Home-based postnatal care following early hospital discharge: A descriptive study of the health care service midwife home.

OBJECTIVE: At St. Olav's University Hospital in Trondheim, Norway, "Midwife Home" (MH) is an integrated home-based postnatal service for mothers who want early discharge (i.e. 6-24 h) after giving birth. The purpose of our study was to evaluate MH by (1) describing the characteristics of mother-newborn pairs followed up by MH to investigate whether the service has an appropriate target group; (2) describing the number and causes of possible readmissions for safety; (3) investigating whether MH follows the criteria set for the service; and (4) exploring whether the service facilitates continuity of care. METHODS: Following a cross-sectional design, we collected data from medical records at St. Olav's University Hospital. RESULTS: In the 212 mother-newborn pairs investigated, most mothers had a high level of education, were multiparous, had vaginal delivery, did not experience postpartum haemorrhage exceeding 500 mL, experienced first-degree or no perineal tear and started breastfeeding before discharge from hospital. Most newborns had a birthweight of 3000-4000 g and an APGAR score exceeding 7 after 5 min. Within the first six weeks postpartum, 1.4 % of the mothers and 2.3 % of the newborns were readmitted. CONCLUSION: Mothers who choose follow-up by MH represent a homogeneous group of healthy, highly educated multiparous mothers with uncomplicated births and healthy newborns. The low number of readmissions imply that MH is a safe service, and that the target group is appropriate.

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.

Norwegian nursing students' experience during clinical placement in an African country: Communication, relationship building and nursing identity. A qualitative study.

AIM: The aim of this study was to gain a deeper understanding of the experience of Norwegian bachelor nursing students during clinical placement in an African country, with a focus on communication, relationship building and nurse identity. DESIGN: Explorative, qualitative methods were used. METHODS: The data consisted of individual written reflection notes from 8 students' clinical placement in Africa, and transcripts from one semi-structured focus group interview. The materials were analysed with systematic text condensation. RESULTS: The students described their experience with the community of practice as challenging and enlightening. They found themselves in contexts where communication and language problems occurred. The students described how important relationships were for their practical training, and how this helped shape their nursing identity.

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.

Discovery and characterization of a novel Dyp-type peroxidase from a marine actinobacterium isolated from Trondheim fjord, Norway.

A new dye-decolorizing peroxidase (DyP) was discovered through a data mining workflow based on HMMER software and profile Hidden Markov Model (HMM) using a dataset of 1200 genomes originated from a Actinobacteria strain collection isolated from Trondheim fjord. Instead of the conserved GXXDG motif known for Dyp-type peroxidases, the enzyme contains a new conserved motif EXXDG which has been not reported before. The enzyme can oxidize an anthraquinone dye Remazol Brilliant Blue R (Reactive Blue 19) and other phenolic compounds such as ferulic acid, sinapic acid, caffeic acid, 3-methylcatechol, dopamine hydrochloride, and tannic acid. The acidic pH optimum (3 to 4) and the low temperature optimum (25 °C) were confirmed using both biochemical and electrochemical assays. Kinetic and thermodynamic parameters associated with the catalytic redox center were attained by electrochemistry.

Breastfeeding attitudes of refugee women from Syria and influencing factors: a study based on the transition theory.

AIMS: This review was designed to systematically examine studies that determine the breastfeeding attitudes of Syrian mothers, and factors influencing their breastfeeding behavior. METHODS: Studies published between 2010 and 2020 were examined using 'Syria OR Syrian mother OR Syrian refugee AND breastfeeding OR breastfeeding practices OR intention OR attitudes OR exclusive breastfeeding' as keywords on PubMed, GoogleScholar, MEDLINE, Scopus, ProQuest, National Thesis Center, Web of Science, ScienceDirect and CINAHL; and five publications meeting the inclusion criteria were included in the study. The researchers independently used JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies and JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses, developed by Joanna Briggs Institute, to assess the methodological quality. RESULTS: A total of 6546 studies were accessed as a result of the literature review. Five studies meeting the inclusion criteria were included in the study. Women who are in this process experience a developmental and situational transition according to the framework of Meleis' theory. Factors affecting their breastfeeding attitudes were grouped under three main and four sub-themes. It was determined that personal factors (socioeconomic factors, cultural beliefs, the significance of breastfeeding practice, preparation), factors related to the immediate environment and social factors affect these women's attitudes toward breastfeeding. CONCLUSION: It was found that most of the Syrian women had positive attitudes toward breastfeeding; however, the breastfeeding duration was less than 6 months for most of the refugees. Furthermore, according to the results of the studies, refugee women from Syria who did not receive social support from their spouses and relatives stopped breastfeeding.

