fanns vilket innebar att preventivmedelsrådgivning för ungdomar på ungdomsmottagning är komplext. Klinisk tillämpbarhet: Studiens resultat skulle kunna innebära ökad förståelse för arbetet på ungdomsmottagning och skapa underlag för att möta utmaningarna som barnmorskorna möter i det dagliga arbetet. / Background: The midwife’s field of work today includes sexual,- reproductive,- and perinatal health and the core of the profession is to promote health. The midwife should have the knowledge, to provide information and teach about sexuality and relationships from a gender and lifecycle approach. The mission of the youth center is to work with sexuality and health and the prevention of unwanted pregnancies and STI’s. Aim: The aim was to describe midwives' experiences of contraceptive counseling at youth clinics. Method: Interviews were conducted with nine midwives in youth clinics. In time of the interview a questionnaire was used and semistructured questions were asked. Qualitative content analysis was used as analyze method. Results: Four categories and 15 subcategories were identified. The categories were as follows: Importance of experience and knowledge, the Clinical approach, Moderating factors and Challenges. Conclusion: Midwives feel they have good knowledge and experience of young people and contraceptive counseling at the youth clinic and has experience that it is a dynamic work that contributes to constant development. When they meet contraception seeking young people they wish to meet them at an individual level. The midwives had experiences in that there are moderating factors and challenges for the contraception counselling and compliance in contraceptive use, this means that contraceptive counselling for young people is complex. Clinical application: The result of the study could mean greater understanding for the work in youth clinics and create a basis for meeting the challenges that midwives face in their daily work.

Magister Curationis - MCur / Globally, there has been significant progress in reducing preventable maternal deaths and disability, and growing attention on improving the quality of care in maternal health care facilities. The World Health Organization (WHO) describes quality care as delivering healthcare that is effective, efficient, accessible, acceptable, patient–centred, equitable and safe (WHO, 2014). Midwives are the backbone of midwifery and therefore the primary care giver for pregnant women accessing maternal care and women’s ability to access quality midwifery care during the antenatal, labour and postnatal period is the key component in midwifery care. The Primary Level Protocol of South Africa is under the umbrella of the Primary Health Care System, and according to this system low risk women are expected to seek antenatal, intrapartum and postnatal care from the nearest Midwife Obstetric Unit (MOU). The choice a woman makes regarding access to maternity care depends on the social norms in her society and what services are offered. However, the services that are available may not meet the needs of pregnant women. Women may need detailed information about the availability of the maternity care system in order to make an informed decision on where to access the health system. The gap between the perceived needs of pregnant women and the care provided by midwives can be bridged by listening to women to create a reciprocal understanding of quality care. In South Africa, limited research has been conducted on midwives and women’s perceptions of maternity care. In the absence of such information, this study was conducted at an MOU in the Western Cape, with the aim of exploring women and midwives’ perceptions of quality care during childbirth.

Background: The role of Midwife Obstetric Units (MOUs) as lead caregivers for low risk pregnancies has been a topic of much debate in recent years. It has been suggested that MOUs are more cost effective, and have a less interventionist approach to low risk pregnancies, when compared to Consultant Obstetric Units (COUs). Objectives: The primary objective of this study was to compare intrapartum delivery procedures, methods of delivery, and maternal and neonatal wellbeing for low risk pregnancies between a MOU and a COU. The second objective was to investigate the predictors of key outcomes such as caesarean sections and perineal tears. The research was carried out at a private obstetric unit in Gauteng from January 2005-June 2006. Materials and Methods: The study design was a retrospective cohort study, by means of a record review of routinely collected data. 808 subjects (212 COU and 596 MOU patients) satisfied the criteria for a low risk pregnancy during the defined period and were included in the analysis. Results: Overall the MOU had fewer interventions than the COU, but had very similar maternal and neonatal outcomes. MOU patients were less likely to have an epidural than COU patients (p<0.001), and more likely to utilise a bath for pain relief (p<0.001). The MOU was also less likely to induce a patient than the COU (p=0.002). Primiparous patients accounted for more than 95% of the caesarean section (C/S) rate (p<0.001), with the COU performing 2.2 times more C/S on primiparous patients than the MOU. Vaginal birth in the MOU was 2.6 times more likely to be an underwater birth (UWB) than the COU (p<0.001). Positive predictors for C/S were COU care, primiparous status and induction of labour. UWB was a positive predictor for grade 1 and 2 perineal tears. There were no maternal or neonatal deaths, in either unit, during the study period. There were no significant differences between the MOU and COU for maternal morbidity indicators (tears, postpartum haemorrhage, and retained placenta) or neonatal morbidity indicators (Apgar < 7 at 5 minutes and neonatal ICU admission). Conclusion: The MOU had fewer intrapartum interventions (epidurals and induction of labour) and lower C/S rates than the COU for low risk pregnancies, yet maternal and neonatal outcomes were similar. This study suggests that the MOU can function just as effectively as the COU for low risk pregnancies. Therefore the establishment of more MOUs would have immense resource implications for both the public and private health sectors in South Africa.

