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  • 1.
    Adolphson, Katja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Axemo, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Midwives' experiences of working conditions, perceptions of professional role and attitudes towards mothers in Mozambique2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 95-101Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: low- and middle-income countries still have a long way to go to reach the fifth Millennium Development Goal of reducing maternal mortality. Mozambique has accomplished a reduction of maternal mortality since the 1990s, but still has among the highest in the world. A key strategy in reducing maternal mortality is to invest in midwifery. AIM: the objective was to explore midwives' perspectives of their working conditions, their professional role, and perceptions of attitudes towards mothers in a low-resource setting. SETTING: midwives in urban, suburban, village and remote areas; working in central, general and rural hospitals as well as health centres and health posts were interviewed in Maputo City, Maputo Province and Gaza Province in Mozambique. METHOD: the study had a qualitative research design. Nine semi-structured interviews and one follow-up interview were conducted and analysed with qualitative content analysis. RESULTS: two main themes were found; commitment/devotion and lack of resources. All informants described empathic care-giving, with deep engagement with the mothers and highly valued working in teams. Lack of resources prevented the midwives from providing care and created frustration and feelings of insufficiency. CONCLUSIONS: the midwives perceptions were that they tried to provide empathic, responsive care on their own within a weak health system which created many difficulties. The great potential the midwives possess of providing quality care must be valued and nurtured for their competency to be used more effectively.

  • 2.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Haugesund, Norway.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Adan, Aisha
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Byrskog, Ulrika
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 107-115Article in journal (Refereed)
    Abstract [en]

    Objective:

    To explore Somali-born parents' experiences of antenatal care in Sweden, antenatal care midwives' experiences of caring for Somali-born parents, and their respective ideas about group antenatal care for Somali-born parents.

    Design:

    Eight focus group discussions with 2-8 participants in each were conducted, three with Somaliborn mothers, two with fathers and three with antenatal care midwives. The transcribed text was analysed using Attride-Stirling's tool "Thematic networks".

    Setting:

    Two towns in mid-Sweden and a suburb of the capital city of Sweden. Participants: Mothers (n = 16), fathers (n = 13) and midwives (n = 7) were recruited using purposeful sampling.

    Findings:

    Somali-born mothers and fathers in Sweden were content with many aspects of antenatal care, but they also faced barriers. Challenges in the midwife-parent encounter related to tailoring of care to individual needs, dealing with stereotypes, addressing varied levels of health literacy, overcoming communication barriers and enabling partner involvement. Health system challenges related to accessibility of care, limited resources, and the need for clear, but flexible routines and supportive structures for parent education. Midwives confirmed these challenges and tried to address them but sometimes lacked the support, resources and tools to do so. Mothers, fathers and midwives thought that language-supported group antenatal care might help to improve communication, provide mutual support and enable better dialogue, but they were concerned that group care should still allow privacy when needed and not stereotype families according to their country of birth.

    Key conclusions:

    ANC interventions targeting inequalities between migrants and non-migrants may benefit from embracing a person-centred approach, as a means to counteract stereotypes, misunderstandings and prejudice. Group antenatal care has the potential to provide a platform for person-centred care and has other potential benefits in providing high-quality antenatal care for sub-groups that tend to receive less or poor quality care. Further research on how to address stereotypes and implicit bias in maternity care in the Swedish context is needed. (c) 2019 The Authors. Published by Elsevier Ltd.

  • 3.
    Alosaimi, Abdullah N.
    et al.
    Univ Tampere, Fac Social Sci, Hlth Sci Dept, Tampere 33014, Finland.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Riitta, Luoto
    Univ Tampere, Fac Social Sci, Hlth Sci Dept, Tampere 33014, Finland.
    Nwaru, Bright I.
    Univ Tampere, Fac Social Sci, Hlth Sci Dept, Tampere 33014, Finland;Univ Gothenburg, Inst Med, Krefting Res Ctr, Gothenburg, Sweden.
    Mouniri, Halima
    Columbia Univ, Averting Maternal Death & Disabil Program, Dept Populat & Family Hlth, Mailman Sch Publ Hlth, New York, NY USA.
    Factors associated with female genital cutting in Yemen and its policy implications2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 99-106Article in journal (Refereed)
    Abstract [en]

    Background:

    A tremendous number of girls in Yemen are still subjected to female genital cutting (FGC), which carries an increased risk of health complications and violates children's rights. This study describes the prevalence of FGC in four Yemeni provinces and investigates the determinants of FGC.

    Methods:

    We analyzed data from women aged 15 to 49 years who responded to a sub-national household survey conducted in six rural districts of four Yemeni provinces in 2008-2009. Logistic regression was used to estimate the association between individual and household socioeconomic factors and FGC practices and attitudes.

    Results:

    The prevalence of women's FGC was 48% while daughters' FGC was 34%. Almost 45.8% of the women surveyed believe the FGC practice should discontinue. Higher odds of FGC practice and positive attitude towards it were associated with older age, family marriage, and lower tertiles of wealth and education indices. Early marriage was also associated with increased odds of FGC practice (p < 0.01).

    Conclusions:

    Socioeconomic indices and other individual factors associated with FGC are differing and complex. Younger generations of women are more likely to not have FGC and to express negative attitudes towards the tradition. Appropriate strategies to invest in girls' education and women's empowerment with effective engagement of religious and community leaders might support the change of attitudes and practice of FGC in the younger generation.

  • 4.
    Andersson, Ewa
    et al.
    Karolinska Institutet, Department of Women's and Children's Health, Division for Reproductive Health, Stockholm, Sweden.
    Christensson, Kyllike
    Karolinska Institutet, Department of Women's and Children's Health, Division for Reproductive Health, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Karolinska Institutet, Department of Women's and Children's Health, Division for Reproductive Health, Stockholm, Sweden.
    Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden.2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000.

