The aim of this magister thesis is to examine the motives behind parents´ choice to sex determine their children, or not, at routine ultrasound examination (RUL). The analysed empirical data consists of 261 responding questionnaires written by expecting parents. My conclusions are that the motives behind parents’ choice can reflect their view of sex as binary or analog. Many parents sex determine their unborn children in order for preparing their rooms, clothes and toys to correlate with the heterosexual matrix. Girls get pink and boys blue, but the colours are of course only the visible part of how children are sexed as social construction. Some parents are experiencing a peer pressure and quite a few parents are influenced by the midwife performing the RUL to chose to sex determine their child. The most common motive to abstain from sex determining the child at RUL is after all to make gender the big happening at birth. Parents prepare to raise – not a child – but a boy or girl.

The rationale of any national screening programme is to recognize the benefits for public health, to test a predominantly healthy population including low risk pregnant women, and to detect risk factors for morbidity in order to provide timely care interventions. The South African health care system faces many challenges that undoubtedly impact on maternal health, resulting in poor quality of care and indirectly causing maternal deaths. The government has embarked on a number of initiatives that address women’s psychosocial wellbeing during pregnancy, for example free maternity care, legalizing abortion, expanding on provider-initiated HIV counseling and testing for antenatal patients. These initiatives imply a re-look at antenatal care screening, in order to identify wider determinants of health that may have an impact on a woman’s psychosocial wellbeing. This includes amongst others, poor socio-economic conditions such as poverty, lack of social support, general health inequalities, domestic violence and a history of either personal or familial mental illness, all of which have the capacity to influence a pregnant woman’s decision to utilize health care services. The intention of this study was therefore to establish the extent of psychosocial risk assessment for pregnant women during antenatal care, with a focus on the psychosocial support.Ethical clearance was obtained from the University of the Witwatersrand Human Research Ethics Committee (Protocol no. M081013). A mixed-method approach was applied through combining quantitative and qualitative research techniques, methods and approaches to address psychosocial risk assessment and psychosocial support by midwives during antenatal care. An explanatory sequential design was used. The methodology was aimed at accommodating the diverse population involved in the study, the nature of data being sought and the number of investigations conducted. A fully mixed research approach was implemented interactively through all the stages of the study. The study took place in six phases to meet the purpose of this research. Phase 1 entailed quantitative data collection and analysis; phase 2 qualitative data collection and analysis; phase 3 report writing; phase 4 formulation of guidelines; phase 5 pilot test; phase 6 integration of results and findings, and writing of final report. The philosophical basis of the study is based on the researcher’s values and belief of holism and comprehensive assessment. Much as values are part of the study, the researcher strove to keep values as separate from the research as possible, to minimise researcher bias. The feminist standpoint theory provided the guiding epistemological framework to address the qualitative research questions for this study as the issues regarding reproduction are of central feminist concern. Pragmatism, which is considered a best philosophical basis for mixed-methods as it values both objective and subjective knowledge, was applied in this study. The methodological goal of the study was guided by two paradigms, “constructivist”, which is the basis of qualitative research and “contemporary empiricist” paradigms, which is the basis of empirical analytic research as the study used a mixed-method approach. Although the empiricist lens is the most appropriate for a sequential explanatory design, both paradigms are acknowledged in this study. A quantitative-qualitative data collection and analysis sequence was followed. The sequential explanatory approach was maintained through, for example, collecting and analyzing quantitative data first, followed by obtaining information from midwives through a questionnaire and focus group discussions, and from pregnant women through a questionnaire and focus group discussions, using the same populations. Non-probability purposive sampling was done for all data sources. All data were collected by the researcher.Qualitative data analysis consisted of the identification of themes and relationships through constant comparison of data, which enabled the researcher to establish group and across-group saturation in focus group discussions. Quantitative data was collected through the review of midwifery