Transition to Motherhood of Puerperal Women With Preterm Birth in a Challenging Lifetime: Transition Theory-Based Study.

Background and purpose: Although the transition process to motherhood of mothers who gave birth preterm has been examined using other theories, no studies have yet utilized Meleis's Transition Theory (TT). The aim of this study was to examine the transition process of mothers who gave birth preterm according to Meleis's TT. Methods: This study is a holistic single-pattern qualitative case study. The qualitative research paradigm was used based on the 32-item Qualitative Research Reporting Consolidated Criteria checklist, a guide for qualitative studies. Face-to-face interviews were conducted with 10 preterm mothers using a semistructured interview form between February 2019 and December 2021. The thematic analysis analysis method was used for the data obtained. After the data were transcribed, all the documents were read, and the data were deciphered. Using the notes, the codings were themed as titles and subtitles according to Meleis' TT. Results: Three main themes were determined using Meleis' TT: facilitators and inhibitors of the transition process, response patterns to motherhood, and nursing care. Visiting the baby in the intensive care unit, touching, and expressing milk for the baby were found to be important milestones in the mothers' transition process. Conclusion: Mothers faced numerous problems after premature birth and required support to cope with the transition process. They attempted to adapt to the transition to motherhood with the support of nurses, husbands, and families. Implications for practice: The researchers stated that may assist a healthy transition process by supporting health professionals to understand the problems faced by mothers during the transition to motherhood and to provide nursing care according to mothers' needs.

Women's experiences of continuity of care from student midwives - A qualitative study from Norway.

OBJECTIVE: The study aimed to gain a deeper understanding of women's experience of continuity of care by student midwives during the childbearing process. METHOD: A qualitative approach was the design used in this study. In-depth interviews were conducted with nine women who had received continuity of care during their childbearing process by student midwives. The interviews were analysed with the help of systematic text condensation. The study was approved by the Norwegian Centre for Research Data (ref. 905085) and the Regional Research Ethics Committee (ref. 2019/608). FINDINGS: Continuity of care enabled a deep relationship between the woman and the student midwife and made the care provided more individualised, giving the woman emotional support and preparing her for birth. The presence of a student midwife during labour and birth who knew the woman's story made the woman able to focus on the birth process. Even when unexpected events occurred, the woman had a positive birth experience due to the relationship between her and the student midwife. Continuity of care made the women feel safe and taken care of and was the preferred model of care. CONCLUSION: Continuity of care contributes to individualised and personalised care, enabling all aspects of the woman's needs to be considered throughout the childbearing process. Due to the positive impact on the women in the present study, it is appropriate to implement a continuity of care model in midwifery education programmes. Further research should be conducted to examine how doing so would influence both student midwives and women.

Self-transcendence among adults 65 years and older: A meta-analysis.

INTRODUCTION: Self-transcendence is a human capacity for wellbeing by expanding one's personal boundaries and may act as a health-promoting resource among adults ≥65 years. Therefore, the objectives of this meta-analysis were to determine the mean score of self-transcendence based on place of residence and gender, and to evaluate the correlations of self-transcendence with meaning, sense of coherence, resilience and depression. METHODS: Based on inclusion criteria, 13 studies were included. Orwin Safe N and Egger's test assessed publication bias. The mean score of self-transcendence and the correlation coefficients of the selected variables were estimated by random effects models. RESULTS: The self-transcendence mean score (n = 1634) was low (M = 43.6) and a bit lower among those staying in care facilities (M = 42.8), but did not vary significantly across gender. The correlation coefficients were self-transcendence_depression (r = -0.40), self-transcendence_meaning-in-life (r = 0.53), self-transcendence_resilience (r = 0.50) and self-transcendence_sense of coherence (r = 0.28). The correlation coefficients, except for meaning-in-life, were homogeneous. CONCLUSION: In a health-promoting perspective, the concept of self-transcendence can help to better understand wellbeing among older individuals and provide guidance for health professionals in facilitating wellbeing and health. The concept and theory of self-transcendence can inspire health professionals in realising new health-promoting approaches to support older individuals in maintaining health, wellbeing and independency.

