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3.
  • Anderson, Rondi, et al. (författare)
  • Implementing midwifery services in public tertiary medical college hospitals in Bangladesh: A longitudinal study.
  • 2023
  • Ingår i: Women and birth : journal of the Australian College of Midwives. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 36:3, s. 299-304
  • Tidskriftsartikel (refereegranskat)abstract
    • A necessary precursor for quality maternity care provision is high quality education. The quality of care that students are exposed to during clinical education on maternity wards shapes their competencies and professional identities. In this study, we look at the introduction of midwives educated to international standards - with facility mentorship - deployed in tertiary level teaching hospitals in Bangladesh with the intention of improving the use of World Health Organization (WHO)-recommended birth practices.To examine the outcomes of introducing midwifery services into tertiary level care facilities in Bangladesh, on the use of WHO-recommended birth practices.A retrospective review of patient register data was carried out to understand level of changes in use of WHO-recommended birth practices after the introduction of a midwifery service. Multivariate linear regression was applied using an interrupted time series analysis, with and without a delayed effect, to assess both level and trend change following the introduction of the midwifery service.A significant increase (p<0.001) in use of WHO-recommended birth practices was found, both immediately following the midwives' introduction and after one year. Quality improvement was observed not only in births attended by midwives, but also in those attended by doctors and nurses.By introducing quality maternity care provision through midwives in clinical sites, especially in tertiary-level care hospitals with large numbers of students, international standard midwives can improve the quality of clinical education in maternity wards, a critical priority for maternal health worldwide.
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4.
  • Andrén, Anna, et al. (författare)
  • One size does not fit all : Perspectives from Swedish midwives on fetal movement counselling
  • 2024
  • Ingår i: Women and Birth. - 1871-5192 .- 1878-1799. ; 37:4
  • Tidskriftsartikel (refereegranskat)abstract
    • PROBLEM: Migration continues to play a role in determining health outcomes related to pregnancy and childbirth in Sweden.BACKGROUND: Migrant women have, compared to Swedish-born women, increased risks of adverse birth outcomes. Previous research suggests that migrant women seek care for decreased fetal movements less than Swedish-born women. Given these documented risks, understanding midwives' perspectives in this context is crucial to address maternal health inequities.AIM: To explore midwives' experiences conveying information about fetal movement to migrant women in antenatal healthcare settings.METHODS: Semi-structured, individual interviews with midwives (n=15) experienced in providing information about fetal movements to migrant women. The interviews were analysed using reflexive thematic analysis.FINDINGS: The midwives' efforts to compensate for the deficiencies within the antenatal healthcare organisation and to ensure that all women received access to information and care regarding fetal movements are described in four themes: (a) building a trusting relationship; (b) empowering women through guidance and support; (c) overcoming communication challenges; and d) navigating safety measures.DISCUSSION: Our findings suggest that the standard antenatal care programme does not support midwives to provide holistic and individualised care that aligns with midwifery care philosophy.CONCLUSION: To reduce health inequities for migrant women, this study highlights the need for more flexible guidelines within the standard antenatal care programme. These guidelines should prioritise the individual woman's needs over institutional protocols, acknowledge the midwife-woman relationship as the core of midwifery practice and support midwives to build a partnership with women through continuity of care.
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5.
  • Baylis, Rebecca, et al. (författare)
  • Women's experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth
  • 2020
  • Ingår i: Women and Birth. - : ELSEVIER. - 1871-5192 .- 1878-1799. ; 33:3, s. E227-E233
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Fear of Birth is common in pregnant women and associated with negative physical and mental health. There is a clear comorbidity with anxiety and depression. Internet-delivered Cognitive Behaviour Therapy has been suggested as a treatment option for Fear of Birth and a randomized controlled trial comparing internet-delivered Cognitive Behaviour Therapy with midwifery led counselling as standard care has been conducted.Objective: The aim of this study was to describe women's experiences of guided internet-delivered Cognitive Behaviour Therapy for Fear of Birth and to describe the content of their fear.Methods: The present study is a qualitative, follow-up interview study following the randomized controlled trial, the U-CARE Pregnancy Trial. In total 19 women allocated to internet-delivered Cognitive Behaviour Therapy for Fear of Birth were interviewed by telephone. A semi-structured interview guide was used and the transcripts were analyzed with thematic analysis.Results: The women's descriptions of Fear of Birth differed, however their fear was most often associated with fear of losing control, fear for the baby's life or health or own life threatening events. The experiences of internet-delivered Cognitive Behaviour Therapy for Fear of Birth varied, some women were positive to its flexibility although most women preferred a face-to face meeting. The treatment did not pin-point their fears, it was challenging to maintain motivation and to work with the treatment in solitude.Conclusions: Women's descriptions of Fear of Birth varied. Most women undergoing internet-delivered Cognitive Behaviour Therapy would have preferred a face-to-face meeting which they imagined would have soothed their fear. Internet-delivered Cognitive Behaviour Therapy for Fear of Birth may be an alternative for some women. 
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6.
  • Bergh, Ingrid H. E., et al. (författare)
  • Assessment and documentation of women's labour pain : A cross-sectional study in Swedish delivery wards
  • 2015
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 28:2, s. E14-E18
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented. Methods: This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden. Results and conclusion: The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
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  • Bergh, Ingrid H. E., et al. (författare)
  • Midwifery students attribute different quantitative meanings to "hurt", "ache" and "pain" : A cross-sectional survey
  • 2013
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 26:2, s. 143-146
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Assessment of women's labor pain is seldom acknowledged in clinical practice or research. The words "aching" and "hurting" are frequently used by women to describe childbirth pain. The aim of this study was to determine the quantitative meanings midwifery students attribute to the terms "hurt", "ache" and "pain". Data was collected by self-administered questionnaire from students at seven Swedish midwifery programs. A total of 230 filled out and returned a completed questionnaire requesting them to rate, on a visual analog scale, the intensity of "hurt", "ache" or "pain" in the back, as reported by a fictitious parturient. Results: The midwifery students attributed, with substantial individual variation, different quantitative meanings to the studied pain descriptors. Conclusions: To be able to communicate about pain with a woman in labor, it is essential that the midwife be familiar with the value of different words and what they mean to her as this may affect her assessment when the woman describes her pain. © 2012.
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  • Bogren, Malin, 1970, et al. (författare)
  • Barriers to delivering quality midwifery education programmes in the Democratic Republic of Congo — An interview study with educators and clinical preceptors
  • 2021
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 34:1
  • Tidskriftsartikel (refereegranskat)abstract
    • © 2020 The Author(s) Background: In the Democratic Republic of Congo, the education of midwives at a higher education level has recently been introduced as a strategy to improve maternal and neonatal health. However, little is known about the preconditions for such an education. Aim: To explore the barriers to delivering high-quality midwifery education programmes in the DRC and reflect on potential areas for improvement. Method: Data was collected through 14 focus group discussions with 85 midwifery educators and clinical preceptors, at four higher education institutions delivering midwifery education programmes. Transcribed discussions were inductively analysed using content analysis. Findings: Overall, the teaching environment was insufficient. Most midwifery educators and clinical preceptors had deficient competencies, and there was a shortage of didactic resources and equipment as well as poor communication routines between the education institutions and clinical education sites. The barriers varied between locations; for instance, the institution in the country's capital was overall well equipped. Conclusion: The identified barriers constitute major risks undermining the quality of future midwives in the DRC. Reforming the education of midwives, together with general higher education reform, will be critical for achieving the Sustainable Development Goal on health in the country. We therefore suggest that (i) midwifery educators have at least one academic level above the programme in which they teach, (ii) continuing education be available for midwifery educators and clinical preceptors, (iii) education institutes and clinical sites are fit for purpose, and (vi) routines for clear communication links between education and clinical sites be used.
