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: Våld i nära relationer är ett allvarligt hot mot kvinnors säkerhet, välbefinnande och hälsa. Kvinnor i hela världen blir utsatta för olika former av våld och gravida kvinnor är inte ett undantag. Våldet kan snarare öka under graviditet för de kvinnor som sedan tidigare varit utsatta för våld med risk för både den gravidas och det ofödda barnets hälsa. Barnmorskor ges en unik möjlighet att ge god vård och stöd till dessa våldsutsatta kvinnor. Syfte : Att beskriva innehållet i mötet mellan barnmorskor och gravida kvinnor med fokus på gravida kvinnors utsatthet för våld i nära relationer och barnmorskans roll i omvårdnaden av dessa kvinnor. Metod: Metasyntes som metod användes vilken inkluderade både kvalitativa studier o kvantitativa studier med kvalitativa delar i resultatet. Artiklar söktes via databaserna PubMed. CINAHL, PsycInfo och Web of Science och dessa analyserades genom meta-ethnografi. Resultat: Studien visade att tid, kunskap och förtroende var viktiga faktorer som kunde leda till att kvinnor berättade för barnmorskor om deras utsatthet för våld under graviditet. Kvinnorna och barnmorskorna hade till största delen samma mönster som de tog upp som både hinder och hjälp till att våld avslöjades under graviditeten. Slutsats: Mönstret stämde väl överens mellan kvinnors uppfattningar och barnmorskors uppfattningar angående den problematik som ses då det gäller våld under graviditet. Förtroende för barnmorskan gällande bemötande och kunskap ansågs vara det viktigaste för att kvinnor skulle känna trygghet i att till barnmorskan avslöja övergrepp under graviditet. Kliniska implikationer: Grundligare utbildning om våld redan under utbildningen till barnmorska skulle kunna vara ett sätt att ge barnmorskor en bättre förutsättning i sin nya roll. För att underhålla och utveckla kunskap om våld bör därför kontinuerlig fortbildning ske för legitimerade barnmorskor och detta ger i sin tur bättre förutsättningar för barnmorskor att möta våldsutsatta gravida kvinnor. / Background: Intimate partner violence is a serious threat against women's security, well-being and health. Women all over the world are subject to different kinds of violence and pregnant women are no exception. The violence can increase during pregnancy among the women that earlier has endured violence, with a risk for both the women’s and unborn baby's health. Midwives have a unique opportunity to care for and support these abused women. Purpose: To describe pregnant women’s encounter with the midwife with focus on exposure to partner violence and the role of the midwife. Method: A meta-synthesis which included both qualitative literature studies and quantitative studies with qualitative elements were used in the result. Articles were searched through databases as PubMed, CINAHL, PsycInfo and Web of Science and these were analysed through meta-ethnography. Results: The study showed that time, knowledge and confidence were important factors that could cause women in revealing to midwives about violence during pregnancy. Both women and midwives had to the most part the same patterns that they spoke about as both obstacles and help for disclosure of violence in care for women in pregnancy. Conclusion: The pattern matched well between women’s and midwive’s perceptions of the problems seen in violence during pregnancy. Trusting the midwife’s encounter and knowledge, were seen as the most important issues for women to feel safe in revealing violence during pregnancy. Clinical implications : Basic education about violence that is already under the supervision of midwives can be a way to give midwives a better prerequisite for their new role. In order to maintain and develop knowledge of violence, continuing education should be continued for legitimate midwives, which in turn provides better conditions for midwives to meet women who are pregnant with violence.

