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| 2. |
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| 3. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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Are healthy and successful organizations working accordingly to Quality Management?
- 2009
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Ingår i: International journal of workplace health management. - : Emerald. - 1753-8351 .- 1753-836X. ; 2:3, s. 245-257
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this paper is to examine if healthy and successful organizations are working accordingly to Quality Management. The purpose is also to describe in more detail how they are working. Methodology/Approach Three Swedish organizations that have shown excellence in leadership, internal partnership, working environment and profitability have been examined, to find out what methodologies they have used for their success. To discover whether these healthy and successful organizations are working accordingly to Quality Management, Deming’s 14-point list has been used as an analytical tool. Findings Identified methodologies used by the healthy and successful organizations are described. Viewed in the light of our analysis, a relationship between the three examined healthy and successful organizations and Quality Management is indicated. Practical implications Working with the methodologies described in the paper, the three organizations have improved co-worker health. Other organizations could probably adopt the identified and described methodologies to improve the health of their co-workers and effectiveness in the organization. Originality/value Concerning the performance evaluation and the continuous improvement component in Quality Management, substantial contributions could be made to the health area by applying the tools that the quality area have used over a considerable period to improve the quality outcomes. Quality and health aspects have common success factors, and a focus on high quality could be seen as positive for health outcomes.
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| 4. |
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| 5. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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Learning from chaos : a necessity for adapting quality management to the future?
- 2007
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this paper is to describe the core leadership behavior in Change Oriented Leadership, the KaosPilots and Deming´s 14 points. Furthermore we aim to compare similarities and differences in these leadership behaviors, in order to propose new leadership behaviors within Quality Management to fit tomorrow´s more creativity based organizations. Methodology The research has been conducted through describing and comparing core leadership behaviors, in Change Oriented Leadership, KaosPilots and Deming´s 14-points. Findings Our comparison indicates that there are behaviors in the Change Oriented Leadership that are missing in Quality Management and probably would benefit organizations if they were adopted. The leadership that the KaosPilots addresses is different from the leadership in Quality Management in many ways but probably necessary to learn from to meet new demands from the customers and the co-workers. Originality/value Leadership within Quality Management developed with innovation and entrepreneurship from Change Oriented Leadership complimented with playfulness and chaos from the KaosPilots would most likely generate a more creative environment and thereby create more competitive organizations.
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| 6. |
- Bäckström, Ingela, et al.
(författare)
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Management methodologies for sustaniable health : a case study at three Swedish organisations
- 2005
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Ingår i: Proceedings of the 8th International Conference on Quality Management for Organisational and Regional Development. ; , s. 703-712
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Konferensbidrag (refereegranskat)abstract
- Good management and leadership are key-factors for sustainable development and long-term success in all types of organisations. Although, many organisations are still struggling with quality problems, sick absence and financial difficulties caused by poor top management. Many researchers have reported on relationships between good management and working environment, quality and efficiency. So the question is why god management is not practised to a larger extent? In this paper, management methodologies for sustainable health among employees, customer satisfaction and good bottom line results are explored by studying top leaders in three Swedish successful organisations. General questions dealt with in the paper are: How can managers commit employees to be part of the proactive work with sustainable health? And what methodologies can top managers use to get well-motivated employees, a good working environment, satisfied customers and good financial results? The studied organisations are two manufacturing companies and one hospital. The organisations have received national awards for their excellence in leadership, internal partnership, working environment and efficiency. They all demonstrate good examples of long-term work with sustainable health among employees which has decreased sick absence. Explorative qualitative methods have been used to identify management methodologies in the case organisations. The results confirm a relation between leadership and sustainable health. In all organisations sustainable leadership has been characterised by great humanity, a long-range perspective and a holistic view of management. These management methodologies with concrete examples have been described in the paper. The leadership has led to healthier organizations with more committed and satisfied employees, and the indicated relationships between sustainable leadership, improved health among employees, satisfied co-workers and bottom line results among the case organisations probably demonstrate a significant improvement potential for today's organizations.
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| 7. |
- Bäckström, Ingela, 1963-, et al.