Early discharge from hospital after birth:How Norwegian parents experience postnatal home visits by midwives - A qualitative study.

BACKGROUND: According to the WHO, the quality of care is not conditioned by the length of stay at the postnatal ward. As long as the postnatal care provided is of high quality, it could be better for the family to stay in their home. AIM: Firstly, to examine parents' experiences of early discharge and home visits by the postnatal ward midwife, in cases where the mother and baby have been discharged within 24 h after birth. Secondly, to examine participants' motivation for opting for early discharge from the hospital. METHODS: 10 individual interviews were conducted, including five where both parents were present. The interviews were carried out 4-12 weeks after birth. The data were analysed using systematic text condensation. RESULTS: The choice of early discharge was influenced by external factors like a wish to be together as a family while receiving sufficient support from both family and midwife. Internal factors, like previous experience, were also significant. The presence and attitude of the midwife, both in professional and practical terms, affected how the parents perceived postnatal care. Home visits from the midwife also affected the parents' feeling of security. CONCLUSION: An offer of home visits from the midwife of the postnatal ward enables parents who wish to leave the hospital shortly after birth to receive the necessary care and support in the early postnatal period. This offer is suitable for healthy women who have given birth to a healthy baby and wish to return home not long after birth.

Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study.

INTRODUCTION: Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions. AIM: This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births. METHODS: In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method. FINDINGS: The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.

Epidurals during normal labour and birth - Midwives' attitudes and experiences.

BACKGROUND: Midwives have their own beliefs and values regarding pain during childbirth. Their preferences concerning labour pain management may influence women's choices. AIM: To gain a deeper understanding of midwives' attitudes and experiences regarding the use of an epidural during normal labour. METHODS: A qualitative approach was chosen for data collection. Ten in-depth interviews were conducted with midwives working in three different obstetric units in Norway. The transcribed interviews were analysed using Malterud's systematic text condensation. FINDINGS: The analysis provided two main themes: "Normal childbirth as the goal" and "Challenges to the practice, knowledge, philosophy and experience of midwives". Distinctive differences in experiences and attitudes were found. The workplace culture in the obstetric units affected the midwives' attitudes and their midwifery practice. How they attended to women with epidural also differed. An epidural was often used as a substitute for continuous support when the obstetric unit was busy. DISCUSSION: Midwives estimate labour pain differently, and this might impact the midwifery care. However, midwives' interests and preferences concerning labour pain management should not influence women's choices. Midwives are affected by the setting where they work, and research highlights that an epidural might lead to a focus on medical procedures instead of the normality of labour. CONCLUSION: Midwives should be aware of how powerful their position is and how the workplace culture might influence their attitudes. The focus should be on "working with" women to promote a normal birth process, even with an epidural.

Midwifery care based on a precautionary approach: Promoting normal births in maternity wards: The thoughts and experiences of midwives.

OBJECTIVE: The aim of this study was to gain a deeper understanding of the thoughts and experiences of midwives in the attempt to promote normal births in Norwegian maternity wards. METHODS: A qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Nine midwives at three different maternity wards in Norway participated in the study. The qualitative data were analysed with the help of systematic text condensation. RESULTS: The findings included two main themes: (1) "Individualized maternity care" (2) "A woman-centred and a biomedical perspective - a dilemma. Working in a small maternity ward increased the possibility for continuous support during labour and continuity of care throughout pregnancy, birth and the postnatal period. The midwives had a great desire to promote normal births with a minimum of interventions. Still, they adhered to an ideology based on both a woman-centred and a biomedical view of birth. Their work was often based on a precautionary approach in which problem-solving strategies were related to potential risks. CONCLUSION: The midwives experienced challenges, as they worked in an environment where different ideologies prevailed. They utilized the positive aspects of small maternity wards, like the opportunity for continuous support during labour and continuity of care during the childbearing process. Midwives should encourage discussions about their precautionary approach and the use of technology for low-risk women, while reflecting on their own views on normal births.

Women's experiences of home visits by midwives in the early postnatal period.

