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  • 1.
    Ehrling, Malin
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Kvinnans individuella upplevelse av förlossningssmärta: En begreppsanalys2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Labor pain is a term used in education and healthcare, where women are cared for during pregnancy and in maternity wards. How the concept is defined is described in literature and how and what is covered by the concept is wide. Labor pain has great location within maternity care but as a concept it is relatively undefined. Aim: The aim was to describe the concept of labor pain through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed; earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: After the analysis of the concept of labor pain the main results is that it is truly one unique experience of labour pain. Defined three dimensions sensory, affective and cognitive. The sensory dimension stands for physiology, the affective dimension for earlier experiences and the cognitive dimension for how a person thinks about pain and the experience of it. Pain in labour is a unique experience. Only the woman in labour knows how it feels like. Pain during labour is an individual experience and just like all other experience it has its unique and individual interpretation for the person involved. Conclusion: Labor pain can be identified as a complex concept adapted to each pregnancy based on the defined dimensions. Clinical applicability: Clarification of the concept is important in education of midwifery students.

  • 2.
    Erlandsson, Kerstin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 1, p. 28-33Article in journal (Refereed)
    Abstract [en]

    Objective. To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition.

    Design. A mixed method approach.

    Setting. One thousand and thirty-four women answered a web questionnaire. Sample. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives.

    Main Outcome Measure. The premonition of an unwell unborn baby. Results. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby.

    Conclusions. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

  • 3.
    Jobs Roos, Kesti
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Roos, Kristin
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Gynekologisk undersökning vid eftervårdsbesök -barnmorskans erfarenheter av att bedöma bäckenbottensstrukturer: Kvalitativ intervjustudie med barnmorskor verksamma inommödrahälsovården2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Undergoing pregnancy and childbirth, entails great strain on a woman’s body.

    When giving birth vaginally, tears may occur, which may cause problems for the woman to a

    different extent. Through the postpartum check-up, midwives have an opportunity to identify

    problems that may have occurred and detect undiagnosed perineal injuries.

    Aim:

    The aim was to describe the midwife’s experiences of pelvic examination and to assess

    pelvic floor structures at the postpartum check-up.

    Method:

    Semi-structured interviews were conducted with eleven midwives working in

    maternal health care. Thematic analysis was used to analyze the material.

    Results:

    One global theme, three organizing themes and ten basic themes were identified.

    The global theme was:

    the woman´s needs. The organizing themes were: to support through

    the approach; to promote health

    and areas for improvement. The basic themes were: to be

    responsive; to confirm; to see individual needs; to motivate for examination; to motivate selfcare;

    education; structure; documentation; time aspect

    and follow-up.

    Conclusion:

    Midwives in maternal health care play an important role in health promotion and

    working with women's needs. They try to personalize each visit and adapt the information

    given, but their experience is that there are difficulties in motivating women to undergo a

    pelvic examination. More education, a better and clearer structure for assessing the pelvic

    floor and an improved way of addressing problems that may persist after childbirth may

    enable women getting the help and care they need.

    Clinical application:

    The study results highlight an existing need for more knowledge,

    education and structure. Attention to this can lead to discussion of further development and

    the subject can also be raised among other healthcare providers.

  • 4.
    Olsson, Anna
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Tengvall, Helena
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Barnmorskans roll i sex- och samlevnadsundervisningen i grundskolan: En kvalitativ intervjustudie2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Today, most of the sex education takes place in school. Studies shows shortcomings in this education and that students experience shortage of the knowledge wanted regarding this subject. Research has also shown that young people prefer to accomplish sex education with someone who feels comfortable and has good knowledge of the subject. The main subject of midwifery is sexual and reproductive health and rights. However, there is a limited amount of studies conducted regarding midwives involvement in sex education in schools. Purpose: The aim of this study was to highlight the role of the midwife in health-promoting public health work with sex education for adolescents in school. Method: Semi-structured telephone interviews were conducted with four teachers who taught sex education at high school and five midwives with experience of sex education. The collected material was analyzed according to Malterud's systematic text condensation. Result: The result showed that the midwife's health promotion work in school was conducted in a few different ways. Partly through lectures and partly by students visiting the youth health center (ungdomsmottagning). The way in which the work was done was due partly to the school's demand and partly to the availability of the midwife. The average time that the midwife was teaching students were between 30-120 minutes, which were distributed on one and the same occasion. The midwife's role in school was described as being proficient, competent and comfortable talking about sex. The fact that the midwife was unacquainted meant that the students felt comfortable and it was easier to ask questions about sensitive subjects. Conclusion: The conclusion of the study is that there is a need for midwifery skills at school and that, in spite of this, there is no clear and obvious role of the midwife in school education. Clinical applicability: This study can be used to support the midwife's work in sexual education in school. The study can also be used as a basis for establishing cooperation between midwife and school.

