Enligt Statistiska Centralbyrån [SCB] föddes det år 2008 109 301 barn i Sverige. Utöver dessa föddes det cirka 600 barn som dött i livmodern innan förlossning. Intrauterin fosterdöd innebär att barn föds döda efter graviditetsvecka 22. Tidigare forskning belyser vikten av att barnmorskor har ett individuellt synsätt vid mötet med par vid intrauterin fosterdöd. Forskningen åskådliggör även hur föräldrar upplevt det stöd som givits under förlossningen. Det finns dock relativt lite forskning kring hur barnmorskor stödjer vid intrauterin fosterdöd. Syftet med detta arbete var därför att undersöka hur barnmorskor upplever sitt stöd i samband med förlossning vid intrauterin fosterdöd. Metoden som användes var kvalitativ innehållsanalys med en induktiv ansats. Fem barnmorskor intervjuades på två förlossningsavdelningar i Västra Götaland och Örebro län. I analysprocessen framkom tre huvudkategorier;individanpassa, ge tid och vara ett verktyg. Resultatet visar att barnmorskors stöd under förlossning inriktar sig på att låta paren styra informationsflödet och genom närvaro lyssna in behoven. Det var av vikt att ge paren tid i förlossningsarbetet men även tid i mötet med barnet. För att stödja bör barnmorskan känna sig trygg både i sig själv och i sin profession. En trygghet kring sin egen syn på döden var också av betydelse i stödet. / According to the Swedish bureau of Statistics [SCB] there were 109 301 children born in Sweden during 2008, in addition to these there where also approximately 600 stillborn children. Intrauterine fetal death means that the child has died in the womb after the 22nd week of pregnancy. Previous research highlights the importance of the midwives´ individual approach to parents with a stillborn child. Research also illustrates how parents experienced the support given during delivery. However, there is a limited amount of research done on how midwives support the parents of a stillborn child. The aim of this study was there for to investigate how midwives experience there support during delivery of a stillborn child. The method used was qualitative content analysis with an inductive approach. Five midwives were interviewed at two maternity wards in Västra Götaland and Örebro County. The analysis process revealed three main categories; adjust to the individual, to give time and to be a tool. The result shows that midwife´s support during delivery focuses on allowing couples to control the flow of information and by being present judge the parents´ needs. It is important to give the parents time both during delivery and to spend time with the stillborn child. To be able to support, the midwife need to feel confident both personally and professionally. It was also significant what the midwife´s own view on death was.

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.

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.

Pappans närvaro under förlossning har ökat de senaste åren. Vid förlossning förväntas de spela en aktiv roll i form av stöd för kvinnan. Många män är inte beredda på att en normal förlossning hastigt kan behöva slutas med kejsarsnitt. Syftet med studien är att ta reda på och beskriva pappors upplevelser av akut kejsarsnitt. För att få fram pappors upplevelse användes en fenomenologisk forskningsmetod i form av kvalitativa forskningsintervjuer. Fem pappor deltog i studien. Data presenteras i fem kategorier; blivande pappors kunskap och förväntningar kring förlossning, att inte veta vad som händer, närvaro ger delaktighet, att bli lämnad ensam eller inte, med eller utan information samt efter operation. Resultatet visade att blivande pappors förväntningar kring förlossning är att det ska gå normalt till. Deras kunskap om akuta kejsarsnitt är liten och därmed känner de sig oförberedda inför händelsen. Om informationen från barnmorskan var bristande medförde det att pappan kände oro och att han inte var delaktig i processen. De pappor som får information känner sig mer trygga och får en mer positiv upplevelse. En sådan enkel handling som att informera om vad som sker kan ändra en hel syn på en upplevelse. / Fathers attendance during childbirth has increased during the years. They are expected to play an important role in supporting the woman during delivery. Many men are not aware that what seems to be a normal delivery suddenly can end with an emergency caesarean section. The aim of this study was to see/find out how prospective fathers experience the situation of emergency caesarean section. To study fathers experience of caesarean section we used a phenomenological research method. Five fathers participated in the study and data was obtained by qualitative research interviews. The data was analysed and divided into five categories: expectant fathers knowledge and expectations about giving birth, to not know what is happening, presence gives a feeling of participation, to be left alone or not with or without information and after the operation. Results of the study showed that prospective fathers´ birth expectations were that it will be a normal delivery. Their knowledge of emergency caesarean section is small and therefore they feel unprepared with the situation. Not receiving continuous information from the midwife makes the father worried and anxious and gives a negative feeling of the delivery. The fathers who received information during the process had a more positive feeling and a feeling of participation. A simple thing like getting information changes the way a person feels about a situation.