OBJECTIVE: The aim of the present study is to gain a deeper understanding of women's experiences of midwifery care in connection with home visits during the early postnatal period. RESEARCH DESIGN/SETTING: A qualitative approach was chosen for data collection, and the data presented are based on six focus group interviews (n: 24). The women were both primiparous and multiparous, aged 22-37, and lived with their partners. All participants had given birth at a maternity unit responsible for about 4000 births a year. The transcribed interviews were analysed through systematic text condensation. FINDINGS: The findings are reflected in three main themes: 'The importance of relational continuity', 'The importance of a postpartum talk' and 'Vulnerability in the early postnatal period'. When the woman had a personal relationship with the midwife responsible for the home visit she experienced predictability, availability and confidence. The women wanted recognition and time to talk about their birth experience. They also felt vulnerable in their maternal role in the early postnatal period and the start of the breast-feeding process. CONCLUSIONS: It is important to promote relational continuity models of midwifery care to address the emotional aspects of the postnatal period. Women generally wish to discuss their birth experience, preferably with the midwife who was present during the birth. Due to the short duration of postnatal care in hospitals, the visit from the midwife a few days after childbirth becomes all the more important.

How can midwives promote a normal birth and a positive birth experience? The experience of first-time Norwegian mothers.

OBJECTIVE: The purpose of this study is to gain a deeper understanding of the experience of first-time mothers regarding how the midwife may promote a normal birth and a positive birth experience. METHODS: A qualitative approach was chosen for data collection, and the data presented are based on in-depth interviews. Twelve healthy, first-time Norwegian mothers, aged 22-34, who had experienced a normal and positive childbirth were interviewed five to six weeks after giving birth. The transcribed interviews were analysed with the help of systematic text condensation. RESULTS: The findings included two main themes: "To be seen as an individual" and "Health-promoting perspective". The experience of being cared for by a midwife who provides presence is vital for the woman to be seen as an individual. When the midwife has a health-promoting perspective, she can more easily assist the woman in developing inner strength and coping strategies. CONCLUSION: Midwives have a pivotal role in helping to promote a normal birth and positive birth experience. The women consider the midwife's attitude and behaviour as essential for their ability to feel safe and cared for. The midwife's individualized and motivating approach promotes the women's inner strength and belief in their own capability to handle the birth. Based on this salutogenic view, the midwife must focus on the woman's resources in order to promote good health during the childbearing process.

Viewing the unborn child - pregnant women's expectations, attitudes and experiences regarding fetal ultrasound examination.

OBJECTIVE: To gain a deeper understanding of pregnant women's expectations, attitudes and experiences regarding ultrasound examination during pregnancy. METHODS: In-depth interviews were conducted with eight pregnant Norwegian women prior to their 18-week scan. The data were analyzed through systematic text condensation. RESULTS: The analysis generated three main themes: (1) I want to know if everything is fine, (2) Viewing the unborn child, (3) Holistic care. The women had a strong wish for ultrasound scanning and medical knowledge about their "baby" was their first priority interest. Visualizing the "baby" represented a strong emotional dimension for the parents-to-be and initiated the bonding process and the planning of a new life. The women wanted to be empowered and approached in a holistic way, where dialogic communication was needed. CONCLUSION: The women wanted medical knowledge about the fetal health. They considered the examination a visual experience together with their partner. The scan provided a personification of and an attachment to the fetus. This experience was the first step in the planning of a new life. The women had ambivalent feelings related to the ultrasound examination and they highlighted the importance of holistic care, where the sharing of information happens on an individual basis.

Promoting a normal birth and a positive birth experience - Norwegian women's perspectives.

