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1.	Finnbogadottir, Hafrún, et al. (author) Expectant first-time fathers’ experiences of pregnancy 2003 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 19:2, s. 96-105 Journal article (peer-reviewed)abstract Objective: to describe first-time-expectant fathers’ experiences of pregnancy.Design: an inductive method using narrative interview formand qualitative content textanalysis.The text of the transcriptswas coded and categorised.Settings and participants: seven first-time-expectant fathers living in a multicultural industrial town in southern Sweden were interviewed individually when their partner was in the 38th to 39thweek of pregnancy.Measurements and findings: all the fathers-to-be experienced some psychological, socialand/or physical change during the pregnancy. The main category, was ‘time of transition’. Eight categories were found under this. They were: ‘feelings of unreality, ‘insufficiency and inadequacy’, ‘exclusion’, ‘reality’, ‘social changes’, ‘physical changes’, ‘responsibility, and development’.Key conclusion: the fathers’-to-be special needs for support and encouragement durin gpregnancymay be as important as those of the mothers’-to-be. The caregiver needs to be as aware of and sensitive to these needs. However, before any interventions can be recommendedmore research is needed.
2.	Berg, Marie, et al. (author) Women's experience of the encounter with the midwife during childbirth 1996 In: Midwifery. - 0266-6138 .- 1532-3099. ; 12:1, s. 11-15 Journal article (peer-reviewed)abstract OBJECTIVE: to describe women's experience of the encounter with the midwife during childbirth.DESIGN: a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews.SETTING: the Alternative Birth Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden in 1994.PARTICIPANTS: 18 women, six primiparous and 12 multiparous who were two to four days post delivery.KEY FINDINGS: the essential structure of the studied phenomenon was described as 'presence' and included three themes: to be seen as an individual, to have a trusting relationship and to be supported and guided on one's own terms.IMPLICATIONS FOR PRACTICE: the need to be seen as an individual can be realised by affirmation and familiarity with the midwife and surroundings. A trusting relationship can be obtained by good communication and proficient behaviour. By providing a sense of control the women can be supported and guided on their own terms. Above all they must feel that the midwife is present.
3.	Hildingsson, Ingegerd, et al. (author) Midwives' lived experiences of being supportive to prospective mothers/parents during pregnancy 1999 In: Midwifery. - 0266-6138 .- 1532-3099. ; 15:2, s. 82-91 Journal article (peer-reviewed)abstract OBJECTIVE: To elucidate midwives' narrated experiences of being supportive to prospective mothers or parents during pregnancy.DESIGN: Phenomenological hermeneutic analysis of transcribed text from seven tape-recorded interviews.SETTING: Midwifery clinics in five health centres in the context of Swedish primary health care.PARTICIPANTS: Seven midwives working in antenatal care.FINDINGS: The interpretation of the text showed that through perception and intuition the midwives seemed to become aware that some women needed increased support. The situations of these prospective mothers were often characterised by difficult social problems or fears. The prospective fathers were mostly absent in the narratives. The midwives acted on both a personal and a professional level with ethical perspectives in mind, when they were advocating their clients' rights to receive proper care. The comprehensive understanding of the interpretation revealed that the midwife sometimes perceived herself as being metaphorically 'The Good Mother'.KEY CONCLUSIONS: Having the role of 'The Good Mother' could be understood as a way for the midwife to establish a fruitful relationship with prospective mothers/parents.IMPLICATIONS FOR PRACTICE: The findings provide a basis for reflection on the mothering and supportive function of midwives when providing antenatal care.
4.	Carlsson, Tommy, et al. (author) Experiences of termination of pregnancy for a fetal anomaly : A qualitative study of virtual community messages. 2016 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 41, s. 54-60 Journal article (peer-reviewed)abstract OBJECTIVE: to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly.DESIGN: cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis.SETTING: two large and active Swedish virtual communities.SAMPLE: 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination).MEASUREMENTS AND FINDINGS: before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child.KEY CONCLUSIONS: spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences.IMPLICATIONS FOR PRACTICE: information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies.
5.	Abrahamsson, Agneta, et al. (author) A salutogenic perspective could be of practical relevance for the prevention of smoking amongst pregnant women 2002 In: Midwifery. - 0266-6138 .- 1532-3099. ; 18:4, s. 323-331 Journal article (peer-reviewed)abstract OBJECTIVE: to use empirical data to assess the theoretical relevance of using a salutogenic, instead of a pathogenic, perspective to prevent smoking during pregnancy. DESIGN: quantitative study, a questionnaire was completed during the first trimester of pregnancy and an interview was conducted after the baby was born. SETTING: a geographically defined area in the south-east of Sweden. PARTICIPANTS: all 395 women in the study area who were pregnant during the study period 1994-1995. FINDINGS: the women were categorised according to their smoking habits. A significant difference in the sense of coherence (SOC) score was shown between smoking and non-smoking women in indicators of bad health. Women who relapsed to smoking showed a lower level of SOC, particularly in the manageability component, than others. The SOC score was higher in the whole study group than in other comparable, non-pregnant populations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a salutogenic perspective could be used in antenatal care as a basis for encouraging pregnant women to stop smoking. This could enhance the SOC by making smoking more understandable for the woman, by discussing smoking as a way of coping, and by encouraging the woman's own capacity and motivation to stop smoking. Starting a dialogue about smoking from the woman's point of view could do this, with the midwife and the woman exploring together the woman's thoughts about the smoking problem.
6.	Abrahamsson, Agneta, et al. (author) A salutogenic perspective could be of practical relevance for the prevention of smoking amongst pregnant women 2002 In: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 18:4, s. 323-331 Journal article (peer-reviewed)abstract OBJECTIVE: to use empirical data to assess the theoretical relevance of using a salutogenic, instead of a pathogenic, perspective to prevent smoking during pregnancy. DESIGN: quantitative study, a questionnaire was completed during the first trimester of pregnancy and an interview was conducted after the baby was born. SETTING: a geographically defined area in the south-east of Sweden. PARTICIPANTS: all 395 women in the study area who were pregnant during the study period 1994-1995. FINDINGS: the women were categorised according to their smoking habits. A significant difference in the sense of coherence (SOC) score was shown between smoking and non-smoking women in indicators of bad health. Women who relapsed to smoking showed a lower level of SOC, particularly in the manageability component, than others. The SOC score was higher in the whole study group than in other comparable, non-pregnant populations. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a salutogenic perspective could be used in antenatal care as a basis for encouraging pregnant women to stop smoking. This could enhance the SOC by making smoking more understandable for the woman, by discussing smoking as a way of coping, and by encouraging the woman's own capacity and motivation to stop smoking. Starting a dialogue about smoking from the woman's point of view could do this, with the midwife and the woman exploring together the woman's thoughts about the smoking problem.
