Being a man, but using the body as a woman - Norwegian midwives' thoughts on providing antenatal care for pregnant transmen.

OBJECTIVE: To explore midwives' thoughts on providing antenatal care to pregnant transmen. METHODS: A qualitative study based on semi-structured, individual interviews with 12 midwives during January 2022. Systematic text condensation was used for data analysis. RESULTS: The analysis of the data material resulted in three result categories: 1) Gender transition and the desire to have children - exposure of the phenomenon can help to avoid stigmatisation, 2) A pregnant person is a pregnant person no matter what - the midwife's role in meeting a pregnant man, and 3) Being a man but using the body as a woman - the knowledge is lacking in the textbooks. CONCLUSION: The study showed that midwives have little knowledge about pregnant transmen. The knowledge gaps will remain unfilled unless more research is done on the topic, and sufficient information provides for good procedures and standards of care. Access to information about pregnant transmen and experiences of their encounters with midwives will contribute with new knowledge and over time, changes in attitudes, both professional and private.

Early labour experience and labour characteristics after introduction of an electronic early labour educational intervention.

OBJECTIVE: The study's aim was to compare first-time mothers' experience of early labour and subsequent labour characteristics before and after introducing an online early labour educational intervention. This article also reports on further testing of the underlying structure of the of the Early Labour Experience Questionnaire (ELEQ) in a Norwegian setting. METHODS: Pre- and post-intervention cohorts were recruited. The ELEQ was translated into Norwegian, back-translated and distributed among primiparous mothers whilst in hospital. Confirmatory factor analyses were used to evaluate model fit, and the internal consistency of the scale was measured by Cronbach's α coefficient. The relationship between cohorts and demographic characteristics were analysed using chi-square statistics and t-tests. RESULTS: Confirmatory factor analysis of the Swedish version of the ELEQ for primiparous women showed an acceptable fit. Neither the overall score nor the scores on the subscales for emotional well-being, emotional distress and perceptions of midwifery care differed significantly, but there was a significant difference between the groups on a few of the items. The cervix was significantly more dilated upon admission in the post-intervention group, and oxytocin use was significantly reduced. The number of telephone consultations increased significantly after the intervention was introduced. CONCLUSION: The intervention did not improve women's experience with early labour. However, women who received the intervention were admitted in more advanced labour and required less oxytocin. The increased number of telephone consultations may indicate that an online early labour educational programme cannot replace women's need to communicate directly with staff.

A qualitative study of Norwegian first-time mothers' information needs in pre-admission early labour.

OBJECTIVE: To explore women's experience with information, and their information needs in pre-admission early labour. DESIGN: A qualitative study with an exploratory and descriptive approach. SETTING: Five focus group interviews with women attending post-natal care at five different well-baby clinics in South-Eastern Norway in 2019. PARTICIPANTS: Sixteen first-time mothers who had given birth to a baby 3-17 weeks prior to the focus group interview. All had experience of staying at home in early labour. FINDINGS: Three themes emerged from the analysis. The first and most substantial theme involved information. The women considered it necessary to have easy access to a suitable amount of trustworthy information at the appropriate time. The second theme described that the women were surprised at how early labour manifested, despite having prepared for it. The third theme was about receiving acknowledgement and support, revealing that information did not meet all woman's needs. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The women found it challenging to prepare for early labour, and no matter how prepared they felt beforehand, unexpected situations arose. Easily accessed online information from reliable sources was useful in early labour, but in order for women to feel safe at home, this should be complemented by telephone conversations with skilled and welcoming midwives in the labour ward. More knowledge about women's information needs in early labour is required, including studies exploring how the information should be provided to help women feel safe when staying at home in early labour.

Norwegian midwives' experiences with screening for violence in antenatal care - A qualitative study.

OBJECTIVE: The aim of this study is to gain a better insight into and understanding of Norwegian midwives' experiences of screening for violence during antenatal care. METHODS: We conducted a qualitative study of semi-structured interviews including midwives working in ten Norwegian municipalities. The interviews were analysed using systematic text condensation. RESULTS: Four main themes can be drawn from the analysis. First, midwives found it difficult to raise the subject of violence, especially in the early phases of the screening programme. Second, the midwives were often provided with information about past experiences of violence, but little on ongoing violence. Third, according to the midwives, building trust was key to initiating direct questions about violence. Finally, more experience and collaboration reduced the barriers for raising the subject of violence. CONCLUSION: Findings from this study suggest that screening for violence entails more than just asking a question. Furthermore, ongoing violence is difficult to identify, and women are more likely to relate stories of past violence. To overcome this issue, the midwives underlined the necessity to ask questions and have the capacity to listen to the potentially challenging answers. Findings from this study show that the training received by the midwives in relation to violence varied considerably. Hence, the study demonstrates the need for reinforced and standardised training in how to address violence in antenatal care.

From Midwife-Dominated to Midwifery-Led Antenatal Care: A Meta-Ethnography.