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9.
  • Bogren, Malin, 1970, et al. (författare)
  • Contextual factors influencing the implementation of midwifery-led care units in India
  • 2023
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 36:1, s. e134-e141
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs.AIM: To explore contextual factors influencing the implementation of MLCUs across India.METHOD: Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis.FINDINGS: Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards.CONCLUSION: Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages.
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  • Bogren, Malin, 1970, et al. (författare)
  • Facilitators of and barriers to providing high-quality midwifery education in South-East Asia—An integrative review
  • 2022
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 35:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: With a diversity in midwifery education across the South-East Asia region, and with the knowledge about the lifesaving competency of the midwife profession, this study's aim is to describe facilitators of and barriers to providing high-quality midwifery education in South-East Asia. Methods: Inspired by Whittemore and Knafl, we conducted a systematic integrative literature review including the five key stages of problem identification, literature search, data evaluation, data analysis, and presentation of results. The literature searches were conducted in October 2020 in the databases CINAHL, PubMed, and Scopus. A deductive data analysis based on global standards was performed. Results: The search identified 1257 articles, 34 of which were included. Countries in South-East Asia did not fully comply with the ICM global standards. Midwifery education was not separated from that of nursing, and educators lacked formal qualifications in midwifery. Curriculum implementation in the clinical area was a key barrier to achieving learning outcomes. Higher academic education for midwifery educators and mentorship programs facilitated the pedagogic and assessment process, focusing on the abilities of critical thinking, reflection, and decision-making. Conclusions: Countries in South-East Asia still have a long way to go before they can provide high-quality midwifery education. The identified facilitators can lead to a difference in students’ academic achievement and confidence in their clinical work. Coordinated actions will enable the progress in achieving competent midwives matching national health priorities. The findings highlight a need for more research on midwifery education in both theory and practice across the region. © 2021 The Author(s)
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  • Bogren, Malin, 1970, et al. (författare)
  • Findings from a context specific accreditation assessment at 38 public midwifery education institutions in Bangladesh
  • 2021
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 34:1
  • Tidskriftsartikel (refereegranskat)abstract
    • © 2020 The Authors Background: In order to promote sustainable midwifery education, it is important to understand what the structural shortcomings are. In this study of 38 public nursing institutions in Bangladesh, we aim to identify a number of structural shortcomings and to discuss strategies for limiting them. Methods: An evaluated context-specific accreditation assessment tool consisting of 37 multi-choice closed-response questions encompassing 14 educational standards aligned with international standards for midwifery education programs and competences for midwifery educators was used to assess all public nursing institutions in Bangladesh (n = 38), the results of which are presented in simple descriptive statistics; number (n), percentage (%), mean, SD and minimum-maximum value. Results: Provision around clinical practice sites is the key structural shortcoming within the Bangladeshi midwifery educational system. Twenty-five percent of the institutions provided no opportunity for midwifery students to practice comprehensive sexual and reproductive health care. Twenty-nine per cent of the clinical sites were not aware of the content of midwifery courses and syllabi. Finally, one third of students achieving a midwifery qualification did not meet the learning outcomes to support women in birth. Conclusions: To measure progress towards national and global milestones to ensure students are equipped with required competencies before graduating as registered midwives will be difficult to meet unless shortcomings within the educational system are addressed. We recommend (i) the inclusion of clinical placement sites in future assessments, (ii) the introduction of an integrated feedback-appeal-response system, and (iii) the development of a system for improved communication links between educational institutions and clinical placement sites.
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12.
  • Bogren, Malin, 1970, et al. (författare)
  • Impact of the Helping Mothers Survive Bleeding After Birth learning programme on care provider skills and maternal health outcomes in low-income countries — An integrative review
  • 2021
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 34:5, s. 425-434
  • Forskningsöversikt (refereegranskat)abstract
    • © 2020 The Author(s) Background: To improve maternal health outcomes, highly competent healthcare providers are needed. One strategy used to improve performance among healthcare providers is simulation-based learning. An integrative review was designed with the aim of synthesising available research on Helping Mothers Survive (HMS), a learning programme used in low-income countries, and its impact on care provider skills and maternal health outcomes. Method: A systematic search was conducted in June 2020 in CINAHL, PubMed, Scopus, and Web of Science. All stages of inclusion, quality assessment, and data extraction were done independently by four reviewers. A narrative synthesis was used for the outcomes of care provider skills and knowledge, as well as maternal health outcomes. Findings: The search identified 50 articles, 22 of which were excluded due to being duplicates, 16 based on their title and abstract, and two based on their full text. Eleven papers were included in the synthesis: eight quantitative, two qualitative, and one mixed-method study, originating from India, Malawi, Tanzania, Uganda, and Zanzibar. The Helping Mothers Survive-Bleeding After Birth (HMS-BAB) learning programme was found to have a positive impact on care providers’ competencies and maternal health outcomes, with a reduced number of postpartum haemorrhages and a reduction in maternal mortality. Conclusion: The HMS-BAB learning programme has the potential to increase competence among care providers and improve maternal health outcomes in low-income settings. A successful use of the programme to maintain improved care routines for mothers requires multi-professional teams, facility readiness, a low-dose high-frequency approach, a local coordinator, and accountability and ownership.
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13.
  • Bradford, Billie F, et al. (författare)
  • Fetal movements : A framework for antenatal conversations
  • 2023
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 36:3, s. 238-246
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Presentations for decreased fetal movements comprise a significant proportion of acute antenatal assessments. Decreased fetal movements are associated with increased likelihood of adverse pregnancy outcomes including stillbirth. Consensus-based guidelines recommend pregnant women routinely receive information about fetal movements, but practice is inconsistent, and the information shared is frequently not evidence-based. There are also knowledge gaps about the assessment and management of fetal movement concerns. Women have indicated that they would like more accurate information about what to expect regarding fetal movements.DISCUSSION: Historically, fetal movement information has focussed on movement counts. This is problematic, as the number of fetal movements perceived varies widely between pregnant women, and no set number of movements has been established as a reliable indicator of fetal wellbeing. Of late, maternity care providers have also advised women to observe their baby's movement pattern, and promptly present if they notice a change. However, normal fetal movement patterns are rarely defined. Recently, a body of research has emerged relating to maternal perception of fetal movement features such as strength, presence of hiccups, and diurnal pattern as indicators of fetal wellbeing in addition to frequency.CONCLUSION: Sharing comprehensive and gestation-appropriate information about fetal movements may be more satisfying for women, empowering women to identify for themselves when their baby is doing well, and importantly when additional assessment is needed. We propose a conversational approach to fetal movement information sharing, focusing on fetal movement strength, frequency, circadian pattern, and changes with normal fetal development, tailored to the individual.
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14.
