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Background It is known that healthcare providers might be affected by severe medical events in which patients are badly hurt. In birth care, escalating situations can result in death or injury to a mother or new-born child. Objective To explore the process that Swedish midwives and obstetricians go through after a severe event in the maternity unit. Design A modified Constructivist Grounded Theory analysis, based on fourteen in-depth interviews with birth care professionals. Participants Seven midwives and seven obstetricians. Results A core category, ˈregaining of a professional self-imageˈ, was constructed and interpreted as being constituted of six main categories illustrating a frequently erratic pathway to the regaining of a professional self-image. The process included a search for external acceptance for the re-establishment of belongingness by obtaining corroboration from the woman, work colleagues and manager, and the medico-legal system. Media exposure was invariably seen as something negative. Internal processes involved coping with emotions of guilt and shame and the vulnerability that the work entails, as well as contemplating future work. The possibility to fully regain one’s professional self-image depended on having a sense of confidence and an urge to support others in similar situations by sharing gained insights. However, the process could also result in reconsidering one’s professional self-image by setting up boundaries, creating a better work-life balance, or creating mental back-up plans in case of similar recurrences. For others, the process led to a change of professional identity and a search for roles away from emergency obstetrics or the specialty as such. Conclusions Many midwives and obstetricians will experience severe obstetric events that might affect them, sometimes severely. The vulnerability that healthcare professionals are exposed to should not be underestimated and preparedness in terms of collegial support, as well as an awareness in the workplace of how badly affected employees might be, is important. Growth as well as leaving birth care can be the results of the process following a severe event.

To explore perceptions and experiences among youth who underwent structured questions about violence victimization and alcohol consumption when visiting Swedish youth clinics.This study is part of a larger research project examining the effect of including routine inquiry about violence victimization and alcohol consumption for youth visiting youth clinics. Fifteen youth with experiences of victimization and/or risk drinking (AUDIT-C≥5) were interviewed. Content analysis was used.The findings were grouped into three main categories: The first; "Disclosure - talking about violence" reflected the participants' experiences of being asked about victimization. Participants were in favor of routine inquiry about violence victimization, even when questions caused distress. The questions helped participants reflect on prior victimization and process what had happened to them. The second; "Influence on the life situation" demonstrated that many of the participants still were effected by prior victimization, but also how talking about violence sometimes led to the possibility of initiating change such as leaving a destructive relationship or starting therapy. In the third; "One's own alcohol consumption in black and white" participants considered it natural to be asked about alcohol consumption. However, most participants did not consider their drinking problematic, even when told they exceeded guidelines. They viewed risk drinking in terms of immediate consequences rather than in quantity or frequency of alcohol intake.Routine inquiry about violence victimization and risk drinking at youth clinics was well received. Questions about violence helped participants to interpret and process prior victimization and sometimes initiated change.

Background The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence). Objective To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints. Design Cross-sectional survey. Participants Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG). Methods A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression. Results The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient. Conclusions A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.

low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery.the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting.midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique.the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis.two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency.the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.

postnatal care has gone through remarkable changes, such as reducing the length of hospital stay and increasing the parents' responsibility. Focusing on dissatisfaction, this study describes how new parents experience postpartum care.cross-sectional, population-based study, based on questionnaires.1474 parents.the questionnaires, posted six months after childbirth, addressed how parents experienced postnatal care. The data were analysed with descriptive statistics and content analysis.a main finding was that the close emotional attachment between the parents was not always supported by staff. The father was treated as an outsider and the care was described as 'a woman's world'. The asymmetric encounter between parents and staff was pronounced with respect to decision-making, and some designated this as 'paternalism'. A great deal of the discontent with health care may be due to organisational failure, and the postnatal care should be more prioritised in the health-care organisation.midwives should acknowledge that parents, irrespective of gender, should have equal opportunities as parents during postpartum care as parenting is a joint project.

