Midwives' experiences of facilitating normal birth in midwifery-led units in Norway: A qualitative study.

INTRODUCTION: Normal birth has significant benefits for mothers and infants. However, the advancement of technology has led to increased medicalization of childbirth. Midwives play a pivotal role in promoting normal birth, and positive outcomes are seen in births led by a midwife. The purpose of the study is to gain a deeper understanding of midwives' experiences of facilitating normal birth in midwifery-led units. METHODS: The study has a qualitative design. It was conducted in 2022 and included semi- structured interviews with seven midwives throughout Norway. They were all currently working, or had previously worked, in a midwifery-led unit. The data material was analyzed using systematic text condensation. RESULTS: The data analysis resulted in three result categories. The first category concerned the importance of relationships, continuity and a safe atmosphere. The second concerned being a midwife in the hand, in the heart, and in the mind. The third related to having confidence in the physiological process of childbirth, midwifery autonomy, and a common ideology. CONCLUSIONS: The study highlights several elements that may help to promote normal birth in midwifery units. Relationships, midwifery skills, confidence in normal birth and a supportive collegial environment that fosters midwife autonomy, are prominent factors. These elements were viewed by the midwives as key to their ability to promote normal birth in a midwifery-led unit.

Women's experiences with hypnobirth - A qualitative study.

OBJECTIVE: Hypnobirth is a technique that incorporates elements from hypnosis and is used to prepare women for birth. It aims to promote a normal birth and create a positive birth experience by equipping women with knowledge and tools to reduce fear, anxiety, and pain during labor. The objective of this study was to investigate women's experiences in using this technique during childbirth. METHODS: Qualitative study with nine in-depth interviews, analysed using a descriptive phenomenological method. RESULTS: The women changed their perspective on birth and got to know their inherent resources. They acquired various coping strategies and techniques that enhanced their sense of control. The women gained ownership of their birth and found their active participation to be meaningful. They were informed of different options concerning their birth which made it possible to make informed decisions. The participation in hypnobirth classes, and personal experience from giving birth, made women wish for integration of mental birth preparation in the public health service, thus strengthening women's trust in ther ability to give birth, which was pivotal to the participants' birth satisfaction. CONCLUSION: The participants experienced an empowered birth because of the knowledge, coping strategies and mental training they gained from hypnobirth classes.

Opening Pandora's box: A meta-ethnography about alcohol use in pregnancy from midwives' and other healthcare providers' perspectives.

INTRODUCTION: Alcohol consumption has increased in recent years, including among women of childbearing age. A woman's alcohol intake during pregnancy is linked to complications and injuries in the newborn, and the risk of the child being harmed by the mother's alcohol use increases in proportion to the amount of alcohol she consumes. This meta-ethnography aims to explore midwives' and other healthcare providers' experiences of screening pregnant women for alcohol use in pregnancy and counselling them on the subject. METHODS: A systematic literature search in CINAHL, Maternity & Infant Care, MEDLINE, and Scopus was conducted in August 2021 and updated in January 2023. The CASP checklist was used to assess the included articles and meta-ethnography was used to synthesize the data. RESULTS: Fourteen qualitative studies were included. In the synthesis, we use the metaphor of Pandora's box to deepen our understanding of the topic. We found that some healthcare providers tiptoe around the box, not wanting to face the consequences and responsibilities of asking women about their alcohol use. Others refuse or are reluctant to open the box because they lack knowledge about screening and counselling. Some eventually open the box, understanding the importance of establishing a trusting relationship to address alcohol use and seeing the need for knowledge and screening tools. CONCLUSIONS: Healthcare education has the important task of ensuring that healthcare personnel have sufficient evidence-based knowledge about alcohol use in pregnancy. In the future, a health-promoting, tailored approach offering women in pre-pregnancy and early pregnancy sufficient evidence-based information should be implemented.

"Out of This World": Norwegian Women's Experiences of Medical Abortion Pain.

Introduction: Medical abortion has rapidly become the dominant abortion method in western countries. Pain is a known adverse effect; however, few studies have explored women's subjective experience of medical abortion pain. Purpose: To explore Norwegian women's experiences of pain when performing a medical abortion at home. Material and Methods: We recruited 24 women through an advertisement on Facebook and conducted semi-structured, face-to-face interviews. The interviews were transcribed verbatim and the data were analyzed using a phenomenological hermeneutical method. Results: Our findings consisted of two main themes: 1) Being in pain or becoming pain, and 2) Being caught off guard and struggling to cope. Participants described undergoing severe pain, comparable to giving birth, during the medical abortion. Unprepared for the type and intensity of the pain, they felt anxious and insecure. Pain is physical, but it also has important psychological, social, and existential dimensions. Our culture (in)forms our thoughts and feelings about our pain, affecting our ability to endure suffering. The participants' experiences of abortion pain prompt timely questions concerning gendered socio-cultural and existential meanings connected to pain, specifically in relation to female reproductive functions. Conclusion: Women need realistic information about the type and intensity of abortion pain, as well as evidence-based pain medication. Psychological factors may affect the experience of abortion pain and should therefore be taken into account in abortion care.