Abstract   Objective To study midwives' experiences of working with normal birth in multidisciplinary teams.
 Methods This was a qualitative study based on Semi-structured interviews in focusgroups with 20 midwives at four maternity wards in mid-Sweden. Results The interviews revealed a theme as The midwifery profession is both strong and torned at normal birth in hospital. The results describe that midwives are working independently and are responsible for the normal birth in multidisciplinary team. Hierarchies and relationships influence the independence of the midwives in their work with normal birth. The midwives were also using tools as risk evaluation and medical rounds to identify normal birth. There are no independent guidelines designed by midwives for the normal birth in maternity care. Heavy workload affects the midwives’ ability to work evidence-based and resulted in changes of practices in normal birth. Conclusion The midwives consider they sometimes share involuntary the responsibility in normal birth. A good cooperation and communication is important within a multidisciplinary team for the midwives to support normal birth. Keywords: collaboration, midwives, normal birth, professional responsibility / Sammanfattning                   Bakgrund Att arbeta som barnmorska i Sverige innebär att ansvara för kvinnans vård vid den normala förlossningen. När denna avviker vidtas adekvata åtgärder samt en bedömning av när samverkan krävs med andra professioner. Barnmorskans arbete och ansvar har förändrats över tid och tvärprofessionellt samarbete har växt fram som en rådande arbetsmodell inom förlossningsvården. Syfte: Att studera barnmorskors upplevelser av att handlägga normala förlossningar i tvärprofessionella arbetsgrupper. Metod: Semistrukturerade fokusgruppsintervjuer med 20 barnmorskor vid fyra olika förlossningsavdelningar i Mellansverige. Resultat: Ur fokusgruppsintervjuerna framkommer temat Barnmorskeprofessionen är både stark och söndrad vid normala sjukhusförlossningar. Resultatet visar att barnmorskorna är oftast självständigt ansvariga för den normala förlossningen i en tvärprofessionell arbetsgrupp. Hierarkier och relationer påverkar barnmorskornas självständighet vid handläggningen av den normala förlossningen. Barnmorskorna använder förutom sin professionella kunskap olika verktyg som riskevaluering och rond för att identifiera normala förlossningar. Det saknas självständigt utformade riktlinjer av barnmorskor för normal förlossning inom förlossningsvården. Hög arbetsbelastning påverkar barnmorskans möjligheter att arbeta från ett evidensbaserat perspektiv vilket resulterar i ett förändrat arbetssätt vid normal förlossning. Slutsats: Barnmorskor anser att de ibland har ett ofrivilligt delat ansvar vid normal förlossning. Ett gott samarbete och kommunikation har betydelse inom ett tvärprofessionellt team för att barnmorskan kan stödja kvinnans normala födande.   Nyckelord: barnmorskor normal förlossning, professionellt ansvar, samarbete

Violence against women is a global public health problem as well as a violation against human rights. This descriptive cross-sectional quantitative study was conducted to investigate experience of violence among women who receive midwifery care for childbirth fear. Data were retrieved from 633 patient records. In addition, all obstetric clinics offering care for fear of childbirth in Sweden were asked via e-mail about routines with regard to violence. Response rate was 56 percent. The results showed that only 50 percent of pregnant women had been asked about violence as part of the medical history, despite the national recommendation that all pregnant women should be asked about the subject. Among women who received midwife-led counseling for childbirth fear, 34 percent had reported some form of violence during their lifetime. All obstetric clinics follow the recommendations of The National Board of Health and Welfare regarding the appropriate skills within the team, although supplementary courses taken by the midwives at the clinics do differ. Midwives can play a crucial role for the survival and well-being of women faced with domestic violence. Midwives should keep in mind that there may be earlier or ongoing violence that contributes to the woman´s fear of childbirth. / Våld mot kvinnor är ett globalt folkhälsoproblem samt ett brott mot mänskliga rättigheter. Denna deskriptiva tvärsnittsstudie med kvantitativ ansats genomfördes för att undersöka våldsutsatthet bland kvinnor som fått barnmorskeledd behandling av förlossningsrädsla. Data från 633 journaler inhämtades. Samtliga obstetriska kliniker i Sverige som erbjuder behandling av förlossningsrädsla tillfrågades via e-post om rutiner kring våldsutsatthet. Svarsfrekvensen var 56 procent. Resultatet visade att endast 50 procent av gravida kvinnor hade tillfrågats om våld som en del av anamnesen, trots rekommendationen att alla gravida kvinnor ska tillfrågas. Av kvinnor som fått barnmorskeledd behandling av förlossningsrädsla, hade 34 procent rapporterat att de erfarit någon form av våld under sin livstid. Samtliga obstetriska kliniker som ingick i studien följer Socialstyrelsens rekommendationer om lämplig kompetens i teamen, även om det finns stor variation gällande barnmorskornas påbyggnadsutbildningar. Barnmorskor kan spela en avgörande roll för våldsutsatta kvinnors överlevnad och hälsa. Barnmorskor bör ha i åtanke att det kan finnas tidigare eller pågående våldsproblematik som bidrar till kvinnans förlossningsrädsla.