education regulations, documents and records. Midwives’ questionnaires with a response rate of 46%, questionnaires administered to pregnant women and the review of antenatal cards with a 94% response rate. The data sets provided multiple data sources, a characteristic of the mixed methods approach. Data were analyzed using the Stata Release 10 statistical software package. Data analysis included summary statistics i.e. mean and standard deviation for continuous variables, frequencies and percentages for discrete variables, and Chronbach’s alpha for internal consistency. Confidence intervals of 95% were used to report on discrete variables. Quantitative and qualitative data were initially analyzed separately to develop an understanding of the two data bases before merging the findings and results. The process provided separate and independent results that could be compared for the purposes of corroboration, complementarity and discussion. The results were compared for specific content areas, for example major themes. A tool for psychosocial risk assessment and care was developed in response to the findings from the midwives’ focus group discussions at the three clinics, the expert interviews findings, the cross-sectional survey results from midwives, the self-administered questionnaires for pregnant women, and review of the antenatal cards carried by women during antenatal care. The tool was piloted in the three clinics where data were initially obtained. The general results of the study suggest that depressive and anxiety disorders are common in pregnancy and may be associated with negative experiences during antenatal care. Adequate screening of women and recognition of emotional responses with appropriate interventions are essential to promote a woman’s healthy adjustment to pregnancy. Attempts to minimise high levels of uncertainty, anxiety and depression should be incorporated within routine antenatal care.Midwives should strive to empower women physically and psychosocially in order for women to be able to overcome any barriers to safe motherhood, with emphasis on providing information, in order for them to make informed choices.The findings from the pilot study confirmed that pregnant women experience psychosocial problems which can be identified by the use of a screening tool, howeverthere remains a need to test the tool on a larger sample which might elicit more factors that could hinder or help its implementation. The implication of the findings appears to be that midwives are willing to incorporate the psychosocial assessment tool into routine antenatal care. The findings might be used to advocate for the incorporation of the tool into routine antenatal care. While the use of this antenatal psychosocial pilot tool may increase the midwives’ awareness of psychosocial risks and form a basis for further studies, a bigger sample size and statistical power are required to provide evidence that routine antenatal psychosocial assessment would also lead to improved outcomes for mother and/or child. The final stage of the study, based on research findings, led to the development of guidelines and recommendations for psychosocial care at the midwifery regulation level, midwifery education, clinical practice level and research. Key concepts: Antenatal care; Midwife; Psychosocial risk assessment; Psychosocial support.

Introdução: A Organização Mundial de Saúde propõe características menos intervencionistas da assistência ao parto, enfatizando o papel das obstetrizes e enfermeiras obstétricas como as profissionais mais apropriadas para o acompanhamento das mulheres com gestação e parto normais. A Universidade de São Paulo (USP) iniciou, em 2005, o Curso de Graduação em Obstetrícia da Escola de Artes, Ciências e Humanidades (EACH-USP). Esse Curso nasceu com o desafio de reativar a formação do profissional obstetriz, visando a mudanças no modelo assistencial ao parto vigente. Objetivo: Conhecer a vivência acadêmica e a inserção profissional das(os) obstetrizes egressas(os) da primeira turma do Curso de Obstetrícia da EACH-USP. Método: Pesquisa de caráter exploratório e descritivo, com uma abordagem quantitativa e qualitativa. Para a abordagem qualitativa foi utilizado o Estudo de Caso. A amostra foi composta por 24 egressas(os) da primeira turma do Curso, de um universo de 44 formandas(os) que ingressaram em 2005. Os dados foram coletados no período de maio a agosto de 2010, por meio de entrevista gravada. O instrumento de coleta de dados foi composto por perguntas abertas e fechadas. A análise compreendeu a caracterização do perfil sócio-demográfico e econômico das(os) egressas(os) e sua trajetória acadêmica e profissional. Para análise dos dados foram utilizadas a estatística descritiva e a análise de conteúdo, adotando as concepções pedagógicas da EACH-USP, o Projeto Político-Pedagógico do Curso de Obstetrícia e os estudos sobre egressos como marcos teóricos. Resultados: Identificou-se que a maioria das(os) egressas(os) eram mulheres, solteiras, jovens e residentes na cidade de São Paulo, com renda familiar em torno de três a dez salários mínimos, com formação escolar anterior em escolas privadas. Após