A unified and simple medium for growing model methanogens.

Apart from their archetypic use in anaerobic digestion (AD) methanogenic archaea are targeted for a wide range of applications. Using different methanogenic archaea for one specific application requires the optimization of culture media to enable the growth of different strains under identical environmental conditions, e.g., in microbial electrochemical technologies (MET) for (bio)electromethanation. Here we present a new culture medium (BFS01) adapted from the DSM-120 medium by omitting resazurin, yeast extract, casitone, and using a low salt concentration, that was optimized for Methanosarcina barkeri, Methanobacterium formicicum, and Methanothrix soehngenii. The aim was to provide a medium for follow-up co-culture studies using specific methanogens and Geobacter spp. dominated biofilm anodes. All three methanogens showed growth and activity in the BFS01 medium. This was demonstrated by estimating the specific growth rates ( µ ) and doubling times ( t d ) of each methanogen. The µ and t d based on methane accumulation in the headspace showed values consistent with literature values for M. barkeri and M. soehngenii. However, µ and t d based on methane accumulation in the headspace differed from literature data for M. formicicum but still allowed sufficient growth. The lowered salt concentration and the omission of chemically complex organic components in the medium may have led to the observed deviation from µ and t d for M. formicicum as well as the changed morphology. 16S rRNA gene-based amplicon sequencing and whole genome nanopore sequencing further confirmed purity and species identity.

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.

Simulation as a pedagogical learning method for critical paediatric nursing in Bachelor of Nursing programmes: a qualitative study.

BACKGROUND: In the national education plan for Bachelor of Nursing in Norway, it is emphasized that focus areas for practical studies must include experience related to paediatric nursing. However, given the paucity of children's wards in Norwegian hospitals, few students are offered this. The purpose of this study is to explore undergraduate nursing student's perception of using simulation as a learning method to obtain knowledge and skills in delivering quality healthcare to children and their parents in emergencies. METHOD: A total of 36 students participated in focus groups. The students were asked to reflect on their learning outcomes regarding the educational method during the simulation. In addition, the students were encouraged to discuss whether this pedagogical method was useful in preparing them to deal with critical medical situations in relation to children and their parents. The interviews were transcribed and analyzed using qualitative content analysis. RESULTS: Three subjects emerged from the analysis. The first, simulation as an educational method, showed that the students thought that simulation gave a greater degree of realism and seriousness than other learning activities. The second subject, preparedness for later practice, showed that the students perceived simulation as one of the ways in which they were best prepared for the profession as a nurse. The students emphasized the benefit of having concentrated on children and their parents. The third subject, stress and leadership, showed that simulation as a method was stressful to most students, and lack of knowledge and anxiety about conducting other students kept them from taking the lead. However, the students experienced that they learned a lot about themselves and how they appear as nurses. CONCLUSION: The bachelor-level student nurses experienced simulation as a realistic and effective educational method for gaining knowledge in the critical healthcare of children and their parents. Simulation made them reflect on a nurse's area of responsibility in emergencies. When offered practical experience in children's wards, the use of simulation as a didactic method may help students develop sufficient competence to act appropriately and expediently in critical paediatric nursing settings. TRIAL REGISTRATION: The study (number 52776) was approved by the Norwegian Centre for Research Data.

All that I need exists within me: A qualitative study of nulliparous Norwegian women's experiences with planned home birth.

