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Purpose: New mothers may question the nature of their motherly love after the birth. Most mothers find that feelings of affection come within a week from birth. However, some mothers are still struggling with this after many months. Many studies place strong emphasis on the importance of maternal affection for the development of the child. Few studies look into mothers’ experiences when maternal affection or love remains a struggle. Method:We present an interpretative synthesis based on a systematic analysis of five qualitative studies that report findings related to mothers’ stated inability to exhibit maternal affection. Result:In answer to our question “what characterizes the experiences of women who struggle with, or are unable to exhibit, maternal affection after birth”, we identified the uncertainty involved in imagining the unborn child, birth and maternal future, birth as a disillusionment, and the ensuing process of decreasing agency and increasing alienation. Especially a traumatic birth may lead to disillusionment. Conclusion: Health care workers and research can support a mother’s positive resolution of her struggle by promoting realistic and more open expectations for maternal affection as well as her sense of agency and ownership during birth and the early mother–child relationship.

INTRODUCTION According to WHO, midwives are found competent to provide evidencebased and normalcy-facilitating maternity care. Models for midwifery care exist, but seem to be lacking explicit epistemological status, mainly focusing on the practical and organizational level of care delivery. To make the values and attitudes of care visible, it is important to implement care models with explicit epistemological status. The aim of this paper is to identify and gain an overview of publications of theoretical models for midwifery care. METHODS A mapping review was conducted with systematic searches in nine databases for studies describing a theoretical model or theory for midwifery care that either did or was intended to impact clinical practice. Eligibility criteria were refined during the selection process. RESULTS Six models from six papers originating from different parts of the world were included in the study. The included models were developed using different methodologies and had different philosophical underpinnings and complexity gradients. Some characteristics were common, the most distinctive being the emphasis of the midwife-woman relationship, secondly the focus on woman-centeredness, and thirdly the salutogenic focus in care. CONCLUSIONS Overall, scarcity exists regarding theoretical models for midwifery care with explicit epistemological status. Further research is needed in order to develop generic theoretical models with an epistemological status to serve as a knowledge base for midwifery healthcare.

PURPOSETo explore and describe midwives' experiences of promoting normal birth in medicalized obstetric-led birth units in Norway.STUDY DESIGNA qualitative research design with an explorative/descriptive approach. A convenience sample of 10 midwives was recruited from 2 obstetric-led birth units.MAJOR FINDINGSThree main themes were identified. First, personal attributes and attitudes were perceived to influence the birthing process. Second, lack of time and impatient staff negatively affected the woman's chances of giving birth normally. Third, increasing focus on procedures, selection criteria, and technology threatened the use of midwifery skills and prevented midwives from promoting normal births.MAIN CONCLUSIONPromoting normal birth is influenced by midwives' disposition and attitudes. It is therefore disturbing that midwives experience a loss of their autonomy and responsibility for normal births in obstetric-led wards.

Background Performing obstetric ultrasound is part of midwifery practice in Norway. Knowledge of these midwives’ working situation can enhance understanding of what their work involves and the challenges they encounter in their practice. The aim of this study was to gain insight into how midwife sonographers perceive their work in obstetric ultrasound. Methods A qualitative study with individual interviews was conducted in 2018. Midwives (n = 13) with a postgraduate ultrasound qualification who performed obstetric ultrasound in private clinics and/or the public health sector were included. All four regional health authorities in Norway were represented. The data gathered were analysed using content analysis. Results The analysis resulted in three main themes. (1) Working as a midwife sonographer involves a holistic approach. By practising their competence, in both midwifery and sonography, they could answer questions and reassure pregnant women. The participants also had a feeling of great responsibility in their work. (2) Being part of a professional environment in obstetric ultrasound was important for professional interaction, belonging and learning. (3) Developing and maintaining competence as a midwife sonographer had a positive influence on midwives’ motivation and confidence, and allowed for more variety in their work. Conclusions Holistic care of the pregnant woman, her partner and the unborn baby was an important part of the participants’ work. They wanted to meet colleagues within their field, develop their expertise and have influence over their work situation. Organizational factors seemed to affect the participants’ overall ability to practise their skills and thus also their job satisfaction.