7.	Abrahamsson, Agneta, 1951-, et al. (author) Some lessons from Swedish midwives' experiences of approaching women smokers in antenatal care 2005 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 21:4, s. 335-345 Journal article (peer-reviewed)abstract OBJECTIVE: to describe the qualitatively different ways in which midwives make sense of how to approach women smokers. DESIGN, SETTING AND PARTICIPANTS: a more person-centred national project 'Smoke-free pregnancy' has been in progress in Sweden since 1992. Using a phenomenographic approach, 24 midwives who have been regularly working in antenatal care were interviewed about addressing smoking during pregnancy. FINDINGS: four different story types of how the midwives made sense of their experiences in addressing smoking in pregnancy were identified: 'avoiding', 'informing', 'friend-making', 'co-operating'. KEY CONCLUSION: the midwives' story types about how they approached women who smoke illustrated the difficulties of changing from being an expert who gives information and advice to being an expert on how to enable a woman in finding out why she smoked and how to stop smoking. IMPLICATIONS FOR PRACTICE: health education about smoking that is built on co-operation and dialogue was seen by the midwives as a productive way of working. The starting point should be the lay perspective of a woman, which means that her thoughts about smoking cessation are given the space to grow while she talks.
8.	Abrahamsson, Agneta, et al. (author) Some lessons from Swedish midwives' experiences of approaching women smokers in antenatal care. 2005 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 21:Jul 14, s. 335-345 Journal article (peer-reviewed)abstract Objective: to describe the qualitatively different ways in which midwives make sense of how to approach women smokers. Design, setting and participants: a more person-centred national project 'Smoke-free pregnancy' has been in progress in Sweden since 1992. Using a phenomenographic approach, 24 midwives who have been regularly working in antenatal care were interviewed about addressing smoking during pregnancy. Findings: four different story types of how the midwives made sense of their experiences in addressing smoking in pregnancy were identified: 'avoiding', 'informing', 'friend-making', 'co-operating'. Key conclusion: the midwives' story types about how they approached women who smoke illustrated the difficulties of changing from being an expert who gives information and advice to being an expert on how to enable a woman in finding out why she smoked and how to stop smoking. Implications for practice: health education about smoking that is built on cooperation and dialogue was seen by the midwives as a productive way of working. The starting point should be the lay perspective of a woman, which means that her thoughts about smoking cessation are given the space to grow while she talks.
9.	Adolphson, Katja, et al. (author) Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique 2016 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 40, s. 95-101 Journal article (peer-reviewed)abstract BACKGROUND: low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery. AIM: the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting. SETTING: midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique. METHOD: the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis. RESULTS: two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency. CONCLUSIONS: the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.
10.	Ahrne, Malin, et al. (author) Antenatal care for Somali-born women in Sweden : Perspectives from mothers, fathers and midwives 2019 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 74, s. 107-115 Journal article (peer-reviewed)abstract OBJECTIVE: To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives´ experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.DESIGN: Eight focus group discussions with 2-8 participants in each were conducted, three with Somali-born mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling´s tool "Thematic networks".SETTING: Two towns in mid-Sweden and a suburb of the capital city of Sweden.PARTICIPANTS: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.FINDINGS: Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.KEY CONCLUSIONS: ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed.
11.	Akhavan, Sharareh, et al. (author) Midwives' experiences of doula support for immigrant women in Sweden : A qualitative study 2012 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 28:1, s. 80-85 Journal article (peer-reviewed)abstract Objective: to describe and analyse midwives’ experiences of doula support for immigrant women in Sweden. Design: qualitative study, analysed using content analysis. Data were collected via interviews. Setting: interviews were conducted at the midwives’ workplaces. One midwife was interviewed at a cafe. Participants: ten midwives, who participated voluntarily and worked in maternity health care in western Sweden. Findings: the interview data generated three main categories. (1) ‘A doula is a facilitator for the midwife’ has two subcategories, ‘In relation to the midwife’ and ‘In comparison with an interpreter’, (2) ‘Confident women giving support, ’has two subcategories, ‘Personal characteristics and attitudes’ and ‘Good support,’ (3) ‘Doulas cover shortcomings’ has two subcategories, ‘In relation to maternity care’ and ‘In relation to ethnicity’. Key conclusion and implications for practice: The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women’s confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.
12.	Alosaimi, Abdullah N., et al. (author) Factors associated with female genital cutting in Yemen and its policy implications 2019 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 74, s. 99-106 Journal article (peer-reviewed)abstract Background:A tremendous number of girls in Yemen are still subjected to female genital cutting (FGC), which carries an increased risk of health complications and violates children's rights. This study describes the prevalence of FGC in four Yemeni provinces and investigates the determinants of FGC.Methods: We analyzed data from women aged 15 to 49 years who responded to a sub-national household survey conducted in six rural districts of four Yemeni provinces in 2008-2009. Logistic regression was used to estimate the association between individual and household socioeconomic factors and FGC practices and attitudes.Results:The prevalence of women's FGC was 48% while daughters' FGC was 34%. Almost 45.8% of the women surveyed believe the FGC practice should discontinue. Higher odds of FGC practice and positive attitude towards it were associated with older age, family marriage, and lower tertiles of wealth and education indices. Early marriage was also associated with increased odds of FGC practice (p < 0.01).Conclusions:Socioeconomic indices and other individual factors associated with FGC are differing and complex. Younger generations of women are more likely to not have FGC and to express negative attitudes towards the tradition. Appropriate strategies to invest in girls' education and women's empowerment with effective engagement of religious and community leaders might support the change of attitudes and practice of FGC in the younger generation.
