Midwives' experiences of encountering immigrant women during labour and birth who do not master the host country's language. A lifeworld hermeneutic study

Background - Immigrant women are in a vulnerable position during labour and birth due to language barriers. Communication with women who do not master the host country's language is difficult for midwives, but there are few studies about midwives' experiences. Aim - To explore Norwegian midwives' experiences of encountering immigrant women during labour and birth who do not master the native language. Method - A hermeneutic lifeworld approach. Interviews with eight midwives working at specialist clinics and hospital maternity wards in Norway. Results - The findings were interpreted based on four concepts in the theory “Birth territory: A theory for midwifery practice” by Fahy and Parrat presented in five themes: language barriers can cause disharmony and prevent participation, language barriers can lead to midwifery domination and poorer care, midwives strive for harmony and to be a guardian, medicalisd birth due to language barriers, and disharmony can lead to crossing boundaries. The main interpretation shows that it is midwifery domination and disintegrative power that are prominent. However, the midwives strived to use their integrative power and be guardians, but in doing so they encountered challenges. Conclusion - Midwives need strategies for better communication with immigrant women involving the women and for avoiding a medicalised birth. To be able to meet immigrant women's needs and to establish a good relationship with them, challenges in maternity care need to be addressed. There are needs of care that focus on cultural aspects, leadership teams that support midwives, and both theoretical and organisational care models that support immigrant women

Forbedringspotensial i den norske fødselsomsorgen

Tema for denne artikkelen er medikalisering i norsk fødselsomsorg. I teksten beskriver og analyserer vi noen av faktorene som er knyttet til medikalisering. Til tross for at norsk fødselsomsorg har svært gode medisinske/fysiske utfallsmål for kvinner og barn, er det behov for forbedringer. Norge, som mange andre høy-inntektsland, har for mange keisersnitt og andre fødselsintervensjoner. Medikalisering ser også ut til å føre med seg sentralisering, samt dominans over andre modeller for fødselsomsorg og helsefremmende perspektiv. Til tross for at et av målene i den norske tjenesten er en demedikalisert fødselsomsorg (på ulike nivå i helsetjenesten), har økende grad av sentralisering funnet sted de siste tiår; f.eks. har antallet jordmorledede fødeenheter/fødestuer blitt redusert. Å inkludere en kvinnesentrert modell i tjenesten kan styrke at kvinnenes behov blir møtt. I en kvinnesentrert modell er f.eks. kvinners erfaringer, deres delaktige i omsorgen de tilbys og relasjonen mellom kvinnen og jordmor/helsepersonell, svært viktig. I tillegg kan anvendelse av salutogenese-teorien bidra til å styrke fødselsomsorgens helsefremmende perspektiv.   Potential for improvement in the Norwegian childbirth model In this paper some aspects of medicalization in the Norwegian childbirth context are described and analysed. Despite having very good medical outcomes for women and babies, there is a need for improvement. As in many other high-income countries, there are too many Caesarean sections and interventions during births. Medicalized care tends to lead to centralisation of the care and dominate over other models of care and health promoting aspects. Even if the goal of the Norwegian model is de-medicalised maternity care on different levels, centralisation have occurred during the last decades. For example midwifery-led units has decreased in numbers. Woman-centred care is a model of care that can meet what is lacking by focusing at women´s experiences, women´s participation and involvement in the care and the relationship between the woman and the care-giver. Furthermore, salutogenesis is a health promoting perspective that could contribute to maternity care

Women's lived experiences of induction of labour in late- and post-term pregnancy within the Swedish post-term induction study - a phenomenological study

Purpose: There is a trend worldwide to induce pregnant women earlier. However, few studies have focused on women’s experiences. The aim was to gain a deeper understanding of women’s lived experiences of induction of labour in late- and post-term pregnancy. Methods: Phenomenology with a reflective lifeworld approach was chosen as the method. Twelve women participating in a larger study in which women were randomized to either induction of labour in week 41 or to expectant management until week 42, were interviewed one to three months after giving birth. Results: The essence is described as follows: labour becomes another journey than the intended one. The women adapted to this new journey by seeing the advantages and handing themselves over to the healthcare system, but at the same time something about giving birth could be lost. The result is further described by its four constituents: planning the unplannable, being a guest at the labour ward, someone else controlling the labour, and overshadowed by how it turned out. Conclusion: Induced labour presents a challenge to maternity personnel to support the birthing woman’s normal progress, not to rush her through labour, and to involve her in the process