(författare)
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Management methodologies for sustaniable health : A case study at three Swedish organisations
- 2005
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Ingår i: Proceedings of the 8th International Conference on Quality Management for Organisational and Regional Development : QMOD 2005. - Luleå. ; , s. 703-712, s. 703-712
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Konferensbidrag (refereegranskat)abstract
- Good management and leadership are key factors for sustainable development and long-term success in all types of organisations. Nevertheless, many organisations are still struggling with quality problems, sick ness absence and financial difficulties caused by poor top management. Many researchers have reported on relationships between good management and working environment, quality and efficiency. So the question is why good management is not practised to a greater extent. In this paper, management methodologies for sustainable health among employees and consequent customer satisfaction and good bottom line results are explored by studying top leaders in three Swedish successful organisations. General questions dealt with in the paper are: How can managers commit employees to be part of the proactive work with sustainable health? What methodologies can top managers use to get well-motivated employees, a good working environment, satisfied customers and good financial results? The studied organisations are two manufacturing companies and one hospital. The organisations have received national awards for their excellence in leadership, internal partnership, working environment and efficiency. They all demonstrate good examples of long-term work with sustainable health among employees which has decreased sick ness absence. Explorative qualitative methods have been used to identify management methodologies in the case organisations. The results confirm a relation between leadership and sustainable health. In all organisations sustainable leadership has been characterised by great humanity, a long-range perspective and a holistic view of management. These management methodologies with concrete examples are described in the paper.
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| 8. |
- Bäckström, Ingela, 1963-
(författare)
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On the Relationship between Sustainable Health and Quality Management : Leadership and organizational behaviours from Swedish organizations
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Sickness absence not only causes significant costs for organizations but also leads to other negative consequences for individuals and societies. Previous research has shown that working with organizational values within Quality Management affects job satisfaction and results in increased profitability and customer satisfaction. There would, in addition, seem to be great gains if managers, by working with Quality Management, can manage to establish sustainable health among co-workers. The purpose of the research described in this thesis was to examine how Quality Management could be practised in order to support sustainable health among co-workers and what it is within Quality Management that influences sustainable co-worker health. Accordingly, the purpose was also to contribute to the understanding of the relation between sustainable health and Quality Management. To fulfil this purpose, three research questions were asked. The results are described in three parts related to the three research questions and are the product of six case studies carried out in seven different organizations. Interviews with managers and workshops with co-workers were carried out to investigate how Quality Management can be practised within organizations in order to promote sustainable co-worker health. These investigations took place in four organizations that had received awards. Three had been awarded for their excellence in leadership, work environment and co-workership, along with improved profitability; one for its successful implementation of quality programmes. The results are descriptions of methodologies, behaviours, values and organization structure used by the organizations to support sustainable health. These are exemplified with practical examples. The methodologies, behaviours, values, and organizational structure are considered possible for other organizations to adopt and all of them are already supported in the quality, management and leadership literature. Support from the health literature is also found for most of the behaviours, methodologies, values, and organizational structure. Surveys and focus groups interviews were carried out in five different organizations in order to find out what is of most importance when practising Quality Management in order to influence sustainable co-worker health. The results pointed to ‘Leadership Commitment’ as the most central of the values for achieving sustainable health among the co-workers. Furthermore, the values ‘Continuous Improvements’, ‘Participation of Everybody’ and ‘Customer Orientation’ were found to be related to sustainable health among the co-workers. The values ‘Leadership Commitment’ and the value ‘Participation of Everybody’ were then further elaborated to find aspects of importance for sustainable co-worker health. From the value ‘Leadership Commitment’ four aspects were extracted. These were labelled ‘Empathy’, ‘Presence and Communication’, ‘Integrity’, and ‘Continuity’. The results showed relations between the value ‘Leadership Commitment’ within Quality Management and sustainable health among the co-workers. Thus it is essential for leaders to work in accordance with that value to achieve results in the work towards sustainable co-worker health. The results indicate that this requires management and leadership that are characterized by the aspects above. The leaders have to: • Really understand the co-workers and their work situation. • Be present and available for co-workers and communicate with them. • Act as a role model, be fair and keep their promises. • Stay in their positions long enough to build up trust and confidence. The value ‘Participation of Everybody’ has also been shown to be related to sustainable health among the co-workers. This indicates that it is important to work in accordance with that value in the struggle to achieve sustainable health among the co-workers. The results imply that this value is characterized by the aspects ‘Development’, ‘Influence’ and ‘Being informed’. This could be done by: • Giving the co-workers opportunities to develop their skills and develop personally. • Letting the co-workers influence their work situation and taking suggestions and proposals from them seriously. • Having good communication within the whole organization. To manage this; the managers have to delegate more and empower the co-workers. These results were then further elaborated within another organization in order to develop a measurement approach that can clarify the extent to which the values, ‘Leadership Commitment’ and ‘Participation of Everybody’ permeate an organization. The developed measurement approach can be used to clarify the extent to which the organization is practising the health-promoting values within Quality Management and in what areas improvement is needed to increase co-worker health. The approach can also help the organization to detect those shortcomings within the management which are important for co-worker well-being. The developed measurement approach can be used to establish and enhance co-worker health by improving their well-being, satisfaction and motivation.
