Forbedringspotensial i den norske fødselsomsorgen

Emneord (Nøkkelord): fødselsomsorg, medikalisering, kvinnesentrert modell, childbirth model, medicalization, women-centered model

Sammendrag

Tema for denne artikkelen er medikalisering i norsk fødselsomsorg. I teksten beskriver og analyserer vi noen av faktorene som er knyttet til medikalisering. Til tross for at norsk fødselsomsorg har svært gode medisinske/fysiske utfallsmål for kvinner og barn, er det behov for forbedringer. Norge, som mange andre høy-inntektsland, har for mange keisersnitt og andre fødselsintervensjoner. Medikalisering ser også ut til å føre med seg sentralisering, samt dominans over andre modeller for fødselsomsorg og helsefremmende perspektiv. Til tross for at et av målene i den norske tjenesten er en demedikalisert fødselsomsorg (på ulike nivå i helsetjenesten), har økende grad av sentralisering funnet sted de siste tiår; f.eks. har antallet jordmorledede fødeenheter/fødestuer blitt redusert. Å inkludere en kvinnesentrert modell i tjenesten kan styrke at kvinnenes behov blir møtt. I en kvinnesentrert modell er f.eks. kvinners erfaringer, deres delaktige i omsorgen de tilbys og relasjonen mellom kvinnen og jordmor/helsepersonell, svært viktig. I tillegg kan anvendelse av salutogenese-teorien bidra til å styrke fødselsomsorgens helsefremmende perspektiv.

 

Potential for improvement in the Norwegian childbirth model

In this paper some aspects of medicalization in the Norwegian childbirth context are described and analysed. Despite having very good medical outcomes for women and babies, there is a need for improvement. As in many other high-income countries, there are too many Caesarean sections and interventions during births. Medicalized care tends to lead to centralisation of the care and dominate over other models of care and health promoting aspects. Even if the goal of the Norwegian model is de-medicalised maternity care on different levels, centralisation have occurred during the last decades. For example midwifery-led units has decreased in numbers. Woman-centred care is a model of care that can meet what is lacking by focusing at women´s experiences, women´s participation and involvement in the care and the relationship between the woman and the care-giver. Furthermore, salutogenesis is a health promoting perspective that could contribute to maternity care.

Forfatterbiografier

Gry Skogheim, UiT Norges arktiske universitet

universitetslektor, masterprogrammet i jordmorfag

Ingela Lundgren, UiT Norges arktiske universitet/Gøteborg universitet

Professor, masterprogrammet i jordmorfag

Professor ved masterprogrammet i reproduktiv og perinatal helse

Referanser

Antonovsky, A. (1979). Health, stress, and coping. San Francisco: Jossey-Bass.

Aune, I., Amundsen, H. H., & Skaget Aas, L. C. (2014). Is a midwife's continuous presence during childbirth a matter of course? Midwives' experiences and thoughts about factors that may influence their continuous support of women during labour. Midwifery, 30(1), 89-95. https://doi.org/10.1016/j.midw.2013.02.001

Aune, I., Hoston, M. A., Kolshus, N. J., & Larsen, C. E. G. (2017). Nature works best when allowed to run its course. The experience of midwives promoting normal births in a home birth setting. Midwifery, 50, 21-26. https://doi.org/10.1016/j.midw.2017.03.020

Backe, B., Øian, P., Eide, B., Nilsen, S. T., Pedersen, S. P., Schmidt, N., . . . Taraldsen, S. (2005). Desentralisert og differensiert fødselshjelp - et paradigmeskifte. Tiddskrift for den norske legeforening(125), 606-607. Retrieved from https://tidsskriftet.no/2005/03/kronikk/desentralisert-og-differensiert-fodselshjelp-et-paradigmeskifte

Berg, M., Ólafsdóttir, A. O., & Lundgren, I. (2012). A midwifery model of woman-centred childbirth care – In Swedish and Icelandic settings. Sexual & Reproductive Healthcare, 3(2), 79-87. https://doi.org/10.1016/j.srhc.2012.03.001

