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Background:

Midwifery care is an essential component of providing quality maternal and child health care. Mother and new born health outcomes depends on the quality of education, license to practice, the scope of practice, sufficient resources, referral mechanisms and effective teamwork. The aim of this meta-synthesis was to describe components building midwifery professionalism for delivery of quality care. Method: This study was a meta-synthesis focusing to describe the components needed for building midwifery professionalism for delivery of quality care in high, low and middle-income countries. After assessing for relevance and quality in peer-reviewed journals, 30 qualitative studies were included from 2009 to 2018, written in English. This involved an electronic search using the following databases: PubMed, CINAHL, web of Science, Google Scholar, Summon and manually search. Result: After analysis and synthesis, the major findings can be summarized in two components; Clinical experiences make the midwives’ grow personally and professionally and an enabling environment enhances the midwives’ personal and professional development. Subcategories were; Collaboration with other health professionals and with colleges/ colleagues at the workplace, Extensive hands on clinical experience, Professional management of the workplace, Quality pre-service education and quality of the midwifery educators, In-service training, Policies and guidelines regulate the midwifery workforce, Being a member of a midwifery association. Conclusion: To ensure mothers quality midwifery care; midwives play a critical role in strengthening the midwifery workforce in high and low-middle income countries. This study highlights the benefits of building capacity for strengthening midwives and the midwifery profession. Clinical implications: There is a need to improving the educational status, improving policy and practice of health care program and facilitate the necessary resources. There is need for further research to identify how much improvements the newly deployed midwifery cadre service will bring in the field of quality midwifery care personally and professionally especially in rural setting.

Background: Midwife-led care is yet to be explored as a concept in the context of Bangladesh. Anunderstanding of what constitutes midwife-led care can be lectured at midwifery education and inturn clarify the content of the midwifery practice to the midwifery workforce. The aim is to definethe concept of “Midwife-led care” from a midwifery context, through the synthesis of text fromliterature and interview data with Bangladeshi health care providers, to clarify its meaning enablingcomprehension and use of the concept in clinical practice and education.Methods: A concept analysis consisting of written text from literature and individual interviewswith Bangladeshi health care providers. In total nine participants participated in this study. Theconcept analysis was undertaken according to a hybrid model which consists of theoretical,fieldwork and analytical phases. After a literature review, the concept was empirically elucidated inthe fieldwork phase. The final step was to describe criteria and attributes of the concept.Results: The tentative criteria and attributes of midwife-led care in the context of midwiferyservices in Bangladesh included development of a trustful, friendly relationship between the womanand midwife; promoting normal processes for the pregnant woman in antenatal care, during deliveryand after delivery in the post-partum period. It includes creating awareness about benefits of normalbirth assisted by a skilled birth attendant. Further, having collaboration and communication withother health care professionals when complications arise with the woman or the baby and provide asupportive environment for care which is easily accessed and close to the communities. Finally,professional knowledge and skills are necessary components for midwives working with midwifeledcare.Conclusion: This concept analysis provides a unique examination of midwife-led care. Midwife-ledcare can be establish in the Bangladeshi midwifery context and practice. However, all the aspects ofmidwife-led care need to be supported by a functional health system for the continuity of care.Clinical implications: In midwife-led care centers, the midwifery workforce can be supported intheir clinical practice based on findings in this thesis. As such, this thesis offers a contribution foreducation in the midwife-led care approach within midwife-led maternity services. This is highlyrecommended when introducing evidence-based interventions to improve midwifery servicedelivery in real-world settings.

Background: A woman has the right to give birth in the place of her choice, in privacy and with the company of a trusted supporter. The aim of this study was to define the concept "woman’s choice during labor and birthʺ in the Bangladesh context. Methods: The study design was concept analysis with data consisting of written text from literature and structured interviews. The concept analysis comprises three phases. Phase was 1) a theoretical phase, followed by 2) a field study phase, and finally 3) a synthesis phase with the field study phase in light of the theoretical phase. The setting was labor wards, nursing institutes and nursing college (post basic) at three different places in Bangladesh. Four midwifery students, one clinical midwife and four Midwifery teachers participated in this study. The interviews were recorded with the permission of the respondents. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review the concept was empirically elucidated in the fieldwork phase. Results: The tentative criteria attributes of woman’s choice during labour and birth in the Bangladeshi context are described: Woman choice during labour and birth means labour process, type of delivery, neonatal wellbeing, companionship at birth. Conclusion: Women’s choice in labour and birth is worldwide to make decisions within boundaries and particularly women’s choices are limited in Bangladesh. Professionally and personally the woman’s choices are limited by lack of options in the caring environment influenced by socio-cultural factors, socio-economic standards and education level. Clinical implications: Empirical findings from the theoretical concept analysis confirm the concept’s relevance in the midwifery context.

Background

: Caesarean section is the most common surgery worldwide today. The midwives support is therefore of uttermost important for women undergoing caesarean section. Aim: The aim of the meta-synthesis was to explore the experience related to planned and unplanned cesarean sections among primipara and multipara women in hospital settings worldwide. Method: This study is a meta-synthesis with meta-ethnographic analysis on women’s experiences of caesarean section birth. This is a qualitative research based on scientific literature. The inclusion criterion was peer-review qualitative articles from different original articles about women's experiences. Results: Five categories emerged: Caring attitude and behaviour, pre-existing imagination, relational influence, the need for caring and information. The findings suggest that nurse-midwife enhance their support and increase the women’s knowledge on caesarean section birth in order to improve the experience and also for women to make good choices. Women are influenced by people near to them when choosing to have a cesarean section or not. The mothers face challenges for postoperative recovery and quality of care. Midwives have a duty to assist these mothers. Conclusion: The findings emphasize the importance of person-centered communication skills and relationships in supporting a woman during caesarian section. Organizational systems and services that facilitate continuity of care giver for example, continuity of midwifery care or peer support models, are more likely to facilitate supportive care and a trust-building relationship. Clinical implication: The findings from this study can be used for educational purposes, and to create awareness about the role of midwifery care in relation to CS.

Background: Caesarean section is the most common surgery worldwide today. The midwives support is therefore of uttermost important for women undergoing caesarean section. Aim: The aim of the meta-synthesis was to explore the experience related to planned and unplanned cesarean sections among primipara and multipara women in hospital settings worldwide. Method: This study is a meta-synthesis with meta-ethnographic analysis on women’s experiences of caesarean section birth. This is a qualitative research based on scientific literature. The inclusion criterion was peer-review qualitative articles from different original articles about women's experiences. Results: Five categories emerged: Caring attitude and behaviour, pre-existing imagination, relational influence, the need for caring and information. The findings suggest that nurse-midwife enhance their support and increase the women’s knowledge on caesarean section birth in order to improve the experience and also for women to make good choices. Women are influenced by people near to them when choosing to have a cesarean section or not. The mothers face challenges for postoperative recovery and quality of care. Midwives have a duty to assist these mothers. Conclusion: The findings emphasize the importance of person-centered communication skills and relationships in supporting a woman during caesarian section. Organizational systems and services that facilitate continuity of care giver for example, continuity of midwifery care or peer support models, are more likely to facilitate supportive care and a trust-building relationship. Clinical implication: The findings from this study can be used for educational purposes, and to create awareness about the role of midwifery care in relation to CS.