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| 9. |
- Bäckström, Ingela, 1963-
(författare)
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Quality Management for Sustainable Health : Methodologies, Values and Practices taken from Swedish Organizations
- 2006
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In many Western countries today, not least in Sweden, there are a lot of organizations that have great problems with sickness absence. The costs connected to the high rates of sickness absence have also risen to alarming levels. Healthy co-workers and healthy organizations are obvious goals for many leaders, but this is not always so easy to establish. Work practices and leadership that are beneficial to co-worker health are thus vital to identify. Studies have shown relationships between company-wide implementation of quality programs and improved co-worker satisfaction along with low co-worker turn over; in other words, co-worker health along with improved customer satisfaction and financial results. Despite the great problems concerning sickness absence, there are organizations that have been awarded prizes for excellence in leadership, internal partnership, working environment, and profitability. The overall purposes of the research described in this thesis are to examine and describe how management and leadership can establish sustainable health among the co-workers and examine how the leadership for sustainable health is related to Quality Management. The in-depth purpose is to examine which aspects within the values derived from the quality movement are those that primarily influence the co-workers’ perceived health. The results presented can be described in three parts and are results from four case studies carried out in five different organizations. Three of the organizations have received awards for establishing good working environment, good financial results, and low sick leaves among their co-workers; the fourth received an award for the successful implementation of quality programs. The first part consists of results from case studies in three different organizations and describes how organizations can work to achieve sustainable health among their co-workers, with practical examples. The results are methodologies, values and organizational structure, which it is considered possible for other organizations to adopt in their efforts to achieve good working conditions resulting in fewer sick leaves. The second part is an attempt to investigate if leadership for sustainable health is related to Quality Management. Methodologies, leadership values, organizational structure, and general values found in organizations which have achieved sustainable health are analyzed in the light of Deming’s 14 points, and a correlation is indicated. There is also correlation found between the TQM values and the co-workers’ perception of their health. The third part examines which of the aspects within the values grown from the quality movement are those that influence the co-workers perceived health. The results show significant correlation between the values and the co-workers’ perception of their health. Aspects found within the value “Top management commitment” were named; Empathy, Presence and Communication, Integrity, and Continuity. Within the value “Let everybody be committed” the aspects; Development, Influence and Being informed were found. These aspects are described in more detail and also in one model per value. The result implies that the TQM values; “Top management commitment”, “Improve continuously” “Let everybody be Committed” and “Focus on customers” are important for achieving healthy organizations and sustainable health among co-workers.
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| 10. |
- Ekström, Å., et al.
(författare)
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Planned cesarean section versus planned vaginal delivery : Comparison of lower urinary tract symptoms
- 2008
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Ingår i: International Urogynecology Journal. - : Springer London. - 0937-3462 .- 1433-3023. ; 19:4, s. 459-465
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Tidskriftsartikel (refereegranskat)abstract
- We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p < 0.001) and 9 months (p = 0.001) follow-up. In a multivariable risk model, vaginal delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9 - 42] and for urinary urgency (RR 7.3 95% CI 1.7 - 32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5 - 19) and at 3 months follow-up (OR 3.9, 95% CI 1.7 - 8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section. © International Urogynecology Journal 2007.
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| 11. |
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| 12. |
- Gunnarsson, Svante, et al.
(författare)
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Large Scale use of the CDIO Syllabus in Formulation of Program and Course Goals
- 2007
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Ingår i: Proceedings of the 3rd International CDIO Conference.