Bernitz, S., Dalbye, R., Zhang, J., Eggebo, T. M., Froslie, K. F., Olsen, I. C., . . . Oian, P. (2019). The frequency of intrapartum caesarean section use with the WHO partograph versus Zhang's guideline in the Labour Progression Study (LaPS): a multicentre, cluster-randomised controlled trial. Lancet, 393(10169), 340-348. doi:10.1016/s0140-6736(18)31991-3

Betrán, A. P., Temmerman, M., Kingdon, C., Mohiddin, A., Opiyo, N., Torloni, M. R., . . . Downe, S. (2018). Interventions to reduce unnecessary caesarean sections in healthy women and babies. The Lancet, 392(10155), 1358-1368. https://doi.org/10.1016/S0140-6736(18)31927-5

bibel.no. (2020). Retrieved from https://beta.bibel.no/sok?query=med%20smerte%20skal%20du%20f%C3%B8de&bibles=N11BM&parallels=

Bjerga, B., Risa, M., Blix, E., & Pay, A. S. D. (2019). One-to-one care routines and compliance with the national professional recommendation on continuous intrapartum support in Norway: A national survey. European Journal of Midwifery, 3. https://doi.org/10.18332/ejm/110064

Blix, E. (2010). Ulike syn på svangerskap og fødsel. In E. Tegnander & A. Brunstad (Eds.), Jordmorboka : ansvar, funksjon og arbeidsområde (pp. 53-55). Oslo: Akribe.

Blix, E., Kumle, M., & Øian, P. (2008). Utfall etter planlagte hjemmefødsler’. Tidsskrift for den norske legeforening(128), 2436-2439.

Blix, E., & Ohlund, L. (2007). Norwegian midwives' perception of the labour admission test. Midwifery, 23(1), 48-58. https://doi.org/10.1016/j.midw.2005.10.003

Blix, E., Reinar, L. M., Klovning, A., & Øian, P. (2005). Prognostic value of the labour admission test and its effectiveness compared with auscultation only: a systematic review. Bjog, 112(12), 1595-1604. https://doi.org/10.1111/j.1471-0528.2005.00766.x

Blix, E., & Øian, P. (2017). Metoder for fosterovervåkning under fødsel. In A. Brunstad & E. Tegnander (Eds.), Jordmorboka (2 ed., pp. 507-515): Cappelen Damm Akademisk.

Blaaka, G., & Schauer Eri, T. (2008). Doing midwifery between different belief systems. Midwifery, 24(3), 344-352. http://dx.doi.org/10.1016/j.midw.2006.10.005

Bohren, M. A., Hofmeyr, G. J., Sakala, C., Fukuzawa, R. K., & Cuthbert, A. (2017). Continuous support for women during childbirth. Cochrane Database Syst Rev, 7, Cd003766. https://doi.org/10.1002/14651858.CD003766.pub6

Bonet, M., Oladapo, O. T., Souza, J. P., & Gulmezoglu, A. M. (2019). Diagnostic accuracy of the partograph alert and action lines to predict adverse birth outcomes: a systematic review. Bjog, 126(13), 1524-1533. https://doi.org/10.1111/1471-0528.15884

Brady, S., Lee, N., Gibbons, K., & Bogossian, F. (2019). Woman-centred care: An integrative review of the empirical literature. Int J Nurs Stud, 94, 107-119. https://doi.org/10.1016/j.ijnurstu.2019.01.001

Bringedal, H., & Aune, I. (2019). Able to choose? Women's thoughts and experiences regarding informed choices during birth. Midwifery, 77, 123-129. https://doi.org/10.1016/j.midw.2019.07.007

Dahlen, H. G. (2019). Is it Time to Ask Whether Facility Based Birth is Safe for Low Risk Women and Their Babies? EClinicalMedicine, 14, 9-10. https://doi.org/10.1016/j.eclinm.2019.08.003

Dalbye, R., Bernitz, S., Olsen, I. C., Zhang, J., Eggebo, T. M., Rozsa, D., . . . Blix, E. (2019). The Labor Progression Study: The use of oxytocin augmentation during labor following Zhang's guideline and the WHO partograph in a cluster randomized trial. Acta Obstet Gynecol Scand, 98(9), 1187-1194. https://doi.org/10.1111/aogs.13629

Davis-Floyd, R. (2001). The technocratic, humanistic, and holistic paradigms of childbirth. International Journal of Gynecology & Obstetrics, 75, Supplement 1(0), S5-S23. http://dx.doi.org/10.1016/S0020-7292(01)00510-0

Downe, S., Byrom, S., & Topalidou, A. (2019). Squraring the circle: why physiological labour and birth matter in a technological world. In S. Downe & S. Byrom (Eds.), Squraring the circle (pp. 11-19). London Pinter and Martin Ltd.

