This study aimed to explore the lived experience of the working lives of midwives in the UK who practice independently of the NHS. It was designed to understand their motivations for working in this way and to explore their beliefs and values about midwifery care with particular emphasis on their perceptions of building and maintaining relationships with childbearing women. Hermeneutic phenomenology informed the methodology for the study and an adapted biographical narrative interpretive method (Wengraf 2001) was used for data collection. In depth qualitative interviews were carried out with twenty Independent midwives in the UK between 2007 & 2009. Data were analysed using Ricoeur's theory of interpretation (Ricoeur 1981). Keys findings indicate that motivated by a very strong sense of what it means to be 'with woman'; these midwives initially chose a career path in the NHS that enabled them to better enact this philosophy. However, constraints on their ability to enact this philosophy in the NHS combined with a desire to form more meaningful relationships with childbearing women and to support their individual needs informed a final move from the NHS into independent practice. Independent midwifery is experienced as very positive career move which results in considerable job satisfaction and an opportunity to use the full range of midwifery skills. Formation of the mother midwife relationship is perceived as a pivotal midwifery tool which facilitates understanding of individual childbearing women and their needs. Ricoeur's theory of interpretation (1981) is utilized to explain how Independent midwives form relationships with their clients in this context. The concepts of 'time', 'autonomy' and 'risk' are discussed in the light of study findings, contributing a unique insight into the working lives of Independent midwives, the mother midwife relationship and enactment of the 'with woman' philosophy in this context. The study also demonstrates that whilst there are many positive aspects of working as an Independent midwife there are also several constraints and potential vulnerabilities. These include the blurring of work/life boundaries, financial insecurity and the consequences of working with clients who often have very complex needs and particular expectations of the midwife-client relationship. Supporting women's choices, working flexibly to meet the needs of clients and respecting their right to autonomous decision making can place Independent midwives in a position of potential vulnerability and leave them subject to professional criticism.

Diabetes är en kronisk sjukdom och en av de vanligaste icke smittsamma sjukdomarna i världen. I samband med att sjukdomen blir vanligare, blir också barnmorskans möten med kvinnor som lider av sjukdomen fler och god kompetens inom området är nödvändig. Att leva med diabetes innebär en stor omställning framför allt vid sjukdomsdebuten och vid förändringar som präglas av ändrade levnadsvanor och ökat ansvarstagande. För att kunna minska graviditets komplikationer, bör den gravida kvinnan sträva efter att hålla sina blodsocker inom normal nivå (Diabetesportalen). Gravida kvinnor med typ 1- diabetes från Uppsala län skrivs tidigt över till specialmöd-ravårdsmottagningen på Akademiska sjukhuset i Uppsala. Dessa kvinnor genomgår samtliga av sina graviditetskontroller på specialmödravårdsmottagninen. Mottagningen erbjuder samlad expertis i form av barnmorskor, diabetessköterskor, specialistläkare inom diabetes samt obstetriker som tillsammans utformar en behandlingsplan där hänsyn tas till kvinnans sjukdom och graviditetens utveckling. Syftet med studien var att kartlägga vården i samband med graviditet och barnafödande för kvinnor med diabetes. Metod: En journalgranskning utfördes av vården vid Specialistmödravårds mottagning i Uppsala under år 2014 efter ett utarbetat protokoll. Resultat: De 27 kvinnorna med diabetes typ 1 och typ 2 hade en ökad risk för komplikationer under graviditet och barnafödande. De komplikationerna som beskrevs i journalerna var spontan abort, missbildningar, intrauterin fosterdöd och skulderdystoci. Av de 20 kvinnorna som fullbordade sin graviditet, födde fem kvinnor vaginalt och övriga 15 kvinnor födde med sectio och akut sectio. I de granskade journalerna observerades en fördröjd amningsstart och en kortare amningsduration.  Av de 20 kvinnorna som födde barn hade två kvinnor inte initierat amningen alls, sju ammade delvis och resten initierade amningen först efter två dagar.  Vid efterkontrollen hade 55 % av kvinnorna etablerat exklusiv amning, medan 20 % ammade fortfarande delvis och 25 % av kvinnorna hade slutat amma. Slutsats: Journalgranskningen pekar på att det finns förbättringsområden inom vården av gravida och födande kvinnor med diabetes. Förslag på rutiner som kan utvecklas är amningsförberedelse, hud mot hud vård och ökat stöd vid amningsstarten för de kvinnor som önskar amma. Barnmorskan har en viktig roll att minska oro, ha förståelse för kvinnans situation för att kunna ge en individuellt anpassad vård.

