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Objective To explore aspects of intrapartum care that were importanrt for primiparous women who had given birth in large obstetric units in Norway. Methods We used data from the Babies Born Better (B3) survey, version 1, which is an international, web-based qualitative survey. We performed a reflexive, thematic analysis of the responses to two questions about descriptions of aspects of positive care and areas of care requiring improvement during the intrapartum period. The responders could give up to three responses to each question and there were no word limits. Results In all, 677 first time mothers who gave birth at the five largest specialised obstetric units in Norway during 2014–2015 were included in the study. The thematic analysis of the 2 205 responses resulted in three final themes: ‘Communication and positive interactions with the caregivers’, ‘Autonomy and active involvement in the labour process’, and ‘Safety, competence and quality of labour care’. Conclusion For women who give birth for the first time in specialised obstetric units both relational aspect such as communication and respect, and environmental aspects such as facilities, are of importance. First-time mothers might be particularly vulnerable to absence of positive interactions with caregivers because they lack the resources former birthing experience can give. It is essential to give unexperienced birthing women special attention during childbirth because the first birth may influence decisions in following pregnancies.

Objective To investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care. Methods We used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women’s socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917). Results In total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44–2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control. Conclusion Important socioeconomic disparities in women’s childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth.

An important aspect of achieving the provision of woman-centred maternity services is to seek women's experiences of maternity care.To explore women's experiences of the care received within the Irish maternity system and to identify aspects of positive care and areas requiring improvement.The Babies Born Better pan-European online survey asked open-ended questions on positive aspects of care and aspects of care that could be improved. Data from women who birthed in Ireland within the previous five years were included. Socio-demographic data were analysed descriptively, and descriptive content analysis was conducted for the qualitative comments.Data from 736 participants were included. Four categories were generated from the analysis: Women's interactions with healthcare professionals included five sub-categories of competence and expertise, continuity and consistency, respectful care, communication, and shared decision-making; Interventions and procedures included the five sub-categories of medical interventions, breastfeeding support, pain relief, birth partner's presence and involvement, and facilitating mother and baby attachment; Organisational and infrastructural issues contained three sub-categories of facilities and services, environment and atmosphere, and staffing levels; and the fourth category, Overall evaluations and specific statements, showed the diversity of women's experiences within the services.Several positive aspects of care within the Irish maternity services were identified, many of which related to interpersonal factors and interactions with healthcare professionals. The findings also revealed what could be changed, some of which would require minimal resources or effort, so that women would experience positive care.

Women usually conceptualize pregnancy as a normal physiological state. In contrast, formal maternity care provision tends to be focused on pathology and risk. The authors aim to explore the extent to which childbearing women apply a sickness lens to pregnancy. We have therefore examined antenatal problems spontaneously reported by 4,000 UK and Norwegian women who responded to the international social media-based Babies Born Better survey. We coded and classified the free-text comments of the respondents as either complaint or disease. We found striking differences in the rates and types of problems reported by the women. We discuss our findings by applying different perspectives of medicalization and of lay and biomedical knowledge.

Background: When Europe was hit by the COVID-19 pandemic, changes were made in maternal care to reduce infections. In hospital maternity wards, postnatal wards, and neonatal units’ companions and visitors were restricted. There is emerging evidence that changes in maternity care delivery and restrictions due to social distancing have been distressing for many childbearing women. We aimed to explore the experiences of giving birth and becoming a parent in Norway during the COVID-19 pandemic. Methods: The study is based on the responses from women who provided in-depth qualitative comments to Babies Born Better survey version 3, December 2020. The responses were analysed with inductive thematic analysis.Results: In all, 827 women who gave birth in 42 of 45 available birthing units across Norway, regardless of parity and mode of birth, were included. The qualitative analysis resulted in four themes: 1) Waiting period filled with stress and worries; 2) Feeling lonely, isolated and disempowered without the partner; 3) Sharing experiences and becoming a family; and 4) Busy postnatal care without compassion.Conclusion: The COVID-19 pandemic has had an impact on women’s experiences of giving birth and becoming a parent in Norway. The denial of companionship and postnatal visiting varied between hospitals, which suggests that some of the restrictions were related to organisational protectionism than the protection of women and babies. Early postnatal care is the area of care that seems to have been most negatively affected and clearly requires more attention. The balance between humanised healthcare and protection from infection has not been well maintained through this current pandemic.