    OBJECTIVE: to investigate parents' experiences of group antenatal care in four different clinics in Sweden.

    METHOD: a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used.

    SETTINGS: the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden.

    PARTICIPANTS: the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme.

    FINDINGS: three themes emerged, 'The care-combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, 'The group-a composed recipient of care', showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, 'The midwife-a controlling professional', showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals.

    KEY CONCLUSIONS: in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms.

    IMPLICATIONS FOR PRACTISE: the midwife's role in facilitating group-based antenatal care demands new pedagogical strategies and approaches.

  • 5.
    Arousell, Jonna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Carlbom, Aje
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Johnsdotter, Sara
    Malmo Univ, Fac Hlth & Soc, S-20506 Malmo, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Are 'low socioeconomic status' and 'religiousness' barriers to minority women's use of contraception? A qualitative exploration and critique of a common argument in reproductive health research2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 75, p. 59-65Article in journal (Refereed)
    Abstract [en]

    Objective: 'Low socioeconomic status' and 'religiousness' appear to have gained status as nearly universal explanatory models for why women in minority groups are less likely to use contraception than other women in the Scandinavian countries. Through interviews with pious Muslim women with immigrant background, living in Denmark and Sweden, we wanted to gain empirical insights that could inform a discussion about what 'low socioeconomic status' and 'religiousness' might mean with regard to women's reproductive decisions.

    Design: Semi-structured interviews were conducted in Denmark and Sweden between 2013 and 2016.

    Findings: We found that a low level of education and a low income were not necessarily obstacles for women's use of contraception; rather, these were strong imperatives for women to wait to have children until their life circumstances become more stable. Arguments grounded in Islamic dictates on contraception became powerful tools for women to substantiate how it is religiously appropriate to postpone having children, particularly when their financial and emotional resources were not yet established.

    Conclusion: We have shown that the dominant theory that 'low socioeconomic status' and 'religiousness' are paramount barriers to women's use of contraception must be problematized. When formulating suggestions for how to provide contraceptive counseling to women in ethnic and religious minority groups in Denmark and Sweden, one must also take into account that factors such as low financial security as well as religious convictions can be strong imperatives for women to use contraception.

    Implications for practice: This study can help inform a critical discussion about the difficulties of using broad group-categorizations for understanding individuals' health-related behavior, as well as the validity of targeted interventions towards large heterogeneous minority groups in Scandinavian contraceptive counseling.

  • 6.
    Berg, Marie
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Lundgren, Ingela
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hermansson, E
    Wahlberg, V
    Women's experience of the encounter with the midwife during childbirth1996In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 12, no 1, p. 11-15Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe women's experience of the encounter with the midwife during childbirth.

    DESIGN: a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews.

    SETTING: the Alternative Birth Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden in 1994.

    PARTICIPANTS: 18 women, six primiparous and 12 multiparous who were two to four days post delivery.

    KEY FINDINGS: the essential structure of the studied phenomenon was described as 'presence' and included three themes: to be seen as an individual, to have a trusting relationship and to be supported and guided on one's own terms.

    IMPLICATIONS FOR PRACTICE: the need to be seen as an individual can be realised by affirmation and familiarity with the midwife and surroundings. A trusting relationship can be obtained by good communication and proficient behaviour. By providing a sense of control the women can be supported and guided on their own terms. Above all they must feel that the midwife is present.

  • 7.
    Binder, Pauline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Gustafsson, Annica
    Department of Woman and Child Health/Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Uvnäs-Moberg, Kerstin
    Swedish University of Agriculture, Skara, Sweden.
    Nissen, Eva
    Department of Woman and Child Health/Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Hi-TENS combined with PCA-morphine as post caesarean pain relief.2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 547-552Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to examine effectiveness and overall opiate consumption between high-sensory transcutaneous electrical nerve stimulation (Hi-TENS) combined with patient-controlled analgesia with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. DESIGN: randomised, controlled study. SETTING: a county hospital in south-west Sweden. PARTICIPANTS: 42 multiparous women. MEASUREMENTS AND FINDINGS: participants were randomly assigned and connected to patient-controlled analgesia with morphine alone or in combination with Hi-TENS apparatus. Levels of morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption of morphine differed significantly between the groups: morphine with TENS was 16.2±12.6mg and morphine alone was 33.1±20.9mg (p=0.007). Assessment of pain relief showed no significant difference. Sedation differed significantly between the groups (p=0.045), especially between three and 12 hours post partum (p=0.011). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.

  • 8.
    Binder, Pauline
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Johnsdotter, Sara
    Faculty of Health and Society, Malmö University, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    More than re-establishing the partner relationship: Intimate aftercare for Somali parents in diaspora2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, no 29, p. 863-70Article in journal (Refereed)
    Abstract [en]

    Objective

    to explore the sexual relationship and couples' perceptions about intimate partner support following childbirth.

    Design

    a hermeneutic design using a naturalistic inquiry framework as a qualitative proxy for medical anthropology. Data were collected using a fictional and culturally-specific narrative during focus group discussions (FGDs) in early 2011. Analysis was conducted by ‘functional narrative analysis’ and interpreted for conceptual constructions. Recruitment was by snowball and purposive sampling.

    Setting

    a diasporic context among participants living in six urban centres across Sweden.

    Participants

    successful recruitment included 16 Somali-Swedish fathers and 27 mothers. Three FDGs were conducted with fathers (3–7 participants) and seven with mothers (3–6 participants).