Inom barnmorskans arbetsområden vårdas gravida och barnafödande kvinnor med utvecklingsstörning. Syfte: att undersöka svenska barnmorskors uppfattningar om vården under graviditet och förlossning för kvinnor med utvecklingsstörning. Metod: Kvalitativ innehållsanalys av svar från öppna frågor. Frågeenkäten sändes till 600 slumpmässigt utvalda barnmorskor inom mödravården (n=300) och förlossningsvården (n=300). Total svarsfrekvens var 62,5 %. Huvudresultat: Analysarbetet ledde fram till tio kategorier. Tre kategorier dominerade i form av antal svar, dessa var kommunikation, information och planering. Kommunikation och information var dominerande för både barnmorskemottagning och förlossning. Vilket tyder på att barnmorskor anser att dessa är viktiga redskap i vården av kvinnor med utvecklingsstörning. På barnmorskemottagning ansåg barnmorskorna dessutom att planering av vården var viktig och förlossningsbarnmorskorna ansåg att en stor vikt bör läggas vid bemötande samt att kontrollera och följa upp olika händelser under förlossning. Slutsats: Planering, kommunikation, information och bemötande är det som barnmorskor anser som viktigast i vården av kvinnor med utvecklingsstörning.

This thesis is based on follow-up research from a project undertaken by my supervisor, Cecilia Benoit and colleagues (2007) entitled Social Determinants of Postpartum Depression: A Mixed-Methods Longitudinal Study (henceforth referred to as the “postpartum and health project study” -- PPHS). The PPHS examined the prevalence of postpartum depression amongst a diverse sample of mothers in Victoria, British Columbia. The main findings illustrate that the greater a woman’s satisfaction with maternity care, the lesser her likelihood of postpartum depression. The group of participants with the least satisfaction was those who were transferred from midwifery care to obstetrical care. This group also had a lower mean income than other care provider groups, such as those who retained their midwives, pointing to the connection between socio-economic status and quality of care. In search of dignified maternity care for all women, that is care that is respectful and autonomous, my research foregrounds the narratives of women who were transferred from a midwife to an obstetrician during their labour or birth (n=11). I examine the formal and informal support they receive, and interactions between health care practitioners and reasons for satisfaction or dissatisfaction with care. I also compare the experiences of women who were transferred from a midwife to an obstetrician with those who retained their midwife in the PPHS. My findings indicate that both sample groups’ satisfaction of care and well-being was due to feeling they had autonomy over the birthing process, adequate information from health care providers about medical and technological procedures, and support. The participants’ who were transferred, however, were less likely than the group who retained their midwife to experience the above elements of care. Participants who were transferred said they felt invaded by unnecessary procedures and technology, which contributed to a decreased level of autonomy. However, both sub-samples were affected by a lack of multi-disciplinary teamwork in the hospital setting. This had more of a negative impact on participants who were transferred from a midwife to an obstetrician.