  • Bäck, Lena, 1962-, et al. (författare)
  • Developing competence and confidence in midwifery-focus groups with Swedish midwives
  • 2017
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 30:1, s. E32-E38
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Midwives have a significant impact on the clinical outcome and the birthing experience of women. However,there has been a lack of research focusing specifically on clinical midwives' learning and development of professional competence.Aim: The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence.Methods: A qualitative study based on focus groups with midwives employed in maternity services.Findings: Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding.The meaning of competence is to feel safe and secure in their professional role.There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident.Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field.The midwives felt they were not seen as individuals, and this system made them feel split between different assignments.Discussion: External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning.Conclusions: Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident.
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  • Bäckström, Caroline A., et al. (författare)
  • "It's like a puzzle" : Pregnant women's perceptions of professional support in midwifery care
  • 2016
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 29:6, s. e110-e118
  • Tidskriftsartikel (refereegranskat)abstract
    • ProblemPregnant women are not always satisfied with the professional support they receive during their midwifery care. More knowledge is needed to understand what professional support pregnant women need for childbirth and parenting.BackgroundChildbearing and the transition to becoming a parent is a sensitive period in one's life during which one should have the opportunity to receive professional support. Professional support does not always correspond to pregnant women's needs. To understand pregnant women's needs for professional support within midwifery care, it is crucial to further illuminate women's experiences of this support.AimTo explore pregnant women's perceptions of professional support in midwifery care.MethodsA qualitative study using semi-structured interviews. Fifteen women were interviewed during gestational weeks 36–38. Data was analysed using phenomenography.FindingsThe women perceived professional support in midwifery care to be reassuring and emotional, to consist of reliable information, and to be mediated with pedagogical creativity. The professional support facilitated new social contacts, partner involvement and contributed to mental preparedness. The findings of the study were presented in six categories and the category Professional support contributes to mental preparedness was influenced by the five other categories.ConclusionPregnant women prepare for childbirth and parenting by using several different types of professional support in midwifery care: a strategy that could be described as piecing together a puzzle. When the women put the puzzle together, each type of professional support works as a valuable piece in the whole puzzle. Through this, professional support could contribute to women's mental preparedness for childbirth and parenting.
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16.
  • Estalella, Itziar, et al. (författare)
  • Evaluation of an intervention supporting breastfeeding among late-preterm infants during in-hospital stay
  • 2020
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 33, s. e33-e38
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Late-preterm infants show lower breastfeeding rates when compared with term infants. Current practice is to keep them in low-risk wards where clinical guidelines to support breastfeeding are well established for term infants but can be insufficient for late-preterm.OBJECTIVE: The aim of this study was to evaluate an intervention supporting breastfeeding among late-preterm infants in a maternity service in the Basque Country, Spain.METHODS: The intervention was designed to promote parents' education and involvement, provide a multidisciplinary approach and decision-making, and avoid separation of the mother-infant dyad. A quasi-experimental study was conducted with a control (n=212) and an intervention group (n=161). Data was collected from clinical records from November 2012 to January 2015. Feeding rate at discharge, breast-pump use, incidence of morbidities, infant weight loss and hospital stay length were compared between the two groups.RESULTS: Infants in the control group were 50.7% exclusive breastfeeding, 37.8% breastfeeding, and, 11.5% formula feeding at discharge, whereas in the intervention group, frequencies were 68.4%, 25.9%, and 5.7%, respectively (p=0.002). Mothers in the intervention group were 2.66 times more likely to use the breast-pump after almost all or all feeds and 2.09 times more likely to exclusively breastfeed at discharge. There were no significant differences in morbidities and infant weight loss between groups. Hospital stay was longer for infants who required phototherapy in the intervention group (p=0.009).CONCLUSION: The intervention resulted in a higher breastfeeding rate at discharge. Interventions aimed to provide specific support among late-pretem infants in maternity services are effective.
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17.
  • Faulks, Fiona, et al. (författare)
  • Common mental disorders and perinatal outcomes in Victoria, Australia : a population-based retrospective cohort study
  • 2024
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 37:2, s. 428-435
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Common mental disorders (non-psychotic mental health conditions which impact on day-to-day functioning) are increasingly common in childbearing women and may impact significantly on both maternal and neonatal outcomes. Our study examines the associations between common mental disorders and perinatal outcomes.Methods: We used routinely collected perinatal data (2009–2016) for this population-based retrospective cohort study (n = 597,522 singleton births). We undertook multiple logistic regression adjusting for key maternal medical conditions and sociodemographic factors to determine associations between maternal common mental disorders and adverse perinatal outcomes with confidence intervals set at 95%.Results: Women with common mental disorders were more likely to have an induction of labour and caesarean birth, have a postpartum haemorrhage (PPH), and be admitted to the Intensive Care Unit (ICU) than women without common mental disorders. Neonates of women with common mental disorders were more likely to have an Apgar score at five minutes of less than seven (a measure of neonatal wellbeing at birth), be born preterm and low birthweight, be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (SCN/NICU) and have a congenital anomaly than neonates of women without common mental disorders.Conclusion: Common mental disorders during the perinatal period were associated with poorer perinatal outcomes for mothers and their neonates. Strategies that enable early recognition and response to maternal common mental disorders should be developed to mitigate the consequential impact on maternal and infant wellbeing.
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19.
  • Fritzson, Magdalena, et al. (författare)
  • A mobile application for early labour support -feasibility pilot study
  • 2023
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 36:6, s. 495-503
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Use of mobile applications (apps) Use of mobile applications (apps) are increasing during pregnancy but few of these are evidence-based or evaluated in research.Aim: To examine the feasibility, including perceived usefulness and usability, and the preliminary effects of an app based on the Confident birth method.Methods: A mixed-method approach, including 48 women, was used to evaluate acceptability, usability and to test study design and procedures. iPhone-users (n = 24) tested the app during pregnancy while the remaining (n = 24) formed a control group. Background characteristics and outcome measurements were collected from all women at baseline. Women in the app group received two follow-up phone calls from a midwife concerning usefulness and ease of use of the app. A follow-up questionnaire after birth were used to measure preliminary effects of the intervention as well as system usability of the app.Results: Women using the app found the app exercises simple, understandable, and useful. System usability score showed a mean score of 85.3 indicating excellent system usability. Notes from phone calls resulted in four categories: positive feedback about the app, negative feedback about the app, partners involvement, and knowledge. Preliminary effects of labour experience showed no significant differences between the two groups, in terms of early labour or childbirth experience.Conclusion: The app tested in this feasibility study, was perceived as useful and appreciated by women. Areas for improvement of the app were identified. The result shows promise for further efficacy testing in a forthcoming randomised controlled trial.
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20.
  • Goldkuhl, Lisa, 1983, et al. (författare)
  • The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study
  • 2022
  • Ingår i: Women and Birth. - : Elsevier BV. - 1878-1799 .- 1871-5192. ; 35:4, s. e337-e347
  • Tidskriftsartikel (refereegranskat)abstract
    • Labour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors. Aim: To explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward. Methods: Five months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a ‘Regular’ birthing room (n = 8) or a specially designed, ‘New room’ (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process. Findings: The analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women's agency was facilitated. Conclusion: Institutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women's needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women's sense of agency.
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21.
  • Göransson, Malin, et al. (författare)
  • “If I blink twice everything is OK” – A qualitative study of Swedish midwives’ strategies for supporting birthing women while working in full personal protective equipment
  • 2024
  • Ingår i: Women and Birth. - 1871-5192 .- 1878-1799.