    Findings

    within day 40 post partum, parents learn to rely on each other in the absence of traditional support networks. After the first 40 days, the re-introduction of sexual intimacy is likely to occur. Of the fathers experiencing postpartum sexual aversion, these seemed to experience ‘existential angst’ resulting from a combination of profound remorse over having put the partner into what they perceived as a life-threatening situation during childbirth and their perceived moral and ethical obligations to provide support in this setting. Mothers in general did not directly discuss their own sexuality. Women could imagine men's sexual aversion after witnessing childbirth. However, they seemed unaware of men's potential for angst. Mothers are situated between the loss of traditional postpartum support networks, comprised of close female kin, and their own newly-defined responsibilities in the host setting. Fathers embrace their new role. Both partners articulated the mother's new role as enhancing autonomy and independence in the host setting. However, women held mixed attitudes about fathers replacing traditional kin support.

    Implications for practice

    to date, late postpartum aftercare for immigrant African parents is anecdotally linked to evidence-based recommendations, which have been identified for parents who are ethnically-congruent to a western study setting. Our findings suggest that aftercare meant for Somali parents living in these settings requires an understanding of how traditional intimate support and the postpartum sexual relationship are re-negotiated in the diasporic context. This includes recognition of the father as a willing and supportive partner.

  • 9.
    Bodin, Maja
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Centre for Gender Research.
    Stern, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Käll, Lisa Folkmarson
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Centre for Gender Research. Linkoping Univ, Ctr Dementia Res, SE-58183 Linkoping, Sweden..
    Tydén, Tanja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Coherence of pregnancy planning within couples expecting a child2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 10, p. 973-978Article in journal (Refereed)
    Abstract [en]

    Background: joint planning and decision-making within couples have evident effects on the well-being of the family. The purpose of this study was to investigate the level of pregnancy planning among pregnant women and their partners and to compare the coherence of pregnancy planning within the couples. Methods: pregnant women and their partners were recruited from 18 antenatal clinics in seven Swedish counties between October 2011 and April 2012. Participants, 232 pregnant women and 144 partners, filled out a questionnaire with questions about pregnancy planning, lifestyle and relationship satisfaction. 136 couples were identified and the women's and partners' answers were compared. Results: more than 75% of the pregnancies were very or rather planned and almost all participants had agreed with their partner to become pregnant There was no significant difference in level of pregnancy planning between women and partners, and coherence within couples was strong. Level of planning was not affected by individual socio-demographic variables. Furthermore, 98 % of women and 94 % of partners had non distressed relationships. Conclusion: one of the most interesting results was the strong coherence between partners concerning their pregnancy and relationship. Approaching these results from a social constructivist perspective brings to light an importance of togetherness and how a sense and impression of unity within a couple might be constructed in different ways. As implications for practice, midwives and other professionals counselling persons in fertile age should enquire about and emphasise the benefits of equality and mutual pregnancy planning for both women and men.

  • 10. Byaruhanga, Romano N.
    et al.
    Nsungwa-Sabiiti, Jesca
    Kiguli, Juliet
    Balyeku, Andrew
    Nsabagasani, Xavier
    Peterson, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Hurdles and opportunities for newborn care in rural Uganda2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 6, p. 775-780Article in journal (Refereed)
    Abstract [en]

    Introduction: a set of evidence-based delivery and neonatal practices have the potential to reduce neonatal mortality substantially. However, resistance to the acceptance and adoption of these practices may still be a problem and challenge in the rural community in Uganda. Objectives: to explore the acceptability and feasibility of the newborn care practices at household and family level in the rural communities in different regions of Uganda with regards to birth asphyxia, thermo-protection and cord care. Methods: a qualitative design using in-depth interviews and focus group discussions were used. Participants were purposively selected from rural communities in three districts. Six in-depth interviews targeting traditional birth attendants and nine focus group discussions composed of 10-15 participants among post childbirth mothers, elderly caregivers and partners or fathers of recently delivered mothers were conducted. All the mothers involved has had normal vaginal deliveries in the rural community with unskilled birth attendants. Latent content analysis was used. Findings: two main themes emerged from the interviews: 'Barriers to change' and 'Windows of opportunities'. Some of the recommended newborn practices were deemed to conflict with traditional and cultural practices. Promotion of delayed bathing as a thermo-protection measure, dry cord care were unlikely to be accepted and spiritual beliefs were attached to use of local herbs for bathing or smearing of the baby's skin. However, several aspects of thermo-protection of the newborn, breast feeding, taking newborns for immunisation were in agreement with biomedical recommendations, and positive aspects of newborn care were noticed with the traditional birth attendants. Conclusions: some of the evidence based practices may be accepted after modification. Behaviour change communication messages need to address the community norms in the country. The involvement of other newborn caregivers than the mother at the household and the community early during pregnancy may influence change of behaviour related to the adoption of the recommended newborn care practices.

  • 11.
    Byrskog, Ulrika
    et al.
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). Uppsala Univ, Dept Womens & Childrens Hlth, Akad Sjukhuset, S-75185 Uppsala, Sweden..
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Klingberg-Allvin, Marie
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden..
    'Moving on' Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 10-17Article in journal (Refereed)
    Abstract [en]

    Background: Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method: Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings: A balancing act between keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions: If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on "moving on" and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

  • 12.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Bergman, Gunnar
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Anna-Malin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Languages, Department of Scandinavian Languages.
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Experiences of termination of pregnancy for a fetal anomaly: A qualitative study of virtual community messages2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 41, p. 54-60Article in journal (Refereed)
    Abstract [en]

    Objective: to explore experiences described by posters in Swedish virtual communities before, during and after termination of pregnancy due to a fetal anomaly.

    Design: cross-sectional qualitative study of messages in virtual communities. The messages were purposefully selected in 2014 and analyzed with inductive qualitative manifest content analysis.

    Setting: two large and active Swedish virtual communities.