Background:

The knowledge of facility-based kangaroo mother care (KMC) in Bangladesh is comparatively recent; few facilities have been taking steps towards KMC service. Each year more than a million babies die due to the complication of prematurity. To eliminate the deaths due to prematurity, it is very important to share knowledge about the implementation, experiences, challenges and barriers for KMC practice to promote KMC intervention in the developing countries. Aim: To examine parents’ perceptions, experiences and attitude towards KMC in neonatal wards. Method: This study was a meta-synthesis focusing on parents’ perceptions and experiences of KMC. The included studies used several different qualitative methodologies compiled using Meta ethnography. Result: The results comprised of three categories were identified in this study. The First category was the Barriers towards KMC. This category comprised four preliminary patterns of parent’s perceptions of barriers to have KMC: Separating due to prematurity, Fear of harming, Pain prevented closeness, and Fear prevented closeness. The second category was facilitating factors for KMC, which covered parents’ experiences of the consult support expressed in four preliminary patterns: Own wish for closeness, Having positive experience and Support from the staff. The third category Benefits for KMC included three preliminary patterns of positive perceptions of KMC made by parents: Calming, warming and bonding, connecting with the premature baby and Being able to act as a parent. Conclusion: In this meta-synthesis, the main findings were realized into three categories of KMC- Barriers towards KMC, facilitating factors of KMC, Benefits of KMC. This is a low-cost and effectiveness method of reducing infant mortality. Clinical implications: Health care professionals have opportunities to implement Kangaroo Mother Care in low resource settings. First health care professionals have to be encouraged in all postnatal wards. Secondly, parents need to be aware about KMC so that they can promote their baby’s health and eventually save their baby’s life.

Background:

Supporting the woman and her partner is a major part of the midwifery role during delivery. As the number of newly arrived women increases in Sweden, with varied backgrounds and languages, the demands on midwives’ skills increase. Both migration and childbirth can be described as transitions, which can lead to positive development but also to increased challenges. Migration can be a stressful life process for newly arrived woman and the situation of childbirth can contribute to further vulnerability and uncertainty. The midwife has to understand the needs of newly arrived women in order to support and contribute to a positive experience.

Aim:

The aim of this study is to describe midwives' experiences and strategies in the meeting with newly arrived women at childbirth, focusing on interaction, trust and context.

Method

: Semi-structured interviews with eight midwives analyzed with qualitative content analysis with deductive approach.

Results:

The results of the study provided information on strategies that the midwives use to create interaction, trust and context, as well as their experiences. Common to all midwives was that they experienced that good communication with the patient was very important for creating interaction. Ahead of the meeting with a newly arrived woman, the midwives made sure of that they were well prepared. Strategies used to create trust were to show consideration, be present and take time to listen to the woman. By listening to the woman's wishes, providing information and trying to make the woman feel active and making active choices during her childbirth, midwife creates a context for the woman.

Conclusion:

The study has shown that midwives have conscious strategies for meetings with immigrated women. There is, however, a need for clearer routines

regarding the work of immigrated women in the delivery room, increased cultural skills of midwives and more resources to allow more time for these women.

Clinical application:

This study, through the strategies of midwives, can guide other midwives to support newly arrived women during childbirth. The study provides suggestions for areas of improvement and aids to improve the meeting and hence the quality of care for these women.

Background: Despite the advantages of zero separation, there is still some separation during hospital stay between mother and child after childbirth. At present, variations are seen in the possibility of maintaining zero separation in different hospitals in Sweden. Aim: To examine the delivery-, maternity- and neonatal professionals’ experiences of zero separation between the mother and the newborn child at a medium-sized hospital in Sweden. Method: A qualitive focus group interview study with an inductive approach, with a total of 17 informants, that has been processed with qualitative content analysis. Results: After completing the content analysis 12 subcategories emerged that resulted in four categories; The meaning of zero separation, Enabling approach, Obstacles along the way and Need for improvement. A theme emerged as A mutual effort not to separate, which was regarded to the healthcare professionalls’ willingness and commitment to maintain zero separation between the mother, the child and the family. Conclusion: The healthcare professionalls’ at the concerned hospital had a strong commitment to keep the mother, newborn child and the family as a whole, but at the present there are not always conditions for achieving zero separation to the extent they wish. Clinical implications: The child’s right to their parent is strengthened by the healthcare professionalls’ application of zero separation in their work. The findings of the study could likely be taken into account by healthcare professionalls’ and could form the basis for development of routines and forms of education concerning zero separation.

Background: Having a birth companion during labour and birth to provide mental, emotional support as well as physical support is globally found to be essential for women. The process of giving birth is not only a biological event but also a process with social and emotional aspects. It is a right for every woman to receive evidence-based care during childbirth. There is also a global interest in improving the quality of maternal and newborn care. This includes a strong focus on respectful care as an essential component of quality of care. The aim of this study was to define the concept “Birth companion during labour and birth” through the synthesis of texts from literature and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning, enabling comprehension and use of the concept in clinical practice and education. Methods: The design of this study is a concept analysis that comprises three phases: 1) is a theoretical phase, followed by 2) a field study phase and 3) a synthesis phase. The participants were recruited purposively and invited to the interview with an invitation letter. The interviews were based on semi-structured and open-ended questions following an interview guide. A total of nine participants were enrolled in this study, five midwifery educators, two clinical midwives, and two midwifery students who worked at antenatal care, delivery, postpartum care, menstrual regulation, post abortion care and family planning care or involved in midwifery education. Results: A birth companion supports women during childbirth provide informational support, bridge communication gaps between clinical staff and women, provide practical support and emotional support, act as an advocate for the women, help women feel in control, provide continuous physical presence. Conclusion: The concept “Birth companion during labour and birth” was redefined in the following way: The birth companion can be any person chosen by the woman to provide her with support during labour and childbirth. This support is perceived to be associated with reduced maternal anxiety, it highlights the importance of a birth companion during labour and birth and on the emotional wellbeing of women in the Bangladeshi context. Clinical implications: This paper gives a deep insight to the concept of a birth companion during labour and birth and shows what is, and preferably should be, part of the clinical settings in Bangladesh. Ensuring a birth companion during labour and birth could improve health outcomes of women and give a positive childbirth experience.

Background: Delivery by unskilled birth attendant is causing many maternal and neonatal deaths. Midwives can reduce maternal and neonatal deaths by providing skilled delivery care. To prepare skilled midwives a National Assessment Strategy for Midwifery Education Standards has been introduced.

Aim: To describe midwifery faculty members’ perceptions of how to affirm quality midwifery education in Bangladesh using a national assessment strategy.

Methods: A qualitative research design was chosen using a context-specific accreditation assessment tool, guided by the Global Standards for Midwifery Education. The participants were 33 midwifery teachers, and data were analyzed with content analysis.

Results: The findings indicate that Bangladesh should be prepared to implement the Global Standards for Midwifery Education Accreditation Programmes. The assessment strategy has prepared the faculty for accreditation and paved the way through the development of standards in the tool, overcoming barriers, and using the possible facilitators.

Conclusion: There are remaining challenges in Bangladesh regarding "moving midwifery". Midwifery teachers demand for separate faculty from nursing. Promotion system for careers development can be initiated. Updating teachers knowledge, having adequate number of teachers with competencies, and maintained collaboration between teaching and clinical practice organizations are important for "moving midwifery" in Bangladesh.

Clinical application: The present study results can be useful for midwifery education and clinical practice improvement.

Background: Fear of childbirth can be classified as low fear or worry, moderate fear and severe fear of childbirth. The prevalence of severe fear of childbirth among pregnant women is estimated to be 14 percent globally. Consequences of fear of childbirth is not wanting to have another child, involuntarily long time between pregnancies and more pain during labour.

Method: Qualitative meta- synthesis with meta-ethnographic analysis method. Databases that was used to find the articles were PubMed, Cinahl, Web of Science and PsycINFO. Totally 15 articles are included in the meta-synthesis after a quality review.

Results: Four main themes were identified Description of fear of childbirth, Fear of their own health and the uncontrollable, Fear associated with meetings with healthcare and Fear of the health of the child. Also six subtopics were identified, The unpredictable, Not having control, The physical health, Pain, Encounters with midwives and other healthcare professionals and interventions.