  • Tidskriftsartikel (refereegranskat)abstract
    • Problem: Midwives all over the world have had to adapt to the use of personal protective equipment (PPE) during the COVID-19 pandemic. The issue of how they managed to support birthing women, despite the use of PPE, has been insufficiently studied. Background: Midwives support birthing women in one of their most life-changing situations. Having COVID-19 at the time of childbirth makes birthing women even more vulnerable. PPE has been shown to impact the ability of providing support to birthing women. Aim: To describe midwives’ strategies for supporting birthing women while working in full PPE Methods: A qualitative study based on focus group discussons with Swedish midwives. Data were analysed by inductive content analysis. Findings: To support birthing women while in full PPE, the midwives adapted existing working methods, increased collaboration with colleagues, unveiled, adapted to the requirements for contagion prevention, addressed women's concern for the midwife and maintained focus on the birth while remaining mindful of the risk of contagion. Discussion: Midwives adopted strategies in order to uphold provision of support to the birthing women, as well as to address contextual factors related to PPE that hinder provision of support. Conclusion: The respective effects of different PPE types and models on the birth experience should be explored. Explicit strategies for supporting birthing women while working in full PPE must be created and discussed among midwives.
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23.
  • Halfdansdottir, Berglind, et al. (författare)
  • The association between waterbirth and perineal injury or other adverse outcomes among low-risk women with physiological birth : Results from the Nordic Home Birth Cohort Study
  • 2024
  • Ingår i: Women and Birth. - 1871-5192 .- 1878-1799. ; 37:4
  • Tidskriftsartikel (refereegranskat)abstract
    • PROBLEM/BACKGROUND: Immersion in water has known benefits, such as reducing pain and shortening the duration of labour. The relationship between waterbirth and perineal injury remains unclear.AIM: To compare the incidence of perineal injury in waterbirth and birth on land among low-risk women. Secondary outcomes were postpartum haemorrhage and 5-minute Apgar scores <7.METHODS: Prospective cohort study of 2875 low-risk women who planned a home birth in Denmark, Iceland, Norway, and Sweden in 2008-2013 and had a spontaneous vaginal birth without intervention. Descriptive statistics and logistic regression were performed.FINDINGS: A total of 942 women had a waterbirth, and 1933 gave birth on land. The groups differed in their various background variables. Multiparous women had moderately lower rates of intact perineum (59.3% vs. 63.9%) and primiparous women had lower rates of episiotomies (1.1% vs. 4.8%) in waterbirth than in birth on land. No statistically significant differences were detected in adjusted regression analysis on intact perineum in waterbirth (primiparous women's aOR = 1.03, CI 0.68-1.58; multiparous women's aOR = 0.84, CI 0.67-1.05). The rates of sphincter injuries (0.9% vs. 0.6%) were low in both groups. No significant differences were detected in secondary outcomes.DISCUSSION: The decreased incidence of intact perineum among multiparous women was modest and inconclusive, and the prevalence of sphincter injury was low.CONCLUSION: Low-risk women contemplating waterbirth should be advised to weigh the risks and benefits detected in this study against previously established benefits of waterbirth and should make an informed choice based on their values.
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24.
  • Hansson, Malin, 1975, et al. (författare)
  • Veiled midwifery in the baby factory - A grounded theory study
  • 2019
  • Ingår i: Women and Birth. - Amsterdam : Elsevier BV. - 1871-5192 .- 1878-1799. ; 32:1, s. 80-86
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Midwives' professional role has been changing drastically over time, from handling births in home settings to being part of a team in labour wards in hospitals. This demands a greater effort of interprofessional collaboration in childbirth care. Aim: Explore midwives' work in a hospital-based labour ward from the perspectives of other professions, working in the same ward. Method: Classical grounded theory, using a constant comparative analysis, was applied to focus group interviews with obstetricians, assistant nurses and managers to explore their views of midwifery work during childbirth. Findings: The substantive theory of 'veiled midwifery' emerged as an explanation of the social process between the professions in the 'baby factory' context. The other professionals perceive midwifery through a veil that filters the reality and only permits fragmentary images of the midwives' work. The main concern for the other professions was that the midwives were 'marching to own drum'. The midwives were perceived as both in dissonance with the baby factory, and therefore hard to control, or, alternatively more compliant with the prevailing rhythm. This caused an unpredictability and led to feelings of frustration and exclusion. Which in turn resulted in attempts to cooperate and gain access to the midwifery world, by using three unveiling strategies: Streamlining, Scrutinising and Collaborating admittance. Conclusions: Findings provide a theoretical conceptualisation of a 'veiled midwifery ' that causes problems for the surrounding team. This generates a desire to streamline and control midwifery in order to increase interprofessional collaboration. (c) 2018 The Authors. Published by Elsevier Ltd on behalf of Australian College of Midwives. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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25.
  • Hermanson, Asa, et al. (författare)
  • The effects of early pacifier use on breastfeeding: A randomised controlled trial
  • 2020
  • Ingår i: Women and Birth. - : ELSEVIER. - 1871-5192 .- 1878-1799. ; 33:5, s. E473-E482
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The majority of observational studies have found associations between pacifier use and shorter breastfeeding duration. Results from four randomised controlled trials did not reveal any difference in breastfeeding outcomes. The relationship between early pacifier use and breastfeeding outcomes remains unclear. Aim: To investigate whether a recommendation of early pacifier use affects the proportion of breastfeeding at six months compared to a recommendation to avoid pacifier use during the first two weeks. Methods: An open, randomised controlled trial with parallel group design; 239 primiparous mothers and their term infants were randomly assigned to an intervention group or a control group. The primary outcome was the proportion of breastfeeding at six months. Secondary outcomes were the proportions of breastfeeding and breastfeeding problems at two and four months. To investigate factors which may influence breastfeeding, a multivariate logistic regressions analysis was performed. Findings: A total of 209 participants (87.5%) completed the study. There were no significant differences between the groups with respect to breastfeeding at six months. No negative association for breastfeeding between early versus late introduction of pacifier was found. Factors significantly associated with cessation of breastfeeding at six months were: use of nipple shield, intention to breastfeed, severe breastfeeding problems at two weeks, pacifier use at two months and lower educational level. Conclusion: Early versus late recommendation of pacifier introduction did not affect the proportion of breastfeeding at six months. However, the compliance to the randomised group was insufficient. No negative association was found in the observational analysis. (C) 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
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26.
  • Hildingsson, Ingegerd, 1955-, et al. (författare)
  • 'A perfect fit' : Swedish midwives' interest in continuity models of midwifery care
  • 2023
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 36:1, s. 86-92
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated.OBJECTIVE: to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models.METHODS: A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis.RESULTS: A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest.CONCLUSION: A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.
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27.
  • Hildingsson, Ingegerd, 1955-, et al. (författare)
  • Childbirth experience in women participating in a continuity of midwifery care project
  • 2021
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 34:3, s. e255-e261
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Continuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care.Aim: The aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden.Methods: An experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences.Result: A total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support.Conclusions: The results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.
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28.