    Sample: 1623 messages from 122 posters (112 females, 1 male, and 9 did not disclose their sex), written between 2008 and 2014. The majority of the posters were females (91%) with recent experience of termination of pregnancy following different prenatal diagnoses (63% less than one year since the termination).

    Measurements and findings: before the termination, posters experienced an emotional shock and a difficult decision. During the termination, they needed compassionate care from present caregivers, experienced intense emotional and physical pain, lacked an understanding about the abortion, and expressed varied feelings about the option to view the fetus. After the termination, posters used different strategies to come to terms with and accept the decision, experienced a perinatal loss, expressed fears of recurrence, and longed for a new child.

    Key conclusions: spanning across the time before, during and after the abortion, women who terminate a pregnancy due to a fetal anomaly express considerable physical and emotional pain, with psychosocial and reproductive consequences.

    Implications for practice: information and preparation, including the decision whether or not to view the fetus, are important aspects to consider when caring for individuals who have decided to terminate a pregnancy for a fetal anomaly. The findings indicate a need for structures that offer support to women who suffer from fears of recurrence in future pregnancies. 

  • 13.
    Carlsson, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Starke, Veronica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mattsson, Elisabet
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare. Ersta Skondal Bracke Univ Coll, Dept Hlth Care Sci, Stockholm, Sweden..
    The emotional process from diagnosis to birth following a prenatal diagnosis of fetal anomaly: A qualitative study of messages in online discussion boards2017In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 48, p. 53-59Article in journal (Refereed)
    Abstract [en]

    Objective: to explore written statements found in online discussion boards where parents currently expecting, or with previous experience of expecting, a child with a prenatally diagnosed congenital anomaly communicate about their emotional process from diagnosis to birth.

    Design: cross-sectional qualitative study of messages in public online discussion boards.

    Setting: Swedish public discussion boards about reproductive subjects.

    Sample: ten pregnant women and eight parents (of children with prenatal diagnoses) who had written 852 messages in five threads in Swedish online discussion boards identified via systematic searches.

    Measurements and findings: three phases were identified in the process of moving from the diagnosis to the birth: shock, existential crisis, and life remodeling. The people posting message (‘posters’) moved from initial shock to existential crisis and, lastly, a phase of remodeling life later in the pregnancy. During the pregnancy, considerable worries about both antenatal and postnatal aspects were expressed. To cope with their situation, the posters distanced themselves from the diagnoses, vented their feelings, sought control, and obtained practical support from friends and relatives.

    Key conclusions: expectant parents faced with a prenatal diagnosis move from initial shock to a phase of life remodeling and acceptance. Burdened with considerable worries, expectant parents cope with their situation through informational, emotional, and instrumental support from health professionals, family, friends, and peers.

    Implications for practice: health professionals should make sure that expectant parents feel involved in planning their children's postnatal care, that they are offered sufficient information, and that they have access to emotional and instrumental support structures. 

  • 14.
    Christianson, Monica
    et al.
    Department of Nursing, Umeå University, Sweden.
    Boman, Jens
    Department of Public Health and Clinical Medicine, Dermatology and Venereology, Umeå University, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    'Let men into the pregnancy': Men's perceptions about being tested for Chlamydia and HIV during pregnancy2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 4, p. 351-358Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate how to prevent transmission of HIV and Chlamydia trachomatis (CT) by exploring whether screening of men during pregnancy may be an innovative way to reach men, to increase detection, and to avoid the present gendered responsibility.

    DESIGN:

    an explorative research strategy with in-depth interviews and an analysis informed by grounded theory principles was used.

    SETTING:

    the northern part of Sweden.

    PARTICIPANTS:

    twenty men/becoming fathers in their twenties and early thirties were offered CT and HIV testing and were interviewed about their perceptions about being tested during pregnancy.

    FINDINGS:

    Six categories emerged that concerned the men's risk perceptions, reasons for not testing men, benefits and negative consequences associated with being tested, incentive measures for reaching men and the optional time for testing men during pregnancy. The majority of the men perceived their own risk for having CT or HIV to be close to zero, trusted their stable partner, and did not see men as transmitters. They did not understand how men could play a role in CT or HIV transmission or how these infections could negatively affect the child. However, few informants could see any logical reasons for excluding men from testing and the majority was positive towards screening men during the pregnancy.

    KEY CONCLUSIONS:

    men's sexual health and behaviour on social and biological grounds will affect the health of women and their children during pregnancy and childbirth. As long as expectant fathers do not count in this 'triad', there is a risk that CT and HIV infections in adults and infants will continue to be an unsolved problem.

    IMPLICATIONS FOR PRACTICE:

    knowledge from this research can contribute to influencing the attitudes among health-care providers positively, and inspiring policy changes.

  • 15.
    Fooladi, Ensieh
    et al.
    Monash Univ, Sch Nursing & Midwifery, Level 3,35 Rainforest Walk,Wellington Rd, Melbourne, Vic 3800, Australia;Mazandaran Univ Med Sci, Sch Nursing & Midwifery, Reprod & Sexual Hlth Res Ctr, Sari, Mazandaran, Iran.
    Weller, Carolina
    Monash Univ, Sch Nursing & Midwifery, Level 3,35 Rainforest Walk,Wellington Rd, Melbourne, Vic 3800, Australia.
    Salehi, Maryam
    Mazandaran Univ Med Sci, Sch Nursing & Midwifery, Reprod & Sexual Hlth Res Ctr, Sari, Mazandaran, Iran.
    Abhari, Farideh Rezaee
    Mazandaran Univ Med Sci, Sch Nursing & Midwifery, Reprod & Sexual Hlth Res Ctr, Sari, Mazandaran, Iran.
    Stern, Jenny
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Sophiahemmet Univ, Dept Hlth Promot, Stockholm, Sweden.
    Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 77-86Article in journal (Refereed)
    Abstract [en]

    Objectives: Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women.