Conclusion: The results showed that the most common fear among pregnant women with fear of childbirth were fear of tearing, pain and the health of the baby. The women with fear of childbirth is also afraid of encounter a midwife who would give inadequate support.

Clinical implications: This meta-synthesis shows it is of huge importance to identify fear of childbirth in early pregnancy to promote health and reduce fear of childbirth. To help these women, the midwife may propose parental education for women who feel anxious or afraid of childbirth. This training could include study visits to a maternity ward as well as information on the most common fears and measures taken if complications should occur.

Background:

Women die from preventable causes during pregnancy and childbirth and often in relation to delays in midwifery care. Professional hierarchies might hamper the rights and desires of midwives in provision of normal birth in terms of the provision of quality care to all women and newborns. In health systems where decision making in normal births are influence by doctors this is particularly relevant, with women themselves subordinate to all health care professionals. Aim: The aim of this meta-synthesis was to examine women’s and health care provider’s perceptions and experiences of bottlenecks in midwifery care related to availability, accessibility, acceptability and quality of midwifery care. Method: This study was a qualitative meta-synthesis with a deductive approach, 15 article were selected for this qualitative meta-synthesis. A framework for the evaluation of quality of care and coverage of health services was used for the deductive approach. Results: Four categories emerged based on availability, accessibility, acceptability and quality of care. The delays were due to less awareness of danger signs of severe complications in the community, and delays in decision making by male family members and less empowerment of women, and lack of collaboration between health care professionals. We also identified how to overcome this situation. Conclusion: Midwifes may provide quality maternal care to all women and children and earn trust from community people to promote normal pregnancy and birth and prevent delays when complications arise. Clinical implications: Midwives can provide continuity care and through collaboration with other health care professionals advocate for women empowerment.

Background:

Four million infants die with in the first month of life and 27% of these deaths are directly related to low birth weight (LBW) or preterm birth. The main causes of infant death in premature and LBW infants is neonatal infections. It is thus crucial that the infant is taken care of in an appropriate way regarding caring and feeding and that care is provided to improve the child’s chances of survival and to lay the foundation for a healthy life. Aim: The aim of this meta-synthesiswas to examine parent`s and health care providers perceptions and experiences of supportive care in neonatal wards. Method: A qualitative meta-synthesis based on peer-reviewed scientific literature, and meta-ethnographic analysis method. In this meta-synthesis 16 articles were included. Result: The results comprised of two categories, Parents’ perspective of supportive strategies with eight corresponding preliminary patterns and Health care providers’ perspective of supportive strategies with six corresponding preliminary patterns. In the result section, each categories are presented with its corresponding preliminary patterns. The mothers experienced that the baby was unstable and therefore they wanted to be close to the baby at all times if something happened. Important was closeness to the infant is important, parental support according to needs, adequate communication and information with parents, genuine caring and continuous support to get close to the child. It also meant less light and less noise and privacy for the infant and the parent in the NICU ward.

Conclusion

Parents wanted to be able to be with his infant as rapidly after birth be reunited in case something happened. The importance of receiving information about their infant’s condition underpinned all communications that the parents undertook with NICU staff both in co-care when together with the child and part-care, when separated. Information for the parents was an important requirement of accepting their situation and immediately affected their anxiety. Clinical implications: The organizers of care must take in account that parents and infants will not be befitted by being cared for apart from each other. When planning for co-care enabling infants to be close to the parents, the mother-baby dyad should be prioritized. Context specific interview studies are suggested on co-care and part-care, parents and care providers perspectives.

Background: Four million infants die with in the first month of life and 27% of these deaths are directly related to low birth weight (LBW) or preterm birth. The main causes of infant death in premature and LBW infants is neonatal infections. It is thus crucial that the infant is taken care of in an appropriate way regarding caring and feeding and that care is provided to improve the child’s chances of survival and to lay the foundation for a healthy life. Aim: The aim of this meta-synthesiswas to examine parent`s and health care providers perceptions and experiences of supportive care in neonatal wards. Method: A qualitative meta-synthesis based on peer-reviewed scientific literature, and meta-ethnographic analysis method. In this meta-synthesis 16 articles were included. Result: The results comprised of two categories, Parents’ perspective of supportive strategies with eight corresponding preliminary patterns and Health care providers’ perspective of supportive strategies with six corresponding preliminary patterns. In the result section, each categories are presented with its corresponding preliminary patterns. The mothers experienced that the baby was unstable and therefore they wanted to be close to the baby at all times if something happened. Important was closeness to the infant is important, parental support according to needs, adequate communication and information with parents, genuine caring and continuous support to get close to the child. It also meant less light and less noise and privacy for the infant and the parent in the NICU ward.Conclusion Parents wanted to be able to be with his infant as rapidly after birth be reunited in case something happened. The importance of receiving information about their infant’s condition underpinned all communications that the parents undertook with NICU staff both in co-care when together with the child and part-care, when separated. Information for the parents was an important requirement of accepting their situation and immediately affected their anxiety. Clinical implications: The organizers of care must take in account that parents and infants will not be befitted by being cared for apart from each other. When planning for co-care enabling infants to be close to the parents, the mother-baby dyad should be prioritized. Context specific interview studies are suggested on co-care and part-care, parents and care providers perspectives.

Background: Along with the Sustainable Development Goals (SDG) 3 and 5, the global effort is highly focused on evidence-based practice and respectful maternity care to reduce maternal and newborn mortality and morbidity. In Bangladesh disrespect and abuse against mothers during intrapartum period is common and the midwifery profession was introduced in 2013. The aim of this study is to define the concept “Respectful Care during labour and birth” through the synthesis of text from literature and interview with Bangladeshi health care providers. Methods: The study was done through a concept analysis from the literature and 10 semi-structured interviews with third-year midwifery students, clinical midwives and midwifery faculty. Results: The study found that in low-income countries women are more vulnerable to disrespectful care in various ways like physical and verbal abuse. Midwives provide only non-harmful care, due to poor salary, and lack of quality higher education. Private hospitals and midwife led-care centers provide better service than government hospitals. Conclusion: Midwives play a vital role to ensure respectful care for a mother during labour and childbirth. Clinical implications: The findings could be helpful to develop the profession for countries where the midwifery profession is new, like in Bangladesh

Background: The best birthing position for women to adopt during labour and birth is to vary the positions freely depending on the stages of labour. The aim of this study was to define the concept ‘upright position during labour and birth’ through the synthesis of texts from literature and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning, enabling comprehension and use of the concept in clinical practice and education.Methods: This study design was concept analysis. The setting was three different nursing institutes/colleges and nearby hospitals. Nine participants were invited to participate in an individual in-depth interview (IDI) with semi-structured open-ended questions. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically clarified in the fieldwork phase in the midwifery context of Bangladesh, described with the Quality Maternal and Newborn Care (QMNC) framework components.Results: The concept of upright position during labour and birth in the midwifery context was redefined. Altering between positions widening the pelvic relief labour pain for the woman, potentially resulting in a normal birth with a healthy mother and baby. Women do not expect upright positions in facility-based births but at homebirths.Conclusion: The women’s rights to spontaneously and freely move while in labour, altering between different vertical positions are associated with the midwives’ work “with women” supporting the women.Clinical implications: It is a simple intervention to apply in clinical setting and simple to teach to nurses, midwives and physicians and in graduate and postgraduate education.

Background: Fear of childbirth affects about one-fifth of all pregnant women and midwives face these in their work.

Aim: The aim was to analys the concept fear of childbirth from a midwife perspective.

Methods: A concept analysis with a hybrid model. First a theoretical phase with a search for literature, thereafter a fieldwork phase where five midwifes where interviewed followed by a final analytic phase.