Downe, S., Finlayson, K., Oladapo, O., Bonet, M., & Gülmezoglu, A. M. (2018). What matters to women during childbirth: A systematic qualitative review. PLoS One, 13(4), e0194906. https://doi.org/10.1371/journal.pone.0194906

Downe, S., & Mc.Court, C. (2008). From being to becoming: reconstructing childbirth knowledges. In S. Downe (Ed.), Normal childbirth. Evidence and debate. (2 ed., pp. 3-27). London Churchill Livingstone Elsevier.

Downe, S., & Mc.Court, C. (2019). From being to becoming: reconstructing childbirth knowledge. In S. Downe & S. Byrom (Eds.), Normal birth research, theory and practice in a technological age - squaring the circle (pp. 69-99): Pinter & Martin.

Eri, T. S., Berg, M., Dahl, B., Gottfreðsdóttir, H., Sommerseth, E., & Prinds, C. (2020). Models for midwifery care: A mapping review. European Journal of Midwifery, 4(July). https://doi.org/10.18332/ejm/124110

Fontein-Kuipers, Y., de Groot, R., & van Staa, A. (2018). Woman-centered care 2.0: Bringing the concept into focus. European Journal of Midwifery, 2(May). https://doi.org/10.18332/ejm/91492

Gaudernack, L. C., Frøslie, K. F., Michelsen, T. M., Voldner, N., & Lukasse, M. (2018). De-medicalization of birth by reducing the use of oxytocin for augmentation among first-time mothers - a prospective intervention study. BMC Pregnancy Childbirth, 18(1), 76. https://hdl.handle.net/10642/6438

Gaudernack, L. C., Michelsen, T. M., Egeland, T., Voldner, N., & Lukasse, M. (2020). Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway. BMC Pregnancy and Childbirth, 20(1), 605. https://doi.org/10.1186/s12884-020-03196-0

Grytten, J., Skau, I., & Sørensen, R. (2017). The impact of the mass media on obstetricians' behavior in Norway. Health Policy, 121(9), 986-993. https://doi.org/10.1016/j.healthpol.2017.07.007

Grønset, E. (2011). Debatt om fødestuer. Tidskrift for jordmødre, 4, 8-10.

Grønset, E. (2019). Åpner fødestue på St.Olav Tidsskrift for jordmødre, 9, 6-7.

Grønset, E. (2020). Flere komplekse fødsler - krever endret finansiering. Tiddskrift for jordmødre, 3.

Helse - og omsorgsdepartementet. (1999). Lov om pasient - og brukerrettigheter. Retrieved from https://lovdata.no/dokument/NL/lov/1999-07-02-63#KAPITTEL_3

Helse - og omsorgsdepartementet. (2008-2009). En gledelig begivenhet. Retrieved from https://www.regjeringen.no/no/dokumenter/stmeld-nr-12-2008-2009-/id545600/

Helse - og omsorgsdepartementet. (2012-2013). God kvalitet - trygge tjenester.

Helse - og omsorgsdepartementet. (2015-2016). Nasjonal helse - og sykehusplan 2016-2019. Retrieved from https://www.regjeringen.no/no/dokumenter/meld.-st.-11-20152016/id2462047/sec1

Helsedirektoratet. (2010). Et trygt fødetilbud - kvalitetskrav til fødselsomsorgen.

