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1.	Nilsson, Christina, et al. (author) Causes and outcomes in studies of fear of childbirth: A systematic review 2018 In: Women and Birth. - 1871-5192 .- 1878-1799. Research review (peer-reviewed)abstract PROBLEM:Fear of childbirth negatively affects women during pregnancy and after birth.AIM:To summarise the findings of published studies regarding possible causes/predisposing factors and outcomes of fear of childbirth for childbearing women.DESIGN:A systematic review, searching five databases in March 2015 for studies on causes/predisposing factors and outcomes of fear of childbirth, as measured during pregnancy and postpartum. Quality of included studies was assessed independently by pairs of authors. Data were extracted independently by reviewer pairs and described in a narrative analysis.FINDINGS:Cross-sectional, register-based and case-control studies were included (n=21). Causes were grouped into population characteristics, mood-related aspects, and pregnancy and birth-related aspects. Outcomes were defined as mood-related or pregnancy and birth-related aspects. Differing definitions of fear of childbirth were found and meta-analysis could only be performed on parity, in a few studies.CONCLUSIONS:Stress, anxiety, depression and lack of social support are associated with fear during pregnancy. Need for psychiatric care and presence of traumatic stress symptoms are reported outcomes together with prolonged labour, longer labours, use of epidural and obstetric complications. Nulliparous and parous women have similar levels of fear but for different reasons. Since the strongest predictor for fear in parous women is a previous negative birth experience or operative birth, we suggest it is important to distinguish between fear of childbirth and fear after birth. Findings demonstrate the need for creating woman-centred birthing environments where women can feel free and secure with low risk of negative or traumatic birth experiences and consequent fear.
2.	Nilsson, Christina, 1959, et al. (author) Definitions, measurements and prevalence of fear of childbirth: a systematic review 2018 In: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18 Journal article (peer-reviewed)abstract Background: Fear of Childbirth (FOC) is a common problem affecting women's health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. Methods: Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. Results: In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with >= 85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, rho < 0.0001). Conclusions: Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of >= 85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as 'Are you afraid about the birth?' In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required.
3.	Patel, Harshida, 1958, et al. (author) Experiences of health care in women with Peripartum Cardiomyopathy in Sweden: a qualitative interview study 2016 In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16:1 Journal article (peer-reviewed)abstract Background Peripartum cardiomyopathy is often associated with severe heart failure occurring towards the end of pregnancy or in the months following birth with debilitating, exhausting and frightening symptoms requiring person-centered care. The aim of this study was to explore women’s experiences of health care while being diagnosed with peripartum cardiomyopathy. Method Qualitative interviews were conducted with 19 women with peripartum cardiomyopathy in Sweden, following consent. Data were analysed using qualitative content analysis. Confirmability was ensured by peer-debriefing, and an audit trail was kept to establish the credibility of the study. Results The main theme in the experience of health care was, ‘Exacerbated Suffering’, expressed in three subthemes; ‘not being cared about’, ‘not being cared for’ and ‘not feeling secure.’ The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. Women felt they were on an assembly line in midwives’ routine work where knowledge about peripartum cardiomyopathy was lacking and they showed distrust and dissatisfaction with care related to negligence and indifference experienced from healthcare professionals. Feelings of being alone and lost were prominent and related to a sense of insecurity, distress and uneasiness. Conclusions This study shows a knowledge gap of peripartum cardiomyopathy in maternity care personnel. This is alarming as the deprecation of symptoms and missed diagnosis of peripartum cardiomyopathy can lead to life-threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women’s narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms.
4.	Patel, Harshida, 1958, et al. (author) Fathers’ experiences of care when their partners suffer from peripartum cardiomyopathy: a qualitative interview study 2018 In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18 Journal article (peer-reviewed)abstract Background: Peripartum cardiomyopathy (PPCM), a potentially life-threatening condition in women, can have a profound impact on thefamily. Although structured support systems are developed, these systems tend to be based on the healthcare providers’ perceptions and focus mainly on mothers’ care. Fathers’ vital role in supporting their partners has been advocated in previous research. However, the impact of PPCM on the male partners of women is less understood. The aim of this study was to explore the experiences of healthcare in fathers whose partner was suffering from peripartum cardiomyopathy. Methods: The data from interviews with fourteen fathers were analysed using inductive content analysis. Results: An overarching category “The professionals could have made a difference” was identified from the data, characterised by the sub-categories: ‘To be informed/not informed,’ ‘To feel secure/insecure,’ ‘To feel visible/invisible’ and ‘Wish that it had been different’. Lack of timely information did not allow fathers to understand their partner´s distress, and plan for the future. The birth of the child was an exciting experience, but a feeling of helplessness was central, related to seeing their partner suffering. A desire for follow-up regarding the effect of PPCM on themselves was expressed. Conclusions: When men, as partners of women with PPCM, get adequate information of their partner´s condition, they gain a sense of security and control that gives them strength to handle their personal and emotional life-situation during the transition of becoming a father, along with taking care of an ill partner with PPCM. Hence, maternity professionals should also focus on fathers’ particular needs to help them fulfil their roles. Further research is urgently required in this area.
5.	Patel, Harshida, 1958, et al. (author) Fathers’ reactions over their partner's diagnosis of peripartum cardiomyopathy: A qualitative interview study 2019 In: Midwifery. - : Elsevier BV. - 0266-6138. ; 71, s. 42-48 Journal article (peer-reviewed)abstract Background Fathers' experience of childbirth has been described as both distressing and wonderful, but little has been described in the literature about fathers´ reactions when their partners get life threatening diagnoses such as peripartum cardiomyopathy (PPCM) during the peripartum period. Aim To learn more about fathers' reactions over their partner's diagnosis of peripartum cardiomyopathy. Methods Fourteen fathers, whose partner was diagnosed with PPCM before or after giving birth, were interviewed. Data were analysed using inductive content analysis technique. Results The first reaction in fathers was shock when they heard their partner had PPCM, which was sudden, terrible and overwhelming news. Their reactions to trauma are described in the main category: The appalling diagnosis gave a new perspective on life with emotional sub-categories: overwhelmed by fear, distressing uncertainty in the situation and for the future, feeling helpless but have to be strong, disappointment and frustration, and relief and acceptance. Although terrified, fathers expressed gratitude towards health care professionals for the diagnosis that made it possible to initiate adequate treatment. Conclusion Exploring father's reactions will help peripartum and cardiology healthcare professionals to understand that emotional support for fathers is equally important as the support required for mothers during the peripartum period. Specifically they will help professionals to focus on future efforts in understanding and meeting the supportive care needs of fathers when their partner suffers from a life-threatening diagnosis like PPCM.
6.	Patel, Harshida, 1958, et al. (author) Symptoms in women with Peripartum Cardiomyopathy: a mixed method study 2016 In: Midwifery. - : Elsevier BV. - 0266-6138. ; 32, s. 14-20 Journal article (peer-reviewed)abstract Objective: Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women´s experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women’s experiences of symptoms in Peripartum Cardiomyopathy. Design: A triangulation of methods with individual interviews and data from medical records. Setting: Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. Participants: 19 women were interviewed and medical records were reviewed by authors. Data analysis: All interview transcripts were analyzed using qualitative inductive content analysis to identify key themes. Results: The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in 2 postpartum and time from symptoms to diagnosis varied between 3–190 days (median 40). The physical symptoms were: shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. Conclusions and implications for practice: Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives’ knowledge of Peripartum Cardiomyopathy
7.	Patel, Harshida, 1958, et al. (author) What do we know about women with Peripartum Cardiomyopathy? 2017 In: Virginia Henderson Global Nursing e-Repository. - USA : Sigma Theta Tau. Conference paper (peer-reviewed)abstract Peripartum Cardiomyopathy (PPCM) is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth (Sliwa et al., 2010). The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with PPCM, leading to missed or delayed diagnosis (Germain and Nelson-Piercy, 2011). The aim of the study was to describe women’s experiences of symptoms of PPCM and received care, and identify the areas for improvement. Nineteen women were interviewed. The key themes were identified using content analysis. The main theme emerged is, The eternal suffering. The meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness (Patel et al., 2016). The care experiences are captured in exacerbated suffering, comprising subthemes, not being cared about, not being cared for and not feeling secure (Patel et al., 2016). Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in 2 postpartum, and time from symptoms to diagnosis varied between 3–190 days (median 40). Although women expressed miscellaneous experiences of care, majority of them described being not cared in adequate manner. The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. The deprecation of symptoms and missed diagnosis of PPCM can lead to a life threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women’s narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms. The analyses shows the importance of respecting women’s narratives and positive interactions with midwives and obstetricians as well as the knowledge gap is highlighted in the maternity care personnel.
8.	Wigert, Helena, 1960, et al. (author) Women's experiences of fear of childbirth: a metasynthesis of qualitative studies 2020 In: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 15 Journal article (peer-reviewed)abstract Purpose: Women’s experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women’s experiences of fear of childbirth.Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers.Results: The main results demonstrate a deepened understanding of women’s experiences of fear of childbirth interpreted through the metaphor “being at a point of no return”. Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear.Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth.Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other’s experiences will not happen to them.
