Postpartum care in transition parents' and midwives' expectations and experience of postpartum care including the use of videoconferencing

Sammanfattning: The overall aims are to explore pregnant women's expectations of postpartum care, midwives experience of organizational and professional change and parents' and midwives' experiences of postpartum care using VC. During the 1980s early discharge was introduced to facilitate a more family-oriented postpartum care. At present new parents are discharged from the maternity ward about 48 hours after childbirth. Studies of new parents' needs in the postpartum period show that continuity of care, practical, informational and emotional support are important issues. The midwife's role in postpartum care is evaluated as having a significant importance for new parents through being available, competent and supportive both emotionally and practically. Structural change with the introduction of early discharge and the centralisation of specialties to a few hospitals has affected the parents' situation as well as the midwife's ability to practise care for the new mother, child and family. Sweden's most northern county council has been progressive in its development of ICT and associated ideas concerning its application to healthcare. An intervention was carried out using videoconferencing (VC) equipment between a maternity ward and parents' homes. Data were collected by questionnaires completed by pregnant women (I), parents (III) and midwives (IV), focus-groups' discussions with midwives (II) and interviews with parents and midwives. The data were analysed using descriptive statistics (I, II, IV), thematic content analysis (II, III) and qualitative content analysis (IV). Accessibility to healthcare staff predominated in pregnant women's evaluating of important issues in the postpartum period and when parents used videoconferencing. Distance to healthcare services was not found to be a determining factor when pregnant women wanted to be discharged. One advantage of using VC was that it was felt it saved time and money for the parents. Support during breastfeeding, information about the child's behaviour and condition, were important aspects that needed to be covered in the postpartum period. Midwives felt their work had become more a fragmentised due to the short hospital stay. Parents and midwives found meeting via VC to be almost like a real-life encounter. They had no problem handling the VC equipment and did not have any problem preserving their integrity. Before introducing e-health in postpartum care, midwives stressed the importance of investigating consequences regarding organisation and work assignments. From this thesis it can be understood that VC can function as a bridge to facilitate a caring encounter between the parents and the midwives in the postpartum period. Further research into postpartum care is needed from the perspective of the parents and the midwives as well as into the consequences of implementing e-health