a conclusão da graduação, 17 egressas(os) voltaram a estudar, sendo seis em cursos de mestrado ou doutorado, seis em outro curso de graduação e os demais em cursos de atualização. Havia 14 egressas(os) inseridas(os) no mercado de trabalho, mas apenas quatro atuando na Obstetrícia, devido aos impedimentos legais para obter o registro profissional de Obstetriz. Da análise qualitativa dos dados, extraíram-se as seguintes categorias: Curso de Obstetrícia; Opção pelo Curso de Obstetrícia; Vivência Acadêmica; Formação Acadêmica; Inserção no Mercado de Trabalho, Sugestões para Melhorar a Formação dos Alunos; Sugestões para Aproximar Ex e Atuais Alunos. Ao final do estudo, considerou-se que as(os) obstetrizes perceberam sua formação acadêmica como adequada para enfrentar o mercado de trabalho, mas destacaram limitações como a falta de maiores contatos profissionais durante o curso, a carga horária reduzida em disciplinas práticas e a infra-estrutura deficiente da EACH-USP, que foram parcialmente superadas ao longo do Curso. Os itens mais valorizados na vivência acadêmica foram a realização de estágios, a iniciação científica e o contato com os professores. Em relação à inserção profissional, prevalece o discurso carregado de revolta e indignação com o Conselho Regional de Enfermagem, devido à resistência do órgão em reconhecer seu diploma para fins de registro profissional. Considerações Finais: O Curso de Obstetrícia da EACH-USP oferece um ensino de qualidade e forma obstetrizes com potencial para contribuir para a transformação da assistência obstétrica. Embora venham sendo feitas mudanças para aprimoramento do Curso, dificuldades relativas ao reconhecimento legal do exercício profissional das egressas representam ameaças à sua continuidade. / Introduction: The World Health Organization proposes less interventionist characteristics of childbirth care, emphasizing the role of midwives and nurse-midwives as the professionals best suited to the monitoring of women with normal pregnancy and delivery. The University of São Paulo (USP) began in 2005, the Undergraduate Program in Midwifery at the School of Arts, Sciences and Humanities (EACH-USP). This course was created with the challenge to revive the training of professional midwife in order to change the current model of care delivery. Objective: To know the academic experience and professional inclusion of (the) egresses midwives of the first class of midwifery course EACH-USP. Method: Research on exploratory and descriptive, with a quantitative and qualitative approach. For the qualitative approach was used the case study. The sample was composed of 24 egresses (the) the first class of course, a universe of 44 graduates who were admitted in 2005. Data were collected between May to August 2010, through recorded interviews. The data collection instrument consisted of open and closed questions. The analysis included the characterization of sociodemographic and econimic profile of (the) egresses and his academic and professional trajectories. For data analysis we used descriptive statistics and content analysis, adopting the pedagogical conceptions of EACH-USP, the Pedagogical Policy Project of the midwifery Course and studies of egresses as theoretical frameworks. Results: We identified that the majority of (the) egresses were women, single, young and living in the city of São Paulo, with a family income of around three to ten minimum salary, previous schooling in private schools. After completion of graduation, 17 egresses (the) returned to study, six courses in master\'s or doctorate, six another undergraduate and other in courses to upgrade. There were 14 egresses (the) inserted (the) labor market, but only four working in obstetrics, on account of legal impediments for the registration of professional midwives. The qualitative analysis of data, we extracted the following categories: Midwifery Course, Choice of Midwifery Course, Academic Experience, Academic training; Entering the Labor Market, Suggestions for Improving the Training of Students; Suggestions for bringing Past and Present Students . At the end of the study it was considered that (the) midwives perceived their academic training as appropriate to meet the labor market, but highlighted limitations such as lack of major professional contacts during the course, reduced the workload in practical subjects and deficient infrastructure of the EACH-USP, which were partially overcome throughout the course. Items valued at more academic experience were the realization of stages, the basic scientific research and contact with teachers. In relation to professional inclusion, the prevailing discourse laden with anger and indignation with the Regional Nursing Council, because of resistance of the organ to recognize their qualifications for professional registration. Conclusion: The Midwifery Course EACH-USP offers a quality education and prepares midwives with the potential to contribute to the transformation of obstetrical care. Although changes may be made for improvement of course, difficulties relating to legal recognition of professional practice of the egresses represent threats to its continuity.