9.	Begley, Cecily, 1954, et al. (author) A qualitative exploration of techniques used by expert midwives to preserve the perineum intact 2019 In: Women and Birth. - : Elsevier BV. - 1871-5192. ; 32:1, s. 87-97 Journal article (peer-reviewed)abstract Background: The perineum stretches during birth to allow passage of the baby, but 85% of women sustain some degree of perineal trauma during childbirth, which is painful post-partum. Episiotomy rates vary significantly, with some countries having rates of >60%. Recent Irish and New Zealand studies showed lower severe perineal trauma and episiotomy rates than other countries. Aim: To explore expert Irish and New Zealand midwives' views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth. Methods: Following ethical approval a qualitative, descriptive study was undertaken. Semi-structured, recorded, interviews were transcribed and analysed using the constant comparative method. Expert midwives employed in New Zealand and one setting in Ireland, were invited to join the study. "Expert" was defined as achieving, in the preceding 3.5 years, an episiotomy rate for nulliparous women of <11.8%, a `no suture' rate of 40% or greater, and a severe perineal tear rate of < 3.2%. Twenty-one midwives consented to join the study. Results: Fourcore themes emerged: 'Calm, controlled birth', 'Position and techniques in early second stage', 'Hands on or off?' and 'Slow, blow and breathe the baby out.' Using the techniques described enabled these midwives to achieve rates, in nulliparous women, of 3.91% for episiotomy, 59.24% for 'no sutures', and 1.08% for serious lacerations. Conclusions: This study provides further understanding of the techniques used by expert midwives at birth. These findings, combined with existing quantitative research, increases the evidence on how to preserve the perineum intact during spontaneous birth. (c) 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
10.	Begley, Cecily, 1954, et al. (author) A systematic review identifying outcomes to measure the effect of oxytocin used in treating delay in labour 2014 In: Optimizing childbirth across Europe - an intedisciplinary maternity care conference. 9-10 April 2014, Brussels. Part of COST Action IS0907: Childbirth Cultures, Concerns & Consequences: Creating a dynamic EU framework for Optimal maternity care.. Conference paper (other academic/artistic)abstract Background: Different outcome measures have been used in studies examining the effects of oxytocin used to treat delay in labour. Comparison of study results is thus difficult, and evidence is inconsistent. Aims of review: To identify outcomes, including salutogenic, positive, health-focussed outcomes, used in systematic reviews and randomised trials designed to measure the effectiveness of oxytocin used to treat delay in labour. This review was supported by the European Commission under COST Action:IS0907. Search and review methodology: A comprehensive search strategy was employed, and eight relevant citation databases were searched up to January 2013. randomised trials, and systematic reviews of randomised trials, that measured effectiveness of oxytocin in treating delay in labour were included. Trials comparing different action lines on partograms or active management of labour were excluded. Two reviewers screened a total of 1918 citations identified and data were extracted independently. no results were to be used, therefore no quality assessment of papers was required. five systematic reviews and 26 randomised trials were included. Primary and secondary outcomes were recorded and frequency distributions calculated. Findings: Primary outcomes used most frequently were caesarean section (n=15, 46%), labour length (n=14, 42%), measurements of uterine activity (n=13, 39%) and mode of vaginal birth (n=9, 27%). maternal satisfaction was identified a priori by only one review and included by four papers as a secondary outcome. no further salutogenic or positive health-focussed outcomes were identified. Conclusions: heterogeneous outcomes were used to measure the effectiveness of oxytocin in treating delay in labour. Additional salutogenic, women-centred and health-focussed outcomes should be included in future randomised trials of oxytocin used as a treatment for delayed labour. An improved focus on salutogenesis in childbirth may result, with potential for increased resilience in women. A core outcome dataset, based on evidence and applicable for evaluating the effects of oxytocin in prolonged labour, should be generated to support future research.
11.	Begley, Cecily, 1954, et al. (author) Evaluation of an intervention to increase vaginal birth after caesarean section through enhanced women-centred care: The OptiBIRTH randomised trial (ISRCTN10612254) 2017 In: 31th ICM Triennial Congress. Conference paper (other academic/artistic)abstract Background: Vaginal birth after a previous caesarean (VBAC) is a safe alternative to repeat caesarean section (CS), is the preferred option of most women and may reduce overall CS rates.1 However, VBAC rates vary; e.g., rates in Germany, Ireland and Italy are considerably lower (29-36%) than those in the Netherlands, Sweden and Finland (45-55%). Purpose/Objective: To evaluate the effectiveness of an intervention to maximise VBAC rates. The OptiBIRTH Project was funded by a European Union Grant: FP7-HEALTH-2012-INNOVATION-1-HEALTH.2012.3.2-1. Agreement No:305208 Method: A cluster randomised trial was used. A sample size of 12 maternity units was required, each recruiting 120 consenting women, to detect an absolute 15% difference in successful VBACs (increase from 25% in control to 40% in intervention groups), using an ICC of 0.05, with power of >80% and an alpha of 0.05. To allow for loss to follow-up, 15 trial units were randomised across three countries with low VBAC rates (Germany, Ireland and Italy) and the trial commenced April 2014. An evidence-based intervention was introduced in all intervention sites. Control sites had usual care. Interim analysis by an independent Data Monitoring Committee at mid-point permitted continuation. Data were analysed using intention to treat. Key Findings: Recruitment closed October 2015, with the last babies born in December 2015, and data analysis will be completed in April 2016. The primary outcome, comparison of annual VBAC rates for each hospital before and after introduction of the intervention will be presented, and selected secondary outcomes for the recruited women including: mode of birth, perineal trauma, breastfeeding, uterine rupture, wound breakdown, perinatal mortality, Apgar scores, and admission to neonatal intensive care unit. Discussion: If the OptiBIRTH intervention increases VBAC rates safely, its introduction across Europe could prevent 160,000 unnecessary CSs every year, saving maternity services >€150 million annually and contributing to the normalisation of birth for thousands of women. References: 1 Cunningham et al (2010). National Institute of Health Consensus Development Conference Statement: Vaginal birth after caesarean. Obstet & Gynecol 115(6): 1279-1295. 2 EURO-PERISTAT 2008: CD006066.EURO-PERISTAT Project (2008). European Perinatal Health Report. (www.europeristat.com).
12.	Begley, Cecily, 1954, et al. (author) Outcome measures in studies on the use of oxytocin for the treatment of delay in labour: A systematic review 2014 In: Midwifery. - : Elsevier BV. - 0266-6138. ; 30:9, s. 975-982 Research review (peer-reviewed)abstract Objectives: to identify primary and secondary outcome measures in randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in the first and second stages of labour, and to identify any positive health-focussed outcomes used. Design: eight relevant citation databases were searched up to January 2013 for all randomised trials, and systematic reviews of randomised trials, measuring effectiveness of oxytocin for treatment of delay in labour. Trials of active management of labour or partogram action lines were excluded. 1918 citations were identified. Two reviewers reviewed all citations and extracted data. Twenty-six individual trials and five systematic reviews were included. Primary and secondary outcome measures were documented and analysed using frequency distributions. Findings: most frequent primary outcomes were caesarean section (n=15, 46%), length of labour (n=14, 42%), measurements of uterine activity (n=13, 39%) and mode of vaginal birth (n=9, 27%). Maternal satisfaction was identified a priori by one review and included as a secondary outcome by three papers. No further positive health-focussed outcomes were identified. Key conclusions: outcomes used to measure the effectiveness of oxytocin for treatment of delay in labour are heterogeneous and tend to focus on adverse events. Implications for practice: it is recommended that, in future randomised trials of oxytocin use for delay in labour, some women-centred and health-focussed outcome measures should be used, which may instil a more salutogenic culture in childbirth. © 2014 The Authors.
13.	Begley, Cecily, 1954, et al. (author) Respectful and disrespectful care in the Czech Republic: an online survey 2018 In: Reproductive Health. - : Springer Science and Business Media LLC. - 1742-4755. ; 15 Journal article (peer-reviewed)abstract Background: Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. In the absence of any documented evidence, this study aimed to ascertain maternity care-givers' perceptions of respectful care provided for childbearing women in Czech Republic. Methods: Following ethical approval, an online quantitative survey with qualitative comments was completed by 52 respondents recruited from workshops on promoting normal birth, followed by snowball sampling. The majority were midwives (50%) or doulas (46%) working in one of 51 hospitals, or with homebirths. Chi-square analysis was used for comparisons. Results: Non-evidenced-based interventions, described as 'always' or 'frequently' used in hospitals, included application of electronic fetal monitoring in normal labour (n = 40, 91%), shaving the perineum (n = 10, 29%), and closed-glottal pushing (n = 32, 94%). Positions stated as most often used for spontaneous vaginal births were semi-recumbent (n = 31, 65%) or lying flat (n = 15, 31%) in hospital, and upright at home (n = 27, 100%). Average episiotomy and induction of labour rates were estimated at 40 and 26%, respectively, higher than accepted norms. Eighteen respondents (46%) said reasons for performing vaginal examinations were not explained to women in hospitals, and 21 (51%) said consent was 'never' sought. At home, 25 (89%) said reasons were explained, and permission always' sought (n = 22, 81%). Thirteen (32%) said hospital clinicians explained why artificial rupture of membranes was necessary, but only ten (25%) said they 'always' sought permission. The majority said that hospital clinicians 'never'/'almost never' explained reasons for performing an episiotomy (13 = 34%), gained permission (n = 20, 54%) or gave local anaesthetic (n = 19, 51%). Contrastingly, 17 (100%) said midwives at home explained the reasons for episiotomy and asked permission. When clinicians disagreed with women's decisions, 13 (35%) respondents said women might be told to 'face the consequences', six (16%) stated that the 'psychological pressure' experienced caused women to give up and 'give their permission', and four (11%) said the intervention would be performed 'against her will.' Conclusions: Findings reveal considerable levels of disrespectful, non-evidenced-based, non-consensual and abusive practices that may leave women with life-long trauma.
