| 1. |
- Nieminen, Katri, et al.
(författare)
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Internet-provided cognitive behaviour therapy of posttraumatic stress symptoms following childbirth—a randomized controlled trial
- 2016
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Ingår i: Cognitive Behaviour Therapy. - : Routledge. - 1650-6073 .- 1651-2316. ; 45:4, s. 287-306
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyse the effects of trauma-focused guided Internet-based cognitive behaviour therapy for relieving posttraumatic stress disorder (PTSD) symptoms following childbirth, a problem that about 3% women encounter postpartum. Following inclusion, 56 traumatized women were randomized to either treatment or to a waiting list control group. Primary outcome measures were the Traumatic Event Scale (TES) and Impact of Event Scale—Reversed (IES-R). Secondary measures were Beck depression inventory II, Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory, Quality Of Life Inventory and the EuroQol 5 Dimensions. The treatment was guided by a clinician and lasted eight weeks and comprised eight modules of written text. The between-group effect size (ES) was d = .82 (p < .0001) for the IES-R. The ES for the TES was small (d = .36) and not statistically significant (p = .09). A small between-group ES (d = .20; p = .02) was found for the PHQ-9. The results from pre- to post-treatment showed large within-group ESs for PTSD symptoms in the treatment group both on the TES (d = 1.42) and the IES-R (d = 1.30), but smaller ESs in the control group from inclusion to after deferred treatment (TES, d = .80; IES-R d = .45). In both groups, the treatment had positive effects on comorbid depression and anxiety, and in the treatment group also on quality of life. The results need to be verified in larger trials. Further studies are also needed to examine long-term effects.
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| 2. |
- Eldestrand, E., et al.
(författare)
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Supporting young women with menstrual pain – Experiences of midwives working at youth clinics
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier B.V.. - 1877-5756 .- 1877-5764. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Background: Menstrual pain is relatively common among young girls. Many girls turn to youth clinics when seeking care for menstrual problems. Objective: The objective of the study was to describe midwives’ experiences of supporting girls with menstrual pain. Methods: This is a qualitative study with an inductive approach. Semi-structured interviews were conducted with 15 midwives working at Swedish youth clinics. Interviews were held in September 2021. The recordings were transcribed and analyzed using thematic analysis. Results: Two main themes, consisting of three subthemes each, emerged: Guiding and educating young women about menstrual pain and Striving toward pain relief. It was important to the midwives to increase young womens knowledge of menstrual pain and coping strategies, and to guide them in finding a method for menstrual pain relief. Hormonal contraceptives were often a natural choice and an effective method for pain relief, although the midwives occasionally faced resistance from young women or their mothers when recommending this. The midwives also referred to a gynecologist if needed. Conclusion: The results highlight that midwives working at youth clinics have an important role in the care of young women with menstrual pain. The midwives found it important to increase young womens knowledge about menstrual pain and coping strategies, since they had noticed knowledge gaps in these areas. The results suggest a need to improve education about menstrual pain and coping strategies for young women, preferably in school and in cooperation with healthcare professionals. © 2022 The Author(s)
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| 3. |
- Grundström, Hanna, et al.
(författare)
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Factors related to a positive childbirth experience - a cross-sectional study
- 2024
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Ingår i: Journal of Reproductive and Infant Psychology. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 0264-6838 .- 1469-672X.
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Tidskriftsartikel (refereegranskat)abstract
- Background/aimsGiving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience.Design/MethodsA digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation.ResultsOverall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors.ConclusionAlthough Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.
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| 4. |
- Grundström, Hanna, et al.
(författare)
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Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications - a cross-sectional study
- 2022
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Ingår i: Archives of Women's Mental Health. - Wien : Springer. - 1434-1816 .- 1435-1102. ; 25:2, s. 485-491
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged >= 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage >= 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann-Whitney U-test, chi-square test or Fishers exact test, and Spearmans rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.
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| 5. |
- Grundström, Hanna, et al.