Results: Fear of childbirth is something that can affect women before, during or after pregnancy and childbirth. Fear of childbirth for primiparous women can be a lack of confidence in her ability to give birth, and for multiparous women have had a previous traumatic birth experience. The midwives described that fear of childbirth was a complex concept. Women did not usually use the word fear of childbirth, but the midwives interpreted what they noticed or saw in the woman as manifestations of fear of childbirth.

Conclusion: Midwives use the concept in different ways and call for a clearer definition and way of working with fear of childbirth. The fear of childbirth is a great suffering for the pregnant woman and therefore the authors of this thesis consider that preventive work is important and that the midwife has a central and important role.

Clinical Applicability: Midwives can use this study to develop their knowledge of fear of childbirth and see how other midwives view on the concept fear of childbirth.

Background: Yoga during pregnancy has become increasingly popular in Sweden and the western world in recent years. Earlier studies suggest that yoga for pregnant women may increase well-being during pregnancy, reduce fear for giving birth and increase prenatal attachment. Today, yoga for pregnant women is available at private yoga and fitness centres and at certain maternity clinics. However, there seems to be a gap of knowledge about midwifes experiences of working with yoga for pregnant women. Aim: Describe midwives experiences of working with prenatal yoga. Method: Eight semistructured interviews were conducted with midwives who have experience instructing yoga classes during pregnancy. Qualitative content analysis was used for analysis of the material. Result: Four main categories were identified. The categories were Birth Preparation, Well-being during Pregnancy, Prenatal attachment, and Contraindication or Adjustment. Furthermore, there were 11 subcategories and an overall theme: Sense of security and Trust. Conclusion: The midwives experience that yoga during pregnancy can contribute to increased well-being, both mentally and physically, establish prenatal attachment and prepare the pregnant women for childbirth. The midwives emphasize that their professional experiences in midwifery contributes to a deeper dimension in the yoga classes, enabling a safe practise during pregnancy. Clinical application: The study can inspire midwives to work with, or recommend prenatal yoga and inspire to further studies.

Background: Every year, about 2.6 million stillbirths occur globally. The majority occur in low- or middle-income countries. In 2018, 442 babies died before birth in Sweden. This means that Sweden have the highest proportion of stillbirths in the Nordic countries. It is a clear difference in proportion of stillbirths within Sweden´s regions and countries, which indicates opportunities to lower the number of stillborn babies nationally. Over the past 10 years, the number of stillborn in Sweden has been relatively constant.

Aim: The aim for this study was to describe parent’s experience at the time of the diagnosis that the baby died before birth.

Methods: Qualitative meta-synthesis. In total, 16 scientific studies were analyzed and qualified for this study. Data was analyzed by meta-ethnography.

Results: Three main themes were identified. The Diagnosis, with subthemes; When every second is an eternity, Emotions that occur, Alone in silence and Not realizing the worst. The second main theme was The needs of parents with subtheme; Confirmation, The possibility to have impact on the care and The impact of the environment. The last main theme was Communication, with subthemes; Clear and empathetic and The unspoken.

Conclusion: The parents experienced a waiting for the diagnosis, the next step and meeting their child. The diagnosis brought up a lot of emotions and reactions. The parents experienced loneliness in a situation that they could not control. The parents expressed a need for validation for themselves and their child. The environment influenced the way the parents handled the diagnosis. They needed to stay in a secluded part on the maternity ward. Parents expressed a need for open, clear and empathetic communication.

Clinical applicability: The study can provide and increased knowledge to midwives and other caregivers who are encounters of the parents at the time of the diagnosis.

Background: Postpartum depression is a condition that affects up to 15 percent of women in               Sweden after childbirth. Untreated, this condition can have a negative effect on the health of both                the woman and the child. Midwives have an important role in identifying women who have               developed or are at risk of developing postpartum depression. ​Aim: ​To describe women's             experiences of postpartum depression. ​Method: ​Qualitative metasynthesis with metaethnographic         analysis method. Data was collected through three databases; PubMed, CINAHL and PsycInfo. A             total of 17 articles are included in the result of this metasynthesis, of which all of them passed a                   thorough quality critique.​Results: Four themes were identified;Achangingidentity,Anewroleas               a mother, A hindered bondingandAnemotionalstorm.​Conclusion:​Duringpostpartumdepression             women experience feelingsoflosingtheiridentity,difficultiesadaptingtomotherhood,problemsin             bonding with the child as well as a rollercoaster of emotions.Themidwifehasanimportantrolein                  prevention and early identification of postpartum depression. ​Clinical implications: This          metasynthesis can be used by midwives working in maternity care, as atooltoimprovethequality                 of care for women who have developed or are at risk of developing postpartum depression.

Background: How the midwife treats the women impacts her experience of childbirth. Women with GDM experience the diagnosis as stressful and worrisome, time-consuming and they wish for a pregnancy without GDM. The number of studies about their childbirth experience is low. Aim: A comparison of the self-assessed childbirth experience between women with a normal pregnancy and women with a GDM-diagnosis. To identify factors that can impact on the childbirth experience. Methods: A retrospective cross-sectional study. Data was collected thru a survey, using the VAS-scale, and registerdata from MFR. A total of 391 participated, 326 with a normal pregnancy and 65 with GDM. The material was analyzed using parametric and non-parametric statistics. Result: A total of 36,1% had a negative childbirth experience. It was more common within the GDM-group (55,4%) to have a negative experience than for women with a normal pregnancy (32,2%). Factors correlating with a negative experience was, a high BMI, born outside of Sweden, primiparous and if the women were unsatisfied with the provided pain-relief. Conclusion: Women with a GDM-diagnosis has a significantly more negative childbirth experience, factors related to pregnancy and childbirth showed a correlation with a negative childbirth experience. Clinical application: The results can be used to improve healthcare for women with GDM to contribute to a more positive childbirth experience.

Background: A planned home birth is defined as a birth that during the pregnancyis planned to take place at home or in a homelike environment outside the hospital,with the support from a midwife. The prevalence for planned home births variesglobally. In the Nordic countries the rate of planned home births is low, while in theNetherlands for example home birth is much more common. The reason why womenchoose a planned home birth is that they believe they will have more control overthe birth if they are at home, they want to avoid unnecessary interventions and theywant to give birth in a familiar setting. Aim: The purpose of the metasynthesis is todescribe women’s experiences of planned home birth. Method: A qualitative metasynthesis with meta-ethnography as tool for the analysis. The data collectionwas executed in the databases Cinahl and Pubmed. A quality check was made andin the end 17 studies were included in the result. Result: Three main themes wereidentified; To have the authority in one´s own hands, The habitat of the natural birthand To rest in the hands of the midwife. Conclusion: Women who had experienceda planned home birth felt that they had control over the birth, felt that they couldlisten to their bodies and follow their instincts and that they had a midwifesupporting and guiding them. Focus were on the natural birth without unnecessaryinterventions. Some women had negative experiences which were when they feltsome of these aspects were lacking and this led to a negative perception of the birth.Clinical implications: The result increases the understanding of the women´sexperiences of planned home birth and also the importance of getting to choose birthenvironment by yourself. The increased understanding could contribute to changein the clinical guidelines considering home birth in the different regions.

Objective

In this paper settings from Nepal and Somalia are used to focus on the perspectives of healthcare providers within two fragile health systems. The objective of this study was to describe barriers inhibiting quality healthcare in Nepal and Somalia from a health workforce perspective.

Methods

Data were collected through 19 semi-structured interviews with healthcare providers working in healthcare facilities. Ten interviews were conducted in Nepal and nine in Somalia.

