Through the bubble : universal design and equitable pelvic floor care
(2025)- Abstract
- Giving birth is a profound life event. Most of the time, mothers move their attention to their newborn, as do healthcare providers. Childbirth can cause severe pelvic floor (PF) injuries, potentially leading to complications, such as incontinence. Despite their impact, these injuries are often deprioritised or normalised—both by postpartum women and healthcare providers. In Sweden, 1–4% of women who give birth vaginally experience severe PF injury. The early weeks following childbirth, widely recognised for their emotional and physical complexity, become even more challenging when compounded by the demands of managing such an injury.
This thesis aims to contribute to new knowledge on how the period before, during, and after a... (More) - Giving birth is a profound life event. Most of the time, mothers move their attention to their newborn, as do healthcare providers. Childbirth can cause severe pelvic floor (PF) injuries, potentially leading to complications, such as incontinence. Despite their impact, these injuries are often deprioritised or normalised—both by postpartum women and healthcare providers. In Sweden, 1–4% of women who give birth vaginally experience severe PF injury. The early weeks following childbirth, widely recognised for their emotional and physical complexity, become even more challenging when compounded by the demands of managing such an injury.
This thesis aims to contribute to new knowledge on how the period before, during, and after a severe PF injury can be understood from a design perspective, and how universal design (UD) can be used as a critical lens to examine and discuss women’s lived experiences. Ten women with grade three and four PF injuries participated. The research methods included observations in a care setting followed by in-depth interviews. Transcripts of the interviews were analysed using qualitative content analysis, and comics were used to inquire through satire and multimodality. The findings revealed a spectrum of experiences: from women reporting no symptoms and feeling like before, those who normalised or deprioritised their symptoms, and others who felt profoundly traumatised.
This licentiate thesis presents the following outcomes: Contextual sketching during observations served as a tool to capture situated moments. The Bubbleverse concept materialises the interconnected phases women experience through the bubble metaphor, enabling ways to make them noticeable and open to debate to help raise questions. Comics as Inquiry is a multimodal method that combines sketching and satirical storytelling, providing women with the opportunity to openly express their stories and initiate conversations about often taboo topics in PF care. UD sensitives for PF care were developed through synthesising the results using the UD framework to support questioning and discussion of future care pathways in PF health, while also contributing with sensitivity to aspects related to equity and design.
In the research process, different approaches to the PF care context have emerged—contextual sketches, the Bubbleverse metaphor, Comics as satirical inquiry, and UD sensitives from an UD theoretical perspective—which together open up the scene and contribute to a deeper understanding of PF care by combining inquiry with a critical questioning of norms in PF care.
Note: “Universal design for equity in pelvic floor care” is a PhD project collaboration between Lunds University, Mid Sweden University, Umeå University and Region Västernorrland (Funding agency: Mid Sweden University, Dnr 2022/2876). The study is approved by the Swedish Ethical Review Authority (Dnr 2023-06969-01)
(Less) - Abstract (Swedish)
- Förlossningen är en omvälvande och minnesvärd livshändelse. Den nyblivna
mammans fokus ligger på det nyfödda barnet, likaså vårdpersonalens. En
förlossning kan leda till allvarliga skador på bäckenbotten (pelvic floor, PF),
ibland med komplikationer som inkontinens. Tyvärr förbises eller tonas dessa
skador ofta ned – både av nyblivna mödrar och vårdgivare. I Sverige drabbas
ungefär 1–4% av kvinnor som föder vaginalt av allvarliga bäckenbottenskador. De första veckorna efter förlossningen är redan emotionellt och fysiskt krävande, och att hantera sådana skador gör situationen ännu svårare.
Denna licentiatuppsats syftar till att bidra med ny kunskap om hur perioden före,
under och efter en allvarlig... (More) - Förlossningen är en omvälvande och minnesvärd livshändelse. Den nyblivna
mammans fokus ligger på det nyfödda barnet, likaså vårdpersonalens. En
förlossning kan leda till allvarliga skador på bäckenbotten (pelvic floor, PF),
ibland med komplikationer som inkontinens. Tyvärr förbises eller tonas dessa
skador ofta ned – både av nyblivna mödrar och vårdgivare. I Sverige drabbas
ungefär 1–4% av kvinnor som föder vaginalt av allvarliga bäckenbottenskador. De första veckorna efter förlossningen är redan emotionellt och fysiskt krävande, och att hantera sådana skador gör situationen ännu svårare.
Denna licentiatuppsats syftar till att bidra med ny kunskap om hur perioden före,
under och efter en allvarlig bäckenbottenskada kan förstås ur ett designperspektiv, samt hur universell utformning (UD) kan användas som ett kritiskt verktyg för att studera och diskutera kvinnors levda erfarenheter under denna tid. Tio kvinnor med allvarliga bäckenbottenskador deltog och delade sina erfarenheter genom observationer i klinisk kontext och djupintervjuer. Vi analyserade deras berättelser med kvalitativa metoder och skapade serieteckningar och skisser för att bättre förstå deras resor. Vi fann ett brett spektrum av erfarenheter – från kvinnor som kände sig nästan opåverkade till de som normaliserade eller tonade ner sina symptom, och andra som kände sig djupt traumatiserade.