(författare)
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Perceived Professional Support During Pregnancy, Childbirth, and Postpartum Among Women Reporting Severe Fear of Childbirth Postpartum
- 2021
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Ingår i: Journal of reproductive medicine. - : SCI PRINTERS & PUBL INC. - 0024-7758 .- 1943-3565. ; 66:3-4, s. 89-96
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe how women with severe fear of childbirth postpartum recall the professional support they received before, during, and after childbirth. STUDY DESIGN: This is a qualitative study based on telephone interviews with 10 women reporting fear of childbirth postpartum and who had given birth in 2018. They were interviewed using a semi-structured interview guide. The interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis according to Braun and Clarke. RESULTS: The results showed that most women expressed satisfaction with the support they received from the healthcare professionals before, during, and after childbirth, and most of them could not identify any lacking support. The experiences were categorized into 3 themes: "validation and trust," "guidance," and "being in control." CONCLUSION: In summary, the womens reported fear of childbirth postpartum did not seem related to any perceived lack of professional support. The supposed association between fear of childbirth, negative childbirth experiences, and perceived support may need further illumination.
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| 6. |
- Grundström, Hanna, et al.
(författare)
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Previous Trauma Exposure and Its Associations with Fear of Childbirth and Quality of Life among Pregnant Lesbian, Bisexual, Transgender, and Queer People and Their Partners
- 2023
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Ingår i: LGBTQ FAMILY-AN INTERDISCIPLINARY JOURNAL. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 2770-3371 .- 2770-338X. ; 19:2, s. 175-185
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of this study was to determine the prevalence of previous trauma exposure among expectant birth-giving parents and their partners within a LBTQ population. The secondary aims were to compare fear of childbirth (FOC) and quality of life (QoL) in relation to previous trauma exposure in pregnant LBTQ people and their partners. A further aim was to analyze associations between severe FOC and clinical and demographic factors in this population. Data was collected from a Swedish LGBTQ competent antenatal clinic. Trauma-exposed pregnant (n = 32) and non-pregnant (n = 21) individuals and pregnant (n = 48) and non-pregnant (n = 30) individuals without previous trauma experiences responded to instruments measuring FOC (Wijma Delivery Expectancy Questionnaire) and QoL (EuroQol 5 D-index/-visual analogue scale, VAS). Differences between groups were assessed using non-parametric tests. The proportion of trauma exposure was similar among pregnant responders and their partners (40.0% vs. 41.2%). Trauma-exposed pregnant respondents had a significantly higher prevalence of severe FOC compared to the pregnant respondents without previous trauma. Pregnant trauma-exposed respondents scored lower on EQ5D-VAS than pregnant respondents without trauma, as did non-pregnant trauma exposed respondents compared with non-pregnant -respondents without trauma. Furthermore, trauma-exposed non-pregnant respondents scored lower on the EQ5D-index compared to non-pregnant respondents without trauma. Previous trauma was the only clinical and demographic factor that had any significant association withto severe FOC in the regression analysis. In conclusion, our results suggest that previous trauma exposure may contribute to the risk of suffering from severe FOC and lower QoL among LBTQ-identifying prospective parents.
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| 7. |
- Grundström, Hanna, et al.
(författare)
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Supporting womens reproductive capabilities in the context of childbirth : Empirical validation of a midwifery theory synthesis
- 2022
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Ingår i: Midwifery. - : Elsevier Science Ltd. - 0266-6138 .- 1532-3099. ; 110
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To conduct an empirical validation of the theoretical model of midwifery care suggested by Peters et al. (2020). Design: A qualitative deductive methodology was used to validate the theoretical model of aims and objectives of midwifery care. The existing model was validated for midwifery care before, during and after childbirth by interviewing women who had reported high satisfaction with childbirth and low fear of childbirth postpartum. Setting: Data were collected via interviews with women who had given birth from January to March 2018 at a middle-sized hospital in south-east Sweden. Participants: Swedish-speaking women aged > 18 years, were invited by midwives to participate at a postpartum maternal healthcare ward, and they received oral and written information. They filled in a demographic questionnaire, a grading of their birth experience on a 0-10 numeric rating scale (NRS) and the Wijma Delivery Experience Questionnaire Version B (W-DEQ B). We used >7 as the cut-off for high satisfaction with childbirth (NRS), and a sum score <= 60 for low fear of childbirth (W-DEQ B). Of 172 women, 28 were eligible, of whom 20 were interviewed 8-13 months postpartum. The interviews were analysed using qualitative content analysis with a directed approach. Findings: All of the models levels and their aspects were found in the interviews. All women had experienced a trusting relationship, including individual and woman-centred care, communication, choice and continuity, prompt attention and an empathic attitude. A majority described midwifery in terms of promoting security, and almost all had experienced aspects of personal control. The objective of midwifery care, described as the facilitation of womens reproductive capabilities, was described as being met by half of the women. The importance of pep talks and coaching was emphasized, and partner support could be added to the model. Key conclusions and implications for practice: Our findings indicate that the theoretical model proposed by Peters et al. (2020) is mainly applicable to midwifery care of women reporting high satisfaction with their birth experience and low postpartum fear of childbirth. Our findings suggest that this model may serve as a clarification of the unique objective of midwifery care, and could be used by midwives in daily clinical work and in midwifery education programs.