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Konferensbidrag (refereegranskat)abstract
- A large scale application of the CDIO Syllabus in formulation of course and program goals is presented. The application involves all programs and courses within the engineering education at Linköping University. Key components in the work are course level ITU-matrices for mapping of the course contents to the CDIO Syllabus, and a suggested way to organize suitable verbs for formulation of learning outcomes according to the sections in the CDIO Syllabus
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| 13. |
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| 14. |
- Gunnarsson, Svante, et al.
(författare)
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Using the CDIO Syllabus in Formulation of Program Goals - Experiences and Comparisons
- 2009
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Ingår i: Proceedings of the 5th International CDIO Conference.
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Konferensbidrag (refereegranskat)abstract
- This paper presents experiences and results from large scale and systematic use of the CDIO Syllabus for developing program goals and formulating learning outcomes at Linköping University (LiU), Sweden, and Technical University of Denmark (DTU). The approaches are based on the use of tools for program design such as ITU-matrices and skill progression matrices. During the process local adaptations of the Syllabus have been made in order to meet regulations by authorities in higher education as well as to cover programs in related areas as natural sciences. The experiences are that the CDIO Syllabus is a very useful tool in this process and that the way of organizing the management of the education programs is important for success as well as support from students, faculty members and stakeholders.
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| 15. |
- Jonas, W., et al.
(författare)
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Newborn skin temperature two days postpartum during breastfeeding related to different labour ward practices
- 2007
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Ingår i: Early Human Development. - : Elsevier BV. - 0378-3782 .- 1872-6232. ; 83:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate (1) the skin temperature pattern in newborns two days after birth in connection to breastfeeding and to examine (2) if the administration of epidural analgesia (EDA) and oxytocin (OT) infusion during labour influences this parameter at this point of time. Method: Forty-seven mother-infant pairs were included in the study: nine mothers had received OT stimulation during labour (OT group), 20 mothers had received an EDA and OT during labour (EDA group), while 18 mothers had received neither EDA nor OT stimulation during labour (control group). A skin temperature electrode was attached between the newborn's shoulder blades. The newborn was placed skin-to-skin on the mother's chest and covered with a blanket. The temperature was recorded immediately after the newborn was put on the mother's chest and at 5, 10, 20 and 30 min. Results: The temperature measured when the newborns were put skin-to-skin on their mothers' chest was significantly higher in the infants of the EDA group (35.07 °C) when compared to the control group (34.19 °C, p = 0.025). Skin temperature increased significantly (p = 0.001) during the entire experimental period in the infants belonging to the control group. The same response was observed in infants whose mothers received OT intravenously during labour (p = 0.008). No such rise was observed in infants whose mothers were given an EDA during labour. Conclusion: The results show that the skin temperature in newborns rises when newborns are put skin-to-skin to breastfeed two days postpartum. This effect on temperature may be hampered by medical interventions during labour such as EDA. © 2006 Elsevier Ireland Ltd. All rights reserved.
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| 16. |
- Jonas, W., et al.
(författare)
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Short- and long-term decrease of blood pressure in women during breastfeeding
- 2008
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Ingår i: Breastfeeding Medicine. - New Rochelle : Mary Ann Liebert Inc. - 1556-8253 .- 1556-8342. ; 3:2, s. 103-109
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: The benefits of breastfeeding for infants are well known. Recently data have started to emerge showing that breastfeeding may also induce positive effects in the mother. This study aimed to investigate the pattern of maternal blood pressure before, during, and after a breastfeed 2 days postpartum. Additionally, blood pressure during the following 25-week breastfeeding period was investigated. Methods: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at -5, 10, 30, and 60 minutes in connection with a morning breastfeed. Thirty-three women continued to measure blood pressure before and after breastfeeding for 25 weeks. Results: Blood pressure fell significantly in response to breastfeeding 2 days after birth. The fall in systolic and diastolic blood pressure amounted to 8.8 (SD = 11.00) and 7.7 (SD = 9.3) mm Hg, respectively. During the 25-week follow-up period a significant fall of basal blood pressure (systolic, df = 3, F = 7.843, p < 0.001; diastolic, df = 3, F = 5.453, p = 0.002) was observed. The total fall in systolic and diastolic blood pressure amounted to a mean of 15 (SD = 10.4) mm Hg and 10 (SD = 9.7) mm Hg, respectively. In addition, blood pressure fell significantly in response to individual breastfeeding sessions during the entire observation period. Conclusions: In conclusion, both systolic and diastolic blood pressures fall during a breastfeeding session, and pre-breastfeeding blood pressure decreases during at least the first 6 months of a breastfeeding period in a homelike environment. This study lends further support to the health-promoting effects of breastfeeding. © 2008 Mary Ann Liebert, Inc.