13.	Andersson, E, et al. (author) Fathers' satisfaction with two different models of antenatal care in Sweden - Findings from a quasi-experimental study 2017 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 50, s. 201-207 Journal article (peer-reviewed)
14.	Andersson, Ewa, et al. (author) Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden 2012 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 28:4, s. 442-448 Journal article (peer-reviewed)abstract Background: group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000. Objective: to investigate parents' experiences of group antenatal care in four different clinics in Sweden. Method: a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used. Settings: the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden. Participants: the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme. Findings: three themes emerged, 'The care-combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, 'The group-a composed recipient of care', showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, 'The midwife-a controlling professional', showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals. Key conclusions: in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms. Implications for practise: the midwife's role in facilitating group-based antenatal care demands new pedagogical strategies and approaches.
15.	Andrén, Anna, et al. (author) Miscommunication influences how women act when fetal movements decrease : An interview study with Swedish Somali migrant women 2023 In: Midwifery. - 0266-6138 .- 1532-3099. ; 126 Journal article (peer-reviewed)abstract OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs.DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis.SETTING: The study was conducted in Sweden.PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth.FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information.KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns.IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.
16.	Annborn, Anna, et al. (author) Obstetric violence a qualitative interview study. 2021 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 105 Journal article (peer-reviewed)abstract OBJECTIVE: To investigate the meaning of the concept of 'obstetric violence' to women in Sweden, who reported a negative birth experience.DESIGN: An inductive qualitative approach with individual narratives. A thematic qualitative content analysis was used.SETTING: Three midwifery clinics in southwest Scania.PARTICIPANTS: Twelve women who had given birth less than three years previously and reported a negative/traumatic birth experience.FINDINGS: The key findings showed that the women had experienced psychological and physical abuse during childbirth which may be interpreted as 'obstetric violence'. Four categories emerged from the analyses describing the women's experiences: Lack of information and consent including poor information and no right to participate in decisions concerning the process of labour, Insufficient pain relief, which encompassed unbearable pain without pain relief, Lack of trust and security where the women experienced staff with bad attitudes and jargon, and The experience of abuse including threats of violence from midwives and where the birth experience was compared to rape.KEY CONCLUSIONS: The study shows that physical and psychological abuse during childbirth exists in Sweden and that women experience this as being subjected to 'obstetric violence' during childbirth. The phenomenon of obstetric violence is very complex. The abuse of women during childbirth might be a significant problem and quality assurance is required to secure the rights of women giving birth.IMPLICATIONS FOR PRACTICE: In order to secure the rights of birthing women and to promote respectful and supportive care for new mothers, quality development programs are required.
17.	Arousell, Jonna, 1985-, et al. (author) Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? : A qualitative exploration and critique of a common argument in reproductive health research 2019 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 75, s. 59-65 Journal article (peer-reviewed)abstract Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions. Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016. Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established. Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception. Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling. (C) 2019 The Authors. Published by Elsevier Ltd.
18.	Askelsdottir, B., et al. (author) Home care after early discharge : Impact on healthy mothers and newborns 2013 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 29:8, s. 927-934 Journal article (peer-reviewed)abstract Objective: to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth. Design: retrospective case-control study. Setting: a labour ward unit in Stockholm, Sweden handling both normal and complicated births. Participants: 96 women with single, uncomplicated pregnancies and births, and their healthy newborns. Intervention: early discharge at 12-24 hours post partum with 2-3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (. n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (. n=51). Instruments: mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded. Findings: women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (. p=0.021). Contact between the mother, newborn and partner did not differ between the groups. Conclusion: early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates. © 2012 Elsevier Ltd.
19.	Asplin, Nina, et al. (author) Pregnancy termination due to fetal anomaly : women's reactions, satisfaction and experiences of care 2014 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 30:6, s. 620-627 Journal article (peer-reviewed)abstract OBJECTIVE:to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.METHOD:an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.SETTING:four fetal care referral centres in Stockholm, Sweden.PARTICIPANTS:11 women opting for pregnancy termination due to fetal malformation.FINDINGS:in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.CONCLUSION AND IMPLICATIONS FOR PRACTICE:The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.
20.	Avelin, Pernilla, et al. (author) Parental grief and relationships after the loss of a stillborn baby 2013 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 29:6, s. 668-673 Journal article (peer-reviewed)abstract OBJECTIVES: to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN: a postal questionnaire at three months, one year and two years after stillbirth. SETTING: a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS: 55 parents, 33 mothers and 22 fathers. FINDINGS: mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS: experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE: anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.
21.	Barimani, Mia, et al. (author) Childbirth and parenting preparation in antenatal classes 2018 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 57, s. 1-7 Journal article (peer-reviewed)abstract Objectives: to describe topics (1) presented by midwives' during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics. Design: qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses. Setting and participants: 3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants. Findings: class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents' understanding of the childbirth process, birthing milieu, the partner's role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents' questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%). Key conclusions: childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations. Implications for practice: while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new topics, and investigate: (i) ways in which antenatal course development and planning can improve; (ii) measures for evaluating courses; (iii) facilitator training; and (iv) parent satisfaction surveys.
22.	Barimani, Mia, et al. (author) Open dialogue - A grounded theory study on peer learning at birthing units. 2022 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 111, s. 103355- Journal article (peer-reviewed)abstract BACKGROUND: Peer learning in clinical settings is supported in nursing research but has rarely been studied in the context of student midwives at birthing units.AIM: To create a theoretical model of peer learning in the context of birthing units.SETTINGS: Four hospitals and maternity units in Stockholm, Sweden.METHODS: A Straussian approach to grounded theory was applied. Data consisted of interviews with fifteen final-term student midwives and 21 preceptors. Further, six peer learning seminars were held with approximately 200 midwives. At these, data was collected from fourteen preceptors presenting their experiences of working with peer learning.FINDINGS: The core of the action emerging was the Open dialogue describing the communication between the pair of students, between students-preceptor and students-becoming parents, that developed skills in communication, participation and reduced prestige and hierarchy. It facilitated social interaction and reinforced a dynamic way of learning and teaching midwifery.CONCLUSIONS: With preparation and a clear framework, peer learning can be used with midwifery students at birthing units. The open dialogue includes the becoming family in decision making and fits in a woman centered care providing support, safety, and participation. The pedagogical benefits are consistent with previous studies on nursing students.
