Ja, visst gör det ont när rutiner brister – barnmorskors upplevelse av att följa upp förlossningsbristning

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Sammanfattning: Background: Vaginal tears during childbirth is a common phenomenon. They can vary inmagnitude and lead to subsequent inconvenience for the affected women. Most regions inSweden offer a multi professional follow-up programme for women with third- and fourthdegreetears while women with first- and second degree tears are dependent on the follow-upvisit included in the maternal health care package offered by the midwife at an outpatient unit.Objective: To examine midwives’ experience of following up vaginal tears caused bychildbirth at the follow-up visit.Method: A qualitative interview study. A total of six registered midwives at midwifery-ledoutpatient units were included. Qualitative content analysis as described by Elo and Kyngäswas used for analysis of data.Results: The study revealed eleven categories that were ordered into four main categories:Guardian of women’s right to health, Insufficient presuppositions, Need of structure, Furtherreferral. Midwives considered the following up of vaginal tears to be an important work tasksince it influences the future health of the affected women. The midwives did not feel theyhave the necessary knowledge and the tools to carry out this part of their responsibility in apatient safe manner. Furthermore, there seems to be a lack of appropriate places to referpatients in need of an expert opinion. It is dependent on the individual midwife where patientsare referred to. Midwives expressed that there is a lack of feedback on the outcome followingthe referral. This feedback could contribute to their professional development. Cumulativelythis can result in patients in need of help not receiving the care that they require.Conclusion: Midwives experience a lack of competence regarding following up vaginal tearsafter childbirth as well as an absence of guidelines for refferal. There is a wish for a cohesivechain of care with a possibility for a cross-proffessional knowledge exchange. As well as aneed for competence inventory within the midwifery led units.

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