Results

Various structural barriers inhibiting the availability, accessibility, and acceptability of the quality care were similar in both countries. Barriers inhibiting the availability of quality care were linked to healthcare providers being overburdened with multiple concurrent jobs. Barriers inhibiting the accessibility to quality healthcare included long distances and the uncertain availability of transportation, and barriers to acceptability of quality healthcare was inhibited by a lack of respect from healthcare providers, characterised by neglect, verbal abuse, and lack of competence.

Conclusions

Inequality, poverty, traditional and cultural practices plus the heavy burden placed on healthcare providers are described as the underlying causes of the poor provision of quality care and the consequential shortcomings that emerge from it. In order to improve this situation adequate planning and policies that support the deployment and retention of the healthcare providers and its equitable distribution is required. Another important aspect is provision of training to equip healthcare providers with the ability to provide respectful quality care in order for the population to enjoy good standard of healthcare services.

Bakgrund: Sexuell hälsa definieras som ett tillstånd av fysiskt, psykiskt, emotionellt och socialt välbefinnande i relation till sexualitet. Att uppnå god sexuell hälsa är viktigt för kvinnors livskvalitet. Barnafödandet innebär en stor omställning i kvinnan och hennes parters liv. Det finns önskemål från kvinnor att samtala mer om den sexuella hälsan med sin barnmorska. Syfte: Syftet med denna studie var att beskriva kvinnors upplevelse av sexuell hälsa efter en förlossning, oavsett förlossningssätt. Metod: Kvalitativ metasyntes med metaetnografisk ansats. Datainsamling utfördes i databaserna CINAHL, PubMed och Web of Science. 15 artiklar kvalitetsgranskades och ingick i metasyntesens resultat. Resultat: Fyra huvudkategorier: Påverkad kroppsuppfattning, Sexuellt umgänge efter förlossning, Barnet i fokus samt Stöd och information. Till dessa följde sex underkategorier: Förändrad självbild, Bröstens tudelade syfte, Tidpunkt för återupptagande, Problem som uppstår, Från barnmorska och annan vårdpersonal och Från närstående. Slutsats: Kvinnors sexuella hälsa påverkas efter barnafödande. Kvinnors fysiska och psykiska mående påverkas, men även relationen till partnern. Kvinnor upplever brist på stöd och information från barnmorskor och annan vårdpersonal. Klinisk tillämpbarhet: Resultatet kan användas för att skapa en ökad förståelse och kunskap hos barnmorskor om vikten av kvinnors sexuella hälsa efter barnafödande.

Background: The concept of ‘continuous labour support’ is a non-medical support, one-toone support and continuous presence. Aim: The aim of this study is to define the concept ‘continuous labour support’ through the synthesis of texts from literatures and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning enabling comprehension and use of the concept in clinical practice and education. Design: The study design is concept analysis with data consisting of written texts from literature and nine semi structured interviews in nursing institutes, nursing colleges and maternity wards in Bangladesh. Measurements and finding: The result of the fieldwork phase of this study regarding continuous labour support has been categorized according to the midwifery and quality care model developed. The main challenges are staff shortages, heavy workload, and low level of autonomy in medical hierarchy and insufficient and interrupted supplies. Conclusion: Continuous support during childbirth is an important and essential component of midwifery practices, but it is not widely and universally practiced in the Bangladeshi hospitals due to different policy levels and contextual causes. Clinical implications: Practical findings from the concept analysis confirms the relevance of the concept in the midwifery context.

Background: Midwifery education has been provided in Bangladesh since 2013. Midwiferycare includes family planning, normal physiological process of pregnancy, birth, and thepostpartum period up to six weeks including newborn care. The aim is to define the concept“Family planning advice during postpartum care” through the synthesis of text from literatureand interview with Bangladeshi health care providers.Methods: This study design is a concept analysis from the literature and nine semi-structuredinterviews with third-year midwifery students, clinical midwives and midwifery faculty.Results: The results of the concept analysis are the description of the concept "familyplanning advice during postpartum care” through the lens of the Quality Maternal andNewborn Care Framework (QMNCF), as well as barriers and possibilities of the concept inthe Bangladeshi context.Conclusion: The study provided descriptions useful for the teaching of midwifery students,different family planning methods and they could be more clearly described in curriculum andsyllabuses. There has not been other similar studies done in the new midwifery context ofBangladesh.Clinical implications: The findings of this concept analysis is of relevance to the midwiferycontext.

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:

Many women sustain a second-degree tear when giving birth vaginally. The work field of a midwife includes managing these injuries. There is limited research regarding this field and the focus tend to be on third- and fourth-degree tears, even though second-degree tears may also result in long-term complications.

Aim:

The aim was to investigate the midwife’s experience of managing second-degree tears.

Method:

Eight semi-structured individual interviews were conducted with midwives working at a medium large maternity ward located in the middle of Sweden. Qualitative content analysis was used to analyze the material.

Results:

Four categories and two subcategories were identified. The categories were: Information, The support of colleagues, The need for follow-ups and Physical examination and the subcategories were: Feedback strategies and Documentation.

Conclusion:

The result show that midwives feel insecure when managing second-degree tears, especially the midwives with less experience. The midwives also requested more feedback from the women they sutured regarding their second-degree tears and the midwives also wished for a better follow-up for the women with second-degree tears. The result also showed that the midwives give different information to women regarding their tears. No pronounced routines were found regarding what information to give and in what way.

Clinical application:

The results of the study aim to increase the knowledge and to develop routines regarding second-degree tears. More knowledge is needed about information given about the tear and when it is the best time to give information.

Background: Newborn infants are sensitive and the neonatal mortality remains high in low resource settings for various reasons such as hyperthermia, hypoglycemia and infections. In both low and high income settings the bonding is important for children in the long run. Skin-to-skin care of the newborn both enhances the infant’s wellbeing and health.Aim: The aim of this meta- synthesis was to describe family members’ care of the newborn after birth, during maternal-infant separation or in the presence of the mother.Methods: Methasynthesis with metaethnography as analysis method. 15 scientific articles are included.Result: The content of the care provided is presence, emotional and practical support to the newborn. In presence, close body contact or preferably skin-to-skin contact is the main caring activity. Emotional support is provided through the presence when consoling the baby. Practical support is provided by changing diaper, through breastfeeding support etc. practical activities which in turn enhance emotions (bonding).Conclusion: The mother to the newborn should provide skin-to-skin care immediately after birth of the infant. When this is not possible the father or another family member such as grandmother, sister, or aunt could be close to the infant.Clinical implications: The results from this study can be used to foster midwives to provide evidence based care of the newborn including close contact and preferably skin-to-skin contact with the mother, father or other family member after birth. This to enhance health and wellbeing of the newborn. This thesis could be a lecture in the midwifery education.

Background: Since poverty and lack of transportation make it hard for people to have access to hospital care, it is common that a pregnant woman deal with her pregnancy, childbirth and postpartum time on her own or with help of family members. This is the most vulnerable period of a woman life and knowledge about danger signs and signs of complications could be life-saving to women who are affected. Antenatal education is therefore suggested in various studies and relevant topics for such courses are expected to be reviled through the results of this study. Aim: The aim of this study was to describe topics and outline of a culturally tailored antenatal education to families in Nepal, illuminated by healthcare providers experiences. Methods: A qualitative design with semi-structured interviews was chosen. An interview guide was prepared beforehand with topics inspired by the Swedish antenatal education guide. A total of 26 interviews with healthcare providers including midwives, skilled birth attendants (SBA’s), medical doctors, village nurses or nurses, were conducted in both urban and rural areas in Nepal form province 3, 4 and 5. Findings: This study identified health care providers’ perceptions of what to include in a country contextual adjusted antenatal education/family support program to Nepali parents and potentially to other family members of the extended family. The descriptions of what to include in the parental education/family support program, provide a wide range of areas, this in a context where parental education does not exist. Five main themes were found; Course format and content, Pregnancy, Birth preparedness, Childbirth and postpartum. Conclusion: Increased knowledge and more involvement of fathers in pregnancy, childbirth and in the care of the child will promote equality between men and women in Nepal. Furthermore, it may empower women with self-confidence and their decision-making power regarding their own and their children’s health and wellbeing. Clinical application: This study may be used as an underlying document in the design of antenatal education for expectant parents and possibly extended family members in Nepal.