Bakgrund: Hinnsvepning är en icke farmakologisk induktionsmetod som används i syfte att framkalla spontan förlossningsstart eller förbereda cervix för annan induktionsmetod. Svensk förening för obstetrik och gynekologi (SFOG) rekommenderar hinnsvepning i graviditetsvecka 41 för att minska överburenhet. Metoden är omstridd och dess effekt ifrågasatt. Syfte: Att belysa barnmorskors erfarenhet av och attityd till hinnsvepning. Metod: Enskilda halvstrukturerade intervjuer med tolv barnmorskor verksamma inom mödrahälsovården i södra Sverige genomfördes. Data analyserades genom kvalitativ innehållsanalys. Resultat: I resultatet framkom att barnmorskor saknar utbildning i hinnsvepning och att majoriteten lärt sig utföra detta genom sina kollegor den dag de ställts inför uppgiften. Det saknas tydliga riktlinjer vilket kan innebära att hinnsvepning utförs på olika indikationer, vid olika tidpunkter i graviditeten och med olika tillvägagångssätt. Attityden till hinnsvepning varierar mellan barnmorskor, där en del tror på metoden och andra är mer skeptiska till dess effekt. Slutsats: Utbildning och tydliga riktlinjer saknas. Kvinnans önskan om och tilltro till hinnsvepning ligger ofta till grund för interventionen. / Background: Sweeping of membranes is a non-pharmacological induction method used to initiate labor or to prepare cervix for induction with other methods. The Swedish Association for Obstetrics and Gynecology (SFOG) recommends that membranes are swept after 41 full weeks of pregnancy to reduce post-term pregnancies. The method is disputed, and the effect is questioned. Aim: To describe midwives experiences and attitudes to membrane sweeping. Method: Individual half structured interviews with twelve midwives active in maternal healthcare in southern Sweden were performed. Data was analyzed by qualitative content analysis. Results: In the result emerged that midwives lack educating about membrane sweeping and that the majority had learned how to perform the intervention by colleagues the day they were faced with the task. Because of unclear guidelines membrane sweeping can be performed on various indications, in different times in the pregnancy and with different approaches. The midwives attitude towards membrane sweeping varies, some have belief in the method while others are more skeptical. Conclusion: Education and clear guidelines are missing. The woman´s desire for and confidence in the method is often the basis for the intervention.

Forskning har visat att blivande pappor, som i denna studie även benämns som män eller förstagångspappa, har svårt att känslomässigt knyta an till graviditeten innan den blir synlig. Informationen och stödet från Mödrahälsovården under graviditeten är främst riktat till kvinnan, vilket gör att män ges en känsla av utanförskap. De beskriver känslor som att bli åsidosatt av barnmorskan vilket ökar känslan av oro. I Sverige har alla föräldrar rätt till föräldrastöd och individuellt anpassat stöd. Hur upplever blivande förstagångspappor sin delaktighet och vad är delaktighet för dem? Syftet med studien är att belysa förstagångspappors upplevelse av delaktighet i alla tänkbara aspekter av graviditet. En kvalitativ intervjustudie med åtta blivande förstagångspappor utfördes i Västra Götaland, Sverige under hösten 2013. Intervjuerna genomfördes när deras partner var i graviditetsvecka 31 till 40. Resultatet tydliggörs genom tre kategorier: Att vara inkluderad men stå vid sidan av, Relationens trygghetsskapande betydelse och Föreställningar om det okända. Resultatet redogör för mäns tankar och känslor om att vara delaktig under graviditeten. Barnmorskan ses som en kunskapskälla och inkluderar pappan genom ett gott bemötande, trots detta upplever pappor ett utanförskap. Under graviditeten antar männen en stödjande roll och har tankar om samhörighet och föräldraskap. För att män skall kunna uppleva delaktighet i alla tänkbara aspekter av graviditet behöver graviditeten förkroppsligas, vilket synliggörs i studiens övergripande tema: Frånvaro av förkroppsligande- ett hinder för delaktighet. Samhället har en föråldrad syn på graviditet och föräldraskap. Barnmorskan behöver få ökad kunskap om mäns behov av stöd under en graviditet, för att möjliggöra transitionen mot faderskapet och ge alla män rätt till lika föräldrastöd. Abstract: Research shows that expecting fathers, which in this study also referred to as male or first-time fathers’, have difficulties to emotionally connect to the pregnancy before it is visible. Information and support from the maternity care during pregnancy is mainly directed towards the women, this makes men feel left out. They describe feelings like being neglected by the midwife, which increases their feelings of anxiety. In Sweden all parents have the right to attend childbirth education and are entitled to individual support. What possibilities do men have for participating and how are they participating in the pregnancy? The aim of the study is to illuminate first-time fathers’ experiences of participating in all possible aspects of pregnancy. A qualitative study with eight expectant first-time fathers’ was conducted in Västra Götaland, Sweden in the autumn of 2013. The interviews occurred between 31th to 40th weeks of pregnancy. The result is illuminated through three categories: To be included but stand beside, The relationship that enhances security significance and Preconceptions about the unknown. The result describes men´s thoughts and feelings about being included in the pregnancy. Midwifes is seen as a source of knowledge and includes the father with her good care. Despite this, fathers experience being side lined. During pregnancy men takes on a supporting role and has thoughts about togetherness and parenting. If men shall be able to experience participation in all aspects of pregnancy, the pregnancy requires to be embodied, which get visible in the study´s main theme: Absence of embodiment- an impediment to participation. The midwife needs knowledge about men’s need for support during pregnancy in order to enable the transition to fatherhood and give all men the right to equal childbirth education. / Program: Barnmorskeutbildning

Bakgrund: Kvinnan i förlossningsarbete har haft stöd vid sin sida genom alla tider. För att få en så omfattande förståelse som möjligt av begreppet ”stöd till kvinnor i förlossningsarbete” genomfördes en begreppsanalys. Syfte: Syftet med begreppsanalysen var att definiera begreppet ”barnmorskans stöd till kvinnor i förlossningsarbete” genom syntes av texter hämtat från litteratur och intervjuer med svenska barnmorskor. Metod: En begreppsanalys med hybridmodell. Först en teoretisk fas med litteratursökning, därefter en fältstudiefas där fem barnmorskor intervjuades följt av en syntes med identifikation av begreppets kännetecken utifrån den teoretiska fasen och fältstudiefasen. Resultatdelen avslutas med fallbeskrivningar. Resultat: Barnmorskor ser hög närvaro och lyhördhet tillsammans med information och individualisering som viktiga delar av stödet till kvinnor i förlossningsarbete. Detta skapar tillsammans trygghet och tillit i relationen mellan barnmorskan och kvinnan. Slutsats: I detta examensarbete framkom fem empiriska kännetecken på stöd till kvinnor i förlossningsarbete. Utan de empiriska kännetecken, Trygghet, Information, Lyhördhet, Närvaro, Individualisering, kan inte känslan av stöd uppstå hos kvinnan i relationen mellan kvinnan och partnern/närstående och barnmorskan och kvinnan i förlossningsarbete. Klinisk tillämpbarhet: Barnmorskelitteraturen bör revideras så att närvaron i rummet av barnmorskan lyfts som ett kännetecken på stöd i samma grad som information och övriga kännetecken på stöd. Kunskap kring stöd kan utvecklas kliniskt genom exempelvis workshops på arbetsplatsen. / Background: Women in labor have had support by their sides through all times. In order to gain as wide understanding as possible of the concept of ' support for women in labor, a concept analysis was carried out. Objective: The purpose of the concept analysis was to define the concept of "support to women in labor by midwives" through the synthesis of texts from literature and interviews with Swedish midwives. Method: A concept analysis with a hybrid model. First, a theoretical phase with literature search was performed, then a field study phase where five midwives were interviewed followed by a synthesis identifying attributes of the concept from the theoretical phase and the field study phase. The result ends with case descriptions. Result: Midwives see high presence and sensitivity along with information and individualisation as important parts of the support for women in labor. This together creates security and trust in the relationship between the midwife and the woman. Conclusion: In this thesis five empirical characteristics of support were revealed; security, information, sensitivity, presence and individualisation. Without these empirical characteristics, the sense of support cannot arise in the relationship between the woman and the partner/relatives and the midwife and the woman in labor. Clinic´s applicability: Midwifery literature should be revised so that the midwife´s presence in the room is lifted as a sign of support to the same degree as information and other characteristics of support. Knowledge of support as a concept can be developed and implemented in clinical setting through workshops in the workplace.

This study focuses on the characterization of Cushman’s healers in her three medieval novels The Midwife’s Apprentice; Catherine, Called Birdy; and Matilda Bone. I specifically look at the physical descriptions, medical practices, and the healer’s role within the community as an accepted medical authority. Cushman’s portrayals illuminate the different locations and situations in which women practiced medicine during the Middle Ages, thus she presents more historically accurate portrayals of female healers. The significance of this project is that Cushman challenges the stereotype of the isolated and disfigured old crone that has been, perhaps inadvertently, perpetuated by authors and focuses on the historical accuracies of female healers. Many young readers learn about history through novels and it is important that authors present accurate historical representations of the past they are trying to describe to their audiences. In addition, this project will bring multiple disciplines together such as medieval studies, young adult literature, medical history, and folklore in order to illuminate the historical accuracies and representations of female healers.