OBJECTIVE: The aim of this study was to gain knowledge regarding how Norwegian nulliparous women experience planned home birth and why they choose this route of giving birth. DESIGN: A qualitative approach was used, and the study data were derived from semi-structured individual interviews, which were analysed through systematic text condensation. PARTICIPANTS: Ten Norwegian women aged nineteen to thirty-nine years were interviewed. They had each gone through with a successful planned home birth of their first child within the last two years. These women all resided in the middle, western and eastern areas of Norway. A certified midwife was present throughout the labour and birth, and no transfer to the hospital was necessary. FINDINGS: The following two main themes were identified: 'inner motivation' and 'giving birth in safe surroundings'. The women in this study had a strong inner faith in the normal physiological processes of labour and birth and had educated and prepared themselves carefully for their planned home birth. To be able to enter one's own inner world was considered crucial for labour, and the trusting relationship they had with their midwife made this possible. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.

Fathers' experiences during the first postnatal week at home after early discharge of mother and baby from the maternity unit: A meta-synthesis.

Aim: The aim of this study was to explore and describe fathers' experiences during the first postnatal week after early discharge of mother and baby from the maternity unit. Methods: A meta-synthesis. Inclusion criteria: peer-reviewed qualitative single studies of fathers' experiences during the first week after early discharge (defined as less than 72 hours postpartum) from hospital after the birth of a healthy singleton baby born between weeks 37 and 40. Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Maternity and Infant Care, Joanna Briggs, SweMed+ and PsycInfo were searched in May 2015 and May 2018. Of the 940 titles scanned for eligibility, three articles met the inclusion criteria. The consolidated criteria for reporting qualitative research checklist was used. Findings: All included studies were conducted in Sweden during the period 2002-2012. The total sample of participants in the meta-synthesis comprised 35 fathers. Analysis of the included studies generated two themes: building confidence and coping with responsibility. Conclusions: The fathers' experiences were affected by the emotional support of midwives, which boosted their confidence. This seems to be a premise for taking and coping with responsibility during the first days at home. Good cooperation between hospitals and municipalities is vital, and midwives must be available and present in order to ensure continuity in maternity care.

Caesarean birth experiences. A qualitative study from Sierra Leone.

BACKGROUND: Positive birth experiences lead to better postnatal functioning, and influence mode of delivery choice for subsequent pregnancies. Healthcare workers can influence the birth experience through relevant support and care. This study seeks to explore the experience of Sierra Leonean women in relation to ante-natal, intrapartum and post-partum care with special reference to their experience of caesarean section. METHODS: In November 2016, individual semi structured interviews were performed with sixteen women of varying age from different geographical areas, levels of schooling, and parity. The interviews were analysed by systematic text condensation. RESULTS: During interviews, participants mentioned a fear of dying or losing their baby. This fear was managed by praying and putting trust in a higher power. However, placing trust in healthcare workers was also described by some participants. Moreover, the present study demonstrates that women experienced a great deal of pain and discomfort after the caesarean section was performed, and that they found it difficult to return to expected activities. This was managed by a large amount of practical assistance from their social network. Healthcare workers were described as providing medicines, advice, and practical care. Negative experiences in which healthcare workers took money for medicines and refused to help women were also described. CONCLUSIONS: This study indicates that women locate resources to cope with pain and fear within themselves, while also utilising extended support from social networks and healthcare workers. This confirms that women from all backgrounds in Sierra Leone have access to resources for health and well-being.

Able to choose? Women's thoughts and experiences regarding informed choices during birth.

OBJECTIVE: To gain a deeper understanding of women's thoughts and experiences regarding informed choices during childbirth. DESIGN/SETTING: A qualitative approach with individual in-depth interviews was chosen for data collection. Ten women were interviewed three to four weeks after the birth of their first child. The transcribed interviews were analysed using systematic text condensation. FINDINGS: Two main themes emerged based on the analysis: "women's resources and coping abilities" and "women's abilities to make informed choices during birth". Women's resources and coping abilities influenced how they retrieved information and made their own choices. Their abilities to make informed choices during birth were influenced by the course of the birth process and the fact that they were patients and submitted to the hospitals' routines. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Instead of using the term "informed choice", women in this study discussed involvement, participation and being heard and seen as individuals. How receptive women are to information during birth varies, and midwives play an important role during pregnancy in informing and encouraging them. The relationship between women and midwives influences women's abilities to make informed choices during birth. Women need individual care and should be encouraged to have realistic expectations and to gain knowledge and confidence in their ability to give birth. A model of care in which women experience greater continuity will have an impact on their expectations, decision-making and experience of birth.