Magister Curationis - MCur / The Objective Structured Clinical Examination (OSCE) is a formative and summative assessment method used in several health science disciplines. The primary focus of this research study was to explore and describe the experiences of student midwives of the OSCE as used in a specific university context and determine how effective it is in preparing student midwives for clinical practice. However the researcher acknowledges the value of the OSCA (Objective Structured Clinical Assessment), which was not used in the context where the study was conducted. Due to the scarcity of academic literature in South Africa and internationally regarding the experiences of student midwives of OSCE assessments, this research study attempted to increase evidence of students’ experiences for improving the OSCE as an assessment method at a school of nursing used in this study. Research purpose: The purpose of the study was to explore and describe student midwives’ experiences of the Objective Structured Clinical Examination, at the SoN, at a university in the Western Cape, and ascertain whether it prepared them adequately for clinical practice. Research design: A qualitative approach with an exploratory descriptive design was used for the investigation of the student midwives' experiences of this assessment method. Sample: Purposive sampling was utilised to select third year Bachelor of Nursing students, who completed the OSCE during semester one in 2014, at a University in the Western Cape. Nine participants were interviewed. Data collection: The data collection was obtained through semi-structured interviews. Data analysis: The data analysis was done manually using the Thomas (2003) data analysis process. Saturation was reached after nine interviews, when no new relevant knowledge was being acquired. Findings: OSCE preparation was supported by theory and clinical learning opportunities. The OSCE environment was found to be challenging and stressful. Alignment of OSCE stations to clinical skills, theory, clinical practice and appropriateness of time allocation. Students had differing views about their level of confidence and competence. Recommendations: Although the OSCE is a valued instrument in the summative assessment of midwifery students, attention must be given to the careful planning of the OSCE environment and the use of simulation techniques. Adequate support for students is essential, and adherence to a standard method of facilitation in clinical learning, in the skills laboratory, is crucial to fairness in learning and assessment. The direct input from valuable stakeholders in clinical training, such as educators and clinical supervisors, must be considered in order to identify ways to improve the OSCE.

Bakgrund: Fosterrörelserna ses som ett friskhetstecken. Fostrets rörelser ändrar karaktär under graviditeten, men det är en myt att de ofta blir svagare i slutet av graviditeten. Minskade fosterrörelser är ett viktigt kliniskt tecken som kan föregå intrauterin fosterdöd (IUFD). Kvinnan tar telefonkontakt när hon är orolig då hon upplever ett ändrat rörelsemönster. Socialstyrelsens nya riktlinjer finns till för korrekt handläggning, undersökning utan fördröjning kan förebygga livshotande tillstånd hos fostret. Syftet var att beskriva barnmorskors erfarenheter av telefonrådgivning till gravida som kontaktar förlossningsavdelningen gällande minskade fosterrörelser.Design: Studien har utgått ifrån en kvalitativ design med deskriptiv ansats. Datainsamlingen utfördes med semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys.Deltagare och omgivning: Tio barnmorskor som arbetade vid en förlossningsavdelning i norra Sverige.Resultat: I studien framkom två huvudkategorier, försöka bemöta oron samt komma till ett beslut och sju kategorier. Barnmorskorna är medvetna om vilka riskfaktorer som föreligger för minskade fosterrörelser och IUFD samt kring andra faktorer som kan ha betydelse för fosterrörelserna. Barnmorskorna ger “handgripliga” råd till kvinnan innan hon återkommer och i vissa fall erbjuds undersökning direkt. Telefonrådgivning förekommer dagligen och barnmorskorna belyser vikten av att vara lyhörd och ta kvinnans oro på allvar. Det ses som svårt att bedöma fostrets välmående över telefonen. Kommunikationen och erfarenhetsutbyte mellan kollegor anses värdefullt, men det upplevs även som en svårighet att ta del av nya riktlinjer på kliniken. Slutsats: Telefonrådgivningen är en komplex uppgift där en korrekt handläggning som grundar sig på evidens är avgörande för fostrets överlevnad. Riktlinjer och PM måste utformas för att barnmorskorna ska kunna handlägga minskade fosterrörelser på likartat sätt. Kliniska implikationer: Gravida kvinnor bör få information om fosterrörelser på mödravården för att öka medvetenheten. Ett nationellt utformat PM för rådgivning vid minskade fosterrörelser bör upprättas för kvinnors lika vård på lika villkor. Ökad medvetenhet hos vårdgivare om att undvika avvaktande råd då dessa saknar evidens. Nyckelord: Barnmorska, minskade fosterrörelser, IUFD, telefonrådgivning, rådgivning

Magister Curationis - MCur / The objectives of this study were to determine midwives’ knowledge in performing foetal heart rate monitoring, to assess midwives’ abilities in the interpretation of foetal heart rate patterns according to their years of clinical experience as a registered midwife.

Magister Curationis - MCur / The present study examined the extent of utilization of partogram among nurses and midwives in Rwamagana health facilities located in the eastern province of Rwanda. The study specifically sought to; assess knowledge and use of partogram among nurses and midwives in Rwamagana health facilities, to identify the challenges facing nurses and midwives with regards to the utilization of partogram in the health facilities and to determine factors influencing the use of partogram among nurses and midwives in Rwamagana health facilities. Patricia Benner’s model of nursing practice was used to guide this study

