uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Rubertsson, ChristineORCID iD iconorcid.org/0000-0001-7416-6335
Publications (10 of 62) Show all publications
Cato, K., Sylvén, S. M., Georgakis, M. K., Kollia, N., Rubertsson, C. & Skalkidou, A. (2019). Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding six weeks postpartum: a longitudinal population-based study. BMC Pregnancy and Childbirth, 19, Article ID 49.
Open this publication in new window or tab >>Antenatal depressive symptoms and early initiation of breastfeeding in association with exclusive breastfeeding six weeks postpartum: a longitudinal population-based study
Show others...
2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 49Article in journal (Refereed) Published
Abstract [en]

Background

Depressive symptoms negatively impact on breastfeeding duration, whereas early breastfeeding initiation after birth enhances the chances for a longer breastfeeding period. Our aim was to investigate the interplay between depressive symptoms during pregnancy and late initiation of the first breastfeeding session and their effect on exclusive breastfeeding at six weeks postpartum.

Methods

In a longitudinal study design, web-questionnaires including demographic data, breastfeeding information and the Edinburgh Postnatal Depression Scale (EPDS) were completed by 1217 women at pregnancy weeks 17–20, 32 and/or at six weeks postpartum. A multivariable logistic regression model was fitted to estimate the effect of depressive symptoms during pregnancy and the timing of the first breastfeeding session on exclusive breastfeeding at six weeks postpartum.

Results

Exclusive breastfeeding at six weeks postpartum was reported by 77% of the women. Depressive symptoms during pregnancy (EPDS> 13); (OR:1.93 [1.28–2.91]) and not accomplishing the first breastfeeding session within two hours after birth (OR: 2.61 [1.80–3.78]), were both associated with not exclusively breastfeeding at six weeks postpartum after adjusting for identified confounders. Τhe combined exposure to depressive symptoms in pregnancy and late breastfeeding initiation was associated with an almost 4-fold increased odds of not exclusive breastfeeding at six weeks postpartum.

Conclusions

Women reporting depressive symptoms during pregnancy seem to be more vulnerable to the consequences of a postponed first breastfeeding session on exclusive breastfeeding duration. Consequently, women experiencing depressive symptoms may benefit from targeted breastfeeding support during the first hours after birth.

Keywords
Antenatal depression, Breastfeeding initiation, Exclusive breastfeeding, Breastfeeding discontinuation
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-377343 (URN)10.1186/s12884-019-2195-9 (DOI)000457123700001 ()30696409 (PubMedID)
Funder
Swedish Research CouncilMarianne and Marcus Wallenberg Foundation
Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-02-25Bibliographically approved
Hildingsson, I., Karlstrom, A., Rubertsson, C. & Haines, H. (2019). Women with fear of childbirth might benefit from having a known midwife during labour. Women and Birth, 32(1), 58-63
Open this publication in new window or tab >>Women with fear of childbirth might benefit from having a known midwife during labour
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 1, p. 58-63Article in journal (Refereed) Published
Abstract [en]

Aim: Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time.

Methods: A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth.

Results: 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not.

Conclusions: Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife-woman relationship rather than counseling per se could be the key issue when it comes to fear of birth.

Keywords
Counseling, Continuity, Fear of childbirth, Pregnancy, Intrapartum care
National Category
Obstetrics, Gynecology and Reproductive Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-375809 (URN)10.1016/j.wombi.2018.04.014 (DOI)000455681800026 ()29773474 (PubMedID)
Funder
Swedish Research Council
Available from: 2019-02-08 Created: 2019-02-08 Last updated: 2019-02-08Bibliographically approved
Larsson, B., Hildingsson, I., Ternström, E., Rubertsson, C. & Karlström, A. (2019). Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study. Women and Birth, 32(1), e88-e94
Open this publication in new window or tab >>Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study
Show others...
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 1, p. e88-e94Article in journal (Refereed) Published
Abstract [en]

Background: Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women’s views about counselling for childbirth fear.

Aim: To explore women’s experiences of midwife-led counselling for childbirth fear.

Method: A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth.

Findings: The overarching theme ‘Midwife-led counselling brought positive feelings and improved confidence in birth’ was identified. This consisted of four themes describing ‘the importance of the midwife’ and ‘a mutual and strengthening dialogue’ during pregnancy. ‘Coping strategies and support enabled a positive birth’ represent women’s experiences during birth and ‘being prepared for a future birth’ were the women’s thoughts of a future birth.

Conclusions: In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable.