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| 17. |
- Larsson, C., et al.
(författare)
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Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration
- 2006
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:12, s. 1448-1452
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Tidskriftsartikel (refereegranskat)abstract
- Background. Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. Methods. Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. Results. Inter-individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over-estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2=0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2=0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. Conclusions. The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over-estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions. © 2006 Taylor & Francis.
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| 18. |
- Larsson, Johan, et al.
(författare)
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Leadership and organizational behaviour : Similarities between three award-winning organizations
- 2009
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Ingår i: International Journal of Management Practice. - 1477-9064 .- 1741-8143. ; 3:4, s. 327-345
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The purpose of this paper is to examine if healthy and successful organizations are working accordingly to Quality Management. The purpose is also to describe how the organizations are working. Methodology/Approach Three Swedish organizations that have shown excellence in leadership, internal partnership, working environment and profitability have been examined, to find out what methodologies they have been used for their success. To find out if the healthy and successful organizations are working accordingly to Quality Management, Deming’s 14 point list have been used as analysing tool. Findings Indentified methodologies used by the healthy and successful organisations are described. Viewed through our analysis, a relationship between the three examined healthy and successful organizations and Quality Management is indicated. Practical implicationsWorking with the methodologies described in the paper, the three organizations have improved co-worker health. Other organizations could probably adopt the identified and described methodologies to improve the health of their co-workers and effectiveness in the organization. Originality/valueConcerning the performance evaluation and the continuous improvement component in Quality Management, substantial contributions could be made to the health area by applying the tools that the quality area have used for such a long time to improve the quality outcomes.Quality and health aspects have common success factors, and a focus on high quality could be seen as positive for health outcomes.
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| 19. |
- Shaw, Michael, et al.
(författare)
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The Reflux Disease Questionnaire: a measure for assessment of treatment response in clinical trials
- 2008
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Ingår i: Health and Quality of Life Outcomes. - : Springer Science and Business Media LLC. - 1477-7525. ; 6:31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Critical needs for treatment trials in gastroesophageal reflux disease (GERD) include assessing response to treatment, evaluating symptom severity, and translation of symptom questionnaires into multiple languages. We evaluated the previously validated Reflux Disease Questionnaire (RDQ) for internal consistency, reliability, responsiveness to change during treatment and the concordance between RDQ and specialty physician assessment of symptom severity, after translation into Swedish and Norwegian. Methods: Performance of the RDQ after translation into Swedish and Norwegian was evaluated in 439 patients with presumed GERD in a randomized, double-blind trial of active treatment with a proton pump inhibitor. Results: The responsiveness was excellent across three RDQ indicators. Mean change scores in patients on active treatment were large, also reflected in effect sizes that ranged from a low of 1.05 (dyspepsia) to a high of 2.05 (heartburn) and standardized response means 0.99 (dyspepsia) and 1.52 (heartburn). A good positive correlation between physician severity ratings and RDQ scale scores was seen. The internal consistency reliability using alpha coefficients of the scales, regardless of language, ranged from 0.67 to 0.89. Conclusion: The results provide strong evidence that the RDQ is amenable to translation and represents a viable instrument for assessing response to treatment, and symptom severity.
