Supporting maternal health and wellbeing in the perinatal period : the impact of midwifery care

The perinatal period involves significant psychological and physical changes that impact women's health and wellbeing. Despite improvements in maternal health, key gaps remain in understanding and supporting women during this period. This thesis addresses these gaps by exploring physical and mental health challenges, the need for continuity and support, and the impact of intimate partner violence (IPV).

STUDY I describes new mothers' and midwives' experiences and perceptions of a coordinated postnatal care intervention. The study found that mothers highlighted continuity and accessibility as empowering factors, while midwives emphasized the care model in facilitating care tailored to individual needs.

STUDY II investigates the prevalence of IPV among pregnant women and its association with sociodemographic and health factors. The study found 2.1% of 3371 women experienced IPV, primarily psychological violence, with significant associations with living situation, depressive symptoms, education, and employment status.

STUDY III investigates new mothers' health problems, reasons for emergency department visits, and support from midwifery clinics. A lot of symptoms and problems were reported and 16% of 580 mothers sought emergency care, with higher age and poorer health increasing the likelihood. Mothers who did not receive the supported they wanted expressed a need for earlier contact and better accessibility.

STUDY IV explored changes in IPV exposure before and during pregnancy, and the frequency of screening and disclosure. IPV decreased from 6.2% pre-pregnancy to 2.1% during pregnancy, with 64% out of 3371 exposed women asked about violence, and diverse reasons for disclosure or non-disclosure.

Conclusion: Both pregnant women and new mothers face a range of challenges, including IPV, that impact their health and perception of care. This thesis highlights the importance of high-quality maternity care that meets women's individual needs, emphasizing midwives' role in preventive care and addressing the complexities of violence during pregnancy and postpartum health challenges. Keywords: Support, Continuity of care, Transition to motherhood, Intimate partner violence, Pregnancy, Postnatal care, Emergency department visits, Midwifery, Screening.

List of scientific papers

This thesis is based on the following papers, referred to in the text by their Roman numerals I - IV.

I. Eikemo, R., Vikström, A., Nyman, V., Jonas, W., & Barimani, M. (2023). Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden. Scandinavian Journal of Caring Sciences, 37(1), 260-270. https://doi.org/10.1111/scs.13103

II. Eikemo, R., Barimani, M., Elvin-Nowak, Y., Eriksson, J., Vikström, A., Nyman, V., Backman-Enelius, M & Jonas, W. (2023). Intimate partner violence during pregnancy-Prevalence and associations with women's health: A cross-sectional study. Sexual & Reproductive Healthcare, 36, 100843. https://doi.org/10.1016/j.srhc.2023.100843

III. Eikemo, R., Barimani, M., Nyman, V., Jonas, W., & Vikström, A. (2024). Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden. Midwifery, 134, 104020. https://doi.org/10.1016/j.midw.2024.104020

IV. Eikemo, R., Elvin-Nowak, Y., Åhlund, S., Vikström, A., Nyman, V., Jonas, W., Barimani, M. (2024) I had to tell to survive"- a cross-sectional study on exposure to intimate partner violence in pregnant women and the importance of screening. Sexual & Reproductive Healthcare, 42, 101045. https://doi.org/10.1016/j.srhc.2024.101045