23.	Barimani, M, et al. (author) Parents' experiences when students are present during labour and childbirth : A cross-sectional survey of parents in Sweden 2019 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 77, s. 130-136 Journal article (peer-reviewed)abstract OBJECTIVE: Various student groups participate in clinical intrapartum care, but limited data are available on parents' perceptions of student presence during labour and childbirth. This study explored parents' experiences of having a student present during labour and childbirth.DESIGN AND PARTICIPANTS: Qualitative study based on an analysis of 362 parents' responses to one open-ended question from a cross-sectional survey.RESULTS: When they experienced students as interactive and supportive, parents reacted positively to student participation. Parents displayed clear willingness to contribute to students' learning. Some parents, however, reported unexpected, uncomfortable, or inappropriate experiences that they attributed to insufficient autonomy or undergoing many vaginal examinations.KEY CONCLUSIONS: Parents, clinical supervisors, and students can benefit from clinical learning situations, but women's needs must be prioritised and student involvement balanced with women's right to choose who is with them during labour and childbirth.
24.	Barimani, M, et al. (author) Successful early postpartum support linked to management, informational, and relational continuity 2015 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 31:8, s. 811-817 Journal article (peer-reviewed)
25.	Bell, AF, et al. (author) The birth experience and women's postnatal depression: A systematic review 2016 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 39, s. 112-123 Journal article (peer-reviewed)
26.	Benjamin, Caroline M., et al. (author) Educational priorities and current involvement in genetic practice: a survey of midwives in the Netherlands, UK and Sweden 2009 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 25:5, s. 483-499 Journal article (peer-reviewed)abstract Objective: to investigate whether practising midwives are adequately prepared to integrate genetic information into their practice. Design: a cross-sectional, postal, structured questionnaire survey was sent to practising midwives. Setting: practising midwives from the Netherlands (NL), Sweden (SE) and the United Kingdom (UK). Participants: 1021 replies were received, achieving a response rate of 62%. Findings: 79% (799/1015) of midwives reported attending courses with some 'genetic content' during their initial training. Sixty-eight per cent (533/784) judged this to have been useful for clinical practice. Variation was seen between countries in the amount of genetic content in post-registration training (SE 87%, NL 44%, UK 17%) and underpinned by genetic knowledge. For eight of the 12 procedures, fewer than 20% of midwives considered themselves to be confident. Differences were apparent between countries. Midwives identified psychosocial, screening and risk assessment aspects of genetic education as being important to them, rather than technical aspects or genetic science. Conclusions: given the low reported confidence with genetic issues in clinical practice, it is essential that this is addressed in terms of the amount, content and targeting of genetic education. This is especially important to ensure the success of national antenatal and baby screening programmes. The results of this study suggest that midwives would welcome further training in genetics, addressing genetic topics most relevant to their clinical practice. (C) 2007 Elsevier Ltd. All rights reserved.
27.	Berggren, Vanja, 1972-, et al. (author) An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth 2004 In: Midwifery. - 0266-6138 .- 1532-3099. ; 20:4, s. 299-311 Journal article (peer-reviewed)abstract OBJECTIVE: to explore Sudanese midwives' motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. DESIGN: triangulation of methods, using observational techniques and open-ended interviews. SETTING AND PARTICIPANTS: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. FINDINGS: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives' potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.
28.	Berggren, Vanja, et al. (author) An explorative study of Sudanese midwives' motives, perceptions and experiences of re-infibulation after birth 2004 In: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 20:4, s. 299-311 Journal article (peer-reviewed)abstract OBJECTIVE: to explore Sudanese midwives' motives for and perceptions and experiences of re-infibulation after birth and to elucidate its context and determinants. DESIGN: triangulation of methods, using observational techniques and open-ended interviews. SETTING AND PARTICIPANTS: two government hospitals in Khartoum/Omdurman, Sudan, for the observations and in-depth interviews with 17 midwives. FINDINGS: midwives are among the major stakeholders in the performance of primary female genital cutting (FGC) as well as re-infibulation. Focusing on re-infibulation after birth, midwives were trying to satisfy differing, and sometimes contradictory, perspectives. The practice of re-infibulation (El Adel) represented a considerable source of income for the midwives. The midwives integrated the practice of re-infibulation into a greater whole of doing well for the woman, through an endeavour to increase her value by helping her to maintain her marriage as well as striving for beautification and completion. They were also trying to meet socio-cultural requests, dealing with pressure from the family while balancing on the edge of the law. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the findings confirm that midwives are important stakeholders in perpetuating re-infibulation, and indicate that the motives are more complex than being only economic. The constant balancing between demands from others puts the midwives in a difficult position. Midwives' potential role to influence views in the preventative work against FGC and re-infibulation should be acknowledged in further abolition efforts.
29.	Bergh, Ingrid, 1956, et al. (author) Comparison of the PainMatcher and the Visual Analogue Scale for assessment of labour pain following administered pain relief treatment. 2011 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 27:1 Journal article (peer-reviewed)abstract OBJECTIVE: during childbirth, it is necessary to assess and monitor experienced pain and to evaluate the effect of pain relief treatment. The aim of this study was to compare the PainMatcher((R)) (PM) with the Visual Analogue Scale (VAS) for the assessment of labour pain and the effect of pain relief treatment. DESIGN: randomised controlled trial. SETTING: labour ward with approximately 2500 childbirths per year in western Sweden. PARTICIPANTS: 57 women with labour pain treated with acupuncture or sterile water injections scored their electrical pain threshold and pain intensity with the PM. Pain intensity was also assessed with the VAS. Electrical pain threshold and pain intensity were assessed immediately after a uterine contraction before and 30, 60, 90, 120, 150 and 180minutes after treatment. MEASUREMENTS AND FINDINGS: the results showed a weak correlation (r=0.13, p<0.05) between the pain intensity scores on the PM and the VAS. The PM detected changes (decrease) in pain intensity to a lower degree than the VAS. Surprisingly, in over 10% of sessions, women scored their pain intensity during a uterine contraction lower than their electrical pain threshold with the PM. However, electrical pain thresholds with the PM correlated well throughout all measurements. CONCLUSIONS: the PM is a reliable tool for the assessment of electrical pain threshold; however, the VAS is more sensitive than the PM for recording changes in pain intensity when assessing the effects of treatment on labour pain. IMPLICATIONS FOR PRACTICE: the PM and the VAS are not interchangeable in the case of labour pain, and there is still a need for research in this area to find a more suitable assessment instrument for the evaluation of labour pain.