Helsedirektoratet. (2012). Retningslinje for hjemmefødsel. Retrieved from https://www.helsedirektoratet.no/tema/svangerskap-fodsel-og-barsel

Helsedirektoratet. (2014). Nasjonal retningslinje: Nytt liv og trygg barseltid for familien Retrieved from https://www.helsedirektoratet.no/retningslinjer/barselomsorgen

Helsedirektoratet. (2018). Fødsel - ristimulering under fødsel Retrieved from https://www.helsedirektoratet.no/statistikk/statistikk/kvalitetsindikatorer/graviditet-og-fodsel/ristimulering-under-fødsel

Helsedirektoratet. (2020). Endringer i fødepopulasjon og konsekvenser for bemanning og finansieringssystem. Retrieved from

Henriksen, L., & Lukasse, M. (2016). Burnout among Norwegian midwives and the contribution of personal and work-related factors: A cross-sectional study. Sex Reprod Healthc, 9, 42-47. https://doi.org/10.1016/j.srhc.2016.08.001s

Hildingsson, I., Westlund, K., & Wiklund, I. (2013). Burnout in Swedish midwives. Sex Reprod Healthc, 4(3), 87-91. https://doi.org/10.1016/j.srhc.2013.07.001

Holmboe, O., & Strømseng, I. S. (2018). Brukererfaringer med fødsels- og barselomsorgen i 2017. Nasjonale resultater. Retrieved from https://www.fhi.no/publ/2018/brukeres-erfaringer-med-fodsels--og-barselomsorgen-i-2017/

Husom, N. (2003). Selvbestemt keisersnitt - valg og viten i konflikt. Tidsskrift for den norske legeforening, 123, 1552-1555.

Hutton, E. K., Reitsma, A., Simioni, J., Brunton, G., & Kaufman, K. (2019). Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine. https://doi.org/10.1016/j.eclinm.2019.07.005

ICM. (2020). Definition and scope of midwifery. Retrieved from https://www.internationalmidwives.org/our-work/policy-and-practice/icm-definitions.html

Jenabi, E., Khazaei, S., Bashirian, S., Aghababaei, S., & Matinnia, N. (2019). Reasons for elective cesarean section on maternal request: a systematic review. J Matern Fetal Neonatal Med, 1-6. https://doi.org/10.1080/14767058.2019.1587407

Johansen, L. T., Pay, A. S. D., Broen, L., Roland, B., & Øian, P. (2017). Følges fastsatte kvalitetskrav i fødselsomsorgen? Tidsskrift for den norske legeforening. https://doi.org/10.4045/tidsskr.16.1070

Johanson, R., Newburn, M., & Macfarlane, A. (2002). Has the medicalisation of childbirth gone too far? BMJ, 324(7342), 892-895. https://doi.org/10.1136/bmj.324.7342.892

Jørandli, K., Nese, A. K., Vik, E. S., & Aasekjær, K. (2019). Bruk av innkomst-CTG hos lavrisikofødende: en klinisk audit. Sykepleien forskning, 14. https://doi.org/10.4220/Sykepleienf.2019.78661

Karlstrom, A., Nystedt, A., Johansson, M., & Hildingsson, I. (2011). Behind the myth--few women prefer caesarean section in the absence of medical or obstetrical factors. Midwifery, 27(5), 620-627. https://doi.org/10.1016/j.midw.2010.05.005

Kay, L., Hundley, V., & Tsekulova, N. (2019). Media representation of childbirth. In S. Downe & S. Byrom (Eds.), Normal birth research, theory and practice in a technological age - quaring the circle (pp. 130-139): Pinter & Martin.

Kjølsrød, L. (1985). Verstefallstenkningen i fødselsomsorgen. Tidsskrift for samfunnsforskning, 26, 133-157.

Kristjánsson, M. (2010, 15.04.10). Fødselsrapport slaktes. Klassekampen.

Larsen, M., Dahlø, R., Syse, J., & Løvvik, T. S. (2017). Årsaker til selvvalgt keisersnitt. Sykepleien. Retrieved from https://sykepleien.no/meninger/innspill/2017/03/arsaker-til-selvvalgt-keisersnitt

Lavender, T., Cuthbert, A., & Smyth, R. M. (2018). Effect of partograph use on outcomes for women in spontaneous labour at term and their babies. Cochrane Database Syst Rev, 8, Cd005461. https://doi.org/10.1002/14651858.CD005461.pub5

Leap, N. (2009). Woman-centred or women-centred care: does it matter? British Journal of Midwifery, 17(1), 12-16. doi:10.12968/bjom.2009.17.1.37646

Lindström, B., & Eriksson, M. (2015). Haikerens guide til salutogenese : helsefremmende arbeid i et salutogent perspektiv. Oslo: Gyldendal akademisk.