  • Hildingsson, Ingegerd, 1955-, et al. (författare)
  • Exploring the Fear of Birth Scale in a mixed population of women of childbearing age : A Swedish pilot study
  • 2018
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 31:5, s. 407-413
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this pilot study was to explore the Fear of Birth Scale in a mixed sample of women of childbearing age, by investigating the levels of childbirth fear and the content of women's thoughts when completing the scale. Methods: A cross-sectional mixed method study of 179 women who completed a short questionnaire and a think aloud interview. Results: The mean score of the Fear of Birth Scale was 40.80 (SD 27.59) and 28.5% were classified as having fear of childbirth (>= 60). The internal consistency showed a Cronbach's alpha > 0.92, and a mean inter-item correlation of 0.85. The highest scores were found in women younger than 25 years (mean 60.10), foreignborn women (mean 54.30) and women who did not have any previous children (48.72). The lowest scores were found in women who had recently given birth (mean 34.82) and women older than 35 years (mean 34.85). The content analysis categorization matrix clearly accommodated all 436 statements into the five pre-existing categories. The largest categories were: the content of fear and worry with 138 statements and strategies to cope with fear or worry (122 statements). Conclusion: The Fear of Birth Scale seems to be a useful instrument for different subgroups of women. The construct of fear of childbirth may be universally understood and experienced by women of childbearing age irrespective of whether they are currently pregnant, have recently given birth or do not have children. Identifying fear of birth is important in clinical practice in order to support women's reproductive needs.
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29.
  • Hildingsson, Ingegerd, et al. (författare)
  • Fathers' birth experience in relation to midwifery care
  • 2011
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 24:3, s. 129-136
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim was to identify the proportion of fathers having a positive experience of a normal birth and to explore factors related to midwifery care that were associated with a positive experience. Background: Research has mainly focused on the father's supportive role during childbirth rather than his personal experiences of birth. Methods: 595 new fathers living in a northern part of Sweden, whose partner had a normal birth, were included in the study. Data was collected by questionnaires. Odds Ratios with 95% confidence interval and logistic regression analysis were used. Results: The majority of fathers (82%) reported a positive birth experience. The strongest factors associated with a positive birth experience were midwife support (OR 4.0; 95 CI 2.0-8.1), the midwife's ongoing presence in the delivery room (OR 2.0; 1.1-3.9), and information about the progress of labour (OR 3.1; 1.6-5.8). Conclusion: Most fathers had a positive birth experience. Midwifery support, the midwife's presence and sufficient information about the progress of labour are important aspects in a father's positive birth experience. The role of the midwife during birth is important to the father, and his individual needs should be considered in order to enhance a positive birth experience.
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30.
  • Hildingsson, Ingegerd, et al. (författare)
  • Increasing levels of burnout in Swedish midwives : A ten-year comparative study
  • 2024
  • Ingår i: Women and Birth. - 1871-5192 .- 1878-1799. ; 37:2, s. 325-331
  • Tidskriftsartikel (refereegranskat)abstract
    • PROBLEM: Midwives' levels of burnout seem to be increasing worldwide.BACKGROUND: Previous research show a high prevalence of burnout in midwives.AIM: To compare levels of burnout in two national Swedish samples of midwives completing a similar survey.METHODS: A comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used.FINDINGS: The sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience.DISCUSSION: The highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical.CONCLUSION: This study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.
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31.
  • Hildingsson, Ingegerd, 1955-, et al. (författare)
  • Increasing levels of burnout in Swedish midwives : A ten-year comparative study
  • 2024
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 37:2, s. 325-331
  • Tidskriftsartikel (refereegranskat)abstract
    • ProblemMidwives’ levels of burnout seem to be increasing worldwide.BackgroundPrevious research show a high prevalence of burnout in midwives.AimTo compare levels of burnout in two national Swedish samples of midwives completing a similar survey.MethodsA comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used.FindingsThe sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience.DiscussionThe highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical.ConclusionThis study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.
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32.
  • Hildingsson, Ingegerd M (författare)
  • New parents' experiences of postnatal care in Sweden
  • 2007
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 20:3, s. 105-113
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: The aim was to study new parents' satisfaction with postnatal care and to estimate the proportion of fathers who were given the option of spending the night at the postnatal ward. PROCEDURES: A questionnaire was mailed to new parents 6 months after the birth of their child in a Swedish hospital. The main outcome was overall satisfaction with postnatal care. FINDINGS: Two hundred and ninety-four new mothers and 280 new fathers completed the questionnaire. Thirty-four percent of the mothers were dissatisfied with the overall postnatal care. The strongest associated factors for new mothers' dissatisfaction were: unfriendly and unhelpful staff (RR 10.3; 3.2-32), lack of support from staff (RR 6.4; 2.3-17.5), new fathers not permitted to stay overnight (RR 5.2; 1.8-14.5), dissatisfaction with postnatal checks of the woman herself (RR 2.6; 1.1-6.3) and dissatisfaction with practical breast-feeding support (RR 1.6; 1.2-2.1). Sixty-three percent of the fathers were given the option of spending the night at the postnatal ward. The fathers who chose not to spend the night on the ward were older, had other children and were dissatisfied that they were not allowed to play a greater role in the care of their newborn baby. MAIN CONCLUSIONS: In order to increase patient satisfaction, the needs of the new family must be highlighted and more support and help provided to new parents on the postnatal ward. It is essential to have family oriented postnatal care and to give fathers the opportunity to stay overnight and involve them in the care of their newborn baby.
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33.
  • Hildingsson, Ingegerd, et al. (författare)
  • Partner support in the childbearing period : a follow up study
  • 2008
  • Ingår i: Women and birth. - : Elsevier BV. - 1878-1799 .- 1871-5192. ; 21:4, s. 141-148
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Social support is important during pregnancy and childbirth and the partner is usually the main source of support. Lack of partner support is associated with less emotional well-being and discontinuation of breastfeeding. RESEARCH PROBLEM: The purpose of the study was to investigate the proportion of women dissatisfied with partner support in early pregnancy, and to identify risk factors associated with dissatisfaction through a follow up 2 months and 1 year after childbirth. PARTICIPANTS AND METHODS: A national cohort of 2430 Swedish speaking women recruited in early pregnancy and followed up 2 months and 1 year postpartum. Data were collected by means of three postal questionnaires. RESULTS: Five percent of women were dissatisfied with partner support in early pregnancy. Women dissatisfied with partner support were more likely to be multiparas, not living with their partner in early pregnancy and to report unfavorable timing of pregnancy. They experienced more physical symptoms, and less emotional well-being in terms of more depressive symptoms, more major worries and a lower sense of coherence. One year after childbirth a higher rate of divorces and disappointment with the partner's participation in childcare and household chores and understanding from partner was found in women being dissatisfied in early pregnancy. DISCUSSION AND CONCLUSIONS: This study shows that it might be possible to identify women who are lacking partner support already in early pregnancy. Women's social network and their support from partner should be investigated by health care providers and women in need of additional support should be refereed to available community resources.
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34.
  • Hildingsson, Ingegerd, et al. (författare)
  • Presence and process of fear of birth during pregnancy - Findings from a longitudinal cohort study
  • 2017
  • Ingår i: Women and Birth. - : ELSEVIER SCIENCE BV. - 1871-5192 .- 1878-1799. ; 30:5, s. E242-E247
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The prevalence of fear of birth has been estimated between 8–30%, but there is considerable heterogeneity in research design, definitions, measurement tools used and populations. There are some inconclusive findings about the stability of childbirth fear.Aim: to assess the prevalence and characteristics of women presenting with scores ≥60 on FOBS-The Fear of Birth Scale, in mid and late pregnancy, and to study change in fear of birth and associated factors.Methods: A prospective longitudinal cohort study of a one-year cohort of 1212 pregnant women from a northern part of Sweden, recruited in mid pregnancy and followed up in late pregnancy. Fear of birth was assessed using FOBS-The fear of birth scale, with the cut off at ≥60.Findings: The prevalence of fear of birth was 22% in mid pregnancy and 19% in late pregnancy, a statistically significant decrease. Different patterns were found where some women presented with increased fear and some with decreased fear. The women who experienced more fear or less fear later in pregnancy could not be differentiated by background factors.Conclusions: More research is needed to explore factors important to reduce fear of childbirth and the optimal time to measure it.