To explore and describe what women who have given birth in Norway emphasise as important aspects of care during childbirth.The study is based on data from the Babies Born Better online survey, version 2.The maternity care system in Norway.Women who gave birth in Norway between 2013 and 2018.Descriptive statistics were used to describe sample characteristics and to compare data from the B3 survey with national data from the Medical Birth Registry of Norway. The open-ended questions were analysed with an inductive thematic analysis.Themes developed from two open-ended questions.The final sample included 8401 women. There were no obvious differences between the sample population and the national population with respect to maternal age, marital status, parity, mode of birth and place of birth, except for the proportion of planned home births. Four themes and one overarching theme were identified; Compassionate and Respectful Care, A Family Focus, Sense of Continuity and Consistency, and Sense of Security. Overarching theme: Coherence in Childbearing.Norwegian women across all birth settings emphasise maternity care that authentically focuses on both socio-cultural and psychological aspects of care, and physical and clinical factors. If the positive aspects of care identified in this study are adopted at all levels of the maternity care system and from all care providers, there is a high chance that most women will have a safe outcome, and a strong sense of coherence related to a positive birth and motherhood experience.Having a baby is a pivotal life changing experience and not just a clinical event, according to a survey of 8400 women in Norway. Positive birth and motherhood experiences depend on maternity staff who are both skilled and kind.

Background: Globally, some evidence suggests that up to one third of nulliparous women experience delay in the first stage of labour. Diagnosing prolonged labour is complicated by uncertainty related to the definition of both onset of labour and normal labour progression.Prolonged labour inhabits an increased risk of poor neonatal and maternal outcomes. To our knowledge, few studies have assessed the clinical challenges of prolonged labour from a health care professional perspective. In this study we aim to improve understanding of how clinical challenges related to prolonged labour are perceived by doctors and nurse-midwives in Tanzania. Methods: A qualitative study with group interviews of either doctors (2 interviews) or nurse-midwives (7 interviews). A qualitative content analysis was performed. The study setting comprised one zonal consultant university hospital and one regional referral hospital in Northern Tanzania. Results: A total of 37 respondents, among them 32 registered nurse-midwives and 5 doctors, all with experience from labour ward. Five categories emerged. Challenges were expressed in relation to 1) various ways of understanding prolonged labour, 2) assessing progress in labour, 3) monitoring foetal heart rate, 4) appropriate intervention at the appropriate time and 5) working as a team. Conclusions: The study provides a broader understanding of the clinical challenges encountered by nurse-midwives and doctors when managing prolonged labour. The grounds on which decisions are made, are somewhat inconsistent. The respondents request clear guidelines and frequent training.

INTRODUCTION: According to WHO, midwives are found competent to provide evidencebased and normalcy-facilitating maternity care. Models for midwifery care exist, but seem to be lacking explicit epistemological status, mainly focusing on the practical and organizational level of care delivery. To make the values and attitudes of care visible, it is important to implement care models with explicit epistemological status. The aim of this paper is to identify and gain an overview of publications of theoretical models for midwifery care.METHODS: A mapping review was conducted with systematic searches in nine databases for studies describing a theoretical model or theory for midwifery care that either did or was intended to impact clinical practice. Eligibility criteria were refined during the selection process.RESULTS: Six models from six papers originating from different parts of the world were included in the study. The included models were developed using different methodologies and had different philosophical underpinnings and complexity gradients. Some characteristics were common, the most distinctive being the emphasis of the midwife-woman relationship, secondly the focus on woman-centeredness, and thirdly the salutogenic focus in care.CONCLUSIONS: Overall, scarcity exists regarding theoretical models for midwifery care with explicit epistemological status. Further research is needed in order to develop generic theoretical models with an epistemological status to serve as a knowledge base for midwifery healthcare.