14.	Carlsson, Jenny, et al. (author) Management of intrapartum care in expected normal childbirth: A prospective cross-sectional survey at a university hospital in Nepal 2016 In: NJF (Nordiskt Jordemoderförbund) Congress. Programme and abstracts. Gothenburg, May 12-14, 2016. - 9789163742699 Conference paper (other academic/artistic)abstract Background Women and children die needlessly in childbirth every day. Appropriate care may prevent this, and keeping birth normal is crucial to reduce the risk of complications. Nepal has radically reduced maternal and neonatal mortality in the last decade, yet the numbers remain high. Of the initiatives implemented by the government to ensure safe motherhood, none focuses on improving normal, physiological processes of childbirth. Aim To study the quality of intra-partum care in expected normal childbirth at a university hospital in Nepal Methods: Following ethical approval, a prospective cross-sectional study using a structured questionnaire was conducted in November 2013. Over three weeks, nurses employed at the labor ward collected data from 292 consecutive women giving birth. Of these, 164 were expected to have a normal childbirth and 107 (65%) were nulliparous. The questionnaire covered; background variables, previous pregnancies and births, current pregnancy, and current labor and birth. Care management was assessed using nine items, including the five that constitute the Bologna score: presence of a companion, use of partograph, absence of augmentation, non-supine position, and skin-to-skin care. Results Births were assisted by physicians (56%), nurses (41%), and medical or nursing students under supervision (2%). The mean Bologna score was 1.43 (variance 0-3, min 0, max 5). Circa half of the women had an episiotomy and two had a postpartum hemorrhage of >500 ml. All women were well after birth, and all infants had an Apgar score ≥7 at five minutes. Conclusion Intra-partum care in expected normal childbirth must be continuously assessed to safe-guard the normal, physiological process. Results indicate a medicalized perspective in the studied setting, including an over-use of medico-technical intervention. One important activity to support normal childbirth is to establish the professional midwife, educated with the right competencies. To support such initiative, further activities including research are needed.
15.	Carroll, M., et al. (author) The prevalence of women's emotional and physical health problems following a postpartum haemorrhage: a systematic review 2016 In: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16 Journal article (peer-reviewed)abstract Background: Postpartum Haemorrhage (PPH) is a leading cause of maternal mortality with approximately 225 women dying as a result of it each day especially in low income countries. However, much less is known about morbidity after a PPH. This systematic review aimed to determine the overall prevalence of emotional and physical health problems experienced by women following a postpartum haemorrhage. Methods: Eight databases were searched for published non-randomised, observational, including cohort, primary research studies that reported on the prevalence of emotional and/or physical health problems following a PPH. Intervention studies were included and data, if available, were abstracted on the control group. All authors independently screened the papers for inclusion. Of the 2210 papers retrieved, six met the inclusion criteria. Data were extracted independently by two authors. The methodological quality of the included studies was assessed using a modified Newcastle Ottawa Scale (NOS). The primary outcome measure reported was emotional and physical health problems up to 12 months postpartum following a postpartum haemorrhage. Results: Two thousand two hundred ten citations were identified and screened with 2089 excluded by title and abstract. Following full-text review of 121 papers, 115 were excluded. The remaining 6 studies were included. All included studies were judged as having strong or moderate methodological quality. Five studies had the sequelae of PPH as their primary focus, and one study focused on morbidity postnatally, from which we could extract data on PPH. Persistent morbidities following PPH (at >= 3 and < 6 months postpartum) included postnatal depression (13 %), post-traumatic stress disorder (3 %), and health status 'much worse than one year ago' (6 %). Due to the different types of health outcomes reported in the individual studies, it was possible to pool results from only four studies, and only then by accepting the slightly differing definitions of PPH. Those that could be pooled reported rates of acute renal failure (0.33 %), coagulopathy (1.74 %) and re-admission to hospital following a PPH between 1 and 3 months postpartum (3.6 %), an appreciable indication of underlying physical problems. Conclusion: This systematic review demonstrates that the existence and type of physical and emotional health problems post PPH, regardless of the volume of blood lost, are largely unknown. Further large cohort or case control studies are necessary to obtain better knowledge of the sequelae of this debilitating morbidity.
16.	Cederfeldt, Johanna, et al. (author) Quality of intra-partum care at a university hospital in Nepal: A prospective cross-sectional survey 2016 In: Sexual & Reproductive HealthCare. - : Elsevier BV. - 1877-5756. ; 7, s. 52-57 Journal article (peer-reviewed)abstract Objective: To investigate the quality of intra-partum care provided to women with an expected normal birth at a university hospital in Nepal. Methods: A prospective cross-sectional study was conducted during three weeks in November 2013. Nurses at the labor ward collected data from 292 consecutive births. Of these, 164 women of low risk were expected to have a normal birth and were included in the study; 107 (65%) were nulliparous. The selfadministered questionnaire covered maternal characteristics, previous pregnancies and births, current pregnancy, labor and birth. Nine items assessed care management, five of which comprised the Bologna score with a total possible score of 5: presence of a companion, use of partograph, non-use of augmentation, non-supine position, and skin-to-skin contact. Results: The women were assisted by physicians (56%), nurses (42%) or students under supervision (2%). All were in good health after birth. Two had a postpartum hemorrhage exceeding 500 ml and 49% had an episiotomy. Apgar score in all neonates was ≥ 7 at five minutes. Mean Bologna score was 1.43 (variance 0-3). Conclusions: The management of care in normal birth could be improved in the studied setting, and there is a need for more research to support such improvement.
17.	Daly, D., et al. (author) Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study 2019 In: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 30:6, s. 965-975 Journal article (peer-reviewed)abstract Introduction and hypothesisAll pregnant women should be given advice on the benefits of pelvic floor muscle exercises (PFMEs) in preventing urinary incontinence (UI) and know how to exercise correctly. This study explored women's knowledge and practice of PFMEs, their sources of knowledge and prevalence of UI before and during pregnancy.MethodsWe conducted a cross-sectional study with 567 women, 239 primiparous and 328 multiparous, recruited from one maternity hospital in Ireland. Logistic regression was used to examine associations.ResultsPre-pregnancy, 41% of women (n=232) learnt to do PFMEs, 30% (n=172) did exercises and 28% (n=159) experienced UI. Women more likely to report UI were aged 35years (p=0.03), had a BMI 30kg/m(2) (p=0.01) or did PFMEs but were unsure they were exercising correctly (p=0.03). During pregnancy, 50% of women (n=281) received PFME information during antenatal visits and 38.6% (n=219) attended antenatal classes. Women less likely to do PFMEs daily or weekly had no formal educational qualification (p=0.01), did not do PFMEs pre-pregnancy (p<0.0001) or did not attend the physiotherapist-led PFME education session (p<0.0001). In multivariable analysis, the two factors significantly associated with UI during pregnancy were being aged 30-34years (p=0.05) and reporting UI pre-pregnancy (p<0.0001).ConclusionsThis benchmarking exercise revealed considerable gaps in the totality of PFME education and services offered in the site hospital. We recommend that others do likewise to enable learning from those who have addressed service deficits.
18.	Daly, D., et al. (author) Stop, think, reflect, realize-first-time mothers' views on taking part in longitudinal maternal health research 2019 In: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 22:3, s. 415-425 Journal article (peer-reviewed)abstract Background Longitudinal cohort studies gather large amounts of data over time, often without direct benefit to participants. A positive experience may encourage retention in the study, and participants may benefit in unanticipated ways. Objective To explore first-time mothers' experiences of taking part in a longitudinal cohort study and completing self-administered surveys during pregnancy and at 3, 6, 9 and 12 months' postpartum. Design Content analysis of comments written by participants in the Maternal health And Maternal Morbidity in Ireland study's five self-completion surveys, a multisite cohort study exploring women's health and health problems during and after pregnancy. This paper focuses on what women wrote about taking part in the research. Ethical approval was granted by the site hospitals and university. Setting and participants A total of 2174 women were recruited from two maternity hospitals in Ireland between 2012 and 2015. Findings A total of 1000 comments were made in the five surveys. Antenatally, barriers related to surveys being long and questions being intimate. Postpartum, barriers related to being busy with life as first-time mothers. Benefits gained included gaining access to information, taking time to reflect, stopping to think and being prompted to seek help. Survey questions alone were described as valuable sources of information. Discussion and conclusions Findings suggest that survey research can "give back" to women by being a source of information and a trigger to seek professional help, even while asking sensitive questions. Understanding this can help researchers construct surveys to maximize benefits, real and potential, for participants.