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35.
  • Hildingsson, Ingegerd, et al. (författare)
  • Support interventions to reduce psychological distress in families experiencing stillbirth in high income countries : a systematic review
  • 2024
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 37:2, s. 296-302
  • Forskningsöversikt (refereegranskat)abstract
    • Background: Previous research indicates disparities in the care of bereaved parents and siblings following a stillbirth in the family. The aim of this systematic review was to assess the effects of interventions aimed at reducing psychological distress among parents or siblings in high-income countries after experiencing a stillbirth.Methods: The databases CINAHL, Medline, PsycInfo, Cochrane Library, and EMBASE were searched in August 2022.Results: Four intervention studies from the United States (US), the United Kingdom (UK), Finland, and Australia, met the inclusion criteria. The interventions comprised a perinatal grief support team; a perinatal counselling service; a grief support program; and a support package including contacts with peer supporters and health care staff. No studies of interventions for siblings were found. The results could not be synthesised due to disparities in interventions and outcome measures. The risk of bias was assessed as high in all four studies and the certainty for all outcomes was rated as very low.Conclusion: More controlled trials with rigorous methods are needed to evaluate the effect of bereavement support interventions in parents and siblings after stillbirth. Future studies should include a core outcome set to make them more comparable. Most of the studies in this review were assessed to have an overall high risk of bias, mainly due to problems with missing outcome data; thus, future studies could specifically target this problem.
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36.
  • Hildingsson, Ingegerd, 1955-, et al. (författare)
  • Women with fear of childbirth might benefit from having a known midwife during labour
  • 2019
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 32:1, s. 58-63
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time.Methods: A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth.Results: 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not.Conclusions: Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife-woman relationship rather than counseling per se could be the key issue when it comes to fear of birth.
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37.
  • Hildingsson, Ingegerd (författare)
  • Women's birth expectations, are they fulfilled? : Findings from a longitudinal Swedish cohort study
  • 2015
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 28:2, s. E7-E13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The importance of women's expectations on the experience of birth has shown contradictory results regarding fulfilment. The aim of this study was to describe pregnant women's expectations of birth and to investigate if these expectations were fulfilled. An additional aim was to determine if unfulfilled expectations were related to the mode of birth, use of epidural and the birth experience. Methods: This research investigated a prospective regional cohort study of 1042 Swedish-speaking women who completed a questionnaire about birth expectations in late pregnancy and were followed up with two months after birth. Five areas were under study: support from partner, support from midwife, control, participation in decision making and the midwife's presence during labour and birth. An index combining expectations and experiences was created. Results: Certain background characteristics were associated with expectations as well as experiences. Statistically significant differences were shown between expectations and experiences in support from midwife (mean 3.41 vs 3.32), support from partner (mean 3.70 vs 3.77), and midwife's presence (mean 3.00 vs 3.39). Experiences 'worse than expected' regarding decision making and control were associated with modes of birth other than vaginal and four out of five areas were associated with a less positive birth experience. Conclusion: Some women had high birth expectations of which some were fulfilled. An expectation on support from the midwife was less likely to be achieved, while support from partner and the midwives' presence were fulfilled. If the woman's expectations were not fulfilled, e.g. became 'worse than expected' this was associated with a less positive overall birth experience as well as with instrumental or surgical mode of birth. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.
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38.
  • Hildingsson, Ingegerd, 1955-, et al. (författare)
  • Women's satisfaction with antenatal care : Comparing women in Sweden and Australia
  • 2013
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 26:1, s. e9-e14
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Satisfaction with antenatal care could differ depending on the organisation and the context of care.AIM:To compare antenatal care in Australia and Sweden, to identify deficiencies in the content of antenatal care and what aspects contributed most in dissatisfaction with antenatal care.METHODS: A longitudinal survey of 123 Australian and 386 Swedish women recruited during one year in regional hospitals in Sweden and Australia. Data collected by three questionnaires.RESULTS:Women in Australia had more antenatal visits, less continuity of midwife caregiver but were more satisfied with antenatal education and the emotional aspects of antenatal care. Although the overall satisfaction was high, deficiencies were found in more than half of the studied variables in the content of care. Women in Sweden were more dissatisfied with information about labour and birth (OR 3.1; 1.8-5.3) and information about the time following birth (OR 3.8; 2.2-6.3), but more satisfied with the involvement of the father (OR 0.3; 0.2-0.6). Factors that contributed most to dissatisfaction with antenatal care overall were deficiency in information about pregnancy related issues (OR 3.4; 1.3-8.7) and not being taken seriously by the midwife (OR 4.1; 1.6-10.1).CONCLUSION:Satisfaction with antenatal care was high in both groups of women. Australian women were more satisfied than the Swedish women with the emotional aspects of care. Deficiencies were found in more than half of the variables measured relating to the specific aspects of care. Lack of information and not being treated seriously were important factors for not being satisfied.
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39.
  • Häggsgård, Cecilia, et al. (författare)
  • Women's experiences of the second stage of labour
  • 2021
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 35:5, s. e464-e470
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The second stage of labour is generally considered as an intensive part of labour. Despite this, knowledge about women's experiences of the second stage of labour is scant.AIM: To explore experiences of the second stage of labour in women with spontaneous vaginal birth.METHODS: This is a qualitative study where twenty-one women with a spontaneous birth at term, were interviewed four to ten weeks after birth. Data were analysed using qualitative thematic analysis based on descriptive phenomenology. The participating women had experienced a vaginal birth; some for the first time, having previously given birth by caesarean section and some with a previous vaginal birth.FINDINGS: Three themes emerged: "An experience of upheaval" which represents the women's experiences of intensity, power and pain during the second stage of labour. "The importance of trusting relationships" signifies the meaning of women's relationships during the second stage of labour. "Becoming a mother" which is characterised by feelings of accomplishment and the experience of the final moments of birth.CONCLUSION: During the second stage of labour women experienced overwhelming sensations which made evident the importance of trusting relationships with those involved in the birth. The women were in a transformative state between pregnancy and motherhood where experiences of being involved and being provided with information and guidance were all considered crucial. Continuous support should be offered to women during the second stage of labour.
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40.
  • Höglund, Berit, et al. (författare)
  • Midwives' comprehension of care for women with intellectual disability during pregnancy and childbirth : An open-ended questionnaire study in Sweden
  • 2015
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 28:3, s. E57-E62
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Few studies have investigated midwifery care for women with intellectual disability (ID). Aim: To gain a deeper understanding of midwives' comprehension of care for women with ID during pregnancy and childbirth. Methods: A cross-sectional study among 375 midwives at antenatal clinics and delivery wards in Sweden. Findings 2476 quotations were sorted into six categories: information; communication and approach; the role of the midwife; preparing for and performing interventions and examinations; methods and assessments; and organisation of care. The midwives affirmed that individual, clear and repeated information together with practical and emotional support was important for women with ID. The midwives planned the care as to strengthen the capacity of the women, open doors for the unborn child and reinforce the process of becoming a mother. Extra time could be needed. They tried to minimise interventions. The midwives felt a dual responsibility, to support the mother-child contact but also to assess and identify any deficits in the caring capacity of the mother and to involve other professionals if needed. Conclusions: The midwives described specially adapted organisation of care, models of information, practical education and emotional support to facilitate the transition to motherhood for women with ID. They have a dual role and responsibility in supporting the woman, while making sure the child is properly cared for. Healthcare services should offer a safe and trusted environment to enable such midwifery care. When foster care is planned, the society should inform and co-operate with midwives in the care of these women.