Background: A positive childbirth experience that meets the woman's expectations is more than giving birth to a healthy baby. The research often focuses on the medical outcome of childbirth. If one instead focuses on what maintains health as in the salutogenic model, one can gain increased knowledge about women's birth experience. Purpose: The aim of this study was to investigate sense of coherence in relation to women's feelings and health in connection with childbirth.   Methods: The method was a descriptive cross-sectional study. A questionnaire was answered 2–3 months after giving birth. 1193 women agreed to participate in the study and 738 women answered, giving a response rate of 62%.  Results: Women with a high SOC did to a higher extent describe their feelings of security, control, pride higher and estimated also their physical health and mental well-being higher. Women with low SOC rated to a higher extent that the staff contributed to a feeling of being ignored and failed during labour and birth. The result showed no significant differences between SOC and demographic data, parity or birth outcomes.  Conclusion: Women's experience of feelings and emotions during childbirth is connected to their sense of coherence. A higher focus is required to women with low SOC in order to improve their positive feelings during childbirth, and thereby contributing to increased physical and mental health.  Clinical applicability: SOC can be used as a screening tool during pregnancy to identify those women who need increased support during childbirth.

Background: Working as a midwife means being an important key to health and counsellor for women, their families and the community. Post conflict refer to the fragile situation occurring after a conflict. The effects of the war in Somalia led to a collapse of the health care system, with consequences for midwives catering for women before, during and after childbirth.

Purpose: To describe midwives’ experiences of becoming and being a midwife in the post-conflict setting of Somaliland.

Method: A qualitative and empirical interview study with inductive approach was chosen for this study to gain broader a view of midwives' experiences. Eleven individual interviews with midwives were analysed by thematic analysis.

Findings: Time as refugees and current social situation were factors that had shaped the midwives, as well as challenges in professional life related to lack of equipment and training, encountering women with low health status, and women in need of additional health education and awareness in general and in reproductive health. Improvement of women's health and rights was also described as a key part of the midwives' jobs.

Conclusion: Previous life experiences combined with challenges in working life and the desire to change and improve were of great importance for the midwives working in the post conflict setting of Somaliland and gave the them roles as changemakers for Somali women.

Clinical Applicability: This study can be used to increase the understanding of women’s health and the prerequisites for midwives and women living in, or originating from, a conflict or post conflict setting with experiences of war and displacement.

Background: Involuntary childlessness is a disability and a global problem affecting 10–15 percent of the population. Women's sexual and reproductive health looks different in the world and is affected by discrimination and gender inequality. Involuntary childlessness is seen in some parts of the world as a condition with medical cause and in other parts as a stigma and plays a significant role for women who are involuntarily childless.

Purpose: The aim of this essay was to describe women´s experiences of involuntary childlessness from a global perspective.

Methods: The method used in this essay was a qualitative metasynthesis with metaethnographic analysis method. A total of 17 articles were quality checked and used in the result.

Results: Five main categories with several subcategories were identified. The categories that were created were Psychological impact, Changing relationships, Support and the importance of health care services, Managing the new life situation and Thoughts about the future.

Conclusion: Involuntary childlessness affected women emotionally through grief, guilt, anxiety and lost identity. Childlessness affects women's relationships and could lead to isolation, exclusion and violations. Women perceived support from the partner important, found support from other infertile women and lacked support from the healthcare system. The life situation was handled through a religious belief or emotional handling.

Clinical applicability: The study could show an increased understanding of involuntary childlessness and sustained support for the midwife, who work globally with women and family planning. The work of midwives globally is also about strengthening women's rights. An understanding of women's experiences of involuntary infertility gives the midwife a tool to support women in their sexual and reproductive health.

Background: While setting international standards for midwifery education has attracted considerable global attention, the education and training of midwifery educators has been relatively neglected, particularly in low-resource settings where capacity building is crucial. Objective: The aim of this study was to describe the expectations of midwifery educators in Bangladesh who took part in a blended web-based master's programme in SRHR and the extent to which these were realized after 12 months of part-time study. Methods: Both quantitative and qualitative methods have been used to collect data. A structured baseline questionnaire was distributed to all participants at the start of the first course (n = 30) and a second endpoint questionnaire was distributed after they (n = 29) had completed the core courses one year later. At the start of the first course, five focus group discussions (FGD) were held with the midwifery educators. Descriptive statistics and content analysis were used for the analyses. Results: Midwifery educators who took part in the study identified expectations that can be grouped into three distinct areas. They hoped to become more familiar with technology, anticipated they would learn pedagogical and other skills that would enable them to better support their students' learning and thought they might acquire skills to empower their students as human beings. Participants reported they realized these ambitions, attributing the master's programme with helping them take responsibility for their own teaching and learning, showing them how to enhance their students' learning and how to foster reflective and critical thinking among them. Conclusions: Midwifery educators have taken part in a creative learning environment which has developed their engagement in teaching and learning. They have done this using a blended learning model which combines online learning with face-to-face contact. This model can be scaled up in low resource and remote settings.

To record the variation of perceptions of midwifery faculty in terms of the possibilities and challenges related to the completion of their first online master's level programme in Sexual and Reproductive Health and Rights in Somaliland. The informants included in this phenomenongraphical focus group study were those well-educated professional women and men who completed the master's program. The informant perceived that this first online master's level programme provided tools for independent use of the Internet and independent searching for evidence-based information, enhanced professional development, was challenge-driven and evoked curiosity, challenged professional development, enhanced personal development and challenged context-bound career paths. Online education makes it possible for well-educated professional women to continue higher education. It furthermore increased the informants' confidence in their use of Internet, software and databases and in the use of evidence in both their teaching and their clinical practice. Programmes such as the one described in this paper could counter the difficulties ensuring best practice by having a critical mass of midwives who will be able to continually gather contemporary midwifery evidence and use it to ensure best practice. An increase of online education is suggested in South-central Somalia and in similar settings globally.

In Somaliland, women’s perceptions of barriers to accessing antenatal care is sparsely described, particularly with regard to marginalized women. The aim was to investigate perceptions of barriers to accessing antenatal care from the perspective of pregnant women living in Internal Displaced Persons camps. Individual semi-structured interviews with fifteen women were conducted and analysed using content analysis. The overriding theme was “With knowledge and support, women can attend antenatal care”.  The findings highlighted that to obtain antenatal care, it is crucial for women to have knowledge and trust regarding antenatal services, a supporting environment, and ways to overcome practical barriers, such as patient fees and long waiting hours. If women and families received relevant information about the structure and benefits of ANC, they would probably prioritize ANC, given that the care is tailored to each woman’s needs. For this, community awareness and trust between women, families and ANC providers are central.

Background: The abdominal muscle separation between the two rectus abdominis muscles is also known as diastasis recti (DrA) and expands during pregnancy. The duration of the natural recovery takes approximately eight weeks postpartum, but for some people the separation will remain much longer. In this paper, the diastasis will be referred as an increased DrA. According to ICM, midwives should be able to identify what deviates from normal, and if necessary, to collaborate and refer to other professionals. Aim: The aim of the study was to explore midwives and physiotherapists experiences regarding meeting women with increased diastasis recti after pregnancy.Method: A qualitative content analysis with Malteruds method systematic text condensation (STC) of focus group interviews were conducted with a total of nine physiotherapists and seven midwives around Sweden.Results: Four overall areas were identified; Increased body awareness in today's society, Views of increased DrA as a symptom of illness, The lack of knowledge about increased DrA and the acquisition of knowledge through own interest and Views on professional responsibility and the desire for cooperation and guidelines.Conclusion: Midwives and physiotherapists say they lack experience and knowledge regarding increased DrA. National guidelines and a more improved collaboration is needed for safer patient care.Clinical application: The study can inspire workplaces to invest in interprofessional training and establish guidelines based on more extensive research.