Bakgrund: SFOG har tillsammans med SBF, SNS och LÖF upprättat riktlinjer för förlossningsvården som bland annat berör dokumentation av CTG. Dessa har tagits fram genom ”Projekt säker förlossningsvård” och antagits av Blekingesjukhuset Karlskrona år 2008. Syfte: Syftet var att undersöka barnmorskors och läkares följsamhet av CTG-dokumentation, vid aktivt förlossningsförlopp, i förhållande till lokala PM, aktuella riktlinjer och nationella styrdokument på förlossningsavdelningen, Karlskrona. Metod: Retrospektiv journalgranskningmed deskriptiv design har använts.  Datainsamling omfattar tidsperioden 2011-07-01 t.o.m. 2012-03-04. Totalt ingick 748 journaler och 1547 dokumentationer i studien. Dataanalys har skett med hjälp av statistikprogrammet SPSS. Resultat: Av journalerna hade 22% ingen dokumentation om CTG och 46% av dokumentationerna innehöll en klassifikation. Åtgärd har dokumenterats i 80% och dokumentationerna var skriven utan förkortning i 45%. Följsamheten av klassificering och åtgärd tillsammans var totalt 44%medan barnmorskors var 38% och läkares 8%. Konklusion: Följsamheten av CTG-dokumentationbehöver förbättras på förlossningsavdelningen i Karlskrona. Majoriteten av vad som dokumenteras följer inte PM, riktlinjer och nationella styrdokument. / Background: SFOG, SBF, SNS and LÖF have conducted guidelines for obstetric care including documentation of CTG. These have been developed during “Projekt säker förlossningsvård” and adopted 2008 by the hospital in Blekinge, Karlskrona. Aim: The aim of this study was to examine the compliance of CTG documentation by midwives and physician, during active labor, in relation to local PM, current guidelines and national policy at the labor ward Karlskrona. Method: Retrospective study using descriptive design was used. Data collection covers the time period 2011-07-01 to 2012-03-04. Totally 748 records and 1547 documentations were reviewed. Data analysis was progressed in SPSS. Result: Of the total records, 22% did not have any documentation about CTG and 46% of the collected documentations had a classification. Action was documented in 80%, and the documentations were written without an abbreviation in 45%. Compliance of classification and action together was 44%, midwives had  38% and physicians 8%. Conclusion: The compliance of CTG documentation needs improvement in the labor ward in Karlskrona. The majority of documents are not followed by PM, guidelines and national policy documents.

Lifes origin is, in many ways, coupled to understanding the evolution of nucleic acids. In contemporary life, proteins and nucleic acids are intricately dependent upon each other for a host of functions including, but not limited to, replication and chemical ligation. Protein enzymes are necessary for the synthesis of DNA and RNA, while nucleic acids are necessary for both the coding and synthesis of proteins. According to the RNA World hypothesis, early life used nucleic acids for both information storage and chemical catalysis before the emergence of protein enzymes. However, it still remains a mystery how nucleic acids were able to assemble and replicate before the advent of protein enzymes. We have utilized the ability of small molecule intercalation to assemble nucleic acids into stable secondary structures. Our motivation in this pursuit comes from the recently proposed Molecular Midwife hypothesis where small molecules may have acted as nanoscale structural scaffolds upon which the nucleic acid bases were able to stack into stable structures and undergo assembly into polymers. We have also found that the kinetics and thermodynamics of small molecule-mediated assembly and secondary structure formation are strongly dependent upon oligonucleotide length. Small molecules bind to nucleic acids by multiple modes of binding and this phenomenon must be properly understood in order to achieve robust and versatile assembly of nucleic acid structures.

No description available.

Magister Curationis - MCur / Perinatal deaths are emotion-laden events not only for the mothers, but also for physicians and midwives. Hence, mothers experiencing the phenomenon need support to overcome the experience. If the loss occurs in a health institution, the responsibility of supporting the woman is borne by healthcare providers, particularly midwives. However, limited information exists on how midwives manage patients who experience perinatal loss in health institutions. Consequently, this study on midwives' experiences of managing patients' perinatal loss at a maternity hospital in the Western Cape, South Africa was conducted. The aim of the study was to explore midwives' management of patients with perinatal loss. The study utilised a qualitative research design and employs a phenomenological approach. Purposive sampling was used to select eight registered midwives to participate in the study. Data was collected by means of in-depth unstructured interviews, which were audio-recorded. It was then analysed by utilising Colaizzi's (1978) steps of phenomenological data analysis. Four themes emerged from the data, namely, knowledge of perinatal loss, challenges when managing patients, managing perinatal loss, and getting emotionally involved. Themes were informed by several subthemes. In addition, implication on practice indicates that improving support to mothers with pregnancy loss requires a multi-disciplinary approach or teamwork from various professionals in order to enhance mutual collaboration between families and healthcare workers. The study concludes that nursing education programmes should be reviewed to ensure that they include midwives' needs in the area of managing clients experiencing a perinatal loss. Hence, student midwives should be given more clinical experience of caring for bereaved couples under supervision, as well as compassionate support, which would assist them to develop these skills before they graduate.

