Bakgrund: Enligt studier kan möten med föräldrar som föder barn som inte lever framkalla sorg, skuld och stress hos vårdpersonal och stöd är något som efterfrågas. Trots behovet finns begränsad forskning om vilket typ av stöd som behövs. Syfte: Syftet med studien var att identifiera barnmorskors och undersköterskors behov av stöd samt vilket typ av stöd de behöver vid möten med föräldrar som föder barn som inte lever. Metod: Åtta barnmorskor och fem undersköterskor fördelade i tre fokusgrupper intervjuades på en mellanstor förlossningsavdelning i Mellansverige. Semistrukturerade frågor ställdes utifrån en intervjuguide. Analysmetoden var kvalitativ innehållsanalys. Resultat: Ett tema och fem kategorier identifierades. Temat var: Viljan att göra gott. Kategorierna var: Kollegialt stöd, Verksamhetsstöd, Utbildning, Handledning och Reflektion samt Att vara oerfaren. Slutsats: Behovet av stöd varierade men samtliga deltagare ansåg att de fanns för varandra som stöd samt upplevde behov av kontinuitet i möten med föräldrarna och någon typ av utbildning. Fasta handledningstillfällen där deltagarna kunde träffas tvärprofessionellt önskades. Deltagare med lång erfarenhet av förlossningsvård kände sig tryggare i möten med föräldrar som föder barn som inte lever, än de med kortare erfarenhet. Klinisk tillämpbarhet: Studien skulle kunna leda till att stöd implementeras i verksamheten, vilket på sikt kan leda till att drabbade föräldrar får ett bättre bemötande. / Background: According to research health professionals are feeling grief, guilt and stress when they meet parents giving birth to stillborn babies. They are in need of support but research about what kind of support is limited. Aim: To identify midwives’ and assistant nurses’ need of support and what kind of support they need meeting parents giving birth to stillborn babies. Method: Eight midwives and five assistant nurses were interviewed and distributed in three focus groups. They were asked semi-structured questions based on a questionnaire. The analysis method was qualitative content analysis. Results: One theme and five categories were identified. The theme was: The will to do good. The categories were: Collegial support, Education, Support from the hospital management, Tutorial and Reflection and To be inexperienced. Conclusion: The need of support varied but all participants considered they were there for each other as a support and a need of continuity and education in their meetings with parents. They also wished for tutorials with regular occasions where they could meet with different professions in a group. Those participants with longer experience from childbirth care felt more secure in their meetings with parents giving birth to stillborn babies, compared with those with shorter experience. Clinical application: The study could lead to support being implemented in maternity units, which in the end could lead to better treatment for the affected parents.

Background: Within the Stockholm County Council returned in 2013 around 68 percent of the women to the antenatal clinic for a check-up after childbirth. Earlier studies show that new mothers want greater support from maternal health care and do not always know where to seek care. Aim: The aim of this work was to investigate whether the use of a standard model describing midwifery care and procedures for the postpartum check-up could affect the number of women who return to Södermalms clinic. A further aim was to compare the midwife and the patient's perspective, about what were included and discussed at this postpartum check-up. Method: This study had a descriptive quantitative research approach. How and when the woman contacted, and what topic the midwife discussed with the woman during the postpartum visit, was well described in a flowchart. 112 women were enrolled in the study and the project could be evaluated on the basis of data from the Pregnancy Registry and a control group corresponding to the intervention group was appointed. Results: Registered data showed an increased number of women who returned to Södermalms clinic postpartum, in the control group, there was no increase in the percentage of women who came to postpartum visits. There was a difference between the midwife and the woman's perception of what was discussed at the postpartum visit, particularly around the   information about the ruptures and the pelvic floor muscle, there was a discrepancy.  The midwives participating in the study preferred after completion of the study a more structured working model, where the postpartum visits were clarified. Conclusion: There may be advantages to use a standard model describing the midwifery care and procedures for the postpartum visits. The midwives preferred to book in the woman's postpartum check-up during her last pregnancy visit and were more satisfied with the new approach.