19.	Daly, Deirdre, et al. (author) Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors. 2018 In: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 29:3, s. 353-362 Journal article (peer-reviewed)abstract While many women report urinary incontinence (UI) during pregnancy, associations with pre-pregnancy urinary leakage remain under-explained.We performed a multi-strand prospective cohort study with 860 nulliparous women recruited during pregnancy.Prevalence of any urinary leakagewas 34.8% before and 38.7% during pregnancy.Prevalence of UI,leaking urine at least once per month,was 7.2% and 17.7% respectively. Mixed urinary incontinence (MUI) was reported by 59.7% of women before and 58.8% during pregnancy, stress urinary incontinence (SUI) by 22.6% and 37.2%, and urge urinary incontinence (UUI) by 17.7% and 4.0%, respectively. SUI accounted for half (50.0%), MUI for less than half (44.2%), and UUI for 5.8% of new-onset UI in pregnancy. Pre-pregnancy UI was significantly associated with childhood enuresis [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.5-5.6, p=0.001) and a body mass index (BMI) ≥30kg/m2 (AOR 4.2, 95% CI 1.9-9.4, p<0.001). Women aged ≥35years (AOR 2.8, 95% CI 1.4-5.9, p=0.005), women whose pre-pregnancy BMI was 25-29.99kg/m2 (AOR 2.0, 95% CI 1.2-3.5, p=0.01), and women who leaked urine less than once per month (AOR 2.6, 95% CI 1.6-4.1, p<0.005) were significantly more likely to report new-onset UI in pregnancy.Considerable proportions of nulliparous women leak urine before and during pregnancy, and most ignore symptoms. Healthcare professionals have several opportunities for promoting continence in all pregnant women, particularly in women with identifiable risk factors. If enquiry about UI, and offering advice on effective preventative and curative treatments, became routine in clinical practice, it is likely that some of these women could become or stay continent.
20.	Dencker, Anna, 1956, et al. (author) Midwife-led maternity care in Ireland - a retrospective cohort study 2017 In: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 17:101 Journal article (peer-reviewed)abstract Background: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods: MLU data for the six years 2008-2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results: During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman's wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1-2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions: Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.
21.	Dencker, Anna, 1956, et al. (author) Midwifery-led childbirth care in Ireland – five years of experience after the MidU trial. 2014 In: Optimising Childbirth Across Europe An Interdisciplinary Maternity Care Conference. 9-10 April 2014, Brussels, Belgium. Conference paper (other academic/artistic)abstract Introduction and aim Midwifery-led maternity and childbirth care is shown to be a safe alternative for women with low-risk during pregnancy. In Ireland, two midwifery-led units (MLUs) have existed as an option since 2004 when a randomised controlled trial (the MidU study) took place to compare MLU care with consultant-led care. Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate the outcomes of one of the MLUs. Methods University ethical approval was granted. MLU data for the five years 2008-2012 were retrospectively analysed. Rates of transfers, reasons for transfers, mode of birth, and maternal and fetal outcomes were assessed. A retrospective analysis with descriptive statistics was performed. Findings During the study period 3162 women were registered at the MLU. The antenatal transfer rate was 38.5% (1217 women). Twenty women gave birth at home, in transit or at the antenatal ward and 1925 women came to labour in the MLU. Throughout labour and birth 417 women (13.2%) transferred to the consultant-led unit, of which 53 women were transferred after birth due to need for suturing, or postpartum hemorrhage. The most common reasons were fetal reason including meconium stained liquor (38.5%), delayed labour progress in first or second stage (29.7%) and woman´s wish for epidural analgesia (19%). At the MLU, 1561 babies were born, of these 1543 (99%) were spontaneous vaginal births and 18 (1%) were instrumental (ventouse/forceps). Only 14 babies (0.9%) were admitted to neonatal intensive care unit. Conclusion Midwifery-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Countries without the option of MLU care should consider their introduction.
22.	Elliott, N., et al. (author) Barriers and enablers to advanced practitioners' ability to enact their leadership role: A scoping review 2016 In: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489. ; 60, s. 24-45 Journal article (peer-reviewed)abstract Background: Advanced roles such as nurse practitioner, nurse consultant and advanced nurse or midwife practitioner are increasing across the world. In most countries, clinical practice, education, leadership and research are the four components that define the advanced practitioner's role. Of these, leadership is perhaps the most important part of the role, but its study has largely been neglected. There is a risk that failure to identify and respond to barriers to enacting the advanced practitioners' leadership role will limit the extent to which they can become strategic leaders for professional development, and jeopardise the long-term sustainability of the role. Objectives: To identify the barriers and enablers to advanced practitioner's ability to enact their leadership role. Data sources: A search of the research literature was undertaken in electronic databases (PubMed, CINAHL, PsycINFO, ProQuest Dissertation and Theses, from inception to 4-6th June 2015), unpublished research in seventeen online research repositories and institutes, and hand search of 2 leadership journals (March/April 2010-4th June 2015). Review methods: Using pre-set inclusion criteria, the 1506 titles found were screened by two authors working independently. The 140 full text reports selected were reviewed by two authors separately and 34 were included, and data extracted and cross-checked. Any disagreements were discussed by the scoping team until consensus was reached. Using content analysis, the barriers and enablers relating to leadership enactment were sorted into themes based on their common characteristics, and using a Structure-Process-Outcome conceptual framework were categorised under the four structural layers: (1) healthcare system-level, (2) organisational-level, (3) team-level, and (4) advanced practitioner-level. Results: Thirteen barriers to, and 11 enablers of, leadership were identified. Of these a majority (n = 14)were related to organisational-level factors such as mentoring, support from senior management, opportunity to participate at strategic level, structural supports for the role, and size of clinical caseload. Advanced practitioner-level factors relating to personal attributes, knowledge, skills and values of the advanced practitioner were identified. Conclusions: Although building leadership capabilities at advanced practitioner-level and team-level are important, without key inputs from healthcare managers, advanced practitioners' leadership enactment will remain at the level of clinical practice, and their contribution as change agents and innovators at the strategic level of service development and development of the nursing profession will be not be realised.
