From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women's experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women.
Theoretical models for health care practice are important both as tools for guiding daily practice and for explaining the philosophical basis for care.
The aim of this study was to define and develop an evidence-based midwifery model of woman-centred care in Sweden and Iceland.
Using a hermeneutic approach we developed a model based on a synthesis of findings from 12 of our own published qualitative studies about women's and/or midwives' experiences of childbirth. For validity testing, the model was assessed in six focus group interviews with 30 practising midwives in Iceland and Sweden.
The model includes five main themes. Three central intertwined themes are: a reciprocal relationship; a birthing atmosphere; and grounded knowledge. The remaining two themes, which likewise influence care, are the cultural context (with hindering and promoting norms); and the balancing act involved in facilitating woman-centred care.
The model shows that midwifery care in this era of modern medical technology entails a balancing act for enhancing the culture of care based on midwifery philosophies. The next step will be to implement the model in midwifery programmes and in clinical practice, and to evaluate its applicability.
OBJECTIVE: to describe midwives' experience of the encounter with women and their pain during childbirth. DESIGN: qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. SETTING: Sahlgrenska University Hospital, Göteborg, and Karolinska Hospital, Stockholm, Sweden in 2000. PARTICIPANTS: nine experienced midwives between 12 and 28 years of midwifery practice. KEY FINDINGS: the essential structure was described as a striving to become an 'anchored companion'. 'To be a companion' was to be available to the woman, to listen to and see her situation mirrored in her body, and to share the responsibility of childbirth. To be 'anchored' was to show respect for the limits of the woman's ability as well as one's own professional limits. Five constituents can further describe the essential structure: listening to the woman; giving the woman an opportunity to participate and to be responsible; a trusting relationship; the body expresses the woman's situation; and to follow the woman through the process of childbirth. IMPLICATIONS FOR PRACTICE: the basis for maternity care should give an opportunity for midwives to be anchored companions. This could be done by emphasising listening to the woman, participation, responsibility, a trusting relationship and a clear understanding of the professional limits and the limits of the woman's ability.
To describe and analyse midwives' experiences of doula support for immigrant women in Sweden.
Qualitative study, analysed using content analysis. Data were collected via interviews.
Interviews were conducted at the midwives' workplaces. One midwife was interviewed at a cafe.
Ten midwives, who participated voluntarily and worked in maternity health care in western Sweden.
The interview data generated three main categories. (1) 'A doula is a facilitator for the midwife' has two subcategories, 'In relation to the midwife' and 'In comparison with an interpreter', (2) 'Confident women giving support,' has two subcategories, 'Personal characteristics and attitudes' and 'Good support,' (3) 'Doulas cover shortcomings' has two subcategories, 'In relation to maternity care' and 'In relation to ethnicity'.
The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women's confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.
The aim of this study was to obtain a deeper understanding of midwives' lived experience of caring during childbirth in a Swedish context.
Ten midwives were recruited from one university hospital with two separate delivery units in western Sweden. Data were collected by both written narratives and interviews. With an inductive approach using a descriptive phenomenological method, the answers to the question: "Can you describe a situation in which you felt that your caring was of importance for the woman and her partner?" were analysed.
A general structure of the phenomenon of caring in midwifery during childbirth, including five key constituents: sharing the responsibility, being intentionally and authentically present, creating an atmosphere of calm serenity in a mutual relationship, possessing the embodied knowledge, and balancing on the borders in transition to parenthood.
This study emphasises how the midwives shared the responsibility and their possessed embodied knowledge of childbirth and how new unique knowledge was constructed together with the woman, child and her partner. The study has the potential to increase knowledge and understanding of midwives' lived experience of caring during childbirth and therefore has implications for practice, education, and research.
The experience of childbirth is an important life event for women, memories of which may follow them throughout life. The aim of the study reported here was to synthesize the results from four selected studies describing these experiences by focusing on women's and midwives' experiences of the encounter during childbirth, as well as experiences of pregnancy from the women's perspective. The setting was the Alternative Birth Care Centre (Sahlgrenska University Hospital, Goteborg) and Karolinska Hospital (Stockholm, Sweden). A qualitative method grounded in phenomenology and hermeneutics was used as a basis for the studies and synthesis. The essential structure may be conceptualized under the heading 'releasing and relieving encounters', which, for the woman, constitutes an encounter with herself as well as with the midwife, and includes stillness as well as change. Stillness is expressed as presence and being one's body. Change is expressed as transition to the unknown and to motherhood. In the releasing and relieving encounter, for the midwife stillness and change equals being both anchored and a companion. To be a companion is to be an available person who listens to and follows the woman through the process of childbirth. To be anchored is to be the person who respects the limits of the woman's ability as well as her own professional limits in the transition process. A releasing and relieving encounter implies a sharing of responsibility and participation for women. This may be understood as a unique feature, which differs from other caring encounters and should be further studied.
OBJECTIVE: to describe women's experiences of childbirth 2 years after the birth. DESIGN: qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. SETTING: interviews in the women's homes between 1999 and 2000, 2 years after the birth. PARTICIPANTS: 10 women, five primiparous and five multiparous, who had received care at the ABC centre, Sahlgrenska University Hospital, Göteborg, Sweden, between 1996 and 1997. KEY FINDINGS: the essential structure was described as 'an unavoidable situation, which was demanding for both control and loss of control; as going with the flow and at the same time taking command of oneself.' To be in this unavoidable situation may have caused feelings of helplessness if the women were experiencing that the process of childbirth was not progressing. Support and help from the midwife were central to women's ability to handle the situation. To have been in an unavoidable situation changed the women and was also empowering. However, the women's approach to childbirth, to go with the flow and at the same time take command of themselves, is not congruent with the common view of childbirth in Swedish society today. This describes childbirth as something entirely negative that should be handed over to professionals. Five constituents can further describe the essential structure: to be in a situation without return, to receive help, to be changed, to have a different experience and the experience is not in agreement with expectations. IMPLICATIONS FOR PRACTICE: the basis for maternity care should be influenced by women's long-term experiences of childbirth. This could be done by supporting women's own participation, the midwives' opportunity to take a central role, and factors that help women to receive an empowering and strength-giving experience of childbirth.