OBJECTIVE: the aim of this study is to gain a deeper understanding of a woman's internal factors and factors in her environment that are important for a normal birth and a positive birth experience. DESIGN/SETTING: a qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Twelve healthy first time Norwegian mothers, aged 22-34, with a normal childbirth and a positive birth experience were interviewed five to six weeks after giving birth. All participants had given birth at a maternity unit, where 4000 births take place per year. The transcribed interviews were analysed through systematic text condensation. FINDINGS: the findings included two main themes: safe environment and emotional strength. Stability in everyday life and close relationships provided the women with the safe environment they needed. The women had a positive attitude to childbirth and they had all previously developed coping strategies. They highlighted that these acquired coping strategies contributed to higher emotional strength and a positive birth experience. CONCLUSIONS: the women experienced that a safe environment and network contributed to a sense of trust and emotional strength, which were positive factors promoting a normal birth and a positive birth experience. The women had a positive attitude towards the birth and used acquired coping strategies to deal with it, which in turn led to a positive birth experience. The natural vision the women had in connection with childbirth was part of their antenatal preparation, which also contributed to a positive experience of childbirth.

Is a midwife's continuous presence during childbirth a matter of course? Midwives' experiences and thoughts about factors that may influence their continuous support of women during labour.

OBJECTIVE: to gain an understanding about midwives' experiences of providing a continuous supportive presence in the delivery room during childbirth, and to learn about factors that may affect this continuous support. DESIGN/SETTING: qualitative study at a maternity unit in Norway, where about 4000 births take place each year. In-depth interviews were conducted with ten midwives working in two different maternity wards. The qualitative data were analysed using systematic text condensation. FINDINGS: the analysis generated three main themes: relational competence, the midwife's ideology, the culture and philosophy of the maternity unit. The midwives identified being mentally present and actively developing mutual trust with the woman in labour as two very important factors for building a relationship with her. They suggested that the midwife's first encounter with the woman is a key opportunity for establishing rapport during labour. Successfully providing a continuous presence during labour fostered the midwives' perception of themselves as a 'good midwife'; this was considered a feature of holistic care and health promotion. The workload in the unit sometimes made it difficult for them to provide a continuous presence in the delivery room. The midwives experienced feelings of inadequacy when they felt that they had too little time available for the woman in labour. KEY CONCLUSIONS: midwives' skill in building a relationship with the woman in labour combined with their values and understanding of the midwifery profession are important factors influencing their decision to provide a continuous presence during childbirth. If it is policy that maternity units should provide continuous support to women in labour, managers should ensure that it is actually provided.

'From fragmented to interdisciplinary understanding of integrated antenatal and postnatal care'-an interprofessional project between public health nursing students and midwifery students.

BACKGROUND: in Norway, it is expected that public health nurses and midwives will collaborate in providing integrated antenatal and postnatal care. In practice, however, the extent of formal and informal collaboration between these two groups of health professionals appears limited. In this context, an interprofessional project was initiated, bringing together student public health nurses and midwives in a four-step programme. The objective was to develop the students' understanding of interdisciplinary collaboration in antenatal and postnatal care. AIM: to gain knowledge of the students' experiences of the interprofessional project and their interdisciplinary understanding of integrated antenatal and postnatal care. METHODS: the students wrote reflective notes on their experiences, and this qualitative material was analysed through systematic text condensation. FINDINGS: the students gained awareness about each professional group's competence and responsibilities. They developed an interdisciplinary understanding, which is essential for continuity in antenatal and postnatal care. Changes in knowledge and attitudes during the project helped to develop the students' positive attitude towards future interdisciplinary collaborative practice. CONCLUSIONS: the success of this project was due to the students' experiences during the four-step programme. They developed an interdisciplinary understanding in which loyalty to the family was more important than interprofessional disputes and boundaries. To enhance collaboration between the two professions it is essential that this programme is emphasised by the management and is integrated into the curriculum for both educational programmes.

The woman's birth experience---the effect of interpersonal relationships and continuity of care.