<p>Medicinsk abort innebär avbrytande av graviditet på farmakologisk väg, det kan utföras tilloch med nionde graviditetsveckan. Hemabort innebär att kvinnor slutför en medicinsk abort isitt hem, det har varit tillåtet i Sverige sedan 2004. Tidigare studier visar att kvinnor uppleverhemabort som mer naturligt än abort utförd på sjukhus. Stöd kan ses utifrån fyra dimensioner;informativt, instrumentellt, emotionellt och bekräftade. Syftet med studien var att beskrivakvinnors upplevelse av stöd från barnmorskor i samband med medicinsk hemabort. Metodensom använts är kvalitativ innehållsanalys utifrån en induktiv ansats. Datainsamlingen har skettgenom en enkät med öppna frågor. Sex kvinnor valde att delta i studien. Resultatet indelades isex kategorier och ett tema. Resultatet visar att även fast kvinnorna upplever utsatthet, är denöjda med det stöd de erbjuds. Kvinnorna känner sig väl informerade, delaktiga och trygga;de uppskattar telefonsamtalet från barnmorska under abortdagen samt att de kan nå sjukhusetdygnet runt.</p> / <p>Medical abortion means termination of pregnancy in a pharmacological way, it can beperformed until the ninth week of pregnancy. Abortion at home means that women completea medical abortion in their homes, it has been allowed in Sweden since 2004. Previous studiesillustrate that women experience abortion at home as more natural than abortion performed athospital. Support can be seen from four different dimensions; informational, instrumental,emotional and appraisal. The aim of the study was to describe women’s experiences ofsupport from midwives in connection to induced medical abortion at home. The method usedis qualitative content analysis with an inductive approach. The collecting of data has beenmade through a questionnaire with open questions. Six women chose to participate in thestudy. The result was divided into six categories and one theme. The result shows that eventhough the women feel vulnerable, they are satisfied with the support they are offered. Thewomen feel that they are well informed, involved and safe; they appreciate the call from themidwife during the day of the abortion, also that the hospital can be reached day and night.</p>

<p>Enligt Statistiska Centralbyrån [SCB] föddes det år 2008 109 301 barn i Sverige. Utöver dessa föddes det cirka 600 barn som dött i livmodern innan förlossning. Intrauterin fosterdöd innebär att barn föds döda efter graviditetsvecka 22. Tidigare forskning belyser vikten av att barnmorskor har ett individuellt synsätt vid mötet med par vid intrauterin fosterdöd. Forskningen åskådliggör även hur föräldrar upplevt det stöd som givits under förlossningen. Det finns dock relativt lite forskning kring hur barnmorskor stödjer vid intrauterin fosterdöd. Syftet med detta arbete var därför att undersöka hur barnmorskor upplever sitt stöd i samband med förlossning vid intrauterin fosterdöd. Metoden som användes var kvalitativ innehållsanalys med en induktiv ansats. Fem barnmorskor intervjuades på två förlossningsavdelningar i Västra Götaland och Örebro län. I analysprocessen framkom tre huvudkategorier;<em>individanpassa, ge tid</em> och <em>vara ett verktyg.</em> Resultatet visar att barnmorskors stöd under förlossning inriktar sig på att låta paren styra informationsflödet och genom närvaro lyssna in behoven. Det var av vikt att ge paren tid i förlossningsarbetet men även tid i mötet med barnet. För att stödja bör barnmorskan känna sig trygg både i sig själv och i sin profession. En trygghet kring sin egen syn på döden var också av betydelse i stödet.</p> / <p>According to the Swedish bureau of Statistics [SCB] there were 109 301 children born in Sweden during 2008, in addition to these there where also approximately 600 stillborn children. Intrauterine fetal death means that the child has died in the womb after the 22nd week of pregnancy. Previous research highlights the importance of the midwives´ individual approach to parents with a stillborn child. Research also illustrates how parents experienced the support given during delivery. However, there is a limited amount of research done on how midwives support the parents of a stillborn child. The aim of this study was there for to investigate how midwives experience there support during delivery of a stillborn child. The method used was qualitative content analysis with an inductive approach. Five midwives were interviewed at two maternity wards in Västra Götaland and Örebro County. The analysis process revealed three main categories; <em>adjust to the individual, to give time</em> and <em>to be a tool.</em> The result shows that midwife´s support during delivery focuses on allowing couples to control the flow of information and by being present judge the parents´ needs. It is important to give the parents time both during delivery and to spend time with the stillborn child. To be able to support, the midwife need to feel confident both personally and professionally. It was also significant what the midwife´s own view on death was.</p>