Objective to integrate findings of individual studies in order to broaden the understanding of first-time mothers׳ experiences of early labour. Design the methodology was metasynthesis which is based on the interpretive meta-ethnography described by Noblit and Hare (1988). Metasynthesis is research on research which synthesises the findings of previous qualitative studies, and the focus is on interpretation and the creation of new knowledge. Setting all included studies originated from high resource countries (USA 2, UK 4, and Scandinavia 5) and all were carried out in a context of hospital based maternity care. Participants a total of 231 women participated in the studies. Findings 11 articles were included. The main results are presented with the metaphor a balancing act in an unknown territory. The ‘unknown territory' has a double meaning: as the personal experience of going into labour for the first time and as encountering the maternity care system. On both levels women have to make significant decisions: whether labour really has started and subsequently when to go to the hospital. A key challenge is to balance the arrival on the labour ward at the ‘right' time, not too early and not too late. Arriving at the ‘right' time leads to a positive path, while arriving ‘too soon' might lead to a cascade of negative experiences. The results are further presented with five central themes: ‘Finding out if labour has started is absorbing'; ‘Dealing with labour at home'; ‘Trying to arrive at the labour ward at the right time'; ‘There is always a risk of being sent home'; ׳Encountering health professionals arouses strong emotions׳. Conclusions the metasynthesis broadens the understanding of first-time mothers׳ experiences of early labour, and suggests that women׳s needs when planning a hospital birth are not being adequately met at this stage in the labour process. Three areas of future research are suggested: how to support and strengthen women during pregnancy in order to cope with early labour; women׳s experiences of early labour when planning a birth in contexts other than hospital; and to continue to investigate new ways of giving care during early labour.

Background: Maternity intrapartum care research and clinical care more often focus on outcomes that minimise or prevent adverse health rather than on what constitutes positive health and wellbeing (salutogenesis). This was highlighted recently in a systematic review of reviews of intrapartum reported outcomes where only 8% of 1648 individual outcomes, from 102 systematic reviews, were agreed as being salutogenically-focused. Added to this is variation in the outcomes measured in individual studies rendering it very difficult for researchers to synthesise, fully, the evidence from studies on a particular topic. One of the suggested ways to address this is to develop and apply an agreed standardised set of outcomes, known as a ‘core outcome set’ (COS). In this paper we present a protocol for the development of a salutogenic intrapartum COS (SIPCOS) for use in maternity care research and a SIPCOS for measuring in daily intrapartum clinical care.\ud \ud Methods: The study proposes three phases in developing the final SIPCOSs. Phase one, which is complete, involved the conduct of a systematic review of reviews to identify a preliminary list of salutogenically-focused outcomes that had previously been reported in systematic reviews of intrapartum interventions. Sixteen unique salutogenically-focused outcome categories were identified. Phase two will involve prioritising these outcomes, from the perspective of key stakeholders (users of maternity services, clinicians and researchers) by asking them to rate the importance of each outcome for inclusion in the SIPCOSs. A final consensus meeting (phase three) will be held, bringing international stakeholders together to review the preliminary SIPCOSs resulting from the survey and to agree and finalise the final SIPCOSs for use in future maternity care research and daily clinical care.\ud \ud Discussion: The expectation in developing the SIPCOSs is that they will be collected and reported in all future studies evaluating intrapartum interventions and measured/recorded in future intrapartum clinical care, as routine, alongside other outcomes also deemed important in the context of the study or clinical scenario. Using the SIPCOSs in this way, will promote and encourage standardised measurements of positive health outcomes in maternity care, into the future.