    Design: A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60).

    Setting: A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran.

    Participants: Women of reproductive age who were able to conceive.

    Interventions: The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up.

    Findings: At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful.

    Key conclusions: Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established.

    Implications for practice: The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.

  • 16. Gao, Ling-ling
    et al.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Luo, Shu-yuan
    Internet use by Chinese women seeking pregnancy-related information2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 7, p. 730-735Article in journal (Refereed)
    Abstract [en]

    Objective: to investigate whether and how Chinese pregnant women used the Internet to retrieve pregnancy-related information. Design and setting: a descriptive, cross-sectional design using a waiting-room questionnaire was employed to obtain information from Chinese pregnant women attending the antenatal clinic of a general hospital in Guangzhou, mainland China from September to October in 2011. Participants: a total of 335 Chinese women pregnant at least 32 weeks participated in the study with the response rate 85%. Findings: the great majority of the women (91.9%) had access to the Internet. Most of them (88.7%) used it to retrieve health information and began from the beginning of the pregnancy. Fetal development and nutrition in pregnancy were the two most often mentioned topics of interest. More than half of the women regarded the information as reliable. The first most important criterion for judging the trustworthiness of web-based information was if the facts were consistent with information from other sources; the second most important criterion was if references were provided. Most (75.1%) of the women did not discuss the information they retrieved from the Internet with their health professionals. Conclusion: the Internet was a common source for pregnancy related information among Chinese pregnant women, the same as that in the western countries. Health professionals should be able to guide Chinese pregnant women to high-quality, web-based information and then take the opportunity to discuss this information with them during antenatal visits, consultations and childbirth education classes.

  • 17.
    Haines, Helen
    et al.
    School of Rural Health The University of Melbourne, Australia.
    Pallant, Julie F
    The University of Melbourne, Rural Health Academic Centre.
    Karlström, Annika
    Mid Sweden University .
    Hildingsson, Ingegerd
    Mid Sweden University .
    Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 560-567Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool.

    METHODS:

    a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n = 386) and Australia (n = 123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale.

    FINDINGS:

    close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample.

    CONCLUSION:

    the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.

  • 18.
    Haines, Helen
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Pallant, Julie F
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, p. e850-e856Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    the rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event.

    OBJECTIVES:

    to compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy.

    PARTICIPANTS:

    women from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123).

    METHODS:

    questionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care.

    RESULTS:

    the Australian sample was less likely than the Swedish sample to agree that they would like a birth that: 'is as pain free as possible' OR 0.4 (95% CI: 0.2-0.7), 'will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1-0.8), 'will least affect my future sex life' OR 0.3 (95% CI: 0.2-0.6), 'will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2-0.7) and 'is as natural as possible' OR 0.4 (95% CI: 0.2-0.9). They were also less likely to agree that: 'if a woman wants to have a caesarean she should be able to have one under any circumstances' OR 0.4 (95% CI: 0.2-0.7) and 'giving birth is a natural process that should not be interfered with unless necessary' OR 0.3 (95% CI: 0.1-0.7). Four attitudinal subscales were found: 'Personal Impact of Birth', 'Birth as Natural Event', 'Freedom of Choice' and 'Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of 'Birth as a natural event'.

    KEY CONCLUSIONS:

    the Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.

  • 19.
    Halfdansdottir, Berglind
    et al.
    Univ Iceland, Sch Hlth Sci, Fac Nursing, Eiriksgata 34, IS-101 Reykjavik, Iceland..
    Olafsdottir, Olof A.
    Univ Iceland, Sch Hlth Sci, Fac Nursing, Eiriksgata 34, IS-101 Reykjavik, Iceland..
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Dept Nursing, Holmgatan 10, S-85170 Sundsvall, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Solnavagen 1, S-17177 Stockholm, Sweden..
    Smarason, Alexander Kr.
    Univ Akureyri, Inst Hlth Sci Res, IS-600 Akureyri, Iceland..
    Sveinsdottir, Herdis
    Univ Iceland, Sch Hlth Sci, Fac Nursing, Eiriksgata 34, IS-101 Reykjavik, Iceland..
    Maternal attitudes towards home birth and their effect on birth outcomes in Iceland: A prospective cohort study2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 34, p. 95-104Article in journal (Refereed)
    Abstract [en]

    Objective: to examine the relationship between attitudes towards home birth and birth outcomes, and whether women's attitudes towards birth and intervention affected this relationship. Design: a prospective cohort study. Setting: the study was set in Iceland, a sparsely populated island with harsh terrain, 325,000 inhabitants, high fertility and home birth rates, and less than 5000 births a year. Participants: a convenience sample of women who attended antenatal care in Icelandic health care centres, participated in the Childbirth and Health Study in 2009-2011, and expressed consistent attitudes towards home birth (n=809). Findings: of the participants, 164 (20.3%) expressed positive attitudes towards choosing home birth and 645 (79.7%) expressed negative attitudes. Women who had a positive attitude towards home birth had significantly more positive attitudes towards birth and more negative attitudes towards intervention than did women who had a negative attitude towards home birth. Of the 340 self-reported low-risk women that answered questionnaires on birth outcomes, 78 (22.9%) had a positive attitude towards home birth and 262 (77.1%) had a negative attitude. Oxytocin augmentation (19.2% (n=15) versus 39.1% (n=100)), epidural analgesia (19.2% (n=15) versus 33.6% (n=88)), and neonatal intensive care unit admission rates (0.0% (n=0) versus 5.0% (n=13)) were significantly lower among women who had a positive attitude towards home birth. Women's attitudes towards birth and intervention affected the relationship between attitudes towards home birth and oxytocin augmentation or epidural analgesia. Key conclusions and implications for practice: the beneficial effect of planned home birth on maternal outcome in Iceland may depend to some extent on women's attitudes towards birth and intervention. Efforts to de-stigmatise out-of-hospital birth and de-medicalize women's attitudes towards birth might increase women's use of health-appropriate birth services.