Women's experiences with unexpected induction of labor: A qualitative study.

INTRODUCTION: Induction of labor is the most common intervention in modern obstetrics and is a growing phenomenon worldwide. Research on women's experiences with the induction of labor is scarce, especially on being unexpectedly induced. The purpose of this study is to explore women's experiences with unexpected induction of labor. METHODS: We conducted a qualitative study including 11 women who had undergone an unexpected induction of labor within the last three years. Semi-structured interviews were conducted in the period February-March 2022. Data were analyzed using systematic text condensation (STC). RESULTS: The analysis led to four result categories. The decision to induce labor came as a surprise to the women, both for better and for worse. Information was not automatically provided and was often obtained through the women's own efforts. Consent to the induction mainly took the form of a decision by healthcare personnel, and the birth was a positive experience during which the woman felt looked after and reassured. CONCLUSIONS: The women were very surprised when told they had to be induced and were unprepared for the situation. They received insufficient information, and several experienced stress from the time of induction up until they gave birth. Despite this, the women were satisfied with the positive birth experience, and they emphasized the importance of being looked after by empathetic midwives during childbirth.

Midwives' experiences with accompaniment service work in Norway: A qualitative study.

INTRODUCTION: The centralization of health services appears to be prevalent both in and outside Europe. As the distance to the nearest birth institution increases, so does the risk of unplanned births outside of an institution. A primary factor to prevent this is having a skilled birth attendant present. This study examines midwives' experiences of working in the accompaniment services in Norway. METHODS: This was a qualitative interview study of 12 midwives working in the accompaniment services in Norway. Semi-structured interviews were conducted in January 2020. Systematic text condensation was used to analyze the data. RESULTS: The analysis identified four main themes. The midwives felt that accompaniment service work was a heavy responsibility, but it was professionally fulfilling. They felt that being on call was a lifestyle, and they were motivated by their relationships with the pregnant women. Presenting themselves as confident midwives helped the women to feel reassured. The midwives considered the cooperation within the health service to be key to good transport midwifery. CONCLUSIONS: The midwives who worked in the accompaniment services felt that their responsibility for caring for women in labor was challenging, but meaningful. Their professional knowledge was important for identifying the risk of complications and handling difficult situations. Despite carrying a heavy workload, they continued to work in the accompaniment services to ensure that women who had to travel long distances to birth institutions received appropriate help.

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.

No one needs to know! Medical abortion: Secrecy, shame, and emotional distancing.

In 2021, 10,841 abortions were carried out in Norway, of which 95.3% were medical abortions. In this phenomenological study, we explore women's experiences connected to performing a medical abortion at home. We conducted 22 interviews and analyzed the data using Giorgi's descriptive phenomenological method. Our analysis revealed four crucial constituents: The logical and sensible choice-doubt beneath the surface; Secrecy and the dubious comfort of hidden shame; Emotional distancing as a coping strategy; and Moving on-and revisiting the meaning of the abortion. We discuss and reflect on these findings drawing on insights from existential phenomenology and contemporary research.

"Keep It Simple"-Co-Creation of a Tailored Newborn Resuscitation Course for Midwifery Students.

PURPOSE: To develop a tailored newborn resuscitation course for midwifery students. PATIENTS AND METHODS: A qualitative study using an explorative, abductive approach was applied. Co-creation through workshops was facilitated to develop a tailored newborn resuscitation course for midwifery students. Four workshops with midwifery students and midwives were conducted from May to October 2020. Twenty participants attended one workshop of their choice. Five out of Norway's six midwifery education programmes participated, and included midwives from across Norway. All workshops were held digitally via the Zoom platform. A seven-step framework analysis method was applied to analyse the workshop data. RESULTS: We identified four themes: 1) practice guidance, 2) technical skills 3) non-technical skills 4) innovative methods. CONCLUSION: Findings emphasize the importance of practice guidance, technical skills, non-technical skills and innovative methods to facilitate the learning process. However, these skills cannot be acquired without the context to facilitate them, and thus a supportive culture is essential to sustain newborn resuscitation expertise as a midwife/midwifery student. We found that midwives expressed the same need to learn, train and prepare themselves for newborn resuscitation as midwifery students. The importance of facilitating the learning of newborn resuscitation with low-dose, high-frequency training in a supportive culture thus matters to both midwifery students and expert midwives.

Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study.