Syfte: Att beskriva barnmorskors erfarenheter av att hantera separation mellan mor och barn efter kejsarsnitt. Metod: En kvalitativ intervjustudie med tolv barnmorskor från två förlossningskliniker i Mellansverige genomfördes. Kvalitativ innehållsanalys användes som analysmetod. Resultat: Utifrån sex subkategorier framkom tre kategorier ur resultatet: Strävan efter att förebygga separation, omständigheter som kan påverka tiden för separation samt den professionella rollen i verksamheten. Barnmorskor strävade efter att undvika separation mellan mor och barn efter kejsarsnitt för att främja amning, anknytning och se familjen. Omständigheter som kunde påverka tiden för separation var barnmorskors arbetssituation på förlossningsavdelningen, förflyttningar samt brist på nedskrivna riktlinjer och rutiner. Konklusion: Det ses en tendens till förbättringsmöjligheter och ett behov av att utveckla tydligare riktlinjer kring hantering av separation mellan mor och barn efter kejsarsnitt. / Aim: To describe midwives’ experiences of handling separation between mother and infant after a Caesarean section. Method: A qualitative interview study was conducted with twelve midwives from two obstetric clinics in central Sweden. Qualitative content analysis was used as an analytical method. Results: Based on six subcategories, three categories emerged from the result: striving to prevent separation, circumstances that may affect the time of separation, and the professional role of the midwife. Midwives strived to avoid separation between mother and infant after a Caesarean section to promote breastfeeding, attachment, and to see the family. Circumstances that could affect the time for were the midwives' employment situation on the maternity ward, transport (of mother and infant), and lack of written guidelines and procedures. Conclusion: A tendency for improvement opportunities can be seen and a need to develop clearer guidelines on managing separation between mother and infant after a Caesarean section.

Philosophiae Doctor - PhD / Background: Satisfaction with the care mothers receive during child-birth is known to have a very strong influence on their future use of facility-based care during child-birth. Women and children continue to die from complications associated with pregnancy and child-birth and the majority of the causes that lead to mortality are related to labour and delivery. For this reason it is imperative for mothers to access facility-based child-birth care to receive skilled birth care. Mothers report dissatisfaction with facility-based child-birth care as one of the reasons for home births without skilled attendants. The presence of the skilled birth attendants is known to reduce maternal and neonatal mortality rates because of their ability to diagnose any early complications, and to intervene appropriately. Aim: The aim of the current study was to develop an in-service training programme for midwives to provide patient-centred child-birth care that would increase client satisfaction with child-birth care. Method and findings: The intervention research model by Rothman and Thomas (1994) – Design and development (D & D) – was used as the research framework. Only the first four of the six phases of the D & D model were applied in this study. In the first phase, a situational analysis was done using a qualitative study. The expectations, experiences, and satisfaction with child-birth care of antenatal and postnatal mothers, were explored. The research was conducted in four health institutions within the Kumasi Metropolis. Between 12 and 15 participants were purposively sampled in each hospital. Data were collected by means of individual in-depth interviews using an interview guide and data were analysed using content analysis. The study found that mothers expected to receive respectful care and safe care. Mothers had encouraging experiences and discouraging experiences during their child-birth care. The discouraging experiences did not align with their expectations of care, leading to dissatisfaction with child-birth care. In the second phase of the study an integrative literature review was conducted to identify evidence-based best practices to deal with client dissatisfaction with health care. The integrative literature review indicated that in-service training was commonly used as best-practice to improve health professionals' knowledge, skills and attitudes towards work and consequently to improve health outcomes for patients, including client satisfaction. In the third phase of the study, the in-service training programme to enhance patient-centred care was developed using Chinn and Kramer (2005) guidelines for programme development and steps to programme development by Management Sciences for Health (2012). The fourth phase entailed an assessment of feasibility and usability of the in-service training programme using 6 midwives in a district Hospital. The procedure was guided by the I-Tech Technical Implementation guide (2010). The outcomes of the assessment was used to refine and revise the developed in-service training programme. Conclusion: This study sought to develop an intervention to increase client satisfaction with child-birth care service by engaging the following processes in phases: • Assessing the expectations and experiences of mothers about child-birth care services. • An integrative literature review for evidence-based best practice to tackle client dissatisfaction with health care. • Designing a patient-centred care in-service training programme together with experts in the field of maternal and child health. • As assessment of feasibility and usability of the in-service training programme by means of a pilot test to refine the programme. Recommendations: It was recommended among others that, the study is carried out on a national scale to cover all administrative regions of Ghana. It is further recommended that the study findings and the programme developed form part of the continuous professional assessment course requirement for nurses and midwives.

M.Cur. / The purpose of this study is to identify the midwives experience in doing the delivery or a HIV-positive patient. Because the incidence of AIDS is increasing in the heterosexual population and thus the women in their reproductive years, it is important for the midwife to know how feelings for the HIV-positive patient. It is the midwife who has to give counselling and support to tho HlV-positive patients and in doing so, she herself must get counselling end support. Unstructured in-depth interviewB wore held with r Ivo midwives on one occasion. Each midwife should have done at least one delivery of a HIV-positive patient. The experiences of the midwives was then combined and a literature control was done to consult other authors' findings on the heath workers experience of HIV positive patients. Recommendations were made at the end of the study concerning applications to practice, education, further research and the counselling of the midwife.