  • 20.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Gamble, Jenny
    Griffith Univ, Menzies Hlth Inst Queensland, Sch Nursing & Midwifery, Nathan, Qld 4111, Australia..
    Sidebotham, Mary
    Griffith Univ, Menzies Hlth Inst Queensland, Sch Nursing & Midwifery, Nathan, Qld 4111, Australia..
    Creedy, Debra K.
    Griffith Univ, Menzies Hlth Inst Queensland, Sch Nursing & Midwifery, Nathan, Qld 4111, Australia..
    Guilliland, Karen
    New Zealand Coll Midw, Canterbury, New Zealand..
    Dixon, Lesley
    New Zealand Coll Midw, Res Dev, Canterbury, New Zealand..
    Pallant, Julie
    Griffith Univ, Menzies Hlth Inst Queensland, Nathan, Qld 4111, Australia..
    Fenwick, Jennifer
    Griffith Univ, Menzies Hlth Inst Queensland, Sch Nursing & Midwifery, Nathan, Qld 4111, Australia.;Gold Coast Univ Hosp, Southport, Qld, Australia..
    Midwifery empowerment: National surveys of midwives from Australia, New Zealand and Sweden2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 62-69Article in journal (Refereed)
    Abstract [en]

    Background: the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. Aim: to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Method: a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. Results: completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p <.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. Discussion/conclusions: midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.

  • 21.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Johansson, Margareta
    Södersjukhuset, Stockholm, Sweden.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Maternity and Family, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, Australia.
    Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 248-254Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

    DESIGN:

    a longitudinal regional survey. Data were collected by three questionnaires.

    SETTING:

    three hospitals in the middle-north part of Sweden.

    PARTICIPANTS:

    1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

    MEASUREMENTS:

    childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

    FINDINGS:

    expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2-2.8) and mental (OR 3.0; 1.8-5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4-3.0), and the forthcoming birth (OR 4.3; 2.9-6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

    KEY CONCLUSIONS:

    expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

    IMPLICATIONS FOR PRACTICE:

    this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.

  • 22.
    Hildingsson, Ingegerd
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Johansson, Margareta
    Mid Sweden University, Department of Health Science, Sundsvall, Sweden.
    Fenwick, Jennifer
    Griffith University, Gold Coast Hospital, Australia.
    Haines, Helen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 242-247Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

    DESIGN:

    a regional cohort study. Data was collected by a questionnaire.

    SETTING:

    three hospitals in the middle-north part of Sweden

    PARTICIPANTS:

    1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

    MEASUREMENTS:

    prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

    FINDINGS:

    the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2-5.2), country of birth other than Sweden (OR 2.8; 1.3-6.1), a preference for a caesarean birth (OR 2.1; 1.7-4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1-2.0) and expecting the first baby (OR 1.8; 1.2-2.6).

    KEY CONCLUSIONS:

    high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

    IMPLICATIONS FOR PRACTICE:

    engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.

  • 23.
    Höglund, Berit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Professional and social support enhances maternal well-being in women with intellectual disability: a Swedish interview study2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 11, p. 1118-1123Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to gain a deeper understanding of the experience of professional and social support during pregnancy and childbirth among women with intellectual disability (ID) in Sweden.

    DESIGN/SETTING: an interview study among 10 women with ID, who had given birth within seven years. Two interviews were performed with each woman and data were analysed with qualitative content analysis.

    FINDINGS: the overarching theme was: Professional and social support enhances maternal well-being in women with intellectual disability. The women described that the midwife and other caregivers contributed to their own insights and supported their mother-to-be process. They were mostly satisfied with the professional care and support during pregnancy and childbirth, based on aspects such as continuity, competence and professional experience of the midwives but also professional approach and working methods. Dissatisfaction and confusion occurred when questions were left unanswered or when the women׳s special needs were not taken into consideration. Family members, friends and colleagues could also have a supporting role and, together with the health staff, contribute to the well-being of the woman.

    CONCLUSIONS: if professional support and care from midwives and other caregivers is adapted to the special needs of women with ID, it contributes to new insights, enhances well-being and supports the process of becoming a mother. Midwife-led continuity of care together with continuous social support should be offered to pregnant women with ID during pregnancy and childbirth.

  • 24.
    Höglund, Berit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Struggling for motherhood with an intellectual disability: a qualitative study of women's experiences in Sweden2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 6, p. 698-704Article in journal (Refereed)
    Abstract [en]

    Objective

    to gain a deeper understanding of the experiences of childbearing in women with intellectual disabililty (ID).

    Design/setting

    ten women with ID, who had given birth within seven years, were interviewed twice and data were analysed with content analysis.

    Findings

    the overarching theme was: Struggling for motherhood with an ID. The significance of having an intellectual disability became evident when the women encountered mixed reactions from partners and relatives, who sometimes suggested an induced abortion. The women disclosed their diagnosis if they believed it was beneficial for them. Throughout the process the women also felt anxious and distressed about the custody of the child. Women experienced the pregnancy as a physical and psychological transition. It was mostly a happy and responsible life event, and the women were aware of physical signs in their bodies and contact with the unborn child. Parent education was considered important but not adequately adapted to their needs. The women described the delivery as hard and painful work, sometimes difficult to understand and they had different strategies to handle the pain and strain of labour. The child was welcomed with warmth and curiosity by the women, who cared for and breast fed the child even if the hospital environment could be confusing and continued custody not taken for granted.