Lukasse, M., & Henriksen, L. (2019). Norwegian midwives' perceptions of their practice environment: A mixed methods study. Nursing Open, 6(4), 1559-1570. https://hdl.handle.net/10642/7449

Lundgren, I., Berg, M., Nilsson, C., & Olafsdottir, O. A. (2019). Health professionals' perceptions of a midwifery model of woman-centred care implemented on a hospital labour ward. Women Birth. https://doi.org/10.1016/j.wombi.2019.01.004

Maputle, M. S., & Donavon, H. (2013). Woman-centred care in childbirth: A concept analysis (Part 1). 2013, 36(1). doi:10.4102/curationis.v36i1.49

MFR. (2020). Fødselsstatistikk. Retrieved from http://statistikkbank.fhi.no/mfr/

Miller, S., Abalos, E., Chamillard, M., Ciapponi, A., Colaci, D., Comandé, D., . . . Althabe, F. (2016). Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. The Lancet, 388(10056), 2176-2192. https://doi.org/10.1016/S0140-6736(16)31472-6

Moster, D., Lie, R. T., & Markestad, T. (2005). Fornuft og følelser i fødselsomsorgen. Retrieved from https://tidsskriftet.no/2005/10/kronikk/fornuft-og-folelser-i-fodselsomsorgen

National Health Service. (2020). Welcome to NHS Shetland. Retrieved from https://www.shb.scot.nhs.uk/departments/maternity.asp

National Institute for health and care excellence. (2014). Intrapartum care for healthy women and babies planning place of birth. Retrieved from https://www.nice.org.uk/guidance/cg190/chapter/Recommendations#place-of-birth

Nilsson, C., Olafsdottir, O. A., Lundgren, I., Berg, M., & Dellenborg, L. (2019). Midwives' care on a labour ward prior to the introduction of a midwifery model of care: a field of tension. Int J Qual Stud Health Well-being, 14(1), 1593037. doi:10.1080/17482631.2019.1593037

Nordseth, T. (2019). Hjemmefødsler innebærer unødvendig risiko. Retrieved from https://tidsskriftet.no/2019/08/debatt/hjemmefodsler-innebaerer-unodvendig-risiko/kommentarer

O'Connell, R., & Downe, S. (2009). A metasynthesis of midwives’ experience of hospital practice in publicly funded settings: compliance, resistance and authenticity. Health:, 13(6), 589-609. https://doi.org/10.1177/1363459308341439

Pairman, S., & McAra-Couper, J. (2006). Theoretical frameworks for midwifery practice’. In S. Pairman, J. Pincombe, C. Thorogood, & S. Tracy (Eds.), Midwifery – preparation for practice (pp. 237-257). Sidney: Elsevier.

Perriman, N., Davis, D. L., & Ferguson, S. (2018). What women value in the midwifery continuity of care model: A systematic review with meta-synthesis. Midwifery, 62, 220-229. doi:10.1016/j.midw.2018.04.011

Reiger, K., & Dempsey, R. (2006). Performing birth in a culture of fear: an embodied crisis of late modernity. Health sociology review, 15(4), 364-373. https://doi.org/10.5172/hesr.2006.15.4.364

Renfrew, M., Homer, C. S., Downe, S., McFadden, A., Muir, N., Prentice, T., & ten Hoope-Bender, P. (2014b). Midwifery - an executive summary for the Lancet's series. The Lancet. Retrieved from https://www.thelancet.com/series/midwifery

Renfrew, M., McFadden, A., Bastos, M. H., Campbell, J., Channon, A. A., Cheung, N. F., . . . Declercq, E. (2014a). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129-1145. https://doi.org/10.1016/S0140-6736(14)60789-3

Rothman, B. K. (1999). The daughters of time on the paths to midwifery. Midwifery Today Int Midwife(49), 9-11.

Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev(4). https://doi.org/10.1002/14651858.CD004667.pub5

Sandall, J., Tribe, R. M., Avery, L., Mola, G., Visser, G. H., Homer, C. S., . . . Temmerman, M. (2018). Short-term and long-term effects of caesarean section on the health of women and children. Lancet, 392(10155), 1349-1357. https://doi.org/10.1016/s0140-6736(18)31930-5

Sandvik, G. B. (1997). Moderskap og fødselsarbeid : diskurser i reproduktivt arbeid. Bergen-Sandviken: Fagbokforl.