23.	Fobelets, M., et al. (author) Health economic analysis of a cluster-randomised trial (OptiBIRTH) designed to increase rates of vaginal birth after caesarean section 2019 In: BJOG: An International Journal of Obstetrics and Gynaecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 126:8, s. 1043-1051 Journal article (peer-reviewed)abstract Objective: To perform a health economic analysis of an intervention designed to increase rates of vaginal birth after caesarean, compared with usual care. Design: Economic analysis alongside the cluster-randomised OptiBIRTH trial (Optimising childbirth by increasing vaginal birth after caesarean section (VBAC) through enhanced women-centred care). Setting: Fifteen maternity units in three European countries – Germany (five), Ireland (five), and Italy (five) – with relatively low VBAC rates. Population: Pregnant women with a history of one previous lower-segment caesarean section; sites were randomised (3:2) to intervention or control. Methods: A cost–utility analysis from both societal and health-services perspectives, using a decision tree. Main outcome measures: Costs and resource use per woman and infant were compared between the control and intervention group by country, from pregnancy recognition until 3months postpartum. Based on the caesarean section rates, and maternal and neonatal morbidities and mortality, the incremental cost–utility ratios were calculated per country. Results: The mean difference in costs per quality-adjusted life years (QALYs) gained from a societal perspective between the intervention and the control group, using a probabilistic sensitivity analysis, was: €263 (95%CI €258–268) and 0.008QALYs (95%CI 0.008–0.009QALYs) for Germany, €456 (95%CI €448–464) and 0.052QALYs (95%CI 0.051–0.053QALYs) for Ireland, and €1174 (95%CI €1170–1178) and 0.006QALYs (95%CI 0.005–0.007 QALYs) for Italy. The incremental cost–utility ratios were €33,741/QALY for Germany, €8785/QALY for Ireland, and €214,318/QALY for Italy, with a 51% probability of being cost-effective for Germany, 92% for Ireland, and 15% for Italy. Conclusion: The OptiBIRTH intervention was likely to be cost-effective in Ireland and Germany. Tweetable abstract: The OptiBIRTH intervention (to increase VBAC rates) is likely to be cost-effective in Germany and Ireland. © 2019 Royal College of Obstetricians and Gynaecologists
24.	Fobelets, M., et al. (author) Preference of birth mode and postnatal health related quality of life after one previous caesarean section in three European countries 2019 In: Midwifery. - : Elsevier BV. - 0266-6138. ; 79 Journal article (peer-reviewed)abstract Objectives: Women who have had a caesarean section may have a preference for birth mode during their subsequent pregnancy, either ‘vaginal birth after caesarean’ (VBAC) or ‘elective repeat caesarean section’ (ERCS). A mismatch between the preferred and actual birth mode may result in an impaired postnatal Health Related Quality of Life (HRQoL). This study examined the associations between antenatal birth mode preferences, the actual birth mode and postnatal HRQoL in women with one previous caesarean section in three European countries. Design: Prospective longitudinal survey, as a part of a cluster randomised trial (OptiBIRTH) Setting: Fifteen maternity units in three European countries: Germany (5), Ireland (5) and Italy (5). Participants: Women (≥ aged 18 years) living in Germany, Ireland and Italy with one previous caesarean section. The sample consisted of 862 women with complete antenatal and postpartum data. Measurements: Women's preference for birth mode after one previous caesarean section was assessed at inclusion to the trial, and HRQoL was assessed antenatally and at three months postpartum using the Short-Form Six-Dimension health survey. Based on women's preferences and actual birth mode six groups were determined: “match VBAC-VBAC” (preference for vaginal birth, actual mode of birth vaginal birth), “match ERCS-ERCS” (preference for caesarean section, actual mode of birth elective repeat caesarean section), “match ERCS-EMCS” (preference for caesarean section, actual mode of birth emergency repeat caesarean section), “mismatch VBAC-ERCS” (preference for vaginal birth, actual mode of birth elective repeat caesarean section), “mismatch VBAC-EMCS” (preference for vaginal birth, actual mode of birth emergency repeat caesarean section) and “no preference”. Associations between the preferred and actual birth mode were examined using univariate and multivariate analyses. Findings: Women with preference for vaginal birth but who gave birth by elective repeat caesarean section (mismatch VBAC-ERCS) had a lower postnatal HRQoL compared to women with a preference for vaginal birth who actually had a birth vaginally (match VBAC-VBAC, p = 0.02). Poor antenatal HRQoL scores (p < 0.01) and maternal readmission postpartum (p = 0.03) are cofounding factors for poorer postnatal HRQoL scores. Key conclusions: The results show that women with a preference for a vaginal birth who gave birth by an elective repeat caesarean section had a significantly lower HRQoL at three months postnatal. The long-term consequences and psychological health of women who do not achieve a vaginal birth after caesarean require further consideration and research. Implications for practice: Attention should be given to the long-term impact of a mismatch in preferred and actual mode on the psychological health of women. © 2019 Elsevier Ltd
25.	Fobelets, M., et al. (author) Vaginal birth after caesarean versus elective repeat caesarean delivery after one previous caesarean section: a cost-effectiveness analysis in four European countries 2018 In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18, s. 1-10 Journal article (peer-reviewed)abstract Background: The OptiBIRTH study incorporates a multicentre cluster randomised trial in 15 hospital sites across three European countries. The trial was designed to test a complex intervention aimed at improving vaginal birth after caesarean section (VBAC) rates through increasing women's involvement in their care. Prior to developing a robust standardised model to conduct the health economic analysis, an analysis of a hypothetical cohort was performed to estimate the costs and health effects of VBAC compared to elective repeat caesarean delivery (ERCD) for low-risk women in four European countries. Methods: A decision-analytic model was developed to estimate the costs and the health effects, measured using Quality Adjusted Life Years (QALYs), of VBAC compared with ERCD. A cost-effectiveness analysis for the period from confirmation of pregnancy to 6 weeks postpartum was performed for short-term consequences and during lifetime for long-term consequences, based on a hypothetical cohort of 100,000 pregnant women in each of four different countries; Belgium, Germany, Ireland and Italy. A societal perspective was adopted. Where possible, transition probabilities, costs and health effects were adapted from national data obtained from the respective countries. Country-specific thresholds were used to determine the cost-effectiveness of VBAC compared to ERCD. Deterministic and probabilistic sensitivity analyses were conducted to examine the uncertainty of model assumptions. Results: Within a 6-week time horizon, VBAC resulted in a reduction in costs, ranging from €3,334,052 (Germany) to €66,162,379 (Ireland), and gains in QALYs ranging from 6399 (Italy) to 7561 (Germany) per 100,000 women birthing in each country. Compared to ERCD, VBAC is the dominant strategy in all four countries. Applying a lifetime horizon, VBAC is dominant compared to ERCD in all countries except for Germany (probabilistic analysis, ICER: €8609/QALY). In conclusion, compared to ERCD, VBAC remains cost-effective when using a lifetime time. Conclusions: In all four countries, VBAC was cost-effective compared to ERCD for low-risk women. This is important for health service managers, economists and policy makers concerned with maximising health benefits within limited and constrained resources.
26.	Gillen, P. A., et al. (author) Interventions for prevention of bullying in the workplace 2017 In: Cochrane Database of Systematic Reviews. ; 2017:1 Research review (peer-reviewed)
27.	Goldkuhl, Lisa, 1983, et al. (author) Room4Birth – The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial 2022 In: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5764 .- 1877-5756. ; 32 Journal article (peer-reviewed)abstract Objective: To evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms. Methods: A randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic. Results: A total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90–2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71–0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001). Conclusions: The hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.
28.	Gross, Mechthild M., et al. (author) Women's experiences on VBAC: results of a metasynthesis 2014 In: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium.. Conference paper (other academic/artistic)abstract Background: More and more women experience a caesarean section with their first, or later, birth. During a subsequent pregnancy they experience a challenging period of decision making on the mode of birth. Vaginal birth after caesarean section (VBAC) is a relevant option for a large number of women. Despite lots of quantitative studies on VBAC there is a lack of studies that report the experiences of women. Aim of review: To report the main themes of women’s experiences of VBAC. Search strategy: The following databases were searched: CINAHL, EBSCO, Journals@ OVID, Pubmed, PSYCHINFO, using the keywords VBAC, vaginal birth after caesarean section, qualitative study, experiences, qualitative and women´s experiences in various combinations. Review methodology: In total, 1981 papers were identified; of these, 1959 had to be excluded. From the remaining 22 papers eleven were excluded at this stage, as not focusing on women´s experiences, or only focusing on experiences of CS in relation to VBAC. A metasynthesis based on the interpretative meta ethnography method was conducted. Main findings: Four final themes became obvious: ‘to be involved in decision about mode of delivery is difficult but important,’ ‘vaginal birth has several positive aspects mainly described by women,’ ‘vaginal birth after CS is a risky project,’ and ‘own strong responsibility for giving birth vaginally’. The papers discussed issues such as the women´s experience in relation to different aspects of VBAC, decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. Conclusion: It became obvious that women may feel as though they are in a fog when preparing for a VBAC. Women need evidence-based information not only about the risks involved but also about positive aspects of VBAC.
29.	Healy, P., et al. (author) Process evaluation for OptiBIRTH, a randomised controlled trial of a complex intervention designed to increase rates of vaginal birth after caesarean section 2018 In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 19 Journal article (peer-reviewed)abstract Background: Complex interventions encompassing several interconnecting and interacting components can be challenging to evaluate. Examining the underlying trial processes while an intervention is being tested can assist in explaining why an intervention was effective (or not). This paper describes a process evaluation of a pan-European cluster randomised controlled trial, OptiBIRTH (undertaken in Ireland, Italy and Germany), that successfully used both quantitative and qualitative methods to enhance understanding of the underlying trial mechanisms and their effect on the trial outcome. Methods: We carried out a mixed methods process evaluation. Quantitative and qualitative data were collected from observation of the implementation of the intervention in practice to determine whether it was delivered according to the original protocol. Data were examined to assess the delivery of the various components of the intervention and the receipt of the intervention by key stakeholders (pregnant women, midwives, obstetricians). Using ethnography, an exploration of perceived experiences from a range of recipients was conducted to understand the perspective of both those delivering and those receiving the intervention. Results: Engagement by stakeholders with the different components of the intervention varied from minimal intensity of women's engagement with antenatal classes, to moderate intensity of engagement with online resources, to high intensity of clinicians' exposure to the education sessions provided. The ethnography determined that, although the overall culture in the intervention site did not change, smaller, more individual cultural changes were observed. The fidelity of the delivery of the intervention scored average quality marks of 80% and above on repeat assessments. Conclusion: Nesting a process evaluation within the trial enabled the observation of the mode of action of the intervention in its practice context and ensured that the intervention was delivered with a good level of consistency. Implementation problems were identified as they arose and were addressed accordingly. When dealing with a complex intervention, collecting and analysing both quantitative and qualitative data, as we did, can greatly enhance the process evaluation.
30.	Lundgren, Ingela, 1957, et al. (author) Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review 2015 In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 15:16 Journal article (peer-reviewed)abstract BackgroundThe number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.MethodsThe bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, `Effective Public Health Practice Project¿. The primary outcome measure was VBAC rates.Results238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.ConclusionsThis systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.
