Maternal health care professionals perspective on the provision and use of antenatal and delivery care : a qualitative descriptive study in rural Vietnam

Background. High quality maternal health care is an important tool to reduce maternal and neonatal mortality. Services offered should be evidence based and adapted to the local setting. This qualitative descriptive study explored the perspectives and experiences of midwives, assistant physicians and medical doctors on the content and quality of maternal health care in rural Vietnam. Method. The study was performed in a rural district in northern Vietnam. Four focus group discussions with health care professionals at primary health care level were conducted. The data was analysed using qualitative manifest and latent content analysis. Result. Two main themes emerged: "Contextual conditions for maternal health care" and "Balancing between possibilities and constraints". Contextual conditions influenced both pregnant women's use of maternal health care and health care professionals' performance. The study participants stated that women's uses of maternal health care were influenced by economical constraints and cultural norms that impeded their autonomy in relation to childbearing. Structural constraints within the health care system included inadequate financing of the primary health care, resulting in lack of human resources, professional re-training and adequate equipment. Conclusion. Contextual conditions strongly influenced the performance and interaction between pregnant women and health care professionals within antenatal care and delivery care in a rural district of Vietnam. Although Vietnam is performing comparatively well in terms of low maternal and child mortality figures, this study revealed midwives' and other health care professionals' perceived difficulties in their daily work. It seemed maternal health care was under-resourced in terms of staff, equipment and continuing education activities. The cultural setting in Vietnam constituting a strong patriarchal society and prevailing Confucian norms limits women's autonomy and reduce their possibility to make independent decisions about their own reproductive health. This issue should be further addressed by policy-makers. Strategies to reduce inequities in maternal health care for pregnant women are needed. The quality of client-provider interaction and management of pregnancy may be strengthened by education, human resources, re-training and provision of essential equipment.

Pedagogisk dokumentation i förskolan : En intervjustudie om några förskollärares uppfattningar om begreppet pedagogisk dokumentation och dess innebörd

I dagens förskoleverksamhet är det i regel ett måste att dokumentera lärandeprocesser för att kunna uppfylla samtliga mål i utbildningsplaner och bistå med god utbildningskvalitet. Pedagogisk dokumentation – som grundades av Reggio Emilia – är ett utvärderingsverktyg som skall observera barnets lärandeprocesser samt förskollärarnas förhållningssätt. I vardagliga situationer i förskoleverksamheten har pedagogisk dokumentation många fördelar som kan kartlägga och ge bra förutsättningar genom att skapa förståelse för hur barn lär sig och utvecklas bäst. Syftet med denna studie var att genomföra en litteraturstudie i kombination med kvalitativa intervjuer som utgick ifrån följande frågeställningar: Hur definierar förskollärare begreppet dokumentation respektive pedagogisk dokumentation? Hur beskriver förskollärare arbetet med pedagogisk dokumentation? Och hur menar förskollärare att arbetet med pedagogisk dokumentation utvecklar verksamheten? Intervjuerna transkriberades och kategoriserades sedan kring hur förskollärarna använder pedagogisk dokumentation, hur synen på pedagogisk dokumentation ser ut samt vilka olika arbetssätt som används. Vid färdigställande av resultatet framgick det att tre av fyra respondenter upplevde pedagogisk dokumentation som något positivt och modernt. En respondent av fyra fann inte pedagogisk dokumentation som ett bra hjälpmedel för utvärdering, då verktyget kan vara oetiskt på så sätt att det kan användas som ett bedömningsverktyg på det enskilda barnet. Diskussionsavsnittet kopplar samman tidigare forskning med förskollärarnas svar kring hur de ser på pedagogisk dokumentation, hur de beskriver arbetet med pedagogisk dokumentation och hur arbetssättet kan utveckla verksamheten.

Being a bridge : Swedish antenatal care midwives’ encounters with Somali-born women and questions of violence; a qualitative study

Background: Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence. Methods: Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis. Results: The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women’s’ strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman’s access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women. Conclusion: Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives’ ability to identify Somali born woman’s resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.