<p>Pappans närvaro under förlossning har ökat de senaste åren. Vid förlossning förväntas de spela en aktiv roll i form av stöd för kvinnan. Många män är inte beredda på att en normal förlossning hastigt kan behöva slutas med kejsarsnitt. Syftet med studien är att ta reda på och beskriva pappors upplevelser av akut kejsarsnitt. För att få fram pappors upplevelse användes en fenomenologisk forskningsmetod i form av kvalitativa forskningsintervjuer. Fem pappor deltog i studien. Data presenteras i fem kategorier; blivande pappors kunskap och förväntningar kring förlossning, att inte veta vad som händer, närvaro ger delaktighet, att bli lämnad ensam eller inte, med eller utan information samt efter operation. Resultatet visade att blivande pappors förväntningar kring förlossning är att det ska gå normalt till. Deras kunskap om akuta kejsarsnitt är liten och därmed känner de sig oförberedda inför händelsen. Om informationen från barnmorskan var bristande medförde det att pappan kände oro och att han inte var delaktig i processen. De pappor som får information känner sig mer trygga och får en mer positiv upplevelse. En sådan enkel handling som att informera om vad som sker kan ändra en hel syn på en upplevelse.</p> / <p>Fathers attendance during childbirth has increased during the years. They are expected to play an important role in supporting the woman during delivery. Many men are not aware that what seems to be a normal delivery suddenly can end with an emergency caesarean section. The aim of this study was to see/find out how prospective fathers experience the situation of emergency caesarean section. To study fathers experience of caesarean section we used a phenomenological research method. Five fathers participated in the study and data was obtained by qualitative research interviews. The data was analysed and divided into five categories: expectant fathers knowledge and expectations about giving birth, to not know what is happening, presence gives a feeling of participation, to be left alone or not with or without information and after the operation. Results of the study showed that prospective fathers´ birth expectations were that it will be a normal delivery. Their knowledge of emergency caesarean section is small and therefore they feel unprepared with the situation. Not receiving continuous information from the midwife makes the father worried and anxious and gives a negative feeling of the delivery. The fathers who received information during the process had a more positive feeling and a feeling of participation. A simple thing like getting information changes the way a person feels about a situation.</p>

