| 1. |
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| 2. |
- Bergbom, Ingegerd, 1947, et al.
(författare)
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First-time pregnant women’s experiences of their body in early pregnancy
- 2017
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:3, s. 579-586
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Tidskriftsartikel (refereegranskat)abstract
- Background: The body of first-time pregnant women is affected in many ways, and the women may not know what to expect. Conversations between women and healthcare personnel about women’s bodily experience in early pregnancy can contribute to increased body knowledge, which may have a positive impact in later stages of their pregnancy and in relation to delivery. The aim of the study was to describe first-time pregnant women’s experiences of their body in early pregnancy (pregnancy weeks 10–14). Method: Twelve women were asked to draw pictures and answer questions freely about their experiences of their first pregnant body. Hermeneutical text interpretation was used to obtain an overall view of the experiences. Findings: A main theme emerged: ‘the body is connected to the cycle of life’. This theme comprised five subthemes: ‘bodily longing and a sense of ambivalence’, ‘being 'doubtful’, ‘welcoming changes in body and mind’, ‘feeling inner strength and struggle to find strength’ and ‘accepting a different body and mind’. This main theme and the subthemes were further interpreted and were understood as an experience of ‘me and my body’. Conclusions: The body reminded the women to take care of it and gave rise to positive thoughts. When the body exhibited uncomfortable reactions and sensations, these were taken as evidence of pregnancy, which was also seen positive but it also triggered a sense of dissatisfaction with the body and a feeling of it becoming alien.
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| 3. |
- Clarke, Mike, et al.
(författare)
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OptiBIRTH: a cluster randomised trial of acomplex intervention to increase vaginalbirth after caesarean section
- 2020
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are lowin many countries.Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC ratesthrough an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland andItaly. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education ofclinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review,and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annualhospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940women.Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was nostatistically significant difference in the change in the proportion of women having a VBAC between interventionsites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences betweenintervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI:0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited womenwith birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS inmultiparous women, interventions that are feasible and safe and that have been shown to lead to decreasingrepeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. Thismay best be done using an implementation science approach that can modify evidence-based interventions inresponse to changing clinical circumstances.Trial registration: The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.
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| 4. |
- Henriksen, Lena, et al.
(författare)
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Norwegian women's motivations and preparations for freebirth - A qualitative study
- 2020
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Ingår i: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 Elsevier B.V. Aim: This study was aimed at describing Norwegian women's motivations and preparations for freebirth. Methods: This qualitative study involved 12 individual interviews conducted face to face or via Skype with women from different parts of Norway. The material was analysed using qualitative content analysis inspired by Graneheim and Lundman. Results: Three categories describing the women's motivations and preparations for freebirth were identified. Unsatisfied with the care offered today described how the women thought that hospitals did not support normal birth and made an inadequate homebirth offer. The category earlier uncomplicated and traumatic births influence freebirth choices described two different dimensions of motivations for freebirth. Trust in one's own knowledge and capacity referred to how women viewed birth as a natural process, their faith in themselves, how this view and faith influenced their preparation and how they gained knowledge about the birth process to prepare. An overall theme emerged: deep trust in birth as a natural process and the women's own capacity to give birth embedded in distrust of the maternity care system. Conclusion: This study showed that motivations for freebirth were embedded in overall dissatisfaction with today's maternity care, the inadequate homebirth offer and deep trust in the women's own capacity to give birth.
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| 5. |
- Karlsdottir, Sigfridur Inga, et al.
(författare)
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The women's perspective of childbirth pain
- 2017
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Ingår i: 31th ICM Triennial Congress 18-22 June 2017.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Woman’s perspective on pain in childbirth may be called the ‘third perspective’ in labour pain preparation and management; the first being the midwifery perspective and the second the medical perspective. In western society pain is often seen as a negative phenomenon. However, it can be of great importance for women and midwives to acknowledge that pain can be regarded not only in a negative light but also in a positive light. Purpose/Objective: The purpose of the study was to explore women’s experience of labour pain and their strategies to manage the pain in normal childbirth. Method: A phenomenological approach using the Vancouver school of doing phenomenology guided the process. Data were collected through 14 in-depth interviews. Fourteen women, seven primiparas and seven multiparas, all having normal labour with different kinds of pain management. They all had normal pregnancies and healthy babies. The interviews took place from 8-52 hours after birth. Key Findings: The phenomenon of labour pain was constructed by the participants’ descriptions of the pain itself; how the pain made them feel; the context of the pain; the importance of talking about the pain afterwards; and changed ideas about pain after the birth. The three main strategies to manage the pain was constructed of the women’s descriptions of developing strategies during pregnancy to manage the pain during childbirth; strategies used by the women when the pain was not yet too bad and strategies used by the women when the pain got worse. Having a good midwife to help them manage the pain and a spouse present to help them in managing the pain. Discussion: Midwives must strengthen women’s self-confidence, facilitating recognition of her own strengths and capacities during birth and guide women to develop their own strategies to manage the pain before and through birth.
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| 6. |
- Lindgren, Helena, 1965, et al.