    Conclusions

    women with ID struggle for motherhood and fear losing custody of the child. Professionals need to identify and support these women, who may not always disclose their diagnosis. Since pregnancy, delivery and the transition into motherhood can be difficult to understand, information and support should be better tailored to their needs.

  • 25.
    Höglund, Berit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lindgren, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Midwives’ knowledge of, attitudes towards and experiences of caring for women with intellectual disability during pregnancy and childbirth: a cross-sectional study in Sweden2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 8, p. 950-955Article in journal (Refereed)
    Abstract [en]

    Objective: to investigate midwives' knowledge of, attitudes towards andexperiences of caring for women with intellectual disability (ID) during pregnancy andchildbirth. Design/setting: a cross-sectional study among six hundred midwives working at antenatal care and labour wards in Sweden. Results: more than four out of five (81.5%) midwives had experience of caring for womenwith ID. Almost all midwives (97.1%) reported that caring for women with ID is different fromcaring for women without ID. Almost one-half (47.3%) had not received any education aboutpregnancy and delivery of women with ID, and a majority of the midwives (95.4%) requested evidence-based knowledge of women with ID in relation to childbirth. High proportion (69.7%) of the midwives were of the opinion that women with ID cannot satisfactorily manage the mother role, and more than one-third (35.7%) of the midwives considered that womenwith ID should not be pregnant and give birth at all. Most midwives partly/totally agreed that children of women with ID should grow up with their parents supported by the social authorities, but nearly one-fifth (19.1%) partly/totally agreed that the children should grow up in foster care. Conclusions: even if the majority of midwives had experience of caring for women with ID, they were uncertain about how to adapt and give advice and they needed more knowledgeabout these women. Some midwives had negative attitudes towards childbearing amongwomen with ID. Health Service providers should encourage midwives to update theirknowledge and provide supportive supervision in midwifery care for women with ID. 

  • 26.
    Jha, Paridhi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, S-10401 Stockholm, Sweden..
    Svanberg, Agneta Skoog
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Sharma, Bharati
    Indian Inst Publ Hlth, Gandhinagar, Gujarat, India..
    Johansson, Eva
    Karolinska Inst, Dept Publ Hlth, S-10401 Stockholm, Sweden..
    Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 39, p. 78-86Article in journal (Refereed)
    Abstract [en]

    Aim: this study aimed to explore and understand the perceptions and experiences of women regarding quality of care received during childbirth in public health facilities. Design: qualitative in-depth interviews were conducted and analysed using the Grounded Theory approach. Participants: thirteen women who had given vaginal birth to a healthy newborn infant. Setting: participants were interviewed in their homes in one district of Chhattisgarh, India. Data collection: the interview followed a pre-tested guide comprising one key question: How did the women experience and perceive the care provided during labour and childbirth? Findings: 'cashless childbirth but at a cost: subordination during childbirth' was identified as the core category. Women chose a public health facility due to their socio-economic limitations, and to have a cashless and safe childbirth. Participants expressed a sense of trust in public health facilities, and verbalised that free food and ambulance services provided by the government were appreciated. Care during normal birth was medicalised, and women lacked control over the process of their labour. Often, the women experienced verbal and physical abuse, which led to passive acceptance of all the services provided to avoid confrontation with the providers. Conclusions: increasingly higher numbers of women give birth in public health facilities in Chhattisgarh, India, and women who have no alternative place to have a safe and normal birth are the main beneficiaries. The labour rooms are functional, but there is a need for improvement of interpersonal processes, information-sharing, and sensitive treatment of women seeking childbirth services in public health facilities.

  • 27. Johansson, Margareta
    et al.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Fenwick, Jennifer
    Important factors working to mediate Swedish fathers' experiences of a caesarean section2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1041-1049Article in journal (Refereed)
    Abstract [en]

    Objective: to describe and explore fathers' experiences of their partner's caesarean section birth. Design: a qualitative descriptive design was employed. A self-selected sample of 22 Swedish fathers who had experienced an elective or emergency caesarean section agreed to participate. Men were interviewed by telephone seven to 16 months after the birth of their baby. Thematic analysis and the techniques of constant comparison were used to analyse the data. Findings: men were generally worried about the health and well-being of their baby and partner regardless of birth mode. As the reality of the caesarean section approached men's anxiety escalated and remained high during the procedure. The rapid nature of surgical birth was therefore considered as an advantage; once the baby was born and cried men's fear dissipated. Four factors were identified that mediated the men's experience. Men's perceptions of control, preparedness and how the health-care team behaved and interacted with them were integral to their experience. Knowing the date and time of birth also mediated the experience by providing a sense of certainty to men's experiences of the caesarean birth. Key conclusions: caesarean section was considered as a routine and safe procedure that offered most fathers a sense of certainty, control and safety lessening their sense of responsibility over ensuring a healthy baby. The communication patterns of staff played a key role in ensuring a positive caesarean birth experience. Implications for practice: ensuring that men have a positive birth experience, regardless of birth mode, is important for family functioning. However the findings also lend insight into how men may reframe caesarean birth as normal and safe. This may have implications for decision making around birth mode in a subsequent pregnancy further impacting on rising repeat caesarean section rates. Health-care professionals need to provide balanced information about the risks associated with caesarean birth. Any potential benefits need to be contextualised to the pregnant woman's own individual situation. Where possible, and appropriate, professional discourses should support vaginal birth as the safest option for a woman and her baby.