to explore the possibility of using eye movement desensitisation and reprocessing (EMDR) to treat women who have experienced post-traumatic stress after childbirth.the pilot study consisted of a 'before and after' treatment design combined with follow-up measurements 1-3 years after EMDR treatment. Quantitative data from questionnaires (Traumatic Event Scale [TES]) were collected. In addition, qualitative data from individual interviews with the participants were collected as well as data from the psychotherapist's treatment notes of the EMDR treatment sessions.the north of Sweden.four women with post-traumatic stress disorder (PTSD) after childbirth (one pregnant and three non-pregnant).all participants reported reduction of post-traumatic stress after treatment. After 1-3 years, the beneficial effects of EMDR treatment remained for three of the four women. Symptoms of intrusive thoughts and avoidance seemed most sensitive for treatment.EMDR might be a useful tool in the treatment of non-pregnant women severely traumatised by childbirth; however, further research is required.

to elucidate women's experiences of prolonged labour.qualitative research interviews were conducted and thematic content analysis was applied.10 primiparae who, 1-3 months previously, had a prolonged labour with assisted vaginal or caesarean delivery.the narratives about giving birth were interpreted and formulated into three themes and six sub-themes. The first theme, 'being caught up in labour', described the sense of not making progress during labour. The second theme was 'being out of control', and was related to the women's insufficient control of their own bodily processes, and consisted of descriptions of exhaustion and powerlessness. The third theme was 'being dependent on others', and described the women's dependence on care and on the support of the caregivers, and included descriptions of caregivers' assistance with birth as an experience of being relieved from pain and distress.the experience of giving birth was not the experience of a healthy woman in labour, but one of severe labour pains that seemed to go on forever. The experience of prolonged labour could be understood as an experience of suddenly falling ill or finding oneself in a life-threatening condition associated with intractable pain, dependence on others and an overwhelming fear of losing oneself.women with prolonged labour are more dependent on their caregivers than are women without prolonged labour. They have a special need for extra support and encouragement during the delivery as well as increased nursing and midwifery care.

Longitudinal demographic surveillance systems (DSSs) in selected populations can provide important information in situations where routine health information is incomplete or absent, particularly in developing countries. The Butajira Rural Health Project is one such example, initiated in rural Ethiopia in 1987. DSSs rely on regular community-based surveillance as a means of vital event registration, among a sufficient population base to draw meaningful conclusions about rates and trends in relatively rare events such as maternal death. Enquiries into specific health problems can also then use this framework to quantify particular issues or evaluate interventions. Demographic characteristics and trends for a rural Ethiopian population over a 10-y period are presented as an illustration of the DSS approach, based on 336 000 person-years observed. Overall life expectancy at birth was 50 y. Demographic parameters generally showed modest trends towards improvement over the 10-y period. The DSS approach is useful in characterising populations at the community level over a period of time, providing important information for health planning and intervention. Methodological issues underlying this approach need further exploration and development.

There are reports indicating a worsening of women's health in transitional rural societies in sub-Saharan Africa in relation to autonomy, workload, illiteracy, nutrition and disease prevalence. Although these problems are rampant, proper documentation is lacking. The objective of this study was to reflect the health situation of women in rural Ethiopia. Furthermore, the study attempts to address the socio-demographic and cultural factors that have potential influence on the health of women in the context of a low-income setting. A combination of qualitative and quantitative research methods was utilised. In-depth interviews and a cross-sectional survey of randomly selected women were the main methods employed. The Butajira Rural Health Program demographic surveillance database provided the sampling frame. Heavy workload, lack of access to health services, poverty, traditional practices, poor social status and decision-making power, and lack of access to education were among the highly prevalent socio-cultural factors that potentially affect the health of women in Butajira. Though the majority of the women use traditional healers younger women show more tendency to use health services. No improvement of women's status was perceived by the younger generation compared to the older generation. Female genital mutilation is universal with a strong motivation to its maintenance. Nail polish has replaced the rite of nail-extraction before marriage in the younger generation. As the factors influencing the health of women are multiple and complex a holistic approach should be adopted with emphasis on improving access to health care and education, enhancing social status, and mechanisms to alleviate poverty.

The implementation of community midwifery, characterized by a health system approach, political commitment, task-shifting, close supervision and complimentary roles of midwives and doctors, was a major contributor to the decline in maternal and neonatal mortality in Sweden during the late 19th century. In respect of the MDG5 a causal inference between skill birth attendants and decline in maternal mortality might not be straight forward but more a matter of skilled birth attendance, i.e. obstetricians, professional midwives, other midlevel providers and nurse-aides working in an enabling environment. A health system approach, commitment and mobilization, is a necessity to achieve safe abortions and safe deliveries by full coverage and equity.