(författare)
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Taking the matter into one’s own hands –Women’s experiences of unassited homebirths in Sweden
- 2017
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756 .- 1877-5764. ; 11, s. 31-35
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Tidskriftsartikel (refereegranskat)abstract
- Objective: There are no national guidelines or financial support for planned homebirths in Sweden. Some women choose to give birth at home without the assistance of a midwife. The objective of this study was to describe eight women’s experience of unassisted planned homebirth in Sweden. Design: Women who had the experience of an unassisted planned home birth were interviewed. The material was analysed using a phenomenological approach. Results: The essential meaning of the phenomenon giving birth at home without the assistance of a midwife is understood as a conflict between, on one hand, inner responsibility, power and control and on the other hand insecurity in relation to the outside, to other people and to the social system. A wish to be cared for by a midwife is in conflict with the fear of not maintaining integrity and respect in this precious moment of birth. Conclusion: Some women may be more sensitive to attitudes and activities that are routinely performed during pregnancy and childbirth and therefore choose not to turn to any representatives of the medical system. The challenge should be to provide safe care to allwomen so that assistance from a midwife becomes a reality in all settings.
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| 7. |
- Lundgren, Ingela, 1957, et al.
(författare)
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Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section) : a study from countries with low VBAC rates.
- 2016
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship.CONCLUSIONS: The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.
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| 8. |
- Lundgren, Ingela, 1957, et al.
(författare)
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Health professionals' perceptions of a Midwifery Model of Woman-Centred Care implemented on a hospital labour ward
- 2019
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Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundTheoretical models as a basis for midwives’ care have been developed over recent decades. Although there are similarities between these models, their usefulness in practice needs to be researched in specific cultural contexts.AimTo explore whether, when adopted by midwives on labour wards, a midwifery model of woman-centred care (MiMo) was useful in practice from the viewpoint of a variety of health professionals.MethodsData were collected from a variety of health professionals before and after an intervention of implementating MiMo at a hospital-based labour ward in Sweden, using nine focus group interviews with a total of 43 participants: midwives (n = 16), obstetricians (n = 8), assistant nurses (n = 11) and managers (n = 8). The text from interviews was analysed using content analysis.FindingsFrom expressing no explicit need of a midwifery model of woman-centred care before the intervention, there was a shift in midwives, obstetricians and managers perceptions towards identifying advantages of using the MiMo as it gives words to woman-centred midwifery care. Such shift in perception was not found among the assistant nurses.DiscussionClarification of the various roles of health professionals is needed to develop the model. Heavy workloads and stress were barriers to implementing the model. Thus, more support is needed from organisational management.ConclusionsThe model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care.
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| 9. |
- Lundgren, Ingela, 1957, et al.
(författare)
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How can the VBAC rates be improved – according to midwives and obstetricians in six European countries.
- 2017
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Ingår i: 31th ICM Trienníal Congress 18-22 June 2017.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after CS (VBAC) rates vary widely in different healthcare settings and countries. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of ‘OptiBIRTH’, a research project funded by EU aiming to increase VBAC rates across Europe through enhanced woman-centred maternity care. Purpose/Objective: To investigate the views of clinicians on factors of importance for improving VBAC rates. Method: Individual interviews and focus group interviews with clinicians in six countries with high and low VBAC rates were conducted during 2012–2013. 115 clinicians participated: 61 midwives and 54 physicians. Five questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language, translated into English, analysed together, and finally categories were validated in each country. Key Findings: According to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are a common approach, obstetricians’ final decision on the mode of birth, support during birth, and the strengthening of women’s trust in VBAC. Therefore the structure of the maternity care system in the country, cooperation between midwives and obstetricians, and the care offered during pregnancy and birth should be focused. Findings from the low VBAC countries will be presented at the conference and shows similarities in some aspects but also major differences. Discussion: Similarities and differences between factors of importance for improving the VBAC rate are related to both the care structure, and the views and attitudes of midwives and physicians, which has implications for the care of women post CS.
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| 10. |
- Lyckestam, Ida, et al.
(författare)
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Women’s lived experience of vaginal birth after caesarean section (VBAC): a qualitative study from a country with high VBAC rates
- 2016
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Ingår i: Nordisk Jordemor Kongress Midwives for all. 12-14 maj 2016, Göteborg, Sverige..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Vaginal Birth After Caesarean section (VBAC) is a relevant question for women having a previous Cesarean Section (CS). Even if VBAC is the recommended choice for most women VBAC rates differs in an international perspective. There is a great deal of research on VBAC but only a few qualitative studies on women’s experiences. These studies are limited to a few countries, notably in countries with low VBAC rates. Studies from countries with high VBAC rates such as Sweden are few. Objective: The aim of this study was to describe the lived experience of VBAC in women living in a region in Sweden; a country with high VBAC rate. Methods: In-depth interviews were conducted with nine women in western part of Sweden one year after their VBAC experience. The data analysis was performed in accordance to a phenomenological reflective lifeworld approach. Results: Results will be presented at the conference. Conclusion: Few qualitative studies on women’s experience of VBAC are published especially in countries with high VBAC rates. Therefore it is important to gain knowledge regarding the women’s experiences in one of these countries. This knowledge can contribute to increase the understanding of women’s experiences, and be used to optimise the care in countries with high as well as low VBAC rates.
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