31.	Lundgren, Ingela, 1957, et al. (author) Clinicians views of factors of importance for improving the rate of vaginal births after caesarean section (VBAC) - A study from countries with high and low VBAC-rates 2014 In: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium.. Conference paper (other academic/artistic)abstract Introduction: This study is a part of the ongoing 4-year OptiBIRTH project, which is funded by EU and involving eight European countries. The key aim of the project is to promote increased VBAC rates across Europe. Repeat caesarean section (CS) following previous CS is one of the most significant factors contributing to increased CS rates in the EU. Even though VBAC is the recommended option associated with better outcomes for both mothers and babies, vaginal birth rates after CS vary widely through healthcare settings and countries across Europe. It is important to obtain a deeper knowledge about clinician’s views on VBAC in different countries to understand important factors for improving VBAC rates. The findings of this study will assist in the development of educational interventions targeted towards both clinicians and women, and tested in an upcoming randomised trial in three European countries with low VBAC rates. Aim of the study: The aim with this study was to investigate clinicians’ views on important factors for improving the rate of VBAC in women. Research methodology: Individual interviews, telephone interviews and focus groups interviews with clinician’s (doctors and midwives as well as GPs in different maternity care settings and in rural and urban regions) have been conducted in six countries during 2012-2013; Finland, the Netherlands, Sweden (high VBAC rate), Ireland, Italy, Germany (low VBAC rate). In total about 115 clinicians were interviewed. They answered five questions about VBAC and participation in decision-making. The interviews were analysed using content analysis. Ethical approval: Approval was obtained from study sites in each country. Study findings and conclusions: Findings from this ongoing study will be presented at the congress under the domains: important factors for VBAC, barriers for VBAC, views on decision-making, and support for VBAC.
32.	Lundgren, Ingela, 1957, et al. (author) Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section) : a study from countries with low VBAC rates. 2016 In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16:1 Journal article (peer-reviewed)abstract BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship.CONCLUSIONS: The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.
33.	Lundgren, Ingela, 1957, et al. (author) Cultural perspectives on vaginal birth after previous caesarean sectionin countries with high and low VBAC rates – a hermeneutic study 2019 In: Women & Birth. - : Elsevier BV. - 1871-5192. Journal article (peer-reviewed)abstract BackgroundCaesarean section (CS) rates are increasing worldwide, an increase that is multifactorial and not well understood. There is considerable variation in the rates of vaginal birth after previous Caesarean section (VBAC). Cultural differences could be one explanation of the varying rates.ObjectiveTo interpret cultural perspectives on VBAC.MethodsA hermeneutic approach for analysing findings from four published qualitative studies that were part of the OptiBIRTH study, focusing on clinicians and women’s views of important factors for improving the rate of VBAC. 115 clinicians and 73 women participated in individual interviews and focus group interviews in countries with low rates (Germany, Italy and Ireland) and countries with high rates (Sweden, Finland and the Netherlands), in the original studies.ResultsThree themes demonstrated how the culture differs between the high and low VBAC rate countries; from being an obvious first alternative to an issue dependent on many factors; from something included in the ordinary care to something special; and from obstetrician making the final decision to a choice by the woman. The fourth theme, preparing for a new birth by early follow-up and leaving the last birth behind, reflects coherence between the cultures.DiscussionThe findings deepen our understanding of why the VBAC rates vary across countries and healthcare settings, and can be used for improving the care for women.ConclusionIn order to improve VBAC rates both maternity care settings and individual professionals need to reflect on their VBAC culture, and make make changes to develop a ‘pro-VBAC culture’.
34.	Lundgren, Ingela, 1957, et al. (author) 'Groping through the fog': a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section) 2012 In: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 12:1 Journal article (peer-reviewed)abstract Background: Vaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences. Aim: To integrate qualitative findings and deepen the understanding of women's experiences of VBAC. Method: A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis. Results: The included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: 'to be involved in decision about mode of delivery is difficult but important,' 'vaginal birth has several positive aspects mainly described by women,' 'vaginal birth after CS is a risky project,' and 'own strong responsibility for giving birth vaginally'. Conclusion: In order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC.
35.	Lundgren, Ingela, 1957, et al. (author) How can the VBAC rates be improved – according to midwives and obstetricians in six European countries. 2017 In: 31th ICM Trienníal Congress 18-22 June 2017. Conference paper (other academic/artistic)abstract Background: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after CS (VBAC) rates vary widely in different healthcare settings and countries. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of ‘OptiBIRTH’, a research project funded by EU aiming to increase VBAC rates across Europe through enhanced woman-centred maternity care. Purpose/Objective: To investigate the views of clinicians on factors of importance for improving VBAC rates. Method: Individual interviews and focus group interviews with clinicians in six countries with high and low VBAC rates were conducted during 2012–2013. 115 clinicians participated: 61 midwives and 54 physicians. Five questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language, translated into English, analysed together, and finally categories were validated in each country. Key Findings: According to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are a common approach, obstetricians’ final decision on the mode of birth, support during birth, and the strengthening of women’s trust in VBAC. Therefore the structure of the maternity care system in the country, cooperation between midwives and obstetricians, and the care offered during pregnancy and birth should be focused. Findings from the low VBAC countries will be presented at the conference and shows similarities in some aspects but also major differences. Discussion: Similarities and differences between factors of importance for improving the VBAC rate are related to both the care structure, and the views and attitudes of midwives and physicians, which has implications for the care of women post CS.
36.	Lundgren, Ingela, 1957, et al. (author) Vaginal birth after a previous CS –what is the best option and how decide? 2016 In: NJF Congress, May 12-14, 2016, Göteborg, Sverige.. - 9789163742699 Conference paper (other academic/artistic)abstract Background: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining knowledge about the differences across Europe, and women´s and clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Aim: The aim is to discuss the best birthing option for women with a previous CS and the decision-making process between VBAC or CS, based on a summary of research and findings from OptiBIRTH, an ongoing study. Methods: OptiBIRTH is a cluster randomised trial, funded by the European Commission, aiming to increase VBAC rates across Europe through enhanced woman-centred maternity care. An intervention is being tested in Italy, Germany and Ireland based on two systematic reviews and interviews with 71 women and 115 clinicians (midwives and obstetricians) in these countries as well as in countries with high VBAC rates (Finland, Sweden and the Netherlands). Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results: The European perspective related to best option and decision-making, derived from systematic reviews of interventions for clinicians and interventions for women, will be presented and led by Cecily Begley. Women´s views and clinicans´views of best option and how to decide will be presented and led by Christina Nilsson (women) and Ingela Lundgren (clinicians). Findings showed that both women and clinicians wished to have more knowledge about the benefits and drawbacks of VBAC and repeat CS. Conclusion: The evidence-based intervention now includes education of women and information-giving to clinicians, and then bringing both groups together to discuss future birthing plans.
37.	Marchi, Jamile, et al. (author) Mother and baby risks associated with obesity in pregnancy: a systematic review of reviews 2015 In: 16th Healthcare Interdisciplinary Research Conference, 4 – 5 November 2015, at Trinity College Dublin, School of Nursing and Midwifery. Conference paper (other academic/artistic)abstract •Aim To synthesise the findings from all systematic reviews conducted on maternal obesity in order to identify the risk of adverse outcomes on mother and baby. •Background Obesity in pregnancy is linked to a number of maternal and foetal complications. The prevalence of obesity in pregnancy (20-33%) has increased worldwide and has become a central public health issue. •Search and review methodology A protocol was developed a priori. Reviews that compared pregnant women of healthy weight with those who were obese (BMI >30), and reported on a health outcome for mother and/or baby, were eligible for inclusion. PubMed, CINAHL, Cochrane and Scopus databases were searched. Reviews were selected by inclusion criteria, and quality-assured using AMSTAR, independently by all authors, and checked by a second reviewer. •Findings Twenty-two systematic reviews, from a total of 573 original studies, met inclusion and quality criteria. Women with obesity in pregnancy were at increased risk of having an instrumental birth, caesarean section, surgical site infection, depression, gestational hypertension, diabetes mellitus and pre-eclampsia compared to women of healthy weight. Babies of women with obesity were at increased risk of preterm birth, being large-for-gestational-age, having fetal defects or congenital anomalies, perinatal death and neonatal death. Obesity in pregnancy was also associated with lower breastfeeding initiation rates and breastfeeding for a shorter time. •Conclusions and Implications This is the first review of reviews summarising outcomes associated with maternal obesity. The results show the negative impact obesity in pregnancy has on maternal and neonatal outcomes. Women need support to lose weight prior to becoming pregnant, and to avoid excessive weight gain in pregnancy. Additional reviews investigating factors that help women to lose weight before pregnancy and maintain healthy weight during pregnancy are warranted.
38.	Marchi, J., et al. (author) Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews 2015 In: Obesity Reviews. - : Wiley. - 1467-7881. ; 16:8, s. 621-638 Research review (peer-reviewed)abstract Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full-text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.