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| 20. |
- Wiklund, Ingela
(författare)
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Caesarean section on maternal request : personality, fear of childbirth and signs of depression among first-time mothers
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to study healthy first-time mothers requesting and undergoing an elective caesarean section (CS) and to compare these to healthy first-time mothers planning a vaginal delivery. The focus was socio-demographic factors, personality, depression, expectations and experience of birth. Sample: The cohort consisted in total of 558 healthy first time-mothers. Participants were recruited to the trial in late pregnancy and divided into three different groups; women requesting CS in the absence of medical or obstetrical indication, women having an elective CS on indication breech presentation and women planning a vaginal delivery. The focus in this thesis has mainly been to compare two of the groups, namely women requesting a CS and women planning a vaginal birth. Method: The participants completed four different self-assessment questionnaires. At inclusion, they received the first questionnaires concerning socio-demographic background, self-estimated health and family planning, and a personality inventory, Karolinska Scales of Personality (KSP) and a questionnaire revealing their expectancies on the forthcoming delivery, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). At two days postpartum, they were given a questionnaire concerning initiation of breastfeeding, self-estimation of pain and experience of the delivery. At three months after birth, they received a posted questionnaire concerning breastfeeding, sexual life, experience of birth (W-DEQ) and a questionnaire measuring signs of depression, Edinburgh Postnatal Depression Scale (EPDS). At nine months after birth, they received the last questionnaires concerning breastfeeding, sexual life, birth experience, health and the personality inventory (KSP). Results: A significant difference in age was found between the CS and the vaginal group (mean age 33.9 yrs vs.30.8). Analysis of personality traits showed that the subscales Monotony Avoidance and Socialization differed between women requesting CS and women planning a vaginal delivery. It was found that both groups increased their Impulsivity scores and women in CS group lowered their Detachment scores from late pregnancy to nine months after birth. Women requesting CS experienced their health as poorer compared to women planning a vaginal birth and were more often planning for one child only. They often reported anxiety for lack of support during labour, for loss of control and concern for fetal injury/death. At three months after birth they were breastfeeding to a lesser extent than women planning a vaginal delivery. There were no differences in signs of postpartum depression between the groups three months after birth. Mothers requesting a CS had more negative expectancies of a vaginal delivery and 43% in this group showed a clinically significant fear of delivery. Conclusion: Women requesting a CS in the absence of obstetric/medical indication differ in several aspects from those who plan a vaginal delivery. This finding highlights the need for an individual response to a request for CS where obstetricians very carefully weigh and balance outcomes in different ways. For any decision, factors such as age, family plans for the future, psychological factors and medical risks both in CS and in planned vaginal delivery must be considered.
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| 21. |
- Wiklund, Ingela, et al.
(författare)
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Cesarean section on maternal request : Reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers
- 2007
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 86:4, s. 451-456
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Tidskriftsartikel (refereegranskat)abstract
- Objective. The purpose of this study was to investigate first-time mothers undergoing cesarean section in the absence of medical indication, their reason for the request, self-estimated health, experience of delivery, and duration of breastfeeding. We also aimed to study if signs of depression postpartum are more common in this group. Method. In a prospective cohort study 357 healthy primiparas from two different groups, "cesarean section on maternal request" (n=91) and "controls planning a vaginal delivery" (n=266) completed three self-assessment questionnaires in late pregnancy, two days after delivery and 3 months after birth. Symptom scores from the Edinburgh postnatal depression scale at three months after birth were also investigated. Results. Women requesting cesarean section experienced their health ass less good (p<0.001) and were more often planning for one child only (p<0.001). They more often reported anxiety for lack of support during labor (p<0.001), for loss of control (p<0.001), and concern for fetal injury/death (p<0.001). After planned cesarean section women in this group reported a better birth experience compared to women planning a vaginal birth (p<0.001). They were breastfeeding to a lesser extent three months after birth (p<0.001). There were no differences in signs of postpartum depression between the groups three months after birth (p=0.878). Conclusion. The knowledge gained from this study may help in understanding why some women prefer to give birth with elective cesarean section. It also elucidates the need for awareness of professional support during vaginal birth. © 2007 Taylor & Francis.
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| 22. |
- Wiklund, Ingela, et al.