  • 5. Pakbaz, Mojgan
    et al.
    Persson, Margareta
    Umeå universitet.
    Löfgren, Mats
    Mogren, Ingrid
    'A hidden disorder until the pieces fall into place': a qualitative study of vaginal prolapse2010In: BMC women's health, ISSN 1472-6874, Vol. 10, p. 18-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Vaginal prolapse affects quality of life negatively and is associated with urinary, bowel, and sexual symptoms. Few qualitative studies have explored women's experiences of vaginal prolapse. The objective of the study was to elucidate the experiences of living with prolapse and its impact on daily life, prior to surgical intervention.

    METHODS: In-depth interviews were conducted with 14 women with vaginal prolapse, prior to surgical treatment. Recruitment of the informants was according to 'purposive sampling'. An interview guide was developed, including open-ended questions addressing different themes, which was processed and revised during the data collection and constituted part of a study-emergent design. Data were collected until 'saturation' was achieved, that is, when no significant new information was obtained by conducting further interviews. Interviews were audiotaped, transcribed verbatim, and analyzed according to manifest and latent content analysis.

    RESULTS: The theme defining the process of living with prolapse and women's experiences was labelled 'process of comprehension and action'. The findings constitute two categories: obstacles and facilitators to seeking health care. The category obstacles comprises six subcategories that define the factors restraining women from seeking health care: absence of information, blaming oneself, feeling ignored by the doctor, having a covert condition, adapting to successive impairment, and trivializing the symptoms and de-prioritizing own health. The category facilitators include five subcategories that define the factors promoting the seeking of health care: confirmation and support by others, difficulty in accepting an ageing body, feeling sexually unattractive, having an unnatural body, and reaching the point of action.

    CONCLUSION: The main theme identified was the 'process of comprehension and action'. This process consisted of factors functioning as either obstacles or facilitators to seeking health care. The main obstacles described by the participants were lack of information and confirmation. The main facilitators constituted feeling sexually unattractive and impaired physical ability due to prolapse. Information on prolapse should be easily accessible, to improve the possibility for women to gain knowledge about the condition and overcome obstacles to seeking health care. Health care professionals have a significant role in facilitating the process by confirming and informing women about available treatment.

  • 6.
    Persson, Margareta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Winkvist, A
    Dahlgren, L
    Mogren, I
    Struggling with daily life and enduring pain: a qualitative study of women's experiences with pelvic girdle pain during pregnancy2013In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 13, article id 111Article in journal (Refereed)
    Abstract [en]

    Background. Few studies have investigated the experiences of living with pelvic girdle pain (PGP) and its impact on pregnant women’s lives. To address this gap in knowledge, this study investigates the experiences of women living with PGP during pregnancy.

    Methods. A purposive sample, of nine pregnant women with diagnosed PGP, were interviewed about their experiences. Interviews were recorded, transcribed to text and analysed using a Grounded Theory approach.

    Results. The core category that evolved from the analysis of experiences of living with PGP in pregnancy was “struggling with daily life and enduring pain”. Three properties addressing the actions caused by PGP were identified: i) grasping the incomprehensible; ii) balancing support and dependence and iii) managing the losses. These experiences expressed by the informants constitute a basis for the consequences of PGP: iv) enduring pain; v) being a burden; vi) calculating the risks and the experiences of the informants as vii) abdicating as a mother. Finally, the informants’ experiences of the consequences regarding the current pregnancy and any potential future pregnancies is presented in viii) paying the price and reconsidering the future. A conceptual model of the actions and consequences experienced by the pregnant informants living with PGP is presented.