D.Cur. / The midwife is the pivot around whom training activities in midwifery revolve. Her knowledge and skill form an inseparable part of the effectiveness of her practice. The external and internal environment of the midwife play a vital role regarding the demands placed upon her. The internal and external environment of the midwife is dynamic, and change continually. The external environment in the past ten years has undergone marked changes: health policy has changed; legal-ethical changes have occurred; the roles of the private sector and fee-for-service practitioners have changed; a new government with other objectives has placed the emphasis on new needs at professional and lay levels. These changes place new demands on the midwife's practice. Because the internal and external environments are in interaction, changes in the internal environment are continually being made, for example the knowledge and competency required by the midwife must continuously be improved so that she can comply with the new demands in her practice. The training of the midwife ought to be such that she is adequately equipped to fulfil the demands set by practice. The goal of this study is: an exploration and description of the knowledge and skill required by the midwife to be able to accept her responsibility in the new health care service of South Africa and set guidelines for the basic training of midwife who is to function independently.

The perceptions of Nelson Mandela Metropolitan Municipality obstetric unit midwives regarding consulting advanced midwives were researched. Currently South Africa is burdened with an increasing maternal mortality rate despite the control measures that have been put in place. One of those control measures is the skilling of midwives and ensuring that skilled birth attendants assist every woman in confinement. A concern, though, was observed by the researcher that an increasing number of midwives in the country now have an additional qualification in advanced midwifery and yet the maternal and neonatal mortality rates are gradually increasing. The researcher, as a midwife and a midwifery lecturer in that capacity, observed that in the clinical areas midwives prefer to consult with the doctor rather than the advanced midwife. In most cases looking and waiting for the doctor delays the management of the labouring woman as the doctor may not be immediately available. The advanced midwives are supposed to have advanced skills which should be used to assist in the absence of the doctor, particularly in the midwife obstetrics units. The study objectives were firstly, to describe and explore the perceptions of NMM obstetric unit midwives regarding consulting with advanced midwives. Secondly, based on the results of the study, to make recommendations to the managers of the obstetric units within the NMM that will enhance consulting between advanced midwives and midwives in obstetric units. The study was quantitative in nature and utilised an explorative, descriptive and contextual design. Sampling was made possible through simple random probability sampling using the non-replacement approach. The method of data collection was by self-administered questionnaires that were developed by the researcher under the guidance of a qualified and experienced statistician and researcher and the supervision of the research supervisor. Data was collected during July and September of 2014. One hundred and thirty questionnaires were distributed and ninety four were returned. Responses were captured on a spread sheet for easy and accurate calculation and the numerical data was categorized, ordered and manipulated with the help of a statistician using the software package Statistica Version 21 to ensure efficacy of the results The findings were presented by describing the biographic profile of participants, their competence in the identification and management of high risk situations, their consultation with advanced midwives in high risk situations, their reasons for not consulting advanced midwives and a description of factors that might encourage midwives to consult the advanced midwives. Literature controls were utilized to compare findings with current views of other researchers. Trustworthiness was maintained by observing the principles of reliability and validity. The ethical considerations of confidentiality, anonymity and protection of the participants from harm were maintained by the researcher. The findings revealed that there were significant numbers of midwives with many years of clinical experience and years in the units. The age difference of the midwives in the obstetrics units was seen to be an added advantage to the care of women as the young and old could complement each other with the latest information and experience in dealing with midwifery related emergencies respectively. The difference in gender was as expected but did not have an influence on the non-consulting with advanced midwives by the midwives who are working in the obstetrics units. Also, the limited confidence of midwives regarding their performance of certain low risk skills and their confidence in the performance of the advanced midwives was a reason to consult with the advanced midwives in their areas of speciality. Based on these findings, the researcher attended to the second objective and made the necessary recommendations to the managers of the obstetric units within the NMM to enhance consulting with advanced midwives by midwives in obstetric units. Midwives globally would gain information that would assist them in motivating recommendations to the managers of the obstetric units with regard to consulting with advanced midwives by midwives in their obstetric units.