OBJECTIVE: A cohort study was conducted to determine the risk of dystocia for women whose mothers, sisters, or twin sisters had dystocia during childbirth. STUDY DESIGN: A linked database was constructed between 2 separate Swedish birth registries. Obstetric data on mothers giving birth to daughters during the period 1955 to 1972 were studied. Among these daughters, sister-couples and twins were identified. The daughters subsequently became mothers during 1973 and 1990 and obstetric data on the first deliveries were also studied. RESULTS: If a mother had dystocia when delivering her eldest daughter, this daughter had an increased risk of dystocia during her own first childbirth (odds ratio 1.7, 95% confidence interval 1.2 to 2.4). If the mother had an assisted instrumental delivery (vacuum extraction, forceps, or cesarean section) because of dystocia, there was a higher risk for her daughter to have an instrumental delivery because of dystocia (odds ratio 1.8, 95% confidence interval 1.0 to 3.1). Among primiparous sisters the risk of an instrumental delivery because of dystocia in a younger sister was more than tripled (odds ratio 3.5, 95% confidence interval 2.1 to 5.8) if her elder sister had a dystocic labor requiring instrumental intervention. The risk among twins increased more than 20-fold (odds ratio 24.0, 95% confidence interval 1.5 to 794.5) if 1 twin sister had dystocia during her first childbirth. CONCLUSION: Dystocia has a familial occurrence, suggesting a possible genetic factor explaining inefficient uterine action. (Am J Obstet Gynecol 1998;179:117-21.)

Gender differences in mortality risks in rural Somali communities were studied to assess their relation to literacy, marital status and family economy between January 1987 and December 1989. In all, 6947 person-years form the basis for the demographic analysis and estimations of mortality rates and survival. Both sexes showed similar mortality risks in infancy and early childhood, but females demonstrated a greater risk of dying during their reproductive life than males. Respiratory symptoms, diarrhoea, fever and jaundice dominated the symptoms prior to death. Illiteracy in women considerably increased the risk of dying from 15 years and onwards particularly when living with literate men. The life expectancy from 15 years was 58 for a literate male but only 42 years for an illiterate woman living with a literate head of household. Multivariate analyses showed after adjustment for marital status and literacy that an excess female mortality from 15 years, but especially from 45 years, was associated to a household situation, where the woman did not subside on farming but on other, mainly commercial, activities. This vulnerability of females was associated to the recession of the economy in the pre-war situation in Somalia, a backlash hitting women trying to earn their living. To conclude, gender differences in a number of factors in the household—literacy, marital status and especially source of income—were disadvantageous for the women, increasing the mortality risk in this setting.

BACKGROUND: Celiac disease is an immune-mediated enteropathy that is secondary to gluten ingestion and is classically associated with gastrointestinal symptoms. Some studies suggest that reproductive disorders may be the first symptoms of Celiac disease in otherwise asymptomatic women. Our objective was to determine the prevalence of Celiac disease in women presenting with infertility. STUDY DESIGN: Prospective cohort study. METHODS: We collected data on demographics, screening test results, and diagnosis among women presenting with infertility from March 2012 through March 2013. Women were screened for Celiac disease using serologic testing for antibodies against tissue transglutaminase (IgAtTG). RESULTS: 1112 women presented for an initial infertility evaluation. 20 women had a previous diagnosis of Celiac disease, 20 were on a self-imposed gluten-free diet, and 839 were screened. Seven women screened positive, yielding an incidence of 0.83% among women presenting with infertility to our clinic. Median age and body mass index as well as screening results are reported in Table 1. The prevalence of Celiac disease among women presenting with infertility was 3.1% (95% CI 2.54.5). The prevalence of Celiac disease among women with unexplained infertility was 5.2% (95% CI 3.1-8.5). CONCLUSION: The prevalence of Celiac disease is approximately 3 times higher in women with infertility than the general U.S. population (0.8%); however, routine screening at the time of infertility evaluation is likely not warranted given the low incidence. Table 1. Characteristics and Laboratory Values Median (interquartile range)