Bakgrund: Flera studier visar att sjuksköterskor inte tillgodoser patientgruppers behov av att tala om sexualitet och sexuell hälsa. Barnmorskors samtal om sexualitet är ett nästan helt outforskat område. Syfte: Syftet är att undersöka barnmorskors syn på och erfarenhet av samtal om sexualitet på barnmorskemottagningen. Metod: Semistrukturerade intervjuer utfördes med nio barnmorskor på sju olika mottagningar i Skåne. Intervjuerna analyserades med en kvalitativ innehållsanalys genom identifiering av kodord, kategorier och teman. Resultat och analys: Skriptteorin har använts för att analysera och förstå hur barnmorskorna agerar och samtalar i relation till sexualitet. Analysen utmynnade i ett övergripande tema: Sexualitet är betydelsefullt men lätt att tappa bort. Barnmorskorna ser sexualitet som ett angeläget ämne men svårt att adressera i möten. Svårigheter att kommunicera sexualitet beror på tids- och kunskapsbrist samt brist på uppmuntran från ledningen och/eller avsaknad av samtalsverktyg samt ytterligare osäkerhet då patienten avviker från heteronormen eller har en annan kulturell bakgrund. Konklusion: Utbildning i sexologi efterfrågas av barnmorskorna för att kommunicera sexualitet och kunna ge den holistiska vård patienter har rätt till oavsett sexuell orientering eller kulturell bakgrund. Men resultatet antyder att tydliga förväntningar och riktlinjer kring att och hur samtal tas upp är viktigare än fördjupad kunskap. Så länge det finns ett kulturellt och interpersonellt skript på arbetsplatsen i vilket sexualitet inte förväntas adresseras kommer inte utbildning förändra förhållningssättet. Stöd från ledningen och/eller organisationen och möjligheter till handledning/reflektion som rör sexuella frågor kan stötta och uppmuntra barnmorskor att initiera frågor om sexualitet och förändra skripten. Vidare studier behöver göras för att till fullo förstå vilka mekanismer som ligger bakom svårigheten att adressera sexualitet på barnmorskemottagningen. / Background: Several studies show that nurses don’t meet the need from groups of patients to talk about sexuality and sexual health. There are almost no studies on midwives’ view on sexuality counselling. Aim: The aim of this study is to explore midwives’ views and experiences on sexuality counselling at the antenatal care. Method: Semi-structured interviews were conducted with nine midwives’ at seven different antenatal care centers in Skåne. The interviews were then analyzed with a qualitative content analysis through identification of codes, categories and themes. Results and analysis: The study utilizes scripting theory to analyze and understand how midwives act and counsel patients in relation to sexuality. One main theme emerged: Sexuality is important but easy to lose. The midwives’ consider sexuality as important but sometimes hard to address. The reasons for this is said to be lack of time, lack of knowledge, lack of encouragement from the managerial level and/or lack of counseling tools, and, added to that, even more uncertainty when the patient deviates from the heterosexual norm or has another cultural background. Conclusion: Midwives’ ask for education to communicate around sexuality and to be able to provide the holistic care that the patients are entitled to. The result, however, suggest that clear expectations and guidelines about when and how to address sexuality is more important than deepened knowledge. As long as there is cultural and interpersonal scripts in the workplace in which sexuality is not expected to be addressed, additional education won’t help to change addressing patients’ sexuality. Organizational and managerial support along with opportunities for reflection concerning dialogue regarding sexual issues might evoke the interest and intent of midwives’ to approach sexuality and change the cultural and interpersonal scripts. Further studies are needed to understand fully what mechanisms underline the barriers that prevent midwives’ from addressing patients’ sexuality.

Yes / The aim of this paper is to describe the conceptualisation and development of an inclusive educational model. The model is designed to facilitate pre-registration midwifery students' learning around the health and social care needs of pregnant women seeking asylum in the United Kingdom. current literature has identified a concern about the standard of maternity care experienced by asylum seeking women accessing maternity services in the United Kingdom. In response to this, a doctorate study was undertaken which focused on examining the way in which a group of midwifery students approached the provision of care for asylum seekers. This study revealed difficulties that these students had both in identifying these women's needs and also in the wider care issues in practice. Consequently, one of the recommendations was to ameliorate these difficulties through midwifery education. Methods the key findings from this study were used together with relevant supporting literature to construct “the pregnant woman within the global context” model for midwifery education. Results The model is designed to facilitate a holistic assessment of need rather than focusing on the physical assessment at the expense of other aspects of care. It incorporates wider factors, on a global level, which could impact on the health and social care needs of a pregnant woman seeking asylum. It also prompts students to consider the influence of dominant discourses on perceptions of asylum seek;ing and is designed to encourage students' to question these discourses. Recommendations this model can be used in midwifery education to prepare students in caring for pregnant women seeking asylum. It may be especially helpful when students have close contact with pregnant women seeking asylum, for example through caseloading. Further research is recommended to evaluate the effectiveness of this model in enhancing the care of asylum seeking women in the United Kingdom.