No description available.

This thesis describes and analyses concepts of criminal abortions during the 1890s. The analysis is based on source material in a court case about illegal abortions that took place in Malmö in 1892, as well as in articles wish were published in the daily newspapers in connection with the same legal case.Through Michel Foucault's theories of dimensions of power and Norman Fairclough's critical discourse analysis, power relations that may have played a role for individuals' actions are studied. The result shows that there was a disciplinary exercise of power against the accused women based on the way in which these are portrayed in the legal material. The interaction between the individuals in the legal material shows both power and resistance that took place within the discourse.The concept of abortion that emerged from the study shows that there was some acceptance regarding abortions as long as this was handled discreetly. There were also some understandings of the woman's actions which were considered to be based on reasonable causes. However, it turned out that the same understanding did not occur upon the abortionist who was portrayed as a criminal. Reasons for abortion were based on shame, social and economic conditions, and ideological reasons.

The prevalence of post abortion contraception in Zambia is lower than in many other African countries, with unmet family planning needs. Midwives play an important professional role in family planning. In conjunction with an abortion the midwife is provided with an opportunity to inform, discuss, prescribe and initiate family planning with the woman concerned. It is shown that women receiving information and knowledge about post abortion contraception are more likely to use it.   The aim of the study was to describe midwives experiences of working with post abortion family planning in Zambia.   A qualitative interview study with semi-structured questions was used. To conduct the study and find participants with the right inclusion criteria a strategic sampling was used. Ten midwives working with post abortion family planning in Zambia were interviewed. Qualitative content analysis was performed to analyze the collected data from the interviews.   During the data-analysis two categories and eight subcategories were identified. The midwives had experiences of several challenges within post abortion family planning. These included lack of knowledge, supplies and health care staff as well as problem with stigma around family planning and lack of compliance. The midwives also described other factors influencing the work with post abortion family planning. These factors included changes in attitudes, the midwife's knowledge and the importance of information provided by the midwives.   The midwives experienced that there were several factors influencing their work with post abortion family planning. Several challenges within post abortion family planning were identified in this study. Areas of improvement involve education, more midwives working and a better availability to post abortion family planning equipment and services. / Användandet av preventivmedel efter abort är lägre i Zambia i jämförelse med andra afrikanska länder och behovet av familjeplanering är inte tillfredsställt i Zambia. Barnmorskeprofessionen har en viktig roll i familjeplanering. I samband med abort har barnmorskan ett utmärkt tillfälle att informera, diskutera, förskriva samt initiera familjeplanering med den berörda kvinnan. Det har visat sig att kvinnor som får information och kunskap om familjeplanering efter abort är mer benägna att använda sig av preventivmedel.   Syftet med denna studie var att beskriva barnmorskors erfarenheter av att arbeta med familjeplanering för kvinnor i Zambia som genomgått en abort.   En kvalitativ intervjustudie med semistrukturerade frågor användes. För att nå deltagare som uppfyllde studiens inklusionskriterier användes ett strategiskt urval. Tio barnmorskor i Zambia som arbetar med familjeplanering efter abort deltog i studien. En kvalitativ innehållsanalys utfördes för att analysera det insamlade materialet.   Under analysen identifierades två kategorier och åtta subkategorier. Barnmorskorna hade erfarenhet av flera utmaningar inom familjeplanering efter abort. Dessa bestod dels av brist på kunskap, material och vårdpersonal samt problem med stigma kring familjeplanering och brist på följsamhet rörande preventivmedelsanvändning. Barnmorskorna beskrev även andra faktorer som påverkade arbetet med familjeplanering efter abort. Dessa faktorer bestod av ändrade attityder, barnmorskans kunskap och vikten av barnmorskans information.   Barnmorskorna hade erfarenhet av att flera faktorer påverkade deras arbete med familjeplanering efter abort. Flera utmaningar med familjeplanering efter abort identifierades genom den här studien. Förbättringsområden involverar utbildning, fler verksamma barnmorskor och en bättre tillgänglighet till material och familjeplanering efter abort.