Keywords
Childbirth fear, Counselling, Experience, Midwifery, Qualitative research
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-325924 (URN)10.1016/j.wombi.2018.04.008 (DOI)000455681800012 ()29709431 (PubMedID)
Note

Title in thesis list of papers: Women’s experience of midwife-led counselling and its influence on childbirth fear

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2019-02-05Bibliographically approved
Noren, J., Hedberg Nyqvist, K., Rubertsson, C. & Blomqvist, Y. T. (2018). Becoming a mother: Mothers' experience of Kangaroo Mother Care. Sexual & Reproductive HealthCare, 16, 181-185
Open this publication in new window or tab >>Becoming a mother: Mothers' experience of Kangaroo Mother Care
2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 181-185Article in journal (Refereed) Published
Abstract [en]

Objective: To describe mothers' experiences of providing their preterm infants with Kangaroo Mother Care (KMC).

Study design: A qualitative descriptive design.

Setting: Two level III neonatal intensive care units (NICUs) in Sweden.

Participants: Thirteen mothers of preterm infants.

Methods: The mothers were interviewed when their infant had reached a corrected age of 4 months +/- 2 weeks. The interviews were recorded and transcribed and data were analyzed using qualitative content analysis.

Results: The mothers described the skin-to-skin contact with, and closeness to, the preterm infant as something they valued, and involuntary physical separation as something they had to accept and adapt to. Providing the infant with breast milk by expressing and tube feeding was experienced as time-consuming and as impinging on the skin-to-skin contact.

Conclusion: Mothers want to stay close to their preterm infant. The NICU environment and staff can facilitate KMC by providing a private space for parents and infants, and enable mothers to breastfeed and express breast milk by giving them support based on science and proven experience.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
National Category
Pediatrics Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-363075 (URN)10.1016/j.srhc.2018.04.005 (DOI)000440877700028 ()29804764 (PubMedID)
Available from: 2018-10-12 Created: 2018-10-12 Last updated: 2019-06-28Bibliographically approved
Hildingsson, I., Rubertsson, C., Karlström, A. & Haines, H. (2018). Caseload midwifery for women with fear of birth is a feasible option. Sexual & Reproductive HealthCare, 16, 50-55
Open this publication in new window or tab >>Caseload midwifery for women with fear of birth is a feasible option
2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 50-55Article in journal (Refereed) Published
Abstract [en]

Objective: Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. Methods: A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. Result Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. Conclusion: Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Caseload, Fear of birth, Intrapartum care, Midwifery, Pregnancy
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-363073 (URN)10.1016/j.srhc.2018.02.006 (DOI)000440877700009 ()29804775 (PubMedID)
Available from: 2018-10-12 Created: 2018-10-12 Last updated: 2018-10-12Bibliographically approved
Rondung, E., Ternström, E., Hildingsson, I., Haines, H. M., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2018). Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR MENTAL HEALTH, 5(3), Article ID e10420.
Open this publication in new window or tab >>Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial
Show others...
2018 (English)In: JMIR MENTAL HEALTH, ISSN 2368-7959, Vol. 5, no 3, article id e10420Article in journal (Refereed) Published
Abstract [en]

Background: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.

Objective: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.

Methods: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.

Results: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished >= 4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P <= .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F-1,(192).(538) =4.96, P=.03).

Conclusions: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.

Place, publisher, year, edition, pages
JMIR PUBLICATIONS, INC, 2018
Keywords
fear of birth, anxiety, pregnancy, cognitive behavioral therapy, internet-based
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-369526 (URN)10.2196/10420 (DOI)000449378200001 ()30097422 (PubMedID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2018-12-19Bibliographically approved
Hildingsson, I., Rubertsson, C., Karlstrom, A. & Haines, H. (2018). Exploring the Fear of Birth Scale in a mixed population of women of childbearing age: A Swedish pilot study. Women and Birth, 31(5), 407-413
Open this publication in new window or tab >>Exploring the Fear of Birth Scale in a mixed population of women of childbearing age: A Swedish pilot study
2018 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, no 5, p. 407-413Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this pilot study was to explore the Fear of Birth Scale in a mixed sample of women of childbearing age, by investigating the levels of childbirth fear and the content of women's thoughts when completing the scale. Methods: A cross-sectional mixed method study of 179 women who completed a short questionnaire and a think aloud interview. Results: The mean score of the Fear of Birth Scale was 40.80 (SD 27.59) and 28.5% were classified as having fear of childbirth (>= 60). The internal consistency showed a Cronbach's alpha > 0.92, and a mean inter-item correlation of 0.85. The highest scores were found in women younger than 25 years (mean 60.10), foreignborn women (mean 54.30) and women who did not have any previous children (48.72). The lowest scores were found in women who had recently given birth (mean 34.82) and women older than 35 years (mean 34.85). The content analysis categorization matrix clearly accommodated all 436 statements into the five pre-existing categories. The largest categories were: the content of fear and worry with 138 statements and strategies to cope with fear or worry (122 statements). Conclusion: The Fear of Birth Scale seems to be a useful instrument for different subgroups of women. The construct of fear of childbirth may be universally understood and experienced by women of childbearing age irrespective of whether they are currently pregnant, have recently given birth or do not have children. Identifying fear of birth is important in clinical practice in order to support women's reproductive needs.