Introduction: research on intrapartum interventions in maternity care has focused traditionally on the identification of risk factors' and on the reduction of adverse outcomes with less attention given to the measurement of factors that contribute to well-being and positive health outcomes. We conducted a systematic review of reviews to determine the type and number of salutogenically-focused reported outcomes in current maternity care intrapartum intervention-based research. For the conduct of this review, we interpreted salutogenic outcomes as those relating to optimum and/or positive maternal and neonatal health and well-being. Objectives: to identify salutogenically-focused outcomes reported in systematic reviews of randomised trials of intrapartum interventions. Review methods: we searched Issue 9 (September) 2011 of the Cochrane Database of Systematic Reviews for all reviews of intrapartum interventions published by the Cochrane Pregnancy and Childbirth Group using the group filter “hm-preg”. Systematic reviews of randomised trials of intrapartum interventions were eligible for inclusion. We excluded protocols for systematic reviews and systematic reviews that had been withdrawn. Outcome data were extracted independently from each included review by at least two review authors. Unique lists of salutogenically and non-salutogenically focused outcomes were established. Results: 16 salutogenically-focused outcome categories were identified in 102 included reviews. Maternal satisfaction and breast feeding were reported most frequently. 49 non-salutogenically-focused outcome categories were identified in the 102 included reviews. Measures of neonatal morbidity were reported most frequently. Conclusion: there is an absence of salutogenically-focused outcomes reported in intrapartum interventionbased research. We recommend the development of a core outcome data set of salutogenically-focused outcomes for intrapartum research.

Objective : Intimate partner violence (IPV) is a large public health problem with far-reaching consequences for those involved. The aim of this study was to explore fathers’ experiences of change during pregnancy and early parenthood in the context of IPV. Methods : The methodological approach in this interview study was hermeneutics, based on a lifeworld perspective. Ten men, who had subjected their partners to violence during the childbearing period, and had become fathers within the previous 6 years, participated. Results : The analysis revealed four themes: beginning to acknowledge that you are inflicting violence, receiving confirmation that you are more than just a perpetrator of violence, becoming aware of the child, and the desire to receive support in the process of learning how to become a father. Levinas’ concept “the face of the other” is used to interpret the findings. Conclusion : This study contributes to a more nuanced and expanded picture of IPV. It shows that men who inflict violence want to be and learn how to be fathers. We need more knowledge about how to stop violent acts and support these men in the process of fatherhood. Key words: IPV, fathers, experience, pregnancy, childhood, parenthood (Published: 16 June 2016) Citation: Int J Qualitative Stud Health Well-being 2016, 11: 30935 - http://dx.doi.org/10.3402/qhw.v11.30935

Purpose: to explore the priorities and strategies midwives in a labour ward use in their communication with primiparous women who seek contact in the early phase of labour. Design: a qualitative study using focus groups. Setting: Norway. Participants: 18 midwives. Findings: five themes that seemed to constitute the key elements in the communication were identified. The themes were designated ‘Getting the picture’, ‘Normalising the situation’, ‘Giving concrete advice’, ‘Letting the woman make the decision’, and ‘Staying at home for as long as possible’. Conclusions and implications: the findings of this study indicate that the midwives’ overall strategy was to encourage women to remain out of hospital for as long as possible ‘for their own good’. This strategy seems to rely on knowledge derived from non-contextual science within the dominant medical childbirth paradigm, and might not meet women’s needs in early labour. When women are admitted in early labour, midwives should be able to ‘protect’ these women from unnecessary interventions and do so in partnership with the women themselves rather than accepting that women’s mere presence in the labour ward yields complications and increases the likelihood of caesarean section. From the findings of this study, it is reasonable to ask whether an obstacle to this course might be the midwives’ subordination to the medical paradigm. This causes midwives to function as ‘gatekeepers’ to the medical system instead of working in accordance with the philosophy of midwifery: ‘for women’s own good’.