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41.
  • Jha, Paridhi, et al. (författare)
  • Fear of Childbirth and Depressive Symptoms among Postnatal Women : A Cross-sectional Survey from Chhattisgarh, India
  • 2018
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 31:2, s. 122-133
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Prevalence rates of Fear of Birth and postnatal depressive symptoms have not been explored in Chhattisgarh, India.Objective: To validate Hindi Wijma Delivery Experience Questionnaire and to study the prevalence of Fear of Birth and depressive symptoms among postnatal women.Methods: A cross-sectional survey at seventeen public health facilities in two districts of Chhattisgarh, India among postnatal women who gave birth vaginally or through C-section to a live neonate. Participants were recruited through consecutive sampling based on health facility records of daily births. Data were collected through one-to-one interviews using the Wijma Delivery Experience Questionnaire Version B and the Edinburgh Postnatal Depression Scale. Non-parametric associations and linear regression data analyses were performed.Results: The Hindi Wijma Delivery Experience Questionnaire Version B had reliable psychometric properties. The prevalence of Fear of Birth and depressive symptoms among postnatal women were 13.1% and 17.1%, respectively, and their presence had a strong association (p < 0.001). Regression analyses revealed that, among women having vaginal births: coming for institutional births due to health professionals' advice, giving birth in a district hospital and having postnatal depressive symptoms were associated with presence of FoB; while depressive symptoms were associated with having FoB, perineal suturing without pain relief, and giving birth to a low birth-weight neonate in a district hospital.Conclusion: The prevalence of Fear of Birth and depressive symptoms is influenced by pain management during childbirth and care processes between women and providers. These care practices should be improved for better mental health outcomes among postnatal women.
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42.
  • Johansson, Margareta, et al. (författare)
  • 'As long as they are safe- birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section
  • 2014
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 27:3, s. 208-213
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Decision-making in childbirth involves considerations about both the mother and her unborn baby's wellbeing. For men the safety of both is paramount. Aim: To explore and describe Swedish fathers' beliefs and attitudes around the decision for a caesarean section. Methods: Qualitative descriptive study. Twenty one Swedish men whose partners had experienced elective or emergency caesarean participated in a telephone interview. Thematic data analysis was used. Findings: The theme, 'Childbirth is Risky', included "Caesarean birth has lots of advantages" and "Birth mode does not matter". In the context of having experienced a caesarean section male partners considered birth mode to be irrelevant. The majority considered caesarean to be a quick and efficient way of giving birth which equated to being safer. Most men could articulate some risks associated with caesarean but these were mainly minimised. The second theme, 'Simply a matter of trust: Birth mode is not my decision', reflected men's belief that they had little to contribute to the decisions made around birth mode. The decision for a caesarean section was considered to lie with the medical practitioner. Conclusion: Mode of birth was regarded as unimportant. The recommendation for a caesarean section was readily accepted and appreciated, and shifted responsibility for birth to the medical practitioner. Involving men in the decision-making process by means of giving them information was valued. Men's limited knowledge about the risks of a caesarean may contribute to birth mode decisions. Professionals need to provide balanced and correct information within the context of individual circumstances.
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43.
  • Johansson, Margareta, et al. (författare)
  • Intrapartum care could be improved according to Swedish fathers : Mode of birth matters for satisfaction
  • 2013
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 26:3, s. 195-201
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Intrapartum care is expected to be shaped by parents' need and preferences. Aim: The aim was to explore Swedish fathers' intrapartum care quality experiences, with a specific focus on care deficiencies in relation to birth mode. A secondary aim was to explore which issues of quality that contributed most to dissatisfaction with the overall assessment of the care. Methods: Cross-sectional design, part of a prospective longitudinal survey in Sweden. A quality of care index was developed, based on perceived reality and subjective importance of given intrapartum care. Two months after birth 827 fathers answered nine questions related to quality of care. Descriptive statistics and logistic regression analysis were used. Results: Dissatisfaction with overall intrapartum care was related to deficiencies in partner's medical care (OR 5.6; 2.7-11.2), involvement in decision-making during childbirth (OR 2.6; 1.3-4.9), midwives presence in the labour room (OR 2.4; 1.2-4.7), and ability to discuss the birth afterwards (OR 2.0; 1.1-3.8). After emergency caesarean section 46% judged the partner's medical intrapartum care as most deficient (OR 1.73; 1.05-2.86), and after elective caesarean section 40% of the fathers judged involvement in decision-making as deficient (OR 4.07; 1.95-8.50). When the fathers had participated in a spontaneous vaginal birth they were dissatisfied with the presence of the midwife in the labour room (OR 1.72; 1.03-2.87). Conclusions: Deficiencies existed in the intrapartum care and were judged differently depending on mode of birth. The fathers needed to feel secure about the women's medical care, and wanted to be involved and supported.
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44.
  • Johansson, Margareta, et al. (författare)
  • Swedish fathers' experiences of childbirth in relation to maternal birth position : a mixed method study.
  • 2015
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 28:4, s. e140-e147
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Fathers often want to be involved in labour and birth.AIM: To investigate how maternal birth position during second stage of labour may influence fathers' experience of childbirth.METHODS: Mixed method study with 221 Swedish fathers completing an on-line questionnaire. Descriptive statistics and qualitative content analysis were used.RESULTS: In total 174 (78.7%) had a positive overall birth experience. The theme An emotional life-changing event influenced by the birth process and the structure of obstetrical care was revealed and included the categories; Midwives ability to be professional, The birth process' impact, and Being prepared to participate. The most frequently utilised birth position during a spontaneous vaginal birth was birth seat (n=83; 45.1%), and the fathers in this group were more likely to assess the birth position as very positive (n=40; 54.8%) compared to other upright and horizontal birth positions. Fathers with a partner having an upright birth position were more likely to have had a positive birth experience (p=0.048), to have felt comfortable (p=0.003) and powerful (p=0.019) compared to women adopting a horizontal birth position during a spontaneous vaginal birth. When the women had an upright birth position the fathers deemed the second stage of labour to have been more rapid (mean VAS 7.01 vs. 4.53) compared to women in a horizontal birth position.CONCLUSION: An upright birth position enhances fathers' experience of having been positively and actively engaged in the birth process. Midwives can enhance fathers' feelings of involvement and participation by attentiveness through interaction and communicating skills.
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45.