Denna forskning introducerar följande resultat: Kontextuella skisser under
observationer fungerade som ett verktyg för att fånga situerade ögonblick.
Bubbleverse-konceptet, som strävar efter att förstå kvinnornas upplevelser med
hjälp av en bubbelmetafor. Det öppnar för nya sätt att känna igen dessa fenomen och uppmuntrar till öppen diskussion, för att främja större förståelse, medvetenhet och stimulera till nya frågor. Comics as Inquiry är en multimodal metod som kombinerar skissning och satiriskt berättande, vilket ger kvinnor möjlighet att öppet uttrycka sina berättelser och starta samtal om ofta tabubelagda ämnen inom bäckenbottensvård. UD Sensitives för bäckenbottenvård utvecklades genom att syntetisera resultaten med hjälp av UD-ramverket. Det gör det genom att stödja frågor och diskussioner om framtida vårdvägar inom bäckenbottenvård, samtidigt som det bidrar med känslighet för aspekter som rör jämlikhet och design. UD:s känslighet för PF-vård lyfts fram genom att koppla samman kontexten med hjälp av UD-ramverket, vilket stärker möjligheten att följa frågor och diskussioner om framtida vårdvägar inom PF-hälsa. Det bidrar också till en ökad förståelse för
aspekter som rör jämlikhet och design.
Genom användning av kontextuella skisser, Bubbleverse-konceptet, satiriska
serieteckningar och kritiska UD Sensitives, visar denna forskning hur
designforskning med ett kritiskt UD-perspektiv kan ge oss möjlighet att utmana
normer inom bäckenbottenvård. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1a2ce1ce-c0f0-4f65-9257-52238c874aa3
- author
- Sahin Haglund, Semra LU
- supervisor
- organization
- publishing date
- 2025-12-15
- type
- Thesis
- publication status
- published
- subject
- keywords
- Design research, Equity, Lived experiences, Pelvic floor care, Universal Design
- pages
- 77 pages
- publisher
- Media-Tryck, Lund University, Sweden
- ISBN
- 978-91-8104-760-8
- 978-91-8104-759-2
- language
- English
- LU publication?
- yes
- id
- 1a2ce1ce-c0f0-4f65-9257-52238c874aa3
- date added to LUP
- 2025-12-15 10:09:00
- date last changed
- 2025-12-16 13:08:48
@misc{1a2ce1ce-c0f0-4f65-9257-52238c874aa3,
abstract = {{Giving birth is a profound life event. Most of the time, mothers move their attention to their newborn, as do healthcare providers. Childbirth can cause severe pelvic floor (PF) injuries, potentially leading to complications, such as incontinence. Despite their impact, these injuries are often deprioritised or normalised—both by postpartum women and healthcare providers. In Sweden, 1–4% of women who give birth vaginally experience severe PF injury. The early weeks following childbirth, widely recognised for their emotional and physical complexity, become even more challenging when compounded by the demands of managing such an injury.<br/><br/>This thesis aims to contribute to new knowledge on how the period before, during, and after a severe PF injury can be understood from a design perspective, and how universal design (UD) can be used as a critical lens to examine and discuss women’s lived experiences. Ten women with grade three and four PF injuries participated. The research methods included observations in a care setting followed by in-depth interviews. Transcripts of the interviews were analysed using qualitative content analysis, and comics were used to inquire through satire and multimodality. The findings revealed a spectrum of experiences: from women reporting no symptoms and feeling like before, those who normalised or deprioritised their symptoms, and others who felt profoundly traumatised.<br/><br/>This licentiate thesis presents the following outcomes: Contextual sketching during observations served as a tool to capture situated moments. The Bubbleverse concept materialises the interconnected phases women experience through the bubble metaphor, enabling ways to make them noticeable and open to debate to help raise questions. Comics as Inquiry is a multimodal method that combines sketching and satirical storytelling, providing women with the opportunity to openly express their stories and initiate conversations about often taboo topics in PF care. UD sensitives for PF care were developed through synthesising the results using the UD framework to support questioning and discussion of future care pathways in PF health, while also contributing with sensitivity to aspects related to equity and design.<br/><br/>In the research process, different approaches to the PF care context have emerged—contextual sketches, the Bubbleverse metaphor, Comics as satirical inquiry, and UD sensitives from an UD theoretical perspective—which together open up the scene and contribute to a deeper understanding of PF care by combining inquiry with a critical questioning of norms in PF care.<br/><br/>Note: “Universal design for equity in pelvic floor care” is a PhD project collaboration between Lunds University, Mid Sweden University, Umeå University and Region Västernorrland (Funding agency: Mid Sweden University, Dnr 2022/2876). The study is approved by the Swedish Ethical Review Authority (Dnr 2023-06969-01)<br/>}},
author = {{Sahin Haglund, Semra}},
isbn = {{978-91-8104-760-8}},
keywords = {{Design research; Equity; Lived experiences; Pelvic floor care; Universal Design}},
language = {{eng}},
month = {{12}},
note = {{Licentiate Thesis}},
publisher = {{Media-Tryck, Lund University, Sweden}},
title = {{Through the bubble : universal design and equitable pelvic floor care}},
url = {{https://lup.lub.lu.se/search/files/235903663/Avhandling_Semra_Sahin_LUCRIS.pdf}},
year = {{2025}},
}