OBJECTIVE: the aim of the present study was to gain a deeper understanding of how relational continuity in the childbearing process may influence the woman's birth experience. RESEARCH DESIGN/SETTING: a Q-methodological approach was chosen, as it allows the researcher to systematically assess subjectivity. 23 women were invited to sort a sample of 48 statements regarding their subjective view of birth experience after having participated in a pilot project in Norway, where six midwifery students provided continuity of care to 58 women throughout the childbearing process. The sorting patterns were subsequently factor-analysed, using the statistical software 'PQ' which reveals one strong and one weaker factor. The consensus statements and the defining statements for the two factors were later interpreted. FINDINGS: both factors seemed to represent experiences of psychological trust and a feeling of team work along with the midwifery student. Both factors indicated the importance of quality in the relation. Factor one represented experiences of presence and emotional support in the relationship. It also represented a feeling of personal growth for the women. Factor two was defined by experiences of predictability in the relation and process, as well as the feeling of interdependency in the relation. According to quality in the relation, women defining factor two experienced that the content, not only the continuity in the relation, was important for the birth experience. KEY CONCLUSIONS: relational continuity is a key concept in the context of a positive birth experience. Quality in the relation gives the woman a possibility to experience positivity during the childbearing process. Continuity in care and personal growth related to birth promote empowerment for both the woman and her partner. Relational continuity gives an opportunity for midwives to provide care in a more holistic manner.

'I want a choice, but I don't want to decide'--a qualitative study of pregnant women's experiences regarding early ultrasound risk assessment for chromosomal anomalies.

OBJECTIVE: To increase our understanding of how pregnant women experience early ultrasound examination that includes a risk assessment for chromosomal anomalies and how such women perceive the test results. DESIGN/SETTING: Qualitative study at St. Olavs Hospital in Norway. Both pre- and post-examination interviews were conducted with ten pregnant women who underwent risk assessment for chromosomal anomalies. Grounded theory was used to analyse the results. FINDINGS: The study generated a core category (I want a choice, but I don't want to decide), which related to the conflict between choice and decision making. There were also five main categories (existential choices, search for knowledge, anxiety, feeling of guilt and counselling and care). The main categories describe the complex feelings experienced by the women regarding the risk assessment. Factors contributing to the difficulty of choice included loss of control and coping, emotional connection to the fetus and social pressure. As the women sought independent choices without any external influence, they also felt greater responsibility. The women's understanding of the actual risk varied, and they used different types of logic and methods to evaluate the risk and reach a decision. CONCLUSIONS: The pregnant women in this study wanted prenatal diagnostic information and easy access to specialty services. Stress-related feelings and non-transparent information about the actual and perceived risks as well as personal moral judgments made the decision-making process complicated. Improved distribution of information and frequent contact with health professionals may help such women to make informed choices in accordance with their values and beliefs.

Parents' experiences of midwifery students providing continuity of care.

OBJECTIVE: the aim of this study was to gain knowledge and a deeper understanding of the value attached by parents to relational continuity provided by midwifery students to the woman and her partner during the childbearing process. The focus of the study was on the childbirth and the postnatal home visit. DESIGN/SETTING: in this pilot project by researchers at Sør-Trøndelag University College, Norway, six midwifery students provided continuity of care to 58 women throughout their pregnancy, birth and the postnatal period. One group interview of eight women and two group interviews of five men, based on the focus group technique, were conducted at the end of the project. Qualitative data were analysed through systematic text condensation. FINDINGS: the findings included two main themes: 'trusting relationship' and 'being empowered'. The sub-themes of a 'trusting relationship' were 'relational continuity' and 'presence'. For the women, relational continuity was important throughout the childbearing process, but the men valued the continuous presence during birth most highly. 'Being empowered' had two sub-themes: 'individual care' and 'coping'. For the women, individual care and coping with birth were important factors for being empowered. The fathers highlighted the individual care as necessary to feel empowered for early parenting. The home visit of the student was highly appreciated. The relationship with the midwifery student could be concluded, and they had the opportunity to review the progression of the birth with the student who had been present during the birth. During the home visit, the focus was more on the experiences of pregnancy and birth than on what lay ahead. KEY CONCLUSIONS: when midwifery students provided continuous care during pregnancy, birth and the postnatal period, both women and men experienced a trusting relationship. Relational continuity was important for women in the entire process, but for the men this was mostly important during childbirth. Individual care and coping with birth and early parenting enhanced empowerment. The limited sample size in this study means that it cannot be generalised without caution, and further research is needed.