30.	Bergh, Ingrid, et al. (author) Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain 2012 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 28:5, s. e684-e688 Journal article (peer-reviewed)abstract Objective: to investigate the reliability and validity of the Acceptance Symptom Assessment Scale (ASAS) in assessing labour pain.Design: a test-retest approach was used to assess reliability and validity.Setting: labour ward with approximately 2,400 deliveries annually in western part of Sweden.Participants: forty-seven pregnant women in the latent or active phase of labour.Methods: a total of five pain assessments with both the ASAS and the VAS were conducted in three sessions.Main outcome measures: correlation between ASAS and VAS.Findings: both scales demonstrated high and significant test–retest correlations (r=0.83–0.92; p<0.001). High and significant alternative-form reliability correlations (r=0.76–0.93, p<0.001) were found between ASAS and VAS ratings at all five assessments. Construct validity was established when both the ASAS and the VAS identified a pain reduction(p<0.001) 2 hrs after birth, compared to the previous assessment. Over two-thirds of the women preferred the ASAS to the VAS ,mainly(n=30) because the ASAS provided more choices relating to the pain experience, making it possible to label pain acceptable/unacceptable.Conclusions: the ASAS is interchangeable with the VAS for assessing labour pain. Over two-thirds of the women preferred it to the VAS.
31.	Bergstrom, M, et al. (author) A randomised controlled multicentre trial of women's and men's satisfaction with two models of antenatal education 2011 In: Midwifery. - : Elsevier BV. - 1532-3099 .- 0266-6138. ; 27:6, s. E195-E200 Journal article (peer-reviewed)
32.	Binder, Pauline, 1965-, et al. (author) Hi-TENS combined with PCA-morphine as post caesarean pain relief 2011 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 27:4, s. 547-552 Journal article (peer-reviewed)abstract Objectives: to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. Design: randomised, controlled study. Setting: a county hospital in south-west Sweden. Participants: 42 multiparous women. Measurements and ﬁndings: participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the ﬁrst 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed signiﬁcantly between the groups: morphine with TENS was 16.2+/-12.6 mg and morphine alone was 33.1+/-20.9 mg (p = 0.007). Assessment of pain relief showed no signiﬁcant difference. Sedation differed signiﬁcantly between the groups (p = 0.045), especially between three and 12 hours post partum (p = 0.011). Key conclusions and implications for practice: pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed beneﬁt of this treatment combination is that the mother is more alert and better able to interact with her newborn during the ﬁrst hours after birth without drowsiness due to large doses of opiates.
33.	Binder, Pauline, 1965-, et al. (author) More than re-establishing the partner relationship : Intimate aftercare for Somali parents in diaspora 2013 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 29:8, s. 863-870 Journal article (peer-reviewed)abstract Objective: to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth. Design: a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by ‘functional narrative analysis’ and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling. Setting:a diasporic context among participants living in six urban centres across Sweden. Participants: successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3–7 participants) and seven with mothers (3–6 participants). Findings: within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience ‘existential angst’ resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support. Implications for practice: to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence-based recommendations, which have been identified for parents who are ethnically-congruent to a western study setting. Our findings suggest that aftercare meant for Somali parents living in these settings requires an understanding of how traditional intimate support and the postpartum sexual relationship are re-negotiated in the diasporic context. This includes recognition of the father as a willing and supportive partner.
34.	Binfa, Lorena, et al. (author) Chilean midwives and midwifery students' views of women's midlife health-care needs 2011 In: Midwifery. - : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 27:4, s. 417-423 Journal article (peer-reviewed)abstract Objective to determine Chilean midwives’ views with regard to Chilean women’s health-care needs in midlife. The aim was also to explore Chilean midwifery students’ views on the clinical care provided to women in midlife. Design a qualitative study using focus group discussions and narratives which were analysed using thematic manifest and latent content analysis. Setting 10 different primary health care (PHC) centres in Santiago, Chile. Participants 22 midwives, working in PHC clinics and 13 (n=13) midwifery students with PHC clinical experience, attending their fourth or fifth year of midwifery education at the School of Midwifery in Santiago. Findings the midwives felt that women in midlife have special health-care service needs. They also considered themselves to be the most appropriate health staff to provide health care for women in midlife, but recognised that they lacked competence in attending psychological and social health-care needs of women in midlife such as violence, abuse and sexuality issues. The midwifery students remarked that many midwives focused their attention on fulfilling the biomedical requirements. Even if the midwives had knowledge about recent research on menopause, they had difficulties in approaching this issue and including it in their counselling. Some students also questioned the sometimes disrespectful attitude shown, especially towards Peruvian immigrants and women with psychosocial problems. Conclusions and implications for practice the findings suggest that midwives need more education about women’s health-care needs in midlife, and that more focus should be placed on the psychosocial aspects of midwifery. More reflections about the quality of the client–provider relationship in clinical practice are needed. Gender issues, the structure of power relationships, and empowerment should be incorporated and critically discussed during midwifery education and training, and also in clinics.