Although it is considered an everyday occurrence, childbirth is nonetheless an important and dramatic experience in the life of every woman. Childbirth, a normal physiological state in the life of a woman, can be an awe-inspiring and exciting experience, but sometimes disconcerting experiences may also occur. Women sometimes see labour as the end to a long drawn out process following pregnancy and therefore attribute great significance to all occurrences during labour. When complications occur in a usually uncomplicated process of labour, the health care provider must be able to make quick and effective management decisions and implement appropriate interventions. This may include the referral of women in labour to a level of care where complications can be dealt with more effectively, thereby ensuring the best maternal and neonatal outcomes. Patient referral is regarded as a fundamental component of the health care system therefore a well functioning system should ensure that patients are treated in the appropriate manner at the appropriate place at the lowest possible cost to the health system. The goal of this research study was to explore and describe the inter-level health service referral of women in labour by midwives, in order to design guidelines for midwives and other relevant health care providers involved in inter-level health service referral of women in labour in the South African public health care sector. The research design used for this study is a combination of qualitative and quantitative approaches. The paradigmatic perspective of this study was based on the World Health Organization’s Health for All Model. Appropriate data collection and analysis strategies were used for the different stages of the study. Data collection commenced only after permission to conduct the research had been obtained from relevant authorities and University of Port Elizabeth and the Nelson Mandela Metropolitan University structures. Informed consent was obtained from participants included in the study. In stage 1 of this research project, a profile of midwives at lower level maternity care centres was compiled and the perceptions and experiences of midwives working at lower level maternity services, who are responsible for inter-level health referrals of women in labour, were described. Stage 2 described, by means of analysis of maternity case records, aspects of the inter-level referral of women in labour including the profiles of women admitted to midwife obstetric units (MOUs) who are v referred to higher levels of care. Of significance in this study is the appropriateness of midwifery referrals and the maternity care implemented by health care providers during inter-level health service referral of women in labour. In stage 3 clinical guidelines for midwives and other relevant maternity care providers, to assist them in the inter-level health service referral of women in labour, were developed. Findings from stage 1 of this research study revealed that midwives were generally well qualified and sufficiently experienced in the management of women in labour who need referral. Disconcerting findings relating to human and material resource shortages were discovered; these included major problems with patient transportation and difficulties with communication relating to inter-level health service referral of women. These shortages adversely affected midwives’ ability to efficiently care for women during the inter-level health service referral of women in labour in the research area. Stage 2 of the study yielded results of questionable standards of care to women and infants included in the study. A further disturbing finding from the study is the poor state of record keeping. The development of the provisional guidelines in stage 3 of the study was informed by the four main themes identified from the research findings. Before embarking on guideline development, the researcher familiarized herself with theory related to the clinical guidelines. These included clarifying the concept ‘clinical guidelines’, justifying the need for developing clinical guidelines as well as giving consideration to concerns about clinical guidelines. The research findings as well as literature related to these findings informed the researcher on the development of the guidelines. Provisional guidelines were therefore developed on responsibilities of role players in inter-level health service referral of women in labour at first level of referral, namely the midwife obstetric units, transport personnel and maternity care providers at the referral hospital. Steps were taken throughout the study to adhere to ethical standards of research. The researcher will ensure that the research report is available to all health authorities involved, the participants included in the study and the health care providers who may benefit from the research findings.

M.Cur. / Poor quality of midwifery care has been of major concern at St. Elizabeth's antenatal clinic in Eastern Cape. This has been attributed to a number of reasons which one of them is the high maternal mortality rate at St. Elizabeth's hospital. The research question has been, "Do midwives provide quality care to pregnant women at St. Elizabeth's antenatal clinic?" The question has been answered by auditing antenatal records, retrospectively of all the women who have been attending St. Elizabeth's antenatal clinic. Data was collected by means of the Phaneuf audit tool. Twenty antenatal records of women who have been attending antenatal clinic at St. Elizabeth's hospital were selected randomnly. Data analysis was presented in a descriptive way. From the findings, factors that contribute to poor quality care were identified. Beca se of the presence of more negative factors that contribute to poor quality care, the conclusion was that, midwives provide substandard care at St. Elizabeth's antenatal clinic. Recommendations for nursing education, nursing practice and recommendations for further research were outlined. Validity and reliability has been mantained throughout the study. Ethical standards, as stipulated by DENOSA have been considered in the whole chapter

Barnmorskors arbete inom förlossningsvården innebär ofta en nära kontakt med den födande kvinnan, och barnmorskan har kompetens att självständigt bedöma när en situation under förlossningsarbetet avviker från det normala samt förestå en handlingsberedskap för komplikationer och akuta situationer. Svåra händelser kan påverka barnmorskan emotionellt, och syftet med studien är att utforska hur barnmorskor upplever svåra situationer inom förlossningsvården, samt vilket stöd de får i samband med detta. Semistrukturerade intervjuer genomfördes med sex barnmorskor som hade minst tre års erfarenhet från arbete på förlossningsavdelning. Intervjuerna analyserades enligt kvalitativ innehållsanalys med induktiv ansats. Tre huvudkategorier framkom i resultatet med åtta underkategorier Huvudkategorierna är: Att hantera det som känns svårt, Att utsättas för psykisk påfrestning, En utsatthet i relation till professionen. Att handlägga en förlossning är ett stort ansvar, och barnmorskor belyste situationer då de upplevt oro inför det som hände eller kunde ha hänt. Barnmorskorna betonade vikten av stöd både från chefer och kollegor i samband med svåra situationer, samt efterfrågade tid till samtal med kollegor och chefer eller handledning med extern gruppledare.