Bakgrund: Tidigare forskning beskriver hur olika livsval påverkar ungdomars aktuella och framtida sexuella hälsa. Idag får ungdomar kunskap om sex både via skolan, ungdomsmottagningen samt via internet. Detta ställer helt nya krav på barnmorskor och lärare som ska bemöta den information ungdomarna har tillgång till och de frågor det väcker. Genom denna studie önskar författarna klargöra vilka frågor ungdomar ställer om sex genom att studera öppna forum på internet. Syfte: Att studera ungdomars frågeställningar om sex på internetforum Metod: En kvalitativ metod med induktiv ansats har använts till studien. Data inhämtades via umo.se under forumet fråga varandra. Totalt analyserades 48 trådar. Datamaterialet har analyserats enligt Graneheim, Lindgren & Lundmans analysmetod. Resultat: Resultatet utmynnade i 5 underkategorier, 2 kategorier samt ett övergripande tema. Känsla av sårbarhet Konklusion: Internet fungerar som en självklar informationskälla för ungdomar och kan komplettera skolans och ungdomsmottagningens sexualundervisning.  Studien visar att obesvarade frågor om sex väcker både negativa och positiva känslor hos ungdomarna. / Background: Previous research describes how different life choices affect young people's current and future sexual health. Today, young people get to know about sex both through school, youth clinics, as well as via the internet. This places entirely new demands on midwives and teachers to respond to the information available to young people and the issues it raises. Through this study, the authors wish to clarify the questions young people ask about sex by studying the open forums on the internet. Objective: To study young people´s issues about sex on internet forums. Method: A qualitative method with inductive approach has been used to the study. Data was collected through umo.se under the forum “Question each other”. A total of 48 threads were analysed. The data have been analysed according to Graneheim, Lindgren & Lundmans analysis method. Results: The results culminated in 5 subcategories, 2 categories as well as an overall theme: Sense of vulnerability. Conclusion: The Internet works as a natural source of information for young people and can supplement the school's sex education and the youth clinics. The study shows that unanswered questions about sex evokes both negative and positive feelings among the young people.

<p>The main purpose of this stydy was to evaluate the Aurora clinic (for women afraid of birth/delivery) in the south of Sweden. Questionnaires were sent to 197 women who had contact with the Aurora clinic during 2007 and 2008. The group of participants contained both pregnant women and women who have given birth. A total of 136 women replied. The results showed that both the average age and the level of education of the women were high. Nulli-paras and multi-paras had different reasons for fearing delivery. The study also showed that most women felt that the contact with an Aurora midwife helped them to feel secure and to be better prepared before delivery, that the midwife understood them and took them seriously and that the content of the meetings was satisfactory. Three out of four women, who initially wished for a caesarean section, subsequently accepted a normal delivery. This study supports previous research that shows the importance of the supportive conversation provided at the Aurora clinic for women with fear of delivery.</p>

<p>The purpose of this study was to look at the experiences of midwives in maternalhealth care encounters with non-european-born women and men, and to determine ifmidwives deem any special competence necessary to handle these encounters well.We gathered information by means of qualitative interviews and semi structuredquestions with eight midwives all of whom matched the inclusion criterias and gavetheir personal consent. Midwives from four district health care centers in Uppsalawere included. The interviews were transcribed and analyzed by means of qualitativecontent analysis.The results reveal the experiences from encounters with non-european patients to betwofold. On one hand the encounter is a positive, exiting experience with anopportunity to learn more about a foreign culture and exchange experiences. On theother hand complications can occur as patients may have unexpected expectationsregarding the health care, have great difficulties with the language or haveexperienced traumatizing incidents, all on top of coming to Sweden alone withoutrelatives.In the encounter with non-european-born patients the midwives consider it importantto have special competence in form of knowledge of other cultures and religions asthis provides a greater understanding of the reasoning behind the patients’ decisions.Cultural competence is also important as it helps avoid inadvertently insulting thepatient during the encounter.The special competence held by the midwives has been attained from their basic andspecialist education as well as from self acquired experiences and interests. A lifelongeducation is required to uphold this competence as well as a dialog betweenmidwives at the health care clinic.</p>