  • Jonsdottir, Sigridur Sia, et al. (författare)
  • Partner relationship, social support and perinatal distress among pregnant Icelandic women
  • 2017
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 30:1, s. e46-e55
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: It is inferred that perinatal distress has adverse effects on the prospective mother and the health of the foetus/infant. More knowledge is needed to identify which symptoms of perinatal distress should be assessed during pregnancy and to shed light on the impact of women's satisfaction with their partner relationship on perinatal distress.AIM: The current study aimed to generate knowledge about the association of the partner relationship and social support when women are dealing with perinatal distress expressed by symptoms of depression, anxiety and stress.METHODS: A structured interview was conducted with 562 Icelandic women who were screened three times during pregnancy with the Edinburgh Depression Scale and the Depression, Anxiety, Stress Scale. Of these, 360 had symptoms of distress and 202 belonged to a non-distress group. The women answered the Multidimensional Scale of Perceived Social Support and the Dyadic Adjustment Scale. The study had a multicentre prospective design allowing for exploration of association with perinatal distress.FINDINGS: Women who were dissatisfied in their partner relationship were four times more likely to experience perinatal distress. Women with perinatal distress scored highest on the DASS Stress Subscale and the second highest scores were found on the Anxiety Subscale.CONCLUSION: Satisfaction in partner relationship is related to perinatal distress and needs to be assessed when health care professionals take care of distressed pregnant women, her partner and her family. Assessment of stress and anxiety should be included in the evaluation of perinatal distress, along with symptoms of depression.
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46.
  • Karlström, Annika, et al. (författare)
  • Swedish caregivers’ attitudes towards caesarean section on maternal request
  • 2009
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 22:2, s. 57-63
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Caesarean section (CS) is not an option that women in Sweden can chose themselves, although the rise in CS rate has been attributed to women. This study describes obstetricians’ and midwives’ attitudes towards CS on maternal request. Methods A qualitative descriptive study, with content analysis of 5 focus group discussions where 16 midwives and 9 obstetricians participated. Results The overarching theme was identified as “Caesarean section on maternal request—a balance between resistance and respect”. On the one hand, CS was viewed as a risky project; on the other hand, request for a CS was understood and respected when women had had a previous traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear. Five categories were related to the theme. Overall, our findings indicate that caregivers blamed the women for the increase, they considered the management of CS on maternal request difficult, and they suggested preventive methods to reduce CS and means to strengthen their professional roles. Key conclusions and implication for practice Both midwives and obstetricians considered the management of CS on maternal request difficult, and the result showed that they balanced between resistance and respect. The result also showed that the participants stressed the importance of professionals advocating natural birth with evidence-based knowledge and methods to prevent maternal requests. Ongoing discussions among health professionals on attitudes and practice would strengthen their professional roles and lead to a decrease in CS rates in Sweden.    Background:  Caesarean section (CS) is not an option that women in Sweden can chose themselves,although the rise in CS rate has been attributed to women. This study describesobstetricians’ and midwives’ attitudes towards CS on maternal request. Methods:  A qualitative descriptive study, with content analysis of 5 focus group discussions where16 midwives and 9 obstetricians participated. Results:  The overarching theme was identified as ‘‘Caesarean section on maternal request–—abalance between resistance and respect’’. On the one hand, CS was viewed as a risky project; on theother hand, request for a CS was understood and respected when women had had a previoustraumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear.Five categorieswere related to the theme.Overall, our findings indicate that caregivers blamed thewomen for the increase, they considered the management of CS on maternal request difficult, andthey suggested preventive methods to reduce CS and means to strengthen their professional roles. Key conclusions and implication for practice:  Both midwives and obstetricians considered the  
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47.
  • Kildea, Sue, et al. (författare)
  • A review of midwifery in Mongolia utilising the 'Strengthening Midwifery Toolkit'
  • 2012
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 25:4, s. 166-173
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The World Health Organization (WHO) developed the 'Strengthening Midwifery Toolkit' in response to an international emphasis on increasing midwifery's role in providing maternal newborn health services. It was used to assist a review of midwifery in Mongolia.METHOD: A rapid situational assessment included site visits to eight health facilities and four educational institutions resulting in 30 key informant interviews and six focus group discussions (67 midwives and students). A desk review of pertinent documents (n=19) was undertaken. Data collected included assessments of: midwife competency (n=96), scope of practice (n=2), health facilities (n=8), educational institutions (n=4), legislation and regulation (n=1), and midwifery (n=4) Feldsher-Nurse (n=4) and Bachelor-Nurse (n=1) curricula.FINDINGS: Stakeholders in Mongolia are committed to strengthening midwifery across the country to better align with international standards. This requires: a long-term investment in reorientating the health workforce and educational institutions, regulatory changes, educational investment, job description changes which will impact on other maternal newborn health service providers. Additional support and incentives for providers in rural and remote areas is needed and investment in health facilities to enable appropriate infection control; and adequate provision of essential equipment and drugs, are important strategies needed to protect staff. Maternity emergency training is required across the country.CONCLUSION: The Midwifery Toolkit was adapted to suit the local context and provided an excellent framework for this review.
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48.
  • Larsson, Birgitta, et al. (författare)
  • Birth preference in women undergoing treatment for childbirth fear : A randomised controlled trial
  • 2017
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 30:6, s. 460-467
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason. The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment. Methods: Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n = 258) were recruited at one university hospital and two regional hospitals over one year. The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n = 127) or standard care (face-to-face counselling) (n = 131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth. Results: Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience. Conclusion: Women's birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research.
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49.
  • Larsson, Birgitta, et al. (författare)
  • Women's experience of midwife-led counselling and its influence on childbirth fear : A qualitative study
  • 2019
  • Ingår i: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 32:1, s. e88-e94
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women’s views about counselling for childbirth fear.Aim: To explore women’s experiences of midwife-led counselling for childbirth fear.Method: A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth.Findings: The overarching theme ‘Midwife-led counselling brought positive feelings and improved confidence in birth’ was identified. This consisted of four themes describing ‘the importance of the midwife’ and ‘a mutual and strengthening dialogue’ during pregnancy. ‘Coping strategies and support enabled a positive birth’ represent women’s experiences during birth and ‘being prepared for a future birth’ were the women’s thoughts of a future birth.Conclusions: In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable.
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50.
  • Lee, Nigel, et al. (författare)
  • A comparison of two versus four sterile water injections for the relief of back pain in labour : A multicentre randomised equivalence trial
  • 2022
  • Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 35:6, s. e556-e562
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundRecent trials demonstrated the safety and efficacy of sterile water injections to provide relief from labour back pain. While four injections is the most common approach variations in technique, such as employing two injections, are also used.AimTo determine if the analgesic effect of two sterile water injections is clinically equivalent to four.Methods238 women in labour with a Visual Analogue Scale pain score (VAS) of 70 millimetres (mm) (0 = no pain; 100 = worst pain imaginable) were randomised to two or four sterile water injections. The primary outcome was pain measured on a VAS at 30 min post treatment. A priori margin of equivalence was set at ±10 mm. Secondary outcomes included the likelihood of achieving an at least 30% and 50% reduction in pain, birth and neonatal outcomes.ResultsAt 30 min post-injection the difference in VAS scores between the techniques was −5.97 (95% Confidence Interval [CI] −13.18–1.22). As the lower end of the CI exceeds the margin of −10 mm equivalence was not demonstrated. Both techniques achieved an at least 30% reduction in pain in over 75% of participants though duration of effect was longer in the four injection group. There was no difference in other birth related secondary outcomes.ConclusionFour injections provided a margin of benefit over two injections in level and duration of analgesia.DiscussionFour injections remains the technique of choice though two injections still provided significant pain relief and would be suitable where it was not possible or desirable to provide four.
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