Background: Fear of childbirth can be stressful for women, occurs in varying degrees of severity and can lead to negative birth experience. The incidence of fear of childbirth varies between different countries, which to some extent can be explained by different measurement methods. The midwife is a person of significance for women with fear of childbirth. Objective: The purpose of this study was to investigate women's experiences of a midwife's support during fear of childbirth. Method: Qualitative meta synthesis using meta-ethnographic analysis method, where articles were searched in the databases PubMed, CINAHL, Google Scholar, Scopus, Web of Science and PsycINFO. After a quality review, 15 articles were analyzed. Result: Three categories with correlating patterns were identified; A present midwife and a competent midwife where the women's experience of the midwives support contributed to alleviate childbirth fear; Category a distant midwife with correlating patterns displays experiences that tended to increase childbirth fear. Conclusion: The results display the importance of the women's experience of a present and competent midwife for the women to feel safe and dare trust that she can give birth. A continuous support at childbirth and education for the staff that encounters women with fear of childbirth is needed. Caseload could be one model that needs to be implemented in the midwives work.

Background: For many women in developing countries, the possibility of giving birth elsewhere than in the home may be lacking, however, it is a voluntary choice in middle- and high-income countries. In Sweden, planned home birth is not included in the Swedish health care system. Previous research describes both the advantages and disadvantages of planned home birth. A few studies have compiled midwives' experiences of working with planned home birth.

Aim: To investigate midwives' experiences of working with planned home birth in middle- and highincome countries

Method: Qualitative metasynthesis with meta-ethnography as method of analysis. 15 articles were included in the result. Articles were searched in CINAHL, PubMed, Web of Science and Google Scholar.

Results: The synthesis resulted in three main themes; to be with the woman where a good relationship with the woman is highlighted. The belief in the normal describes that birth should have its natural course and that medical interventions should be avoided if there are no indications for it. In the headwind, the difficulties that can arise for midwives working with home birth are described.

Conclusion: The midwives felt that the home was the place most associated with natural childbirth. A calm and safe environment is advantageous for both the midwife and the woman during childbirth. Allowing childbirth to take time, maintaining it as naturally as possible and reducing or completely refraining from medical interventions will result in constant development of the midwife's professional profession.

Clinical applicability: The study's results show that a calm and safe environment for delivery has an impact on the woman and her natural conditions for giving birth. This can advantageously inspire the work not only within home birth but also in childbirth care overall.

Background: More than 100 000 women worldwide dies every year due to pregnancy, childbirth or abortion. Countries worldwide are continuously working towards the global goals to prevent maternal mortality. In Sweden, many women who give birth get to stay at a postnatal care unit for a few days after childbirth due to complications to the mother or the baby. Every day, midwives meet women who have a normal or a complicated pregnancy and childbirth. Postnatal care is a central part in midwifery practice. Aim: The aim of this study was to describe women's experience of postnatal care after having a complicated pregnancy or labor in a Swedish hospital. Method: The study design was a quantitive and qualitive survey study where the authors used previously collected data. Questionnaires were compiled in SPSS and the qualitative data was analysed with a text analysis. Result: The majority of women were satisfied with the postnatal care they received. They experienced that they got great support from the medical staff during their stay at the hospital. No significance was found in satisfaction between the care units at the hospital. Women who had their partner with them at the postnatal care unit were more satisfied than women who didn´t. Areas for improvement in postnatal care were identified. Conclusion: Despite the limited selection with women who had complications during pregnancy or childbirth, the result showed that most women were satisfied with the postnatal care they received. Quality of care improvement in some areas can be done, such as, routine information on each unit, pediatric examination and breastfeeding support. Clinical applicability: It is essential for women with complications during pregnancy or labor to have an individualized care. Postnatal care is very important for the woman's holistic experience. Therefore, it is vital that the midwife has knowledge and can further develop her professional knowledge.

Background:

Breastfeeding is recommended by both international and national

authorities. The breast milk contains all the nutrients the child needs during the

first six months and has also been proven to protect against a number of diseases.

Despite the recommendations, breastfeeding decreases. Studies that investigated

why have shown that many factors fall under the concept of self-efficacy. Thus,

women's breastfeeding self-efficacy is an important factor to study. Breastfeeding

is under the midwife's area of competence and a majority of all first time parents in

Sweden are preparing for parenting through parental prepatory course.

Aim:

The purpose of this study protocol was to formulate detailed project plan for

a pilot study to investigate how breastfeeding self-efficacy change among women

who participate in parental prepatory course through the maternity healthcare.

Method:

A quantitative approach with prospective longitudinal design. By

Breastfeeding Self-Efficacy Scale Short Form (BSES-SF), a validated instrument

for measuring breastfeeding self-efficacy, women's breastfeeding self-efficacy is

planned to be measured before and after the course and eight weeks postpartum.

Also socio-demographic data is planned to be collected.

Discussion:

A detailed method discussion was conducted to discuss the

advantages and disadvantages of the chosen method. Also, the method discussion

presents how other designs and plans for how future major studies may be

conducted to investigate women's breastfeeding self-efficacy.

Background:

Sexual and reproductive health is a human right and involves the right to make decisions concerning your own body and care. The midwife mostly meets and care for women and have an important role in defending and advocating women’s rights. Today there are global political influences that restricts women’s rights even though Sweden is considered to be one of the world’s most equal countries, there can be structures and factors in the Swedish society that affects women’s ability to make decisions about their own bodies in a negative way.

The aim:

To investigate midwives perceptions and experiences concerning professional, sociocultural and health economic barriers for women regarding decisions about their own bodies.

Method:

A qualitative content analysis with a deductive approach. Data from eight semi structured interviews with Swedish registered midwifes, active in different areas of the midwife profession, was analyzed based on the framework "What Prevents Quality Midwifery Care".

Result:

The professional barriers that the midwives perceived resulted in three subcategories: "Laws, clinical guidelines and policies", "Knowledge, education and profession" and "Caretakers personal opinions and commitment". Sociocultural barriers were categorized in: "Politics, equality and the society’s ideals", "Culture, religion and family relations", "Language" and "Personal abilities". The health economic barriers were divided in to: "Lack of time and staff" and "Costs and resources".

Conclusion and clinical applicability:

This study shows that there are professional, sociocultural, and health economic barriers that affects women’s autonomy in the Swedish society according to the midwives’ perceptions. The study can help caretakers increase their understanding and competence in meeting with women in care and help them strengthening their position in the society as well as on a personal level. This study can give a greater understanding for the midwife’s role when it comes to helping individuals in an exposed situation, by strengthen the women’s autonomy and sense of control. The study can also help caretakers to increase critical thinking regarding themselves in their own cultural context and preunderstanding for other individuals.

Background: A gynecological examination involves an examination of the woman’s internaland external genitalia. It is performed in cases of bleeding, pain, pap-smear testing andgynecological diseases. In Sweden, about 1.5 million gynecological examinations areperformed every year. Today, there is a lack of research on how the experience could bepositive for women. Aim: To describe women’s experiences of the gynecological examinationin health care. Method: A qualitative meta-synthesis analyzed with a meta-ethnographicmethod. The study includes 11 articles which were searched for in CINAHL, PubMed andGoogle Scholar. Results: The result are presented in two themes. From insecure toempowered shows that women’s degree of power and participation is affected by information,knowledge and communication. The presence of sexuality describes the women’s sexualexperiences, their sexuality and the gender of the examiner and how these affect thegynecological examination. Conclusion: Women who are well informed and who feel theyhave knowledge about the gynecological examination experience an increased power and agreater participation. Women’s sexual experiences, (hetero)sexuality and the gender of theexaminer affect women’s sense of security. Clinical applicability: By using the result,midwives can influence the different clinics to give more time for information and educationof women about the gynecological examination. Especially to the young women visiting theyouth clinics.