    Conclusions. PGP during pregnancy greatly affects the informant’s experiences of her pregnancy, her roles in relationships, and her social context. For informants with young children, PGP negatively affects the role of being a mother, a situation that further strains the experience. As the constant pain disturbs most aspects of the lives of the informants, improvements in the treatment of PGP is of importance as to increase the quality of life. This pregnancy-related condition is prevalent and must be considered a major public health concern during pregnancy.

  • 7.
    Persson, Margareta
    et al.
    Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    'From stun to gradual balance' - women's experiences of living with gestational diabetes mellitus2010In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 3, p. 454-62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIM: In most parts of the western world, screening routines for gestational diabetes mellitus (GDM) are implemented, however, knowledge of the impact GDM has on the experience of pregnancy and life situation is sparse. The aim of this study was to describe pregnant women's experiences of acquiring and living with GDM during pregnancy.

    METHOD: A Grounded Theory approach was used. Ten pregnant women diagnosed with GDM in current pregnancy were interviewed. Data collection was performed in the north of Sweden over two periods; a first set of interviews in 1998-2000 and additional interviews in 2006 to further explore the experience and reach saturation.

    FINDINGS: 'From stun to gradual balance' emerged as the core category, encompassing of the categories 'Struck by lightning', 'Having a personal responsibility', 'Being under surveillance', 'Struggling for protection', 'Feeling socially apart', 'Being sufficiently supported', 'Changing the self-image', 'Adapting to a new situation' and 'Waiting for the 'Moment of truth''. Our findings indicated that the diagnosis of GDM initiated a number of challenges and demands for the pregnant women. Further, being diagnosed with GDM was not only perceived as a medical complication threatening the pregnancy, moreover as an indicator of a future diabetes mellitus.

    CONCLUSION: The experience of being diagnosed with and living with GDM during pregnancy may be understood as a process 'from stun to gradual balance'. The experience comprises positive and negative dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to a lifestyle and balancing the every day life is the prize most of these women are willing to pay in order to secure optimal maternal and foetal health. Knowledge of the experiences of women diagnosed with GDM may enable midwives to provide increased support as well as provide information and preventive measures in order to delay future diabetes mellitus.

  • 8.
    Persson, Margareta
    et al.
    Umeå universitet.
    Winkvist, Anna
    Mogren, Ingrid
    [No unified guidelines concerning gestational diabetes in Sweden. Noticeable differences between screening, diagnostics and management in maternal health services].2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 45, p. 3365-9Article in journal (Refereed)
    Abstract [en]

    In Sweden, there are noticeable differences between the antenatal health care settings concerning the prevalence of oral glucose tolerance tests (OGTT) to detect gestational diabetes mellitus (GDM). Clinical guidelines for screening, diagnostics and treatment of GDM 2004 were collected from all antenatal health care areas (n=50, 100% of eligible areas) in Sweden. The guidelines were analysed in relation to the available national statistics. The most prominent finding was that there was no consensus on screening, diagnosis and treatment of GDM. In most areas, the well-known risk factors for GDM were used as the criteria for offering OGTT to pregnant women. However, some areas offered OGTT to all pregnant women, resulting in a significantly greater detection of GDM. Hence, it is likely that the reported prevalence of GDM in Sweden is an underestimate. We suggest that national guidelines for screening, diagnosis and treatment of GDM should be developed in order to better fulfil the intentions of the Swedish National Board of Health and Welfare.

  • 9.
    Persson, Margareta
    et al.
    Department of clinical science, Obstetrics and gynecology, Umeå University, Umeå, Sweden.
    Winkvist, Anna
    Mogren, Ingrid
    Surprisingly low compliance to local guidelines for risk factor based screening for gestational diabetes mellitus: A population-based study2009In: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 9, p. 53-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Screening for gestational diabetes mellitus (GDM) is routine during pregnancy in many countries in the world. The screening programs are either based on general screening offered to all pregnant women or risk factor based screening stipulated in local clinical guidelines. The aims of this study were to investigate: 1) the compliance with local guidelines of screening for GDM and 2) the outcomes of pregnancy and birth in relation to risk factors of GDM and whether or not exposed to oral glucose tolerance test (OGTT).