(författare)
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Epidural analgesia : Breast-feeding success and related factors
- 2009
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 25:2, s. e31-e38
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Tidskriftsartikel (refereegranskat)abstract
- Objective: to compare the early breast-feeding behaviours of full-term newborns whose mothers had received epidural analgesia (EDA) during an uncomplicated labour, with a group of newborns whose mothers had not received EDA. Design and setting: a retrospective comparative study design was used and the study was carried out in a labour ward in Stockholm, Sweden between January 2000 and April 2000. The ward has about 5500 deliveries per year. Participants: all maternity records of women who had received EDA during labour (n=585) were included in the study. For each EDA record, a control record was selected, matched for parity, age and gestational age at birth. Women with emergency caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation or an intra-uterine death, as well as neonates with an Apgar score <7 at 5 mins were excluded. After exclusion, the study population consisted of 351 healthy women and babies in each group. Method: logistic regression was performed. The dependent variables: (1) initiation of breast feeding after birth; (2) artificial milk given during hospital stay; and (3) breast feeding at discharge were studied in response to: (a) parity; (b) gestational age at birth; (c) length of first and second stage of labour; (d) administration of oxytocin; (e) administration of EDA; and (f) neonatal weight, as independent variables. Findings: significantly fewer babies of mothers with EDA during labour suckled the breast within the first 4 hours of life [odds ratio (OR) 3.79]. These babies were also more often given artificial milk during their hospital stay (OR 2.19) and fewer were fully breast fed at discharge (OR 1.79). Delayed initiation of breast feeding was also associated with a prolonged first (OR 2.81) and second stage (OR 2.49) and with the administration of oxytocin (OR 3.28). Fewer newborns of multiparae received artificial milk during their hospital stay (OR 0.58). It was also, but to a lesser extent, associated with oxytocin administration (OR 2.15). Full breast feeding at discharge was also positively associated with multiparity (OR 0.44) and birth weight between 3 and 4 kg (OR 0.42). Key conclusions: the study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes. © 2007 Elsevier Ltd. All rights reserved.
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| 23. |
- Wiklund, Ingela, et al.
(författare)
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Expectation and experiences of childbirth in primiparae with caesarean section
- 2008
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 115:3, s. 324-331
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience. Design: A prospective group-comparison cohort study. Setting: Danderyd Hospital, Stockholm, Sweden. Sample: First-time mothers (n = 496) were recruited to the study in week 37-39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between 'caesarean section on maternal request', 'caesarean section due to breech presentation' and 'controls planning a vaginal delivery'. Methods: The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Main outcome measures: Expectations prior to delivery and experiences at 3 months after birth. Results: Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001). Conclusions: Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support. © 2008 The Authors.
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| 24. |
- Wiklund, Ingela, et al.
(författare)
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First-time mothers and changes in personality in relation to mode of delivery
- 2009
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 65:8, s. 1636-1644
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Tidskriftsartikel (refereegranskat)abstract
- Title. First-time mothers and changes in personality in relation to mode of delivery. Aim. This paper is a report of a study conducted to examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries. Background. Birth of the first child is a major life event, possibly influencing personality. The physiological and emotional processes that start in pregnant women have a major impact on the evolving mother-child relationship. Knowledge about changes in personality during pregnancy and motherhood is scarce. Method. A prospective, group-comparative cohort study including 314 healthy primiparas having either 'caesarean section on maternal request' (n = 74) or 'spontaneous vaginal delivery group' (n = 240). The self-report inventory Karolinska Personality Scales was mailed to participants at 37-39 gestational weeks in pregnancy and 9 months after delivery. Data were collected from January 2003 to June 2006. Results. All mean values of the personality variables were within the normal range. There was a statistically significant increase in Impulsivity (P = 0·046) and decrease in Socialization (P = 0·004). The scores developed differently depending on mode of delivery. Thus, women in the vaginal delivery group increased their scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery group decreased their scores. Although women in both groups became more impulsive and less socialized, personality remained comparatively stable in the transition from late pregnancy to motherhood. Conclusion. As interactive therapeutic midwife/client relationships and maternal/social role preparation have been shown to have a great effect on progress in becoming a mother, knowledge about how personality may affect this process is important so that healthcare professionals can attempt to reduce women's anxiety levels during pregnancy. © 2009 Blackwell Publishing Ltd.
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| 25. |
- Wiklund, Ingela, et al.
(författare)
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Personality and mode of delivery
- 2006
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:10, s. 1225-1230
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Tidskriftsartikel (refereegranskat)abstract
- Background. Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning. Method. Three hundred and twenty-eight pregnant women from two different groups, "cesarean section on maternal request" (n = 84), and "vaginal delivery group" (n = 242) completed the self-report inventory Karolinska Scales of Personality at 37-39 gestational weeks in pregnancy. Results. A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p <0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p <0.003) and Socialization (p <0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale. Conclusion. Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not. © 2006 Taylor & Francis.
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| 26. |
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| 27. |
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