Background: Delayed initiation of breastfeeding for more than one hour after birth is associated with increased neonatal morbidity and mortality. Aim: The aim of this meta-synthesis was to examine women’s perceptions and experiences of barriers and facilities for breastfeeding initiation during the postpartum period. Method: The study design was a qualitative meta-synthesis focusing on maternal perceptions and experiences of breastfeeding initiation. Eighteen qualitative articles with several methodologies were included after assessment of relevance and quality. The analysis was based on meta-ethnographic method. Result: The meta-synthesis report identified three categories and 28 sub-categories. Category I: Barriers to establishing breastfeeding described factors that had an impact on breastfeeding initiation. Category II: Facilitators to establish breast-feeding describes supportive factors as experienced by the mothers to initiate breastfeeding. In Category III: Satisfaction maternal confidence for breastfeeding support services was identified. Conclusion: This meta-synthesis study identified factors that impacted maternal confidence. Based on these, it is recommended that there is a need for evidence-based practical knowledge regarding initiation of breastfeeding, social and community awareness, husband and family support, and prenatal and antenatal breastfeeding education. These factors also showed the importance of health workers and midwives providing skilled guidance on breastfeeding initiation and help to resolve difficulties. Clinical implications and further research: The findings from this study can be used for educational purposes, and to create awareness about the evidence for midwifery care. Further country specific research is suggested with both qualitative and quantitative approaches.

Background:

The breast milk supplies the baby with all the nutrition it needs and according to the WHO, breastfeeding is recommended as the only food during the first six months of life. Breastfeeding gives the child proximity, security and strengthening the connection. Studies have shown that women began to breastfeed as a result of breastfeeding education. Studies have also shown that there is a need and demand for breastfeeding educations.

The aim:

The aim was to describe what the educational Sensus breastfeeding course for becoming parents contains, how the course is ment to be evaluated and difficulties with the design. The aim was further to propose an improved design for how an evaluation of the Sensus breastfeeding course can be designed to find out how women's self-efficacy in breastfeeding is affected by a breastfeeding course during pregnancy.

Method:

The original plan is presented as a quantitative method and a proposal for an improved study design is presented as a qualitative method.

Conclusion:

According to the plan an evaluation of the Sensus breastfeeding course is planned to be conducted with a quantitative design, not going to give a fair and objective picture of parents self-efficacy in breastfeeding. Deficiencies are found in the original plan and they will be identified in the essay. A proposal for an improved design for evaluation of the Sensus breastfeeding course for becoming parents has been proposed.

Clinical applicability:

It is important to evaluate whether different interventions and programs can give the woman any benefit, if a breastfeeding course like in this case is recommended in the standard healthcare can give the woman an increased self-efficacy in her breastfeeding. It should also be reflected in whether the breastfeeding course should be recommended to all pregnant women enrolled in the maternal healthcare center by midwife despite the fact that the breastfeeding course not only is based on evidence.

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.

Background

: Midwives and nurses all over the world meet with and care for women who, for various reasons, are undergoing induced abortion. It may be a challenge that requires both knowledge and support for those working in abortion care.Objective: To describe midwives and nurses’ experiences of caring for women who undergo induced abortion. The word experience includes perceptions based on experiences. Method: The study was conducted as a qualitative metasynthesis using meta-ethnography as analysis of data. Twenty-seven (27) peer-reviewed scientific articles were included in the result. Result: Three main categories and ten different patterns highlighted the midwives and nurses' experiences of caring for women undergoing an induced abortion. These were doing a good job by being supportive, putting own values aside and with the goal to create good experiences for the woman. Barriers to qualitative abortion care included negative attitudes from the surroundings, own feelings, receiving the fetus and various issues at the abortion care clinics. The third category was the caregivers’ needs which included support and knowledge. Conclusion: The abortion-seeking woman is in need of support and non-judgmental attitudes from caregivers. Midwives and nurses need knowledge and support in the work of abortion care. Lack of support and knowledge can affect midwives and nurses’ attitudes towards induced abortion as a woman’s right, which in turn can affect the women in need of abortion care.

Background: Childbirth is a personal and individual journey that is different for every woman. Perception of the birth experience is thought to be influenced by many factors, the most significant of which may be the type of delivery. The second stage of labor (delivery or birth stage) starts from full dilation of the cervix or when the woman feels the urge to push to complete expulsion of the fetus. The care and support provided during this phase can have strong influence both on the birth giving experience as a whole and on the pregnancy outcome. Aim: The aim of this meta-synthesis was to examine women’s and family members’ perceptions and experiences of the second stage of labor in order to illuminate components of midwifery support they deemed ’supportive’. Method: This study design is a qualitative meta-synthesis. Qualitative articles were included and analyzed by meta-ethnographic method. electronic searches were performed using the following databases: CINAHL, Web of Science, Google, Pubmed and manual searches. After assessing for relevance and quality by Johanna Briggs Institute (JBI QARI) Critical Appraisal Checklist, 15 articles were included, synthesised and categorised in the analysis. Result: This meta-synthesis describes three main categories and fifteen sub-categories. The first category “A professional midwives” includes being skilled and competent, professional planning, motivate upright position of birth process, encourage the bonding between mother and baby, establish women empowerment, and performing quality of midwifery care. The second category: “A genuine encounter” includes being trustworthy, kind, and protective with a positive attitude, being sympathetic, knowledgeable about pregnancy, encouraging breathing exercises and develop birth plans, having good relationships. The 3rd category includes active communication, enhancing power of the father, accurate and clearly messages. Conclusion: The result of this study should support midwives in providing quality care to mothers during labor, thus providing satisfaction and positive experiences of the mother’s labor. Midwives can enhance fathers’ feelings of involvement and participation by attentiveness through interaction and communicating skills. Clinical implications: This study aim women/family members’ perception and experiences second stages of labor. There is a need to improving the educational status, improving policy and practice of health care program and facilitate the necessary resources. The second stage of labour are condition which have need to extra support and encouragement of women during the delivery as well as midwifery special care.

Background: The Government of Bangladesh recognizes the important role midwives play in preventing maternal and neonatal mortality and morbidity, and their integral link to improving maternal and neonatal health service provision. Thus Save the Children Mentors are created to support and introduce midwives in Bangladesh. The programs clinical mentors will play a critical role to ensuring in-service-training to midwives who provide services in midwife-led care facilities.

Aim: The aim of this study is to describe Save the Children mentors’ experiences of implementing midwifery model of care in clinical setting in Bangladesh.

Methods: A qualitative design was chosen. Fourteen interviews were performed with Save the Children Mentors’ in Bangladesh who were currently working in the Strengthening National Midwifery Program. Data was analyzed by inductive content analysis.

Results: There were all kinds of gaps in the organization of care, in care practices and in community awareness regarding attitudes and knowledge of the midwifery model of care. The Save the Children Mentors learnt how to overcome the hurdles over time while motivating, educating, mentoring, sensitizing and while communicating with manages, health care providers and community members on how to manage implementation of midwifery model of care.

Conclusion: It is important to contribute the government to improvements and fill the gap of evidence based care to implement midwifery model of care in Bangladesh. Save the Children mentors are making aware people to collaborate and support the midwives as it is a mandate of the government to implement the new cadre and gradually the situation is being changing.