Keywords
Childbirth fear, FOBS pilot study, Think aloud interview, Scale validation, Childbearing
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-366948 (URN)10.1016/j.wombi.2017.12.005 (DOI)000445117700018 ()29249331 (PubMedID)
Available from: 2018-11-28 Created: 2018-11-28 Last updated: 2018-11-28Bibliographically approved
Rondung, E., Ekdahl, J., Hildingsson, I., Rubertsson, C. & Sundin, O. (2018). Heterogeneity in childbirth related fear or anxiety. Scandinavian Journal of Psychology, 59(6), 634-643
Open this publication in new window or tab >>Heterogeneity in childbirth related fear or anxiety
Show others...
2018 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 59, no 6, p. 634-643Article in journal (Refereed) Published
Abstract [en]

Many pregnant women experience fear, worry or anxiety relating to the upcoming childbirth. The aim of this cross-sectional study was to investigate possible subgroups in a sample of 206 pregnant women (mean age 29.4 years), reporting fear of birth in mid-pregnancy. Comparisons were made between nulliparous and parous women. In a series of cluster analyses, validated psychological instruments were used to cluster women based on their psychological profiles. A five-cluster solution was suggested, with the clusters characterized by: overall low symptom load, general high symptom load, medium symptom load with high performance-based self-esteem, blood- and injection phobic anxiety, and specific anxiety symptoms. Nulliparous women were more likely to report clinically relevant levels of blood- and injection phobia (OR = 2.57, 95% CI 1.09-6.01), while parous women more often reported previous negative experiences in health care (OR 1.93, 95% CI 1.09-3.39) or previous trauma (OR 2.90, 95% CI 1.58-5.32). The results indicate that women reporting fear of birth are a heterogeneous group. In order to individualize treatment, psychological characteristics may be of greater importance than parity in identifying relevant subgroups.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
Anxiety, fear, childbirth, pregnancy, cluster analysis, blood- and injection phobia
National Category
Obstetrics, Gynecology and Reproductive Medicine Applied Psychology
Identifiers
urn:nbn:se:uu:diva-387249 (URN)10.1111/sjop.12481 (DOI)000449851300009 ()30176051 (PubMedID)
Available from: 2019-06-26 Created: 2019-06-26 Last updated: 2019-06-26Bibliographically approved
Ternström, E., Hildingsson, I., Haines, H., Karlström, A., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2017). A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth: A study protocol. Sexual & Reproductive HealthCare, 13, 75-82
Open this publication in new window or tab >>A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth: A study protocol
Show others...
2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 75-82Article in journal (Refereed) Published
Abstract [en]

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-332598 (URN)10.1016/j.srhc.2017.06.001 (DOI)000411305800011 ()28844361 (PubMedID)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-04-09Bibliographically approved
Larsson, B., Karlström, A., Rubertsson, C., Ternström, E., Ekdahl, J., Segebladh, B. & Hildingsson, I. (2017). Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial. Women and Birth, 30(6), 460-467
Open this publication in new window or tab >>Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial
Show others...
2017 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 6, p. 460-467Article in journal (Refereed) Published
Abstract [en]

Background: Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason.  The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment.

Methods: Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n=258) were recruited at one university hospital and two regional hospitals over one year.  The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n=127) or standard care (face-to-face counselling) (n=131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth.

Results: Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience.

Conclusion: Women’s birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research.  

Keywords
caesarean section, childbirth fear, counselling, internet based cognitive behavioural therapy, randomised controlled trial
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-325923 (URN)10.1016/j.wombi.2017.04.004 (DOI)000418296300007 ()28495462 (PubMedID)
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2018-01-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7416-6335

Search in DiVA

Show all publications