    METHODS: This study design was a population-based retrospective cross-sectional study of 822 women. A combination of questionnaire data and data collected from medical records was applied. Compliance to the local guidelines of risk factor based screening for GDM was examined and a comparison of outcomes of pregnancy and delivery in relation to risk factor groups for GDM was performed.

    RESULTS: Of the 822 participants, 257 (31.3%) women fulfilled at least one criterion for being exposed to screening for GDM according to the local clinical guidelines. However, only 79 (30.7%) of these women were actually exposed to OGTT and of those correctly exposed for screening, seven women were diagnosed with GDM. Women developing risk factors for GDM during pregnancy had a substantially increased risk of giving birth to an infant with macrosomia.

    CONCLUSION: Surprisingly low compliance with the local clinical guidelines for screening for GDM during pregnancy was found. Furthermore, the prevalence of the risk factors of GDM in our study was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors of GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. There is a need of actions improving compliance to the local guidelines.

  • 10.
    Z Ager, Emily
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Helsing, Emma
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Sexualitet, självbild och kropp: En kvalitativ metasyntes om hur kvinnor förhåller sig till det heteronormativa samhällets förväntningar2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Sexuality is important in a person's life. In our society there are norms and expectations that we all are expected to adapt to; these can affect sexuality and sexual health. To describe how women relate to their sexuality, self-image and body from a heteronormative society can give midwives a deeper understanding of women´s living conditions. Aim: To describe how women relate to their sexuality, self-image and body based on norms of society. Method: Meta-synthesis including qualitative data from 25 articles were included in the result. The analysis was done by meta-ethnography. Result: The women adapted and were flexible based on prevailing norms of society by redistributing power in the relationship, coping with lack of education and taboos, adapting to existing gender roles, and striving to fulfill ideals. These are presented as the four main categories in the result. Conclusion: Women shape their sexuality, self-image and body based on social norms and prevailing power structures. They adapt and are flexible, which affect their self-image and sexual health. The self-image and sexual health are characterized by a limited power to shape their own lives. Women need awareness of this situation in order to have the power to protect equality in their own lives and to promote equality in society. Clinical implication: Midwives as a professional group can support women of all ages to embrace their sexuality and see the beauty of their bodies. Inclusion of midwives in school sexual education; In conversation about lust, body acceptance and consent, could help improve sexual health for young women. When the midwife in her daily work meets women, who try to comply with social norms and expectations in different ways, this meta-synthesis can help in reflection on the midwifery's values about gender equality and the treatment of women in different life situations.

  • 11.
    Zadik, Tove
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Sterner, Kathy
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Exploring midwives’ experiences, attitudes and perceptions in relation to unsafe abortion and post abortion care: - a qualitative study with midwives in Kampala, Uganda.2017Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: In the East African region abortion complications causes significant morbidity and mortality, impairing women´s and girls’ health and well-being. Health care provider shortages, physicians in particular, non-availability of safe and effective medicines and technology, and the fact that few midwives and nurses are trained in post abortion care (PAC), result in limited health care access. Stigma and legal repercussions further obstruct access to care and contributes to hesitance among health care providers to provide such care. Previous studies concerning women´s access to sexual and reproductive health (SRH) care in Uganda have revealed several barriers to health care access and limited quality of care. Aim: Exploring midwives´ experiences, attitudes and perceptions in relation to unsafe abortion and their experience of providing PAC. Method: In depth interviews were conducted with twelve midwives at Mulago Referall hospital, Uganda by using a semi- structured interview guide. The transcribed material was then developed through qualitative content analysis using a manifest approach. Result: The analysis resulted in two main categories: 1) stigma and social norms related to women´s sexuality and abortion and 2) quality of post abortion care. The result showed that unintended pregnancies, FP and abortions generally are viewed badly in Uganda and are highly stigmatized. The quality of PAC is perceived reduced due to lack of equipment, high work load and stigma surrounding abortions.

    Conclusion: Unsafe abortions are viewed negatively and is seen as a consequence to stigma surrounding FP and unplanned pregnancies, which is mainly affecting young unmarried women. Midwives experienced reduced quality of PAC due to limited resources. The study also shows that new knowledge and education about PAC can help reduce midwives prejudice towards abortion seeking women and broaden their views.

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