Fear causes tears – perineal injuries in home birth settings : a Swedish interview study

Background: Perineal injury is a serious complication of vaginal delivery that has a severe impact on the quality of life of healthy women. The prevalence of perineal injuries among women who give birth in hospital has increased over the last decade, while it is lower among women who give birth at home. The aim of this study was to describe the practice of midwives in home birth settings with the focus on the occurrence of perineal injuries. Methods: Twenty midwives who had assisted home births for between one and 29 years were interviewed using an interview guide. The midwives also had experience of working in a hospital delivery ward. All the interviews were tape-recorded and transcribed. Content analysis was used. Results: The overall theme was "No rushing and tearing about", describing the midwives' focus on the natural process taking its time. The subcategories 1) preparing for the birth; 2) going along with the physiological process; 3) creating a sense of security; 4) the critical moment and 5) midwifery skills illuminate the management of labor as experienced by the midwives when assisting births at home. Conclusions: Midwives who assist women who give birth at home take many things into account in order to minimize the risk of complications during birth. Protection of the woman's perineum is an act of awareness that is not limited to the actual moment of the pushing phase but starts earlier, along with the communication between the midwife and the woman.

Residential planning, driver mobility and CO2 emission

The literature on residences and citizens’ transports has focused on either reforming traffic managing in response to residential relocation or post-evaluation of urban planning policies or the evolution of the urban spatial form. In a city there are hotspots that attract the citizens and most of the transportation in the city arises as the citizens’ movement between their residence and the hotspots. Little scholarly attention has been devoted to the possibility to minimize citizens’ transportation in the city by the urban planning of residential areas. In this paper we propose a method to evaluate the environmental impact (in terms of CO2-emissions) of urban plans of residential areas. The method is illustrated in a Swedish case of a midsize city which is presently preoccupied with urban planning of new residential areas in response to substantial population growth due to immigration. The residential plans aims to increase the compactness and residential density in the current center and sub centers leads to less CO2 emissions compare to urban expansion to the edge of the city. The plans of concentrated apartment buildings are more effective in meeting residential needs and mitigating CO2 emissions than dispersed single-family houses.