35.	Bitar, Dima, et al. (author) Arabic-speaking women's experiences of communication at antenatal care in Sweden using a tablet application : part of development and feasibility study 2020 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 84:May, s. 1-8 Journal article (peer-reviewed)abstract Objectives: The purpose of this study was to explore Arabic-speaking women´s experiences of communication at antenatal care in Sweden when using a tablet application (app). Design: The study is a part of a major research project, where a Swedish-Arabic app was developed to improve and facilitate communication between Arabic-speaking women and midwives. The first prototype was developed in 2017 and tested at six antenatal clinics in southeast of Sweden. Ten Arabic-speaking women were purposively recruited, and individual interviews were performed. Content analysis was used. Findings: Four main categories emerged: "Adapting the content to the patient group", "language and communication", "user-friendly" and "improvement proposal". The women reported that the content was educational, reliable and understandable. The information gave the women a sense of security. It was time effective and allowed opportunity for dialogue. Depending on language skills, there were different opinions as to whether the App should be a complement to having an interpreter or used separately. Key conclusion: Arabic-speaking women perceived the App as being a communication tool despite their language skills in Swedish. There is a need for digital support for communication in maternity care
36.	Bjelke, Maria, et al. (author) Management of the passive phase of the second stage of labour in nulliparous women—Focus group discussions with Swedish midwives 2019 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 75, s. 89-96 Journal article (peer-reviewed)
37.	Bjelke, Maria, et al. (author) Using the internet as a source of information during pregnancy : a descriptive cross-sectional study in Sweden 2016 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 40, s. 187-191 Journal article (peer-reviewed)abstract ObjectiveThe Internet plays a major role for pregnant women in seeking knowledge and for getting in touch with like-minded women. The information is available at all hours and can be accessed anywhere. The information provides the women with a sense of control and confidence but the large amount of information available can also be overwhelming. The aim of this study was to identify how women use the Internet as a source of information during their pregnancy and how it affects them.Design and settingA descriptive cross-sectional study was conducted.Data were collected through a questionnaire at antenatal clinics in the southern Sweden. The data were analyzed descriptivelyParticipantsA total of 193 Swedish women, pregnant at least 34 weeks, participated in the study. The response rate was 94%.FindingsAlmost all (95%) of the women in the study used the Internet as a source of information. The main reason was to find information and read about people in the same situation. Reading pregnancy-related information on the Internet was seen as positive. However, a majority of the woman experienced feelings of worry due to something they read online. These feelings were most commonly coped with by talking to a partner, relatives, and friends or by asking the midwife at their next appointment. Eleven per cent of the women contacted the general healthcare services because of their feelings of worry.ConclusionAlmost all women in this study searched the Internet to find pregnancy-related information, despite being satisfied with the information they received from the ANC. Using the Internet was seen as complementary to the information from professionals. It also caused feelings of worry, which could lead to the woman contacting healthcare services for support. ANC could help to reduce these feelings for some women by informing about the advantages and disadvantages with online information and recommending suitable web pages.
38.	Blix, Ellen, et al. (author) Norwegian midwives' perception of the labour admission test 2007 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 23:1, s. 48-58 Journal article (peer-reviewed)abstract Objective: to explore what information and knowledge the labour admission test is perceived to provide and what meaning the test carries in the daily work of practising midwives. Design: in-depth interviews transcribed verbatim and analysed using the grounded theory technique. Setting: four different labour wards in Norway. Participants: a theoretical sample of 12 practising midwives. Findings: the core category "experiencing contradictions" was identified during the analyses, indicating that the midwives found conflicting interests within themselves, or between themselves and others when using the labour admission test. They experienced contradictions between professional identity and the increasing use of technology, between feeling safe and feeling unsafe and between having power and being powerless. Key conclusions: the labour admission traces could be difficult to interpret, especially for newly qualified midwives. Some midwives thought that a labour admission trace could protect them in case of litigation. The hierarchy of power in the labour ward influences the use and interpretation of the labour admission test. Some midwives felt their professional identity threatened and that midwives in general are losing their traditional skills because of the increasing use of obstetric technology. Implications for practice: the findings of the present study should be taken into consideration when changing practice to not routinely perform the labour admission test. There is also a need for further research on what effect the increasing use of obstetric technology has on traditional midwifery skills.
39.	Blixt, Ingrid, 1968-, et al. (author) Breastfeeding training improved healthcare professional's self-efficacy to provide evidence-based breastfeeding support : A pre-post intervention study 2023 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 125 Journal article (peer-reviewed)abstract OBJECTIVE: To describe healthcare professional's (HCP's) perceived self-efficacy in their ability to provide breastfeeding support before and after a breastfeeding training program.DESIGN: Pre-post intervention study.SETTING: Antenatal care and child healthcare (CHC) centres in Sweden during 2020.PARTICIPANTS: An intervention group consisting of 39 HCPs (midwives 51.3%, child healthcare nurses 46.2%) completing a questionnaire at baseline and after intervention, and a control group of 34 HCPs (midwives 61.8%, child healthcare nurses 38.2%) completing a questionnaire at baseline.INTERVENTION: A breastfeeding training program in line with the Ten Steps to Successful Breastfeeding and WHO recommendations about breastfeeding.MEASUREMENTS AND FINDINGS: The 11-item Breastfeeding Support Confidence Scale (BSCS) measures HCP's self-efficacy regarding providing breastfeeding support in line with Ten Steps to Successful Breastfeeding and WHO recommendations. The intervention group experienced a significantly increased self-efficacy from pre-intervention to post-intervention for 8 of the 11 BSCS items, with the overall BSCS index score increasing from 36.87 to 39.56 points (p = 0.001). The index score in the intervention group at follow-up was significantly higher than the corresponding score in the control group at baseline (p = 0.025). The intervention group had significantly higher scores at follow-up than the control group at baseline on the questions: "I'm sure that I can help mothers continue to breastfeed even if the infant doesn't follow the growth curve" (p = 0.026) and "I'm sure that I can help mothers continue to breastfeed when the breastfeeding is painful" (p = 0.048).KEY CONCLUSIONS: The breastfeeding training program improved HCP' self-efficacy to provide evidence-based support to breastfeeding mothers.IMPLICATIONS FOR PRACTICE: This training program is well suited to implement in clinical practice and follows the Ten Steps to Successful Breastfeeding.TRIAL REGISTRATION: ACTRN12623000648628.
40.	Blomgren, Johanna, et al. (author) Maternal health leaders' perceptions of barriers to midwife-led care in Ethiopia, Kenya, Malawi, Somalia, and Uganda 2023 In: Midwifery. - 0266-6138 .- 1532-3099. ; 124, s. 103734- Journal article (peer-reviewed)abstract OBJECTIVE: To identify and examine barriers to midwife-led care in Eastern Africa and how these barriers can be reduced DESIGN: A qualitative inductive study with online focus group discussions and semi-structured interviews using content analysis SETTING: The study examines midwife-led care in Ethiopia, Malawi, Kenya, Somalia, and Uganda -five African countries with an unmet need for midwives and a need to improve maternal and neonatal health outcomes.PARTICIPANTS: Twenty-five participants with a health care profession background and current position as a maternal and child health leader from one of the five study countries.FINDINGS: The findings demonstrate barriers to midwife-led care connected to organisational structures, traditional hierarchies, gender disparities, and inadequate leadership. Societal and gendered norms, organisational traditions, and differences in power and authority between professions are some factors explaining why the barriers persist. A focus on intra- and multisectoral collaborations, the inclusion of midwife leaders, and providing midwives with role models to leverage their empowerment are examples of how to reduce the barriers.KEY CONCLUSIONS: This study provides new knowledge on midwife-led care from the perspectives of health leaders in five African countries. Transforming outdated structures to ensure midwives are empowered to deliver midwife-led care at all healthcare system levels is crucial to moving forward.IMPLICATIONS FOR PRACTISE: This knowledge is important as enhancing the midwife-led care provision is associated with substantially improved maternal and neonatal health outcomes, higher satisfaction of care, and enhanced utilisation of health system resources. Nevertheless, the model of care is not adequately integrated into the five countries' health systems. Future studies are warranted to further explore how reducing barriers to midwife-led care can be adapted at a broader level.