BACKGROUND: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. OBJECTIVE: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users' experiences with the website to increase its user-friendliness. METHODS: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website's user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants' feedback on the website. RESULTS: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants' experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website's design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. CONCLUSIONS: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no.

Women's experiences of treatment for mastitis: A qualitative study.

INTRODUCTION: Mastitis (inflammation of the breast) occurs in 10-20% of breastfeeding women. Different levels of the health service meet the needs of women in different ways, and treatment procedures vary at a local level. As maternity care evolves, with a greater need for efficiency, and the treatment for women is also changing. The purpose of the study is to investigate women's experiences of treatment for mastitis in the interface with the health service. METHODS: The study has a qualitative design. It was conducted in 2018 and included semi-structured interviews with 11 women living throughout Norway who received treatment for mastitis. The data material was analyzed using systematic text condensation. RESULTS: The analysis resulted in three themes. The first theme was the interaction with healthcare personnel and related to being treated in a caring manner. The second concerned the women's experience of feeling overwhelmed by pain and having to depend on help. The third theme related to the hospital stay and the women's experiences of how random factors govern the treatment of the disease. CONCLUSIONS: The study shows that women who were treated for mastitis were at risk of being admitted to hospital wards characterized by a lack of knowledge about mastitis, insufficient or flawed treatment competence, and an absence of necessary equipment. Treatment should be organized in a way that enables women to be placed in wards where staff have knowledge and experience, such as maternity and gynaecological wards, as well as associated outpatient clinics.

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.

Women's experiences with information before medication abortion at home, support during the process and follow-up procedures - A qualitative study.

OBJECTIVE: To explore women's experiences of having a medication abortion at home in regard to their perceptions of the information provided before the abortion, support throughout the process and follow-up procedures. STUDY DESIGN: A qualitative study based on interviews with 23 women between October 2019 and January 2020. Systematic text condensation was used for data analysis. RESULTS: Three themes were identified from the analysis. The first theme covers how the women found the information given before the abortion to be inadequate and how this affected their feelings of safety. In the second theme, the participants described how they experienced lack of acknowledgement from health care professionals, and how this affected their feeling of support. The third theme covers how the women perceived access to health care professionals during the home abortion, and how this affected their feeling of well-being. CONCLUSIONS: In general, the women stated that the information provided was inadequate, especially in regard to bleeding and pain. The women also found support during and after the abortion to be insufficient and would have preferred more help and information throughout the process. This suggests that health care professionals should improve their procedures for providing information, support and 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.

Fathers' Experiences of Being Present at an Unplanned Out-of-Hospital Birth: A Qualitative Study.

PURPOSE: The purpose of this study was to investigate fathers' experiences of being present at an unplanned birth outside a maternity facility. MATERIALS AND METHODS: This was a qualitative interview study with 12 fathers from six of Norway's eleven counties. All had been present at an unplanned out-of-hospital birth in 2015-2020. Data were analyzed using systematic text condensation. RESULTS: The data analysis resulted in four themes. The first theme described the fathers' stress and worry and how they managed to keep a cool head and think rationally in a totally unprepared situation. The second theme described the fathers' need for help and the reassuring feeling provided by contact with health professionals. The third theme described how the birth increased the father's attachment to his partner and baby, while the fourth theme described fathers' feelings of exclusion and their reactions following the birth. CONCLUSION: Fathers' perceived lack of expertise and their fear of complications led to stress, worry and anxiety, but support from health personnel provided reassurance and control. Many fathers experienced mastery, pride and joy after the birth, but when arriving at hospital, they felt rejected and wished that maternity care staff had approached them to talk about the experience.

"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.

Balancing Life and Death During the Golden Minute - Midwives' Experiences of Performing Newborn Resuscitation.

PURPOSE: To explore midwives' experiences in performing newborn resuscitation on maternity wards. PATIENTS AND METHODS: It was a qualitative study, using a phenomenological hermeneutic approach. Individual interviews with 16 clinical midwives working in Norwegian maternity wards were conducted from August 2018 to January 2019. RESULTS: The complexity underlying how midwives balance responsibility and vulnerability when performing newborn resuscitation during the Golden Minute was revealed. Midwives described the stress they experienced during resuscitation events and their need for support and confirmation after performing newborn resuscitation. CONCLUSION: The vulnerability and responsibility that midwives bear for mothers and newborns simultaneously affected midwives in several ways. We saw that midwives need support and confirmation to be prepared for newborn resuscitation. We also found that a lack of knowledge, skills and experience were barriers to midwives feeling prepared. Simulation training, including tailored programs, are suggested to improve midwives' skills and help them feel prepared for real-life resuscitations. The importance of midwives' assessment during the Golden Minute and further investigation from other perspectives are needed to understand fully this clinical complexity.