SAMMANFATTNING Amningsfrekvensen i Sverige är lägre än vad som rekommenderas enligt Livsmedelverket och WHO. Sett ur ett folkhälsoperspektiv skulle mödrars och barns hälsa kunna förbättras om fler kvinnor ammade sina spädbarn mer exklusivt och under längre tid, varför bra metoder för amningsförberedelse bland blivande spädbarnsfamiljer behövs. Det amningsförberedande arbetet bör initieras av mödravårdsbarnmorskan redan under graviditeten.   Syfte: Att utforma en standardiserad mall för utförandet av amningsförberedande samtal under graviditet.   Metod: En kvalitativ pilotstudie genomförd med litteraturgranskning och fokusgruppintervju med barnmorskor, analyserade med innehållsanalys.   Resultat: Utifrån identifierade faktorer med visad positiv påverkan på amningsfrekvens samt barnmorskors kliniska erfarenhet utformades en standardiserad mall för amningsförberedande samtal. Mallen innehåller en individanpassad och en generell del. Den individanpassade delen behandlar tidigare amningserfarenheter, förväntningar inför kommande amning samt tankar kring brösten och deras funktion. Den generella delen behandlar information om bröst och bröstmjölk, amningsinformation, övriga tankar/frågor, EDS-screening samt fortsatt planering gällande amning.   Slutsats: Resultaten från litteraturgranskningen och fokusgruppsintervjustudien, med förslag på vad amningsförberedelse kan innehålla, överensstämmer till stor del. Barnmorskorna i fokusgruppsintervjustudien ger dock mer utförliga beskrivningar än de faktorer som sammanställts i litteraturgranskningen. Tillsammans har det gett en grund för utarbetandet av en standardiserad mall för amningsförberedande samtal. Fortsatt forskning får visa om samtalsmallen kan ge positiv effekt på amningsfrekvensen. Mallens användbarhet bör också vidare utvärderas. / ABSTRACT The breastfeeding frequency in Sweden is lower than the recommendation by the Swedish National Food Agency and WHO. From a public health perspective mothers´ and their children´s health would be improved if more women breastfed their infants more exclusively and during a longer period. Therefore good methods for breastfeeding preparation among parents to be is needed. The breastfeeding preparation should be initiated by the midwife at the maternity health care already during the women’s pregnancy.   Aim: To design a standardised guide for performing an anamnesis and care plan for breastfeeding during pregnancy.   Method: A qualitative pilot project based on literature review and focus group interviews with midwives, analysed by content analysis.   Results: A standardised guide for performing an anamnesis and care plan for breastfeeding were designed based on identified factors with proved positive impact on breastfeeding frequency and midwives´ clinical experiences in the interviews. The guide includes an individualised and a general part. The individualised part deals with previous breastfeeding experience, expectations for the coming breastfeeding and thoughts about breasts and their function. The general part deals with information about breasts and breast milk, information about breastfeeding, other thoughts/questions, EDS-screening and continued planning regarding breastfeeding.   Conclusion: The results of the literature review and the focus group interviews with suggestions on what breastfeeding preparation can include correspond to a large extent. Though the midwives in the focus group interviews gives more detailed and wide-ranging descriptions than the factors presented in the literature review. Altogether this has given a base for designing a standardised guide. Coming research will show if the guide can have positive impact on breastfeeding frequency. The usability of the guide should also be further evaluated.

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

Medicinsk abort innebär avbrytande av graviditet på farmakologisk väg, det kan utföras tilloch med nionde graviditetsveckan. Hemabort innebär att kvinnor slutför en medicinsk abort isitt hem, det har varit tillåtet i Sverige sedan 2004. Tidigare studier visar att kvinnor uppleverhemabort som mer naturligt än abort utförd på sjukhus. Stöd kan ses utifrån fyra dimensioner;informativt, instrumentellt, emotionellt och bekräftade. Syftet med studien var att beskrivakvinnors upplevelse av stöd från barnmorskor i samband med medicinsk hemabort. Metodensom använts är kvalitativ innehållsanalys utifrån en induktiv ansats. Datainsamlingen har skettgenom en enkät med öppna frågor. Sex kvinnor valde att delta i studien. Resultatet indelades isex kategorier och ett tema. Resultatet visar att även fast kvinnorna upplever utsatthet, är denöjda med det stöd de erbjuds. Kvinnorna känner sig väl informerade, delaktiga och trygga;de uppskattar telefonsamtalet från barnmorska under abortdagen samt att de kan nå sjukhusetdygnet runt. / Medical abortion means termination of pregnancy in a pharmacological way, it can beperformed until the ninth week of pregnancy. Abortion at home means that women completea medical abortion in their homes, it has been allowed in Sweden since 2004. Previous studiesillustrate that women experience abortion at home as more natural than abortion performed athospital. Support can be seen from four different dimensions; informational, instrumental,emotional and appraisal. The aim of the study was to describe women’s experiences ofsupport from midwives in connection to induced medical abortion at home. The method usedis qualitative content analysis with an inductive approach. The collecting of data has beenmade through a questionnaire with open questions. Six women chose to participate in thestudy. The result was divided into six categories and one theme. The result shows that eventhough the women feel vulnerable, they are satisfied with the support they are offered. Thewomen feel that they are well informed, involved and safe; they appreciate the call from themidwife during the day of the abortion, also that the hospital can be reached day and night.