Scamell, M., Stone, N., & Dahlen, H. (2019). Risk, safety, fear and trust in childbirth. In S. Downe & S. Byrom (Eds.), Squaring the circle (pp. 100-111): Pinter & Martin.

Scarf, V. L., Rossiter, C., Vedam, S., Dahlen, H. G., Ellwood, D., Forster, D., Homer, C. S. E. (2018). Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery, 62, 240-255. https://doi.org/10.1016/j.midw.2018.03.024

Shorey, S., & Ng, E. D. (2019). Application of the salutogenic theory in the perinatal period: A systematic mixed studies review. Int J Nurs Stud, 101, 103398. https://doi.org/10.1016/j.ijnurstu.2019.103398

Simelela, P. N. (2018). A “good birth” goes beyond having a healthy baby. Retrieved from https://www.who.int/mediacentre/commentaries/2018/having-a-healthy-baby/en/

Skogheim, G., & Hanssen, T. A. (2015). Midwives' experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sex Reprod Healthc, 6(4), 230-235. https://doi.org/10.1016/j.srhc.2015.05.001

Smith, V., Daly, D., Lundgren, I., Eri, T., Begley, C., Gross, M. M., . . . Devane, D. (2017). Protocol for the development of a salutogenic intrapartum core outcome set (SIPCOS). BMC Med Res Methodol, 17(1), 61. https://doi.org/10.1186/s12874-017-0341-5

Smith, V., Daly, D., Lundgren, I., Eri, T., Benstoem, C., & Devane, D. (2014). Salutogenically focused outcomes in systematic reviews of intrapartum interventions: A systematic review of systematic reviews. Midwifery, 30(4), e151-e156. https://doi.org/10.1016/j.midw.2013.11.002

Tracy, S., & Page, L. (2019). Choice, continuity and control: a clarion call to putting women at the centre of their care, and supporting normal brith. In S. Downe & S. Byrom (Eds.), Normal birth research, theory and practice in a technological age - squaring the circle Pinter & Martin.

Utdannings - og forskningsdepartementet. (2005). Rammeplan for jordmorutdanning. Retrieved from https://www.regjeringen.no/globalassets/upload/kilde/kd/pla/2006/0002/ddd/pdfv/269373-rammeplan_for_jordmorutdanning_05.pdf

Uvnas-Moberg, K., Ekstrom-Bergstrom, A., Berg, M., Buckley, S., Pajalic, Z., Hadjigeorgiou, E., . . . Dencker, A. (2019). Maternal plasma levels of oxytocin during physiological childbirth - a systematic review with implications for uterine contractions and central actions of oxytocin. BMC Pregnancy Childbirth, 19(1), 285. https://doi.org/10.1186/s12884-019-2365-9

WHO. (2015). WHO statement on caesarean section rates. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf;jsessionid=0E693B5A73B5307D61CD737AF6739C39?sequence=1

WHO. (2017). Maternal mortality ratio (per 100 000 live births. Retrieved from http://gamapserver.who.int/gho/interactive_charts/mdg5_mm/atlas.html

WHO. (2018b). WHO recommendations: intrapartum care for a positive childbirth experience. Retrieved from https://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/

Zhao, Y., Lu, H., Zang, Y., & Li, X. (2020). A systematic review of clinical practice guidelines on uncomplicated birth. BJOG: An International Journal of Obstetrics & Gynaecology, n/a(n/a). https://doi.org/10.1111/1471-0528.16073

Øian, P., Brurberg, K., Reierth, E., Reinar, L., & Blix, E. (2015). Hva gjør vi når forskningen gir uønskede svar? Retrieved from https://www.dagensmedisin.no/artikler/2015/12/14/hva-gjor-vi-nar-forskningen-gir-uonskede-svar/

Aadland, E. (2004). Og eg ser på deg (2 ed.): Universitetsforlaget.

Publisert
2021-04-12
Hvordan referere
Skogheim, G., & Lundgren, I. . (2021). Forbedringspotensial i den norske fødselsomsorgen. Nordisk Tidsskrift for Helseforskning, 17(1). https://doi.org/10.7557/14.5444