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| 8. |
- Grundström, Hanna, et al.
(författare)
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Translation and validation of the Swedish version of the Birth Satisfaction Scale-Revised (BSS-R)
- 2023
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Ingår i: Midwifery. - : ELSEVIER SCI LTD. - 0266-6138 .- 1532-3099. ; 124
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Tidskriftsartikel (refereegranskat)abstract
- Background: Optimizing womens childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised ( BSS-R ) can be used to measure birth satisfaction. Aim: The current investigation sought to translate and validate a Swedish version of the BSS-R. Method: Following translation, a comprehensive psychometric validation of the Swedish - BSS-R ( SW-BSS-R ) was carried out using a multi-model, cross-sectional, between- and within-subjects design. Participants: A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis. Data analysis: Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated. Results: The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R . Important insights into relationships between mode of birth, posttraumatic stress disorder (PTSD), and postnatal depression (PND) were observed. Conclusions and implications for practice: The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.
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| 9. |
- Hallström, Sofia, et al.
(författare)
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Fear of childbirth and mental health among lesbian, bisexual, transgender and queer people : a cross-sectional study
- 2022
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Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology. - : Taylor & Francis Ltd. - 0167-482X .- 1743-8942. ; 43:4, s. 526-531
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most studies of fear of childbirth (FOC) are conducted on heterosexual cisgender pregnant populations of birth-giving parents. Among lesbian and bisexual women, as well as transgender and queer people (LBTQ), minority stress can add an extra layer to FOC. Gender binary and cisnormative assumptions leave it to the patient to educate and navigate healthcare providers, which can increase mental health problems. Objective: The aim of this study is to compare FOC and mental illness among expecting birth-giving parents and their partners in an LBTQ population. Materials and methods: This cross-sectional study recruited 80 self-identified pregnant LBTQ persons and their 54 non-pregnant partners at a LBTQ specialized antenatal clinic in a large Swedish city of over one million inhabitants. The survey included socio-demographic characteristics, sexual and gender orientation, obstetric history, previous mental health, previous trauma exposure and measures of FOC and mental health. Results: Levels of FOC were significantly higher for the pregnant participants (median W-DEQ 67.5) than for partners (median W-DEQ 60.0). The proportion of severe FOC was higher for pregnant participants (20.3%) than for partners (9.4%), although this difference was not statistically significant. Mental illness was significantly associated with FOC. Conclusion: The results add valuable information to our understanding of the specific needs of pregnant LBTQ people and their partners and may help us to develop healthcare in the future.
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| 10. |
- Jonsson, Yvonne, et al.
(författare)
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Cytokine mapping of sera from women with preeclampsia and from women with normal pregnancies
- 2006
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Ingår i: Journal of Reproductive Immunology. - : Elsevier BV. - 0165-0378. ; 70:1-2, s. 83-91
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Preeclampsia is a pregnancy-specific syndrome. The immune system in preeclampsia is changed with an increased innate activity and there is a hypothesis of a shift towards Th1-type immunity. The aim of this study was to determine a spectrum of soluble immunological factors denoting different aspects of immune activation in third trimester sera from women with preeclampsia (N = 15) and compare with levels in sera from normal pregnant women (N = 15). Material and methods IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12 p40, IL-13, IL-15, IL-17, IFN-α, IFN-γ, TNF-α, GM-CSF, MIP-lα, MIP-1β, MCP-1, eotaxin and RANTES were measured in serum using multiplex bead arrays. The levels of soluble CD14 and soluble IL-4 receptor were measured by enzyme-linked immunoassay (ELISA). Results Preeclamptic women had significantly increased levels of circulating IL-6 (p = 0.002), IL-8 (p = 0.003) and soluble IL-4R (p = 0.037), compared to women with normal pregnancies. Conclusion This study supports the hypothesis of increased inflammatory responses in preeclampsia, illustrated by the increased levels of IL-6 and IL-8. The finding of increased levels of soluble IL-4 receptor is an intriguing finding with several interpretations, which may partly support the hypothesis of a Th1 shift in preeclampsia.
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