41.	Bodin, Maja, et al. (author) Coherence of pregnancy planning within couples expecting a child 2015 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 31:10, s. 973-978 Journal article (peer-reviewed)abstract Background: joint planning and decision-making within couples have evident effects on the well-being of the family. The purpose of this study was to investigate the level of pregnancy planning among pregnant women and their partners and to compare the coherence of pregnancy planning within the couples. Methods: pregnant women and their partners were recruited from 18 antenatal clinics in seven Swedish counties between October 2011 and April 2012. Participants, 232 pregnant women and 144 partners, filled out a questionnaire with questions about pregnancy planning, lifestyle and relationship satisfaction. 136 couples were identified and the women's and partners' answers were compared. Results: more than 75% of the pregnancies were very or rather planned and almost all participants had agreed with their partner to become pregnant There was no significant difference in level of pregnancy planning between women and partners, and coherence within couples was strong. Level of planning was not affected by individual socio-demographic variables. Furthermore, 98 % of women and 94 % of partners had non distressed relationships. Conclusion: one of the most interesting results was the strong coherence between partners concerning their pregnancy and relationship. Approaching these results from a social constructivist perspective brings to light an importance of togetherness and how a sense and impression of unity within a couple might be constructed in different ways. As implications for practice, midwives and other professionals counselling persons in fertile age should enquire about and emphasise the benefits of equality and mutual pregnancy planning for both women and men.
42.	Bogren, Malin, et al. (author) Development of a context specific accreditation assessment tool for affirming quality midwifery education in Bangladesh 2018 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 61, s. 74-80 Journal article (peer-reviewed)abstract OBJECTIVE: using the International Confederation of Midwives (ICM) Global Standards for Midwifery Education as a conceptual framework, the aim of this study was to explore and describe important 'must haves' for inclusion in a context-specific accreditation assessment tool in Bangladesh.DESIGN: A questionnaire study was conducted using a Likert rating scale and 111 closed-response single items on adherence to accreditation-related statements, ending with an open-ended question. The ICM Global Standards guided data collection, deductive content analysis and description of the quantitative results.SETTING: twenty-five public institutes/colleges (out of 38 in Bangladesh), covering seven out of eight geographical divisions in the country.PARTICIPANTS: one hundred and twenty-three nursing educators teaching the 3-year diploma midwifery education programme.FINDINGS: this study provides insight into the development of a context-specific accreditation assessment tool for Bangladesh. Important components to be included in this accreditation tool are presented under the following categories and domains: 'organization and administration', 'midwifery faculty', 'student body', 'curriculum content', 'resources, facilities and services' and 'assessment strategies'. The identified components were a prerequisite to ensure that midwifery students achieve the intended learning outcomes of the midwifery curriculum, and hence contribute to a strong midwifery workforce. The components further ensure well-prepared teachers and a standardized curriculum supported at policy level to enable effective deployment of professional midwives in the existing health system.KEY CONCLUSIONS: as part of developing an accreditation assessment tool, it is imperative to build ownership and capacity when translating the ICM Global Standards for Midwifery Education into the national context.IMPLICATIONS FOR PRACTICE: this initiative can be used as lessons learned from Bangladesh to develop a context-specific accreditation assessment tool in line with national priorities, supporting the development of national policies.
43.	Byaruhanga, Romano N., et al. (author) Hurdles and opportunities for newborn care in rural Uganda 2011 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 27:6, s. 775-780 Journal article (peer-reviewed)abstract Introduction: a set of evidence-based delivery and neonatal practices have the potential to reduce neonatal mortality substantially. However, resistance to the acceptance and adoption of these practices may still be a problem and challenge in the rural community in Uganda. Objectives: to explore the acceptability and feasibility of the newborn care practices at household and family level in the rural communities in different regions of Uganda with regards to birth asphyxia, thermo-protection and cord care. Methods: a qualitative design using in-depth interviews and focus group discussions were used. Participants were purposively selected from rural communities in three districts. Six in-depth interviews targeting traditional birth attendants and nine focus group discussions composed of 10-15 participants among post childbirth mothers, elderly caregivers and partners or fathers of recently delivered mothers were conducted. All the mothers involved has had normal vaginal deliveries in the rural community with unskilled birth attendants. Latent content analysis was used. Findings: two main themes emerged from the interviews: 'Barriers to change' and 'Windows of opportunities'. Some of the recommended newborn practices were deemed to conflict with traditional and cultural practices. Promotion of delayed bathing as a thermo-protection measure, dry cord care were unlikely to be accepted and spiritual beliefs were attached to use of local herbs for bathing or smearing of the baby's skin. However, several aspects of thermo-protection of the newborn, breast feeding, taking newborns for immunisation were in agreement with biomedical recommendations, and positive aspects of newborn care were noticed with the traditional birth attendants. Conclusions: some of the evidence based practices may be accepted after modification. Behaviour change communication messages need to address the community norms in the country. The involvement of other newborn caregivers than the mother at the household and the community early during pregnancy may influence change of behaviour related to the adoption of the recommended newborn care practices.
44.	Byrskog, Ulrika, et al. (author) ‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden 2016 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 40, s. 10-17 Journal article (peer-reviewed)abstract BackgroundSomali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care.MethodQualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis.FindingsA balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition.ConclusionsIf confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.