À l'heure actuelle, les résultats périnataux en France demeurent parmi les moins satisfaisants en Europe malgré une très forte médicalisation. Les autorités de santé affirment reconnaître l'influence de la prise en charge et de l'accompagnement pendant la grossesse, l'accouchement et la période néonatale sur l'état de santé de la mère et de l'enfant mais l'offre de soins peine à s'élargir. Contrairement à ce que prévoient les lois concernant le libre choix du praticien en France, les parturientes ne sont pas à même de choisir le professionnel de santé qui les accompagnera lors de leur accouchement. De même, les sages-femmes, contrairement à ce qu'impose leur code de déontologie, ne sont pas en mesure de garantir à leurs patientes ni les conditions, ni le lieu de leur accouchement. De surcroît, peu d'entre elles exercent leur profession de façon autonome tout en pratiquant le plein exercice de leur fonction. En centrant cette recherche anthropologique sur l'expérience des femmes et des sages-femmes dans leurs relations autour de la naissance et de l'accouchement, l'objectif de cette étude qualitative est de faire la lumière sur les tenants et les aboutissants de l'uniformisation de l'offre de soins. Dans un premier temps sont abordés les différents types d'accompagnement proposés aux femmes aujourd'hui ainsi que la place qu'y occupent les sages-femmes. Dans un second temps, l'étude de l'accompagnement global permet l'examen de la prise en charge des patientes et de ses liens de causalité avec les relations interprofessionnelles. Ainsi sont révélés les impacts de cette pratique sur le soutien à la parentalité et la nécessité d'une diversification de l'offre de soins. / Currently, the perinatal results in France remain among the least satisfactory in Europe in spite of a very strong medicalization. However, health authorities acknowledge the influence of maternity care during pregnancy, childbirth and neonatal period on the state of health of the mother and the child but health services hardly increase. Contrary to what French law says on free choice of practitioner, parturient women cannot choose the health professional who will assist them during labor. Likewise, midwives cannot guarantee their patients the place and conditions of childbirth, contrary to their code of ethics. In addition, few of them have the opportunity to work in an independent way and at the same time fully practice their profession. By focusing this anthropological research on women's and midwives' experience in their relationships around childbirth, the aims of this qualitative study are to clarify the ins and outs of the standardization of health services. Initially, the various types of care provided to women today and the place granted to midwives are discussed. Secondly, possible causal links between interprofessional relations and maternity care are searched for through the study of comprehensive care. So are revealed the impacts of a close and trusting relationship in supporting parenthood and of a diversification of health services.

Bakgrund: Att föda barn är en unik händelse och upplevelsen kan följa kvinnan genom hela livet. En negativ förlossningsupplevelse kan leda till psykisk ohälsa och förlossningsrädsla. Barnmorskor har en viktig roll i att ge professionellt stöd vid bearbetning av en negativ förlossningsupplevelse. Syfte: Att belysa omföderskors upplevelse av professionellt stöd i relation till tidigare negativ förlossningsupplevelse som resulterat i sekundär förlossningsrädsla. Metod: Kvalitativ innehållsanalys med induktiv ansats användes. Semistrukturerade intervjuer med sju omföderskor med sekundär förlossningsrädsla utfördes. Resultat: Kvinnorna beskrev vikten av att bli sedd och att barnmorskan tog deras rädsla på allvar. Att inte få gehör försvårade möjligheten till bearbetning av förlossningsupplevelsen och det upplevdes negativt att inte följas av samma barnmorska genom vårdkedjan. Att få stöd i rätt tid uttrycktes vara en viktig faktor för bearbetningen. Konklusion: Att som barnmorska visa intresse och se varje kvinnas unika behov av stöd främjar möjligheten till bearbetning. När i tiden stöd ges har stor betydelse och för att kunna ge mer individanpassad eftervård som utgår från varje enskild kvinnas behov av bearbetning, är det viktigt att barnmorskor är lyhörda. Kontinuitet i vårdkedjan bidrar till en trygg relation mellan kvinnan och barnmorskan och främjar en positiv förlossningsupplevelse. / Background: To give birth is an unique life event and the experience follow women throughout life. A negative birth experience can lead to mental illness and fear of childbirth. Midwives have an important role in providing professional support in processing a negative birth experience. Aim: To illuminate multiparas' experiences of professional support in relation to previous negative birth experience which has resulted in secondary fear of childbirth. Method: Qualitative content analysis with inductive approach was used. Seven semi-structured interviews were performed with multiparas having secondary fear of childbirth.   Result: The women described the importance of being seen and that the midwives took their fear seriously. Not being heard and lack of continuity reduced their capability to process their negative birth experience. Getting support at the right time was an important factor for processing. Conclusion: To promote women's capability to process their negative birth experience midwives need to show an interest in every woman's unique need of support. Timing of support is important and in order to provide more personalized postpartum care midwives needs to be responsive to women's needs. Continuity of care contributes to a good relationship between the woman and the midwife and promotes a positive birth experience.