39.	Marchi, Jamile, et al. (author) Risks for the mother and baby associated with obesity in pregnancy: a systematic review of reviews 2015 In: Poster presentation abstract at Hot Topic Conference: Obesity & Pregnancy 2015, that took place 29-30th October 2015 in London, UK.. Conference paper (other academic/artistic)abstract Risks for the mother and baby associated with obesity in pregnancy: a systematic review of reviews Background: One- to two-thirds of women in reproductive age are overweight or obese in the US and Europe. Obesity is associated with maternal and neonatal complications and has become an issue of concern for policy-makers, healthcare providers and researchers. Aim: This systematic review of systematic reviews, conducted in 2014, aimed to pool the findings on the risks of adverse outcomes in relation to maternal obesity. Methodology: A protocol was developed a priori and a comprehensive search was conducted using the databases PubMed, CINAHL, Cochrane and Scopus from inception to May 2014. Reviews that compared pregnancy outcomes in women of healthy weight to outcomes in women with obesity were eligible for inclusion. Findings: Twenty-two of the 624 original studies met inclusion criteria and methodological quality criteria using AMSTAR. Pooled findings showed that pregnant women with obesity were more likely to develop depression, gestational hypertension, diabetes mellitus, pre-eclampsia and have increased rates of instrumental birth, caesarean section and surgical site infection compared to women of healthy weight. Babies of women with obesity during pregnancy were at greater risk of being born preterm, being large-for-gestational-age, having a fetal defect, congenital anomaly or dying in the perinatal or neonatal period compared with babies of women of healthy weight. Also, women with obesity were less likely to initiate breastfeeding and more likely to breastfeed for a shorter time. Conclusion: Maternal obesity increases the risk for a range of maternal and neonatal complications. Women planning pregnancy need support to help them lose weight prior to conception.
40.	Nilsson, Christina, 1959, et al. (author) Vaginal Birth After Caesarean: Views of women from countries with low VBAC rates 2017 In: Women and Birth. - : Elsevier BV. - 1871-5192 .- 1878-1799. ; 30:6, s. 481-490 Journal article (peer-reviewed)abstract Problem and background: Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women´s views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low. Aim: To investigate women’s views on important factors to improve the rate of vaginal birth after caesarean in countries where vaginal birth rates after caesarean rates are low. Methods: A qualitative study using content analysis. Data were gathered through focus groups and individual interviews with 51 women, in their native languages, in Germany, Ireland and Italy. The women were asked five questions about vaginal birth after caesarean. Data were translated to English, analysed together and finally validated in each country. Findings: Important factors for the women were that all involved in caring for them were of the same opinion about vaginal birth after caesarean section, thet they experience shared decision-making with clinicians supportive of vaginal birth, receive correct information, are sufficently prepared for a vaginal birth, and experience a culture that supports vaginal birth after caesarean section. Discussion and conclusion: Women’s decision-making about vaginal birth after caesarean in these countries involves a complex, multidimensional interplay of medical, psychological, social, cultural, personal and practical considerations. Further research is needed to explore if the information deficit women report negatively affects their ability to make informed choices, and to understand what matters most to women when making decisions about vaginal birth after caesarean as a mode of birth.
41.	Nilsson, Christina, 1959, et al. (author) Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review 2015 In: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 31:7, s. 657-663 Journal article (peer-reviewed)abstract Objective: to evaluate the effectiveness of women centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean. Design: we searched bibliographic databases for randomised trials or cluster randomised trials on women centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors. Findings: in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women's decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth. Key conclusions: few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates. Implications for practice: decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women's decisional conflict and increase their knowledge about possible modes of birth. (C) 2015 Elsevier Ltd. All rights reserved.
42.	Nilsson, Christina, 1959, et al. (author) Women's views of factors of importance for improving the rate of vaginal births after caesarean section (VBAC): A study from countries with high and low VBAC-rates 2014 In: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium.. Conference paper (other academic/artistic)
43.	Nilvér, Helena, 1980, et al. (author) Measuring women's childbirth experiences: a systematic review for identification and analysis of validated instruments 2017 In: BMC Pregnancy Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 17 Journal article (peer-reviewed)abstract Background: Women's childbirth experience can have immediate as well as long-term positive or negative effects on their life, well-being and health. When evaluating and drawing conclusions from research results, women's experiences of childbirth should be one aspect to consider. Researchers and clinicians need help in finding and selecting the most suitable instrument for their purpose. The aim of this study was therefore to systematically identify and present validated instruments measuring women's childbirth experience. Methods: A systematic review was conducted in January 2016 with a comprehensive search in the bibliographic databases PubMed, CINAHL, Scopus, The Cochrane Library and PsycINFO. Included instruments measured women's childbirth experiences. Papers were assessed independently by two reviewers for inclusion, and quality assessment of included instruments was made by two reviewers independently and in pairs using Terwee et al's criteria for evaluation of psychometric properties. Results: In total 5189 citations were screened, of which 5106 were excluded by title and abstract. Eighty-three full-text papers were reviewed, and 37 papers were excluded, resulting in 46 included papers representing 36 instruments. These instruments demonstrated a wide range in purpose and content as well as in the quality of psychometric properties. Conclusions: This systematic review provides an overview of existing instruments measuring women's childbirth experiences and can support researchers to identify appropriate instruments to be used, and maybe adapted, in their specific contexts and research purpose.
44.	O'Malley, D., et al. (author) Prevalence of and risk factors associated with sexual health issues in primiparous women at 6 and 12 months postpartum; a longitudinal prospective cohort study (the MAMMI study) 2018 In: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18:196 Journal article (peer-reviewed)abstract Background: Many women are not prepared for changes to their sexual health after childbirth. The aim of this paper is to report on the prevalence of and the potential risk factors (pre-pregnancy dyspareunia, mode of birth, perineal trauma and breastfeeding) for sexual health issues (dyspareunia, lack of vaginal lubrication and a loss of interest in sexual activity) at 6 and 12 months postpartum. Methods: A longitudinal cohort study of 832 first-time mothers who were recruited in early pregnancy and returned postnatal surveys at 3, 6, 9 and 12 months postpartum were assessed for sexual health issues and associated risk factors. Results: Nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth. On univariate analysis, vacuum-assisted birth, 2nd degree perineal tears, 3rd degree perineal tears and episiotomy were all associated with dyspareunia 6 months postpartum, but, of these only 3rd degree tears, in association with breastfeeding and pre-existing dyspareunia, remained significant on multivariable analysis. Breastfeeding, in combination, with other significant factors, was associated with dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity 6 months postpartum, and, dissatisfaction with body image emerged as a significant factor associated with lack of interest in sexual activity at 12 months postpartum. Pre-pregnancy dyspareunia and breastfeeding emerged as common factors associated with all three outcomes of dyspareunia, a lack of vaginal lubrication and a loss of interest in sexual activity at 6 months postpartum. Conclusion: Breastfeeding and pre-existing dyspareunia are associated with sexual health issues at 6 months postpartum. Pre-existing dyspareunia is associated with a lack of vaginal lubrication at 12 months postpartum and breastfeeding is associated with dissatisfaction with body image. Preparing women and their partners during the antenatal period and advising on simple measures, such as use of lubrication to avoid or minimise sexual health issues, could potentially remove stress, anxiety and fears regarding intimacy after birth. Introducing the topic of pre-existing sexual health issues antenatally may facilitate appropriate support, treatment or counselling for women.
45.	Panda, S., et al. (author) Clinicians' views of factors influencing decision-making for caesarean section: A systematic review and metasynthesis of qualitative, quantitative and mixed methods studies 2018 In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:7 Journal article (peer-reviewed)abstract Background Caesarean section rates are increasing worldwide and are a growing concern with limited explanation of the factors that influence the rising trend. Understanding obstetricians' and midwives' views can give insight to the problem. This systematic review aimed to offer insight and understanding, through aggregation, summary, synthesis and interpretation of findings from studies that report obstetricians' and midwives' views on the factors that influence the decision to perform caesarean section. The electronic databases of PubMed (1958-2016), CINAHL (1988-2016), Maternity and Infant Care (1971-2016), PsycINFO (1980-2016) and Web of Science (1991-2016) were searched in September 2016. All quantitative, qualitative and mixed methods studies, published in English, whose aim was to explore obstetricians' and/or midwives' views of factors influencing decision-making for caesarean section were included. Papers were independently reviewed by two authors for selection by title, abstract and full text. Thomas et al's 12 assessment criteria checklist (2003) was used to assess methodological quality of the included studies. The review included 34 studies: 19 quantitative, 14 qualitative, and one using mixed methods, involving 7785 obstetricians and 1197 midwives from 20 countries. Three main themes, each with several subthemes, emerged. Theme 1: "clinicians' personal beliefs"-('Professional philosophies'; 'beliefs in relation to women's request for CS'; 'ambiguous versus clear clinical reasons'); Theme 2: "health care systems"-('litigation'; 'resources'; 'private versus public/insurance/payments'; 'guidelines and management policy'). Theme 3: "clinicians' characteristics" ('personal convenience'; 'clinicians' demographics'; 'confidence and skills'). This systematic review and metasynthesis identified clinicians' personal beliefs as a major factor that influenced the decision to perform caesarean section, further contributed by the influence of factors related to the health care system and clinicians' characteristics. Obstetricians and midwives are directly involved in the decision to perform a caesarean section, hence their perspectives are vital in understanding various factors that have influence on decision-making for caesarean section. These results can help clinicians identify and acknowledge their role as crucial members in the decision-making process for caesarean section within their organisation, and to develop intervention studies to reduce caesarean section rates in future.