45.	Bäckström, Caroline, et al. (author) Support during labour : first-time fathers' descriptions of requested and received support during the birth of their child 2011 In: Midwifery. - : Elsevier. - 0266-6138 .- 1532-3099. ; 27:1, s. 67-73 Journal article (peer-reviewed)abstract Objective: to explore how ﬁrst-time fathers describe requested and received support during a normal birth. Design: qualitative research design. Ten ﬁrst-time fathers were interviewed during the ﬁrst postpartum week. Individual open-ended interviews were used to explore the fathers’ descriptions, and the interviews were analysed using qualitative analysis. Setting: a labour ward at one hospital in a south-western county of Sweden in November and December 2006. Participants: ﬁrst-time fathers who had experienced a normal birth at the hospital during the study period. Findings: the support described is presented as one main theme, ‘being involved or being left out’, which included four underlying categories: ‘an allowing atmosphere’, ‘balancing involvement’, ‘being seen’ and ‘feeling left out’. Key conclusions: fathers perceived that they were given good support when they were allowed to ask questions during labour, when they had the opportunity to interact with the midwife and their partner, and when they could choose when to be involved or to step back. Fathers want to be seen as individuals who are part of the labouring couple. If fathers are left out, they tend to feel helpless; this can result in a feeling of panic and can put their supportive role of their partner at risk. Implications for practice: the results of this study could initiate discussions about how health-care professionals can develop support given to the labouring couple, with an interest in increasing paternal involvement.
46.	Carlsson, Ing-Marie, 1961-, et al. (author) Maintaining power : women's experiences from labour onset before admittance to maternity ward 2012 In: Midwifery. - Oxon, United Kingdom : Elsevier. - 0266-6138 .- 1532-3099. ; 28:1, s. 86-92 Journal article (peer-reviewed)abstract Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward.Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used.Findings: ‘Maintaining power’ was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: ‘to share the experience with another’, ‘to listen to the rhythm of the body’, ‘to distract oneself’ and ‘to be encased in a glass vessel’, explained how the women coped and thereby maintained power.Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process.
47.	Carlsson, Ing-Marie, 1961-, et al. (author) Swedish women's experiences of seeking care and being admitted during the latent phase of labour : A grounded theory study 2007 In: Midwifery. - Edinburgh : Churchill Livingstone. - 0266-6138 .- 1532-3099. ; 25:2, s. 172-180 Journal article (peer-reviewed)abstract Objective: to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour.Design: a qualitative interview study using the grounded theory approach.Setting: the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600-1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth.Participant: eighteen Swedish women, aged 22-36, who were admitted to the tabour ward while they were stilt in the latent phase of tabour.Findings: 'Handing over responsibility' to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of tabour and their experiences of the Latent phase of tabour. The categories, which all related to the core category, were labelled: (1) 'longing to complete the pregnancy,' (2) 'having difficulty managing the uncertainty,' (3) 'having difficulty enduring the stow progress,' (4) 'suffering from pain to no avail' and (5) 'oscillating between powerfulness and powerlessness.'Conclusions and implications for practice: findings indicate that women being admitted to the tabour ward in the latent phase of tabour experienced a need for handing over responsibility for the tabour, the welt-being of the unborn baby, and for themselves. Midwives have an important role in assisting women with coping during the latent phase of tabour, and in giving the women opportunity to hand over responsibility. This care should include validation of experienced pain and confirmation of the normality of the slow process, information and support. © 2007 Elsevier Ltd. All rights reserved.
48.	Carlsson, Ing-Marie, 1961-, et al. (author) The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes 2015 In: Midwifery. - London : Elsevier. - 0266-6138 .- 1532-3099. ; 31:10, s. 1000-1007 Journal article (peer-reviewed)abstract OBJECTIVE: this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors.DESIGN: a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records.SETTING: data were recruited from antenatal health-care clinics in Halland, Sweden.PARTICIPANTS: a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42.MEASUREMENTS: five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States.FINDINGS: results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy.KEY CONCLUSIONS: this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth. © 2015 Elsevier Ltd.
49.	Carlsson, Tommy, et al. (author) The emotional process from diagnosis to birth following a prenatal diagnosis of fetal anomaly : A qualitative study of messages in online discussion boards 2017 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 48, s. 53-59 Journal article (peer-reviewed)abstract Objective: to explore written statements found in online discussion boards where parents currently expecting, or with previous experience of expecting, a child with a prenatally diagnosed congenital anomaly communicate about their emotional process from diagnosis to birth.Design: cross-sectional qualitative study of messages in public online discussion boards.Setting: Swedish public discussion boards about reproductive subjects.Sample: ten pregnant women and eight parents (of children with prenatal diagnoses) who had written 852 messages in five threads in Swedish online discussion boards identified via systematic searches.Measurements and findings: three phases were identified in the process of moving from the diagnosis to the birth: shock, existential crisis, and life remodeling. The people posting message (‘posters’) moved from initial shock to existential crisis and, lastly, a phase of remodeling life later in the pregnancy. During the pregnancy, considerable worries about both antenatal and postnatal aspects were expressed. To cope with their situation, the posters distanced themselves from the diagnoses, vented their feelings, sought control, and obtained practical support from friends and relatives.Key conclusions: expectant parents faced with a prenatal diagnosis move from initial shock to a phase of life remodeling and acceptance. Burdened with considerable worries, expectant parents cope with their situation through informational, emotional, and instrumental support from health professionals, family, friends, and peers.Implications for practice: health professionals should make sure that expectant parents feel involved in planning their children's postnatal care, that they are offered sufficient information, and that they have access to emotional and instrumental support structures.
50.	Christenson, A., et al. (author) Shame and avoidance as barriers in midwives' communication about body weight with pregnant women: A qualitative interview study 2018 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 63, s. 1-7 Journal article (peer-reviewed)abstract Introduction: Excessive gestational weight gain, regardless of initial BMI, is associated with perinatal risks for both mother and offspring and contributes to obesity in women. Studies report that healthcare professionals find it difficult to communicate about weight and pregnant women perceive healthcare professionals as unconcerned, leaving many women uninformed about weight recommendations and risks. We aimed to explore how midwives approach communication about gestational weight gain recommendations, and to characterize communication barriers and facilitators. Methods: Seventeen midwives from different areas in Sweden were interviewed by a therapist using semi-structured interviews. Interviews were transcribed verbatim and analysed by three researchers using latent content analysis. Recurrent themes were identified and formulated. Results: The main theme identified in the latent part of the analysis was "midwives use avoidant behaviours to cope with fear of inflicting worries, shame or feelings of guilt in pregnant women". Avoidant behaviours include: adjusting weight recommendations, toning down risks and avoid talking about weight. Subthemes identified were (I) Conflicting responsibilities in midwives' professional identity (II) Perceived deficiencies in the working situation. Conclusion: Midwives' empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives' use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weight guidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices.

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