ETT KLIPP R INTE BARA ETT KLIPP Barnmorskors resonemang kring episiotomi A CUT IS NOT JUST A CUT Midwifes` reasoning about episiotomy
Examensarbete inom huvudomrdet Reproduktiv, perinatal och sexuell hlsa Avancerad niv 15 Hgskolepong Hstterminen 2017 Frfattare: Anna Fossen, Jessica Sabel Handledare: Elisabeth Hertfelt Wahn
SAMMANFATTNING
Titel: Ett klipp r inte bara ett klipp. Barnmorskors resonemang kring episiotomi.
Frfattare: Anna Fossen, Jessica Sabel
Institution: Institutionen fr hlsa och lrande, Hgskolan i Skvde
Kurs: Examensarbete i Reproduktiv, perinatal och sexuell hlsa, RP720A, 15
hgskolepong
Handledare: Elisabeth Hertfelt Wahn
Sidor: 27
Mnad och r: augusti 2017
Nyckelord: frlossning, episiotomi, resonemang, perinealskydd.
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Bakgrund: Barnmorskan ska vrda och stdja kvinnan genom hela frlossningsprocessen.
Situationer kan uppkomma under frlossningen dr olika tgrder kan behva utfras som
exempelvis episiotomi i samband med att fregende fosterdel framfds. Studier visar att
bde frdelar och nackdelar r assosierade med episiotomi. Det r drfr viktigt att
barnmorskor vet sitt resonemang kring episiotomi nr resultaten av studier varierar
eftersom barnmorskan har ansvar fr den fdande kvinnan. Syfte: Att underska
barnmorskors resonemang kring episiotomi. Metod: Semistrukturerade intervjuer med nio
barnmorskor som analyserades med kvalitativ innehllsanalys med induktiv ansats.
Resultat: Resultatet presenteras i ett tema, En berg- och dalbana, innehllande tv
kategorier, Blandade knslor till episiotomi samt Det skra fre det oskra, dessa
utmynnade i sex underkategorier. Barnmorskorna ansg att episiotomi inte var ngot som
skulle utfras i ondan och med erfarenhet upplevde barnmorskorna det lttare att avgra
nr episiotomi hade en positiv effekt p frlossningsprocessen. Konklusion:
Barnmorskorna var restriktiva i utfrandet av episiotomi och att det endast var i speciella
situationer det ansgs vara ndvndigt med ingreppet. Tlamod var en viktig egenskap fr
en barnmorska och tillsammans med en kad arbetslivserfarenhet var det lttare att avgra
nr den fdande kvinnan var i behov av episiotomi.
ABSTRACT
Title: A cut is not just a cut. Midwives` reasoning about episiotomy.
Author: Anna Fossen, Jessica Sabel
Department: School of Health and Education
Course: Master Degree Project in Midwifery, 15 ECTS
Supervisor: Elisabeth Hertfelt Wahn
Pages: 27
Month and year: august 2017
Keywords: childbirth, episiotomy, reasoning, perineal protection.
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Background: The midwife will care for and support the woman throughout the childbirth
process. There may occur situations during childbirth when certain measures, like
episiotomy, need be taken in relation to the advance of the fetus. Studies reveal different
advantages, as well as disadvantages associated with episiotomy. Given the multitude of
opinions with regards to episiotomy, it is important that midwives have a clear stance on
the procedure since they are in charge of the woman who is giving birth. Aim: To
investigate midwives' reasoning on the subject of episiotomy. Method: Semi-structured
interviews with nine midwives. The data underwent qualitative content analysis, and
inductive approach was applied. Results: The results present a theme, A roller coaster,
containing two categories, Varied attitudes to episiotomy and The secure before the
insecure, these resulted in six subcategories. The midwives felt that episiotomy should not
be conducted unless absolutely necessary. Midwives further felt that growing experience
helped them to determine in what situations episiotomy would have a positive effect on the
childbirth process. Conclusion: The midwives are cautious about the use of episiotomy
reserving it for special situations when the procedure is deemed absolutely necessary.
Patience, an important characteristic for a midwife, in conjunction with work experience
made it easier to determine when the woman giving birth was in need of episiotomy.
FRORD
Vi vill rikta ett stort tack till alla barnmorskor som valt att medverka i vr studie.
Vi vill ocks rikta ett stort tack till vr handledare Elisabeth Hertfelt Wahn fr all guidning
genom arbetets gng.
INNEHLLSFRTECKNING
INLEDNING ......................................................................................................................... 1
BAKGRUND ......................................................................................................................... 2
Sexuell och reproduktiv hlsa ............................................................................................ 2
Barnmorskans professionella roll ....................................................................................... 2
Stdets olika betydelser .................................................................................................. 2
Episiotomi .......................................................................................................................... 3
Skyddandet av perineum ................................................................................................ 3
Skillnader i vrlden ......................................................................................................... 4
Sverige ............................................................................................................................ 4
Analsfinkterskada ........................................................................................................... 5
Barnmorskor och episiotomi .............................................................................................. 5
PROBLEMFORMULERING ................................................................................................ 6
SYFTE ................................................................................................................................... 6
METOD ................................................................................................................................. 7
Val av metod ...................................................................................................................... 7
Milj ................................................................................................................................... 7
Urval ................................................................................................................................... 7
Datainsamling .................................................................................................................... 7
Analys ................................................................................................................................ 8
Etiska vervganden .......................................................................................................... 9
RESULTAT ......................................................................................................................... 11
Blandade knslor till episiotomi ....................................................................................... 11
Tlamod ........................................................................................................................ 11
Tilltron till det naturliga ............................................................................................... 12
Motiverad tgrd .......................................................................................................... 13
Det skra fre det oskra .................................................................................................. 13
Olika synstt ................................................................................................................. 13
Negativa konsekvenser ................................................................................................. 14
Den nya forskningen ..................................................................................................... 14
Tema: En berg- och dalbana ............................................................................................ 15
DISKUSSION ...................................................................................................................... 16
Metoddiskussion .............................................................................................................. 16
Giltlighet ....................................................................................................................... 16
Tillfrlitlighet ............................................................................................................... 16
verfrbarhet ............................................................................................................... 18
Delaktighet ................................................................................................................... 18
Resultatdiskussion ............................................................................................................ 18
Konklusion ........................................................................................................