"I want a birth without interventions": Women's childbirth experiences from Turkey.

BACKGROUND: Although primarily stemming from research conducted in high-income countries, culturally sensitive knowledge of women's experiences with and needs during childbirth, as well as how such experiences affect their psychological health and wellbeing, is important to add to the big picture of women's experiences with childbirth worldwide. AIM: The aim of the study was to clarify how primiparous women in Turkey experience childbirth and intrapartum care. METHODS: Grounded theory guided depth-interviews with 12 women, whose data were analysed according to the constant comparative method. FINDINGS: Participants reported wanting vaginal birth without interventions (i.e. normal birth), which required their empowerment as well as support from others. Although they recognised their readiness for the birth process as a decisive factor in coping with childbirth, they prioritised quality of care from healthcare professionals during birth, which most participants found unsatisfactory. They also highlighted the importance of giving birth in a health-promoting environment offering privacy, silence and comfort. DISCUSSION: To support normal birth, the World Health Organization's intrapartum care model prioritises continuity of care, respectful labour and childbirth care, effective communication from healthcare personnel and emotional support from a companion of choice. Salutogenesis can also guide clinical birth practices to promote normal birth and positive birth experiences. CONCLUSION: All women strove to experience normal birth, which required antenatal education and emotional support from a partner or family and from healthcare professionals. Normal birth and positive childbirth experiences also required quality intrapartum care and a health-promoting environment.

Simulation as a learning method in public health nurse education.

OBJECTIVE: To view simulation as a learning method in the light of learning theories and to describe the student's reflections and experiences of simulating anaphylaxis during vaccination. DESIGN AND SAMPLE: Public health nursing students at a university in Norway simulated scenarios related to anaphylaxis during vaccination of an infant. The aim of the intervention was to facilitate the competence of public health nurses to handle unforeseen events associated with vaccinations. The students wrote reflection notes about their experiences after the simulation. The reflection notes were analyzed using qualitative content analysis. RESULTS: The students experienced simulation as a realistic educational method with feelings of stress in an acute situation. They discovered the importance of cooperation and communication to avoid misunderstandings that could lead to serious failure in the treatment. The students emphasized that simulation gave them a preparation for practice to handle anaphylaxis associated with vaccines. CONCLUSION: The public health nurse students experienced simulation as a realistic and effective educational method. Simulation made them reflect on the public health nurse's area of responsibility. Kolb's learning theory and Schön's theory of knowledge-in-action, may explain how simulation as a didactic method develops competence to act in a concrete situation of anaphylaxis by vaccination of children.

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.

Nature works best when allowed to run its course. The experience of midwives promoting normal births in a home birth setting.

OBJECTIVE: to gain a deeper understanding of how midwives promote a normal birth in a home birth setting in Norway. DESIGN/SETTING: a qualitative approach was chosen for data collection. In-depth interviews were conducted with nine midwives working in a home birth setting in different areas in Norway. The transcribed interviews were analysed with the help of systematic text condensation. FINDINGS: the analysis generated two main themes: «The midwife's fundamental beliefs¼ and «Working in line with one's ideology¼. The midwives had a fundamental belief that childbirth is a normal event that women are able to manage. It is important that this attitude is transferred to the woman in order for her to believe in her own ability to give birth. The midwives in the study were able to work according to their ideology when promoting a normal birth at home. To avoid disturbing the natural birth process was described as an important factor. Also crucial was to approach the work in a patient manner. Staying at home in a safe environment and establishing a close relationship with the midwife also contributed positively to a normal birth. KEY CONCLUSIONS: the midwife's attitude is important when trying to promote a normal birth. Patience was seen as essential to avoid interventions. Being in a safe environment with a familiar midwife provides a good foundation for a normal birth. The attitude of the midwives towards normal childbirth ought to be more emphasised, also in the context of maternity wards.