Working to develop maternity care

Marie Berg supervises PhD student Viola Nyman

“But I find it hard to focus totally on the work and get it done,” says Berg, a newly appointed professor of care sciences, specialising in reproductive and perinatal health. “I spend my whole time seeing things and thinking ‘This should be done better’ or ‘What if we did that instead?’.”

Marie Berg researches care and support throughout the maternity period, from pregnancy to delivery and into early parenthood. She studies how pregnancy and labour are managed, and also how women who have given birth perceive their situation and the care they were given. Fathers’ experiences also form part of her research.
“The midwife’s approach is key to both the care and the support that are offered, and at the moment my research colleagues and I are working on a theory that deals with the very essence of midwives’ patient-centred care during labour where the normal physiological process is supported,” says Berg, who is developing the theory together with her colleague Ingela Lundgren and Icelandic researcher Ólöf Asta Ólafsdóttir.
Patients’ first encounter on a labour ward is particularly important, and this is something that Berg is researching together with doctoral student Viola Nyman. Nyman is writing a thesis with an action research design, which means that changes are implemented on the labour ward where Nyman works as a midwife.
Berg also supervised the thesis that won the prize for the best doctoral thesis in 2010 at the Sahlgrenska Academy, where Anna Dencker demonstrated that it is fine to wait before using oxytocin to augment labour. Another of Berg’s doctoral students, Lotta Selin, is carrying out further work on issues relating to oxytocin, and is trying to determine which doses should be given when a drip is actually used.

Assessing new support for prospective mothers with diabetes
As both a practising midwife and researcher, Berg has specialised in births that entail greater risks, and how it is possible to promote wellbeing and a normal process. Her involvement with the MODIAB (motherhood and diabetes) research programme allows her to study pregnant women and new mothers with type 1 diabetes.
“These women have a very trying pregnancy,” says Berg. “It is vital that they manage to maintain normal blood sugar levels to reduce the risk of deformities, and to ensure that the child thrives during pregnancy, birth and infancy.”
Berg is heading up a research project that includes colleague Carina Sparud Lundin, and that has worked with an IT company to develop Internet-based support for pregnant women and new mothers with type 1 diabetes. This support is now being evaluated in an intervention study.

Heart lies in the Congo

Even as a child Berg wanted to help people in Africa, an ambition that led her to train as a nurse and then a midwife. Together with her family she has spent three long periods – initially in 1981 – working in the Democratic Republic of the Congo (formerly Zaire) in the town of Lemera in the mountains of the eastern Congo.
“I worked in the hospital on maternity care and deliveries, but we also helped women by providing information on how they could have a life that went beyond having children,” says Berg, who uses both Swahili and French when working in Zaire.
Berg’s office is full of pictures and gifts from her trips to Zaire, including a beautiful wood engraving of a mother and child from a Swedish midwife who Berg helped during labour at Lemera Hospital.

Knowledge strengthens, but war destroys
Berg also helped to set up schools where women could come to do needlework and to learn together. Anyone who could not read was taught how, and was then given lessons in life skills using homemade textbooks in Swahili.
“The lessons covered everything from hygiene and building good latrines to how to grow and eat nutritious food and what happens to the body when you are pregnant and how to avoid getting pregnant.”

Berg also set up a school for teachers for the women’s school so that the movement could continue without Western support. However, the mid-1990s brought war to Zaire in general and Lemera in particular. All the work that Berg and other volunteers had done was destroyed, several patients and members of staff were killed, and the women’s school was commandeered by the rebels for their headquarters.
“I’ve heard terrible stories of things that happened to women during the war,” says Berg. “Rape, genitals that have been shot to pieces and forced cannibalism. But these women still have the capacity to support and help each other, which offers hope for a brighter future.”

EU-funded networks
In a bid to develop scientific knowledge that improves care before, during and after delivery in Europe, Berg has joined forces with other European researchers to set up a research network. Funded by the EU, this project is unique as it not only covers the medical outcome, but also focuses on the complexity of childbirth.
“We ask questions about what works, for whom and in what circumstances during maternity and labour care, and focus on matters such as routines during pregnancy, labour and migrant women,” says Berg, who is responsible for one of the five working groups implementing the scientific programme.

Imminent return to the Congo
As a new professor, Berg wants to emphasise the importance of going beyond research to develop and provide training. She is not only in charge of the University of Gothenburg’s midwifery study programme, but is also involved in midwifery training in other countries. In a few weeks’ time she will be returning to the Congo – to the university in Bukavu and Panzi Hospital – along with staff from the biomedical analyst study programme. She will be discussing the maternity training that the university is planning to start. She will also discuss introducing and applying patient-centred care for women who have sustained injuries to their genitalia as a result of violence or protracted labour.
“The WHO has stated that it is a human right to give birth with skilled attendance, which means that midwifery training needs to be offered at university level,” says Berg. “However, there is a long anchoring process to go through before we get there.”

Selected publications
Berg, M., and Sparud-Lundin, C. (2009). Experiences of professional support during pregnancy and childbirth – a qualitative study of women with type 1 diabetes. BMC Pregnancy Childbirth, 9(1), 27.

Dencker, A., Taft, C., Bergqvist, L., Lilja, H., and Berg, M. (2010). Childbirth Experience Questionnaire (CEQ): development and evaluation of a multidimensional instrument. BMC Pregnancy Childbirth, 10(1), 81.

Nyman, V., Downe, S., and Berg, M. (2011). Waiting for permission to enter the labour ward world: first time parents’ experiences of the first encounter on a labour ward. Sexual & Reproductive Healthcare.

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BY: Elin Lindström Claessen