46.	Panda, S., et al. (author) Factors influencing decision-making for caesarean section in Sweden - a qualitative study 2018 In: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18 Journal article (peer-reviewed)abstract Background: Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. Methods: A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo (c) and thematically analysed. Ethical approval was granted by Trinity College Dublin. Results: The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but ...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. Conclusion: Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.
47.	Panda, S., et al. (author) Readmission following caesarean section: Outcomes for women in an Irish maternity hospital 2016 In: British Journal of Midwifery. - : Mark Allen Group. - 0969-4900 .- 2052-4307. ; 24:5, s. 322-328 Journal article (peer-reviewed)abstract Background: Women who give birth by caesarean section are more likely to require readmission to hospital following birth compared to women who give birth vaginally. Aims: To examine the reasons, management and outcomes for women readmitted to hospital following birth by caesarean section (CS). Methods: A retrospective audit of maternity records was undertaken. Findings: The total number of births for the period of data extraction was 8580, of which 2470 (28.79%) women gave birth by CS. A total of 107 women (4.33% of those who gave birth by CS) were readmitted to hospital between 1 August 2014 and 31 July 2015, of which 46 women (1.86%) were readmitted following elective CS and 61 (2.47%) following emergency CS. The average length of hospital stay was 2.64 and 4.61 nights, respectively, and the average timeline for readmission was 14.6 days following elective CS and 15.7 following emergency CS. The most common reason for readmission was wound infection, with the majority of women requiring analgesics (n=29, 63.05% following elective CS and n=51, 83.61% following emergency CS) and intravenous antibiotics (n=23, 50% following elective CS and n=34, 55.74% following emergency CS). Conclusions: Abdominal wound infection is one of the most common reasons for readmission of women to hospital following birth by CS. These findings will make it easier to understand and identify women at risk of postpartum morbidity following birth by CS. © 2016 MA Healthcare Ltd.
48.	Patel, Harshida, 1958, et al. (author) What About Fathers When Their Partner Suffers From Peripartum Cardiomyopathy? 2019 In: Sigma Nursing Repository. - USA. Conference paper (peer-reviewed)abstract Background: Peripartum cardiomyopathy (PPCM) is a life threatening condition and defined as: An idiopathic cardiomyopathy presenting with heart failure (HF) secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause of HF is found. The left ventricle may not be dilated but the ejection fraction is nearly always reduced below 45% [1]. The diagnosis of PPCM in women can be a transition trigger for fathers, exacerbating the disruptions created in transition to fatherhood. In Sweden, policy enables fathers to take paternal leave, with an allowance, instead of the mother [2]. Such policy practices clearly provide a supportive structure for fathers’ transition to a new role, and have been advocated in the international arena. The World Health Organization (WHO) [3] calls for a broader understanding from healthcare professionals of paternity and men's needs and perspectives related to perinatal care. A meta-synthesis, with data from different continents showed that fathers wish to be included during labour and birth, to support their partner in an adequate manner [4]. Despite this, there appears to be a lack of awareness and recognition by health professionals of the benefits of effective paternal involvement in maternity care [5]. Although structured support systems are developed, these systems tend to be based on the healthcare providers’ perceptions and focus mainly on mothers’ care. Fathers’ vital role in supporting their partners has been advocated in previous research. However, the impact of PPCM on the male partners of women is less understood. This is the first qualitative study about men’s experiences of healthcare while their partner is suffering from PPCM. Aim: To explore the experiences of healthcare in fathers whose partner was suffering from Peripartum cardiomyopathy. Methods: The data from interviews with fourteen fathers were analyzed using inductive content analysis. Results: Being prepared and receiving clear information were essential elements of a positive experience that would support fathers to help their partner in the best way. The birth of the child was an exciting experience, but a feeling of helplessness was central, related to seeing their partner suffering. The negative experiences were related mainly to feelings of being at the periphery due to lack of attention paid by professionals. Lack of timely information did not allow fathers to understand their partner´s distress, and plan for the future. Because the fathers did not directly understand the situation, frustrations arose related to uncertainty and insecurity. An overarching category “The professionals could have made a difference” was identified from the data, characterized by the sub-categories: ‘To be informed/not informed, ’‘To feel secure/insecure, ’‘To feel visible/invisible’ and ‘Wish that it had been different’ [6]. Conclusion: The fathers are not patient nor visitor, and are in between somewhere, acting as a carer and protector for the woman and their children. Professionals, by being attentive to fathers’ need may increase fathers’ self-confidence and help in developing strategies to handle the actual transition. When men, as partners of women with PPCM, get adequate information of their partner´s condition, they gain a sense of security and control that gives them strength to handle their personal and emotional life situation during the transition of becoming a father, along with taking care of an ill partner with PPCM. Hence, maternity professionals should also focus on fathers’ particular needs to help them fulfil their roles.
49.	Rusner, Marie, 1958, et al. (author) Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes 2016 In: Bmc Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 16 Journal article (peer-reviewed)abstract Background: Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy. Methods: An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared. Results: The search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities. Discussion: Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis. Conclusions: It is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction.
50.	Sinclair, Marlene, et al. (author) Assisting women in autonomous decision making about vaginal birth after C section (VBAC): Designing motivational Apps in OptiBIRTH cluster randomised trial (ISRCTN10612254 2017 In: 31th ICM Triennial Congress 18-22 June 2017. Conference paper (other academic/artistic)abstract Background: Optibirth is a funded FP7 research programme using a cluster randomised trial in Ireland, Germany and Italy, with 15 clusters of 94 women per cluster. The aim of OptiBIRTH is to evaluate the effectiveness of a complex intervention aimed at increased VBAC rates through enhanced women-centred care1 .The intervention consisted of motivationally enhanced, evidence-based, educational information for women and clinicians for use in face to face and online modes. Purpose/Objective: This paper reports the design process associated with creating three interrelated mobile apps, as part of a complex intervention, to enable women with a previous caesarean section to decide autonomously between a repeat caesarean section and a vaginal birth. The emphasis has been on using technology creatively and effectively maximizing optimality bearing in mind the needs of the new “Z” generation. Method: Focus groups were undertaken across six European countries to illicit women’s need for information about caesarean section and VBAC. Motivational theory underpinned the development of subsequent e-learning materials to enhance woman-led-decision-making. Ethical approval was obtained from Trinity College University, Dublin. Following analysis of focus group data, consultation with experts and exploration of technological solutions, three electronic applications were designed. Following three iterations, the Apps were reviewed for content, motivational design and functionality by Irish, German and Italian midwifery experts and translated into German and Italian. Key Findings: The following interrelated Apps were designed to provide women and health professionals with rapid access to women’s perceptions of their previous birth experience and their current decision-making-in-progress: “My birth story” uses a wordle to communicate past birth experience “My birth thoughts” enables women to communicate their current decision making “My Birth plan” generates a personalised birth plan Discussion: Discussion will focus on challenges facing midwives including, embedding the Apps into a motivationally-designed portal, staff support and training, timeline, cultural differences and translation issues

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Author/Editor: Begley, Cecily, 1954 (55); Berg, Marie, 1955 (15); Lundgren, Ingela, 19 ... (14); Daly, D. (13); Dencker, Anna, 1956 (10); Patel, Harshida, 195 ... (9); show more...; Nilsson, Christina (8); Nicoletti, Jane (8); Lalor, Joan (8); Nilsson, Christina, ... (7); Smith, V (6); Vehvilainen-Julkunen ... (6); Schaufelberger, Mari ... (5); Devane, Declan (5); Morano, Sandra (5); Smith, Valerie (5); Grylka-Baeschlin, Su ... (5); Carroll, Margaret (5); Devane, D. (5); Gross, Mechthild (4); Healy, Patricia (4); Van Limbeek, Evelien (4); Sparud Lundin, Carin ... (3); Clarke, Mike (3); Panda, S (3); Wigert, Helena, 1960 (3); McCann, C. (3); Daly, Deirdre (3); Sinclair, M (3); Carroll, M. (3); Beeckman, K. (3); Gross, M. M. (3); Reilly, M (2); Dixon, L (2); Hessman, Eva, 1961 (2); Higgins, A (2); Sjöblom, Helen, 1976 (2); Carlsson, Jenny (2); Guilliland, K. (2); Keegan, C. (2); Sinclair, Marlene (2); Putman, Koen (2); Beech, Beverly (2); Nieuwenhuijze, Maria ... (2); Wiseman, Hugh (2); Savage, Gerard (2); Newell, John (2); Stockdale, Janine (2); Bondas, Terese (2); Cederfeldt, Johanna (2); show less...

University: University of Gothenburg (55); University of Borås (9); Uppsala University (1); Mid Sweden University (1); Chalmers University of Technology (1); Swedish University of Agricultural Sciences (1)

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