En graviditet och förlossning är i de allra flesta fall en normal livshändelse. De senaste decennierna har andelen instrumentella- och kejsarsnittsförlossningar ökat på bekostnad av den normala förlossningen. Trots fler interventioner ses ingen skillnad i den maternella och perinatala morbiditeten och mortaliteten. I barnmorskans arbetsområde ingår att handlägga den normala graviditeten och förlossningen. Syftet med studien var att beskriva hur barnmorskan kan främja en normal förlossning. Studien genomfördes som en litteraturstudie där 13 vetenskapliga artiklar, med både kvantitativ och kvalitativ ansats, analyserades. I resultatet framkom tre kategorier som beskriver hur barnmorskan främjar normal förlossning. Barnmorskan skapar genom närhet en god relation till kvinnan och ger vägledning. Genom att använda sig själv som kunskapskälla bidrar barnmorskans sinnen, erfarenheter av tidigare förlossningar och formell kunskap till att fatta korrekta beslut. Barnmorskan stödjer och bekräftar det normala individuellt efter kvinnans behov, vilket skapar en säker miljö runt kvinnan och förhindrar onödiga interventioner. Då det råder en medicinsk kultur inom förlossningsvården, behöver barnmorskans arbete kring normal förlossning stärkas. Forskning behövs på organisationsnivå, eftersom omgivande system inverkar på barnmorskans arbete med att främja den normala förlossningen. / Pregnancy and childbirth are in most cases a normal life event. Over the past decades the rate of instrumental birth and caesarean sections has increased at the expense of normal birth. Despite more interventions no difference is seen in the maternal or perinatal morbidity or mortality. The midwife’s work encompasses the normal pregnancy and labour. The aim of this study was to describe how the midwife can promote normal birth. The study was conducted as a literature study in which 13 scientific articles, with both quantitative and qualitative approach, were analyzed. Three categories emerged that explained how the midwife promotes normal birth. The midwife creates through closeness a positive relationship to the woman and gives guidance. By using herself as a source of knowledge, the midwife’s senses, experiences from previous labours and formal knowledge, contribute to make correct decisions. The midwife supports and confirms the normalcy, from the woman’s individual needs, and thereby creates a safe environment for the woman that prevents her from unnecessary interventions. As there is a medical culture within the maternity care, the midwife’s work with normal birth needs to be strengthened. Since the organization has an impact on the midwife’s promoting work, further research is needed in this area.

Improving the quality of abortion care can reduce stigma, increase access, and enhance knowledge about pregnancy prevention and reproductive health. Midwifery-led medication abortion is considered effective, efficient, accessible, person-centred, equitable, and safe in alignment with the World Health Organization’s framework on quality abortion care. As research on client-centred access to healthcare recommends, Ontario’s expanded midwifery care models are improving the ease with which people can find and use sexual and reproductive services most appropriate to their unique needs. The expanded midwifery care presented in this study demonstrates how midwifery-led medication abortion provides high-quality services, decreases stigma, and improves access to safe, acceptable, and client-centred abortion care, particularly for commonly underserved populations deserving of health equity and Reproductive Justice. / The World Health Organization, the International Confederation of Midwives, and the Canadian Association of Midwives advocate for the inclusion of comprehensive abortion care within midwifery practice. International evidence shows positive outcomes in terms of efficacy, safety, acceptability, and post-abortion contraception uptake when midwives provide abortion services. In Canada, midwifery services are available across various populations, including urban, rural, remote, and Northern areas, suggesting a potential to enhance access and quality of abortion care, particularly for underserved people. Expanding the role of Canadian midwives to include comprehensive abortion care could improve accessibility, address gaps in service provision, support community needs, ensure professional sustainability, foster interprofessional collaboration, and offer continuity of care. Since 2017, the Ontario Ministry of Health has funded Expanded Midwifery Care Models to support midwifery integration, interprofessional collaboration, and delivery of midwifery-led sexual and reproductive care that is not funded under the current payment model. This research explores the individual and shared experiences of midwifery-led medication abortion delivered through Expanded Midwifery Care Models across three distinct regions in Ontario. The study employs interpretive description methodology to understand how midwifery influences the experiences of medication abortion for midwives, collaborating healthcare professionals, and clients. The methodology focuses on exploring how integrating a midwifery model of abortion care supports medication abortion services and promotes Reproductive Justice within primary care settings. By gathering insights from multiple perspectives, the findings hope to inform clinical practice, interest policymakers, and identify outcomes valued by midwives, clients, and healthcare professionals for future research on midwifery-led abortion care. / Thesis / Master of Science (MSc) / Quality abortion care improves the lives, health, and wellness of reproductive-aged people. Abortion is time-sensitive and people face barriers to this care. Reproductive-aged people benefit from healthcare systems that make abortion simple, safe, and effective. Internationally, midwives play a significant role in abortion care by delivering comprehensive services within sexual and reproductive healthcare. In Canada, however, the potential of midwifery in providing abortion care has not been fully realized. As an exception, Ontario’s Expanded Midwifery Care Models (EMCMs) - innovative sexual and reproductive healthcare delivery programs - have made it possible for midwives to provide abortion services. Midwifery-led abortion care in EMCMs includes providing early abortion care in ways that make it easier for people who find it difficult to access care. This research explores and compares the personal and professional experiences of medication abortion care delivered by midwives across three regions in Ontario.