Newly qualified midwives’ self-assessment of education, clinical competence and working conditionsIn Norway, post-graduate nursing programmes are being transformed into master programmes. This occurs without previous evaluation of the study programmes. The level of competence and the requirements of newly qualified are being discussed, and a mentoring programme has been suggested to ensure follow-up and development of clinical competence. In central parts of the country, newly qualified midwives have difficulties getting a permanent full time position, which affects their possibilities to develop clinical competence. An evaluation study of the midwifery program at Vestfold University College has been performed to assess its relevance for professional work, as well as mapping the respondents’ working conditions and their self-assessment of clinical competence. The method used was a survey. The respondents rate the program as good. They lack competence to manage complicated conditions related to the perinatal period, and are inadequate when it comes to issues related to women’s sexual heath. These midwives work part-time, and it may take years to get a permanent position. They rate the follow-up as newly qualified as satisfying, yet they do not feel sufficiently confident during clinical practice. Comprehensive national midwifery competence will require more full time positions and better follow-up of newly qualified. To lay the basis for the content in master programmes, there is a need for a national evaluation of the midwifery programmes and a review of the professional competence of newly qualified.

Purpose To explore first-time mothers’ experiences of waiting for labour onset, and to contribute to the discussion of existing practices surrounding perinatal care. Methods A qualitative study of 17 women in Norway. Diaries written by the informants and in-depth interviews were analysed in a tradition of life-world phenomenology. Results The participants entered a state of active waiting, “the waiting mode”, in the days around the estimated date of delivery. When the women entered the mode there was a marked change in the way they interpreted bodily sensations. The women experienced being in a state of constant bodily alertness, their bodies felt all-consuming and they experienced themselves as being “more and more body”. This generated a sense of being enclosed in the body, intensely trying to identify the signs of labour. Being in the waiting mode seemed to draw labour closer in a manner that opened up for the birthing process and helped the women to prepare for labour. Conclusions The findings indicate that the estimated date of delivery is pivotal in shaping women’s experiences of waiting. It raises concerns related to how women who are giving birth for the first time are prepared for labour, and a worry that too much weight is put on the exact date. A stronger emphasis on the diversity of women’s experiences might be in place. Pregnant women could be encouraged to explore and interpret bodily experiences on their own terms, not merely in relation to the estimated date of delivery.

Objective to explore Norwegian nulliparous women's experiences of communication and contact with midwives at the labour ward in the early phase of labour. Design a qualitative study based on in-depth interviews. Participants 17 women expecting their first baby. Findings four themes that emerged in the collected material seem to be central to how the labouring women decided to make contact with the labour ward and how they experienced this contact with the staff: (a) negotiating on two fronts, (b) avoiding being sent home, (c) searching for regularity, and (d) experiencing vulnerability. Conclusions the study shows how women in labour for the first time negotiate their credibility with midwives through the requisite pattern of regularity, and also shows their vulnerability in attempting to avoid being sent home from hospital because it is ‘too soon' to be admitted. It also argues that the midwifery profession is ambivalent about the paradigm to which it conforms in its contact with women in early labour. Implications for practice the findings of this study show that the way in which questions are asked in this phase is very important. Midwives should be aware that if they only ask the ‘standard question' related to the pattern of contraction regularity, they might lose vital information and also deprive the woman of the chance to verbalise her experiences and her needs as she perceives them. If the focus is shifted from the rigid instructions that women are given to an emphasis on the women's actual experiences, the need for negotiation will probably diminish. The task of assessing and evaluating women in early labour need not necessarily be performed inside the ordinary labour ward, but may be done in a more home-like environment outside the hospital or in the woman's home.

Childbirth has been increasingly concentrated in large centralised hospitals, with a parallel trend toward more birth interventions in Norway. These changes have resulted in new ways of framing birth from: a normal woman's life experience to a medical event. Caring for the birthing mother in a modern centralised ward, take place between two different belief- systems: a biomedical and a phenomenological. A phenomenological account of seven midwives' descriptions of skilled midwifery in a Norwegian high-technology labour ward was carried out. The focus was on how skilled midwives experience their daily work between a biomedical and a phenomenological belief system. Three themes were identified: (1) sensing where the woman is in labour, (2) being available for but not overbearing to the women and (3) being in a room of struggle. The findings are discussed from the perspective of being between these two belief-systems, with special focus on wise midwifery judgement as a way of managing the struggle.