Provision of antenatal care includes risk identification, prevention and management of pregnancy-related diseases, but also health education, health promotion, support and guidance to smooth the transition to parenthood. To ensure good perinatal health, high-quality, free and easily accessed antenatal care is essential. The aim of this study was to identify, integrate and synthesize knowledge of midwives' experiences of providing antenatal care, attending to clients' individual needs whilst facing multiple challenges. We conducted a meta-ethnography, which is a seven-step grounded, comparative and interpretative methodology for qualitative evidence synthesis. A lines-of-argument synthesis based on two metaphors was developed, based on refutational themes emerging from an analogous translation of findings in the included 14 papers. The model reflects midwives' wished-for transition from a midwife-dominated caring model toward a midwifery-led model of antenatal care. Structural, societal and personal challenges seemingly influenced midwives' provision of antenatal care. However, it emerged that midwives had the willingness to change rigid systems that maintain routine care. The midwifery-led model of care should be firmly based in midwifery science and evidence-based antenatal care that emphasize reflective practices and listening to each woman and her family. The change from traditional models of antenatal care towards increased use of digitalization no longer seems to be a choice, but a necessity given the ongoing 2020 pandemic.

"Talk to me, not at me": obese women's experiences of birth and their encounter with birth attendants-a qualitative study.

Purpose: To explore the birth experiences of obese women in regard to their encounter with birth attendants. Methods: Qualitative, in-depth interviews with 10 women were conducted in February 2020. Data were analysed using a descriptive phenomenological method. Results: Four interrelated constituents were identified: The preconception and prejudice of being unhealthy and less able; Being unique among all the other unique women; "Talk to me, not at me"-the importance of information and communication, and; Feeling secure enough to be in the 'birthing bubble'. Conclusion: For the women in our study, being obese meant experiencing challenges as well as opportunities during childbirth and in their encounter with birth attendants. Experiences of preconceptions, alienation, a focus on risk and a loss of autonomy in encounters with birth attendants were found to negatively impact the birthing process. The women desired affirmative and inclusive encounters; these kinds of encounters may improve the birth experiences of obese women.

Education is a private matter: Clinical midwives' experiences of being part-time master's students in midwifery.

When the master's degree in midwifery was introduced in Norway, clinical midwives with a professional diploma soon requested the possibility to upgrade their education to a master's degree. In 2014, a part-time master's program worth 40 ECTS credits was introduced at a Norwegian university. In this study, we aimed to explore clinical midwives' experiences of how taking a part-time master's program in midwifery was received at their workplace. We employed a qualitative research design and an explorative descriptive approach. A convenience sample consisting of 47 clinical midwifes with varying seniority was recruited in 2016 and 2017, and five focus group interviews were conducted at the end of the study programs. Systematic text condensation was used to analyze the data, generating three themes. The first concerns the midwives' experiences of learning new tools to advance their profession. Secondly, they expressed hope for support, but found that education was a private matter. Finally, they experienced that financial support depended on goodwill from their employers. The study demonstrates that a master's degree in midwifery can be instrumental to strengthen clinical practice, but also points towards the need to update and strengthen management and leadership to facilitate and implement new knowledge.

Women's experiences with giving birth before arrival.

OBJECTIVE: To explore women's experiences with giving birth before arrival. DESIGN: A qualitative interview study. SETTING: Individual semi structured interviews with women from Western Norway conducted in their homes in 2015. PARTICIPANTS: 10 women who experienced BBA-births in 2014, or the beginning of 2015. Two primiparous and eight multiparous women participated in the study. KEY FINDINGS: Three themes were generated from the analysis. In the encounter with the healthcare services, the women described midwives as gatekeepers defining active labour. Giving birth before arrival was dramatic, but at some point fear of giving birth alone was replaced by feelings of coping, and in hindsight they felt empowered. The women described giving birth before arrival to be a special experience, but this was not always acknowledged by the midwives. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The findings in this study question the cost-benefit of today's maternity care system pointing towards a more differentiated and decentralised care. To enhance patient safety adequate capacity of midwives in the maternity care is essential. Furthermore, good communication skills are key to improving practice and enhancing safety. Further research must be conducted.

Lesbian women's experiences with healthcare providers in the birthing context: a meta-ethnography.

OBJECTIVE: to explore research knowledge about lesbian women's experiences with health-care providers in the birthing context. METHOD: a systematic search for relevant qualitative studies in selected databases identified 13 articles of sufficient quality. The findings were synthesized using a meta-ethnographic approach as described by Noblit and Hare. SYNTHESIS AND FINDINGS: issues related to covert or overt homophobia and prejudice were demonstrated and were sometimes mediated by subtle mechanisms that were difficult to understand and to manage. On the other hand, small gestures of support were described to make a huge difference. A lack of knowledge was demonstrated, contrasted by staff showing a positive and informed attitude. Disclosure was an important issue, but due to the risk involved the women demonstrated a need to be in control. Finally, being acknowledged, both as individuals and as family were considered vital. In this regard, it was essential to recognize and include co-mother as equal parent and to look upon lesbian sexuality as normal and natural. KEY CONCLUSIONS: midwives' emotional involvement in the situation is significant for moral perception of the women's intimate citizenship, even when they are distressed by lesbian sexuality. IMPLICATIONS FOR PRACTICE: our findings reveal the importance of including sexuality as an issue deserving reflection in maternity wards, whether or not this might cause unrest in midwives who do not feel comfortable with intimate citizenships beyond mainstream.