  • 28.
    Larsson, Margareta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    A descriptive study of the use of the Internet by women seeking pregnancy-related information2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 1, p. 14-20Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to investigate whether pregnant Swedish women used the Internet to retrieve pregnancy-related information, how they perceived the reliability of the information, and whether they discussed this information with their midwife during antenatal care visits. DESIGN AND SETTING: a descriptive, cross-sectional design using waiting-room questionnaires to obtain information from pregnant women attending 11 antenatal clinics in a county in mid-Sweden during 2004. PARTICIPANTS: all Swedish-speaking women who visited the clinics during a 2-week period, and who were at least 32 weeks pregnant, were invited to participate. A total of 182 women, with a mean age of 31 years, participated in the study; the response rate 85%. FINDINGS: most (91%) of the women had access to the Internet and, to a great extent (84%), used it to retrieve information, most often in the early stages of their pregnancy. Fetal development and stages of childbirth were the two most often mentioned topics of interest. Most participants considered the information to be reliable, and the two most important criteria for judging the trustworthiness of web-based information were if the facts were consistent with information from other sources and if references were provided. Most (70%) of the women did not discuss the information they had retrieved from the Internet with their midwife, but more than half of them (55%) searched for information on topics brought up by the midwife. CONCLUSION: Swedish pregnant women often use the Internet to find information on various topics related to pregnancy, childbirth and the expected baby. They perceive the information to be reliable but rarely discuss it with their midwives. Antenatal care providers should be able to guide pregnant women to high-quality, web-based information and then take the opportunity to discuss this information with them during antenatal visits.

  • 29.
    Larsson, Margareta
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Aldegarmann, Ulrike
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Aarts, Clara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Professional role and identity in a changing society: three paradoxes in Swedish midwives' experiences2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 4, p. 373-381Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to explore how experienced midwives understand and experience their professional role and identity after the continuing changes that have taken place within their working domain over the last 20-25 years. DESIGN: four focus group interviews with 20 a total of participants in total were conducted and analysed by thematic content analysis. SETTING: one university hospital in mid-Sweden. FINDINGS: two main themes were conceptualised: (1) organisation of and situation at the workplace; and (2) the societal context. Three paradoxes became apparent. The midwives felt that their professional role in childbirth care had decreased in favour of other professionals, but they had a better dialogue with physicians and auxiliary nurses, which led to better teamwork and joint decisions. Secondly, the midwives expressed a strong professional identity on the basis of self-confidence and long experience, but their handcraft skills and clinical experience have become less valued due to increased medical technology and organisational changes that contributed to loss of locus of control. Finally, the midwives described a more humanised childbirth care and better collaboration with women/couples over the last decades. The couples are, however, more knowledgeable and enquiring, and the midwives expressed a fear that professional competency could be set aside. Furthermore, lack of trust in the normal birth process among women also affects midwives and the risk of litigation influences practice. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the midwives had experienced both positive and negative changes, but generally felt that their role had become more limited and their professional identity challenged by technology, other professionals and contemporary parents. A loss of locus of control may increase the risk of illness and burn-out symptoms, and must be considered by supervisors and managers.

  • 30.
    Litorp, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Mgaya, Andrew
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Kidanto, Hussein L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Johnsdotter, Sara
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    "What about the mother?": Women's and caregivers' perspectives on caesarean birth in a low-resource setting with rising caesarean section rates2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 7, p. 713-720Article in journal (Refereed)
    Abstract [en]

    Objective: in light of the rising caesarean section rates in many developing countries, we sought to explore women's and caregivers' experiences, perceptions, attitudes, and beliefs in relation to caesarean section. Design: qualitative study using semi-structured individual in-depth interviews, focus group discussions, and participant observations. The study relied on a framework of naturalistic inquiry and data were analysed using thematic analysis. Setting: a public university hospital in Dar es Salaam, Tanzania. Participants: we conducted a total of 29 individual interviews, 13 with women and 16 with caregivers, and two focus group discussions comprising five to six caregivers each Women had undergone a caesarean section within two months preceding the interview and were interviewed in their homes. Caregivers were consultants, specialists, residents, and midwives. Findings: both women and caregivers preferred vaginal birth, but caregivers also had a favourable attitude towards caesarean section. While caregivers emphasised their efforts to counsel women on caesarean section, women had often reacted with fear and shock to the caesarean section decision and perceived that there was a lack of indications. Although caesarean section was perceived as involving higher maternal risks than vaginal birth, both women and caregivers justified these risks by the need to 'secure' a healthy baby. Religious beliefs and community members seemed to influence women's caesarean section attitudes, which often made caregivers frustrated as it diminished their role as decision makers Undergoing caesarean section had negative socio-economic consequences for women and their families; however, caregivers seldom took these factors into account when making decisions. Key conclusions and implications for practice: we raise a concern that women and caregivers might overlook maternal risks with caesarean section for the benefit of the baby, a shift in focus that can have serious consequences on women's health in low-resource settings. Caregivers need to reflect on how they counsel women on caesarean section, as many women perceived a lack of indication for their operations. Supportive attendance by a relative during birth and more comprehensive antenatal care counselling about caesarean section indications and complications might enhance women's autonomy and birth preparedness.

  • 31.
    Lundberg, Pranee C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Trieu, T. N. T.
    Breast-feeding attitudes and practices among Vietnamese mothers in Ho Chi Minh City2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 2, p. 252-257Article in journal (Refereed)
    Abstract [en]

    Objective: to describe breast-feeding attitudes and practices among Vietnamese women in Ho Chi Minh City.

    Design: a descriptive qualitative study was used. The theory of planned behaviour provided the conceptual framework.

    Setting: the Well-baby Clinic, Department of Obstetrics and Gynaecology of a university hospital in Ho Chi Minh City, Vietnam.

    Participants: 23 voluntary Vietnamese mothers.

    Data collection and analysis: semi-structured in-depth interview with five open-ended questions and observation was used. The interviews were tape-recorded and transcribed verbatim. The data from the interviews and observations were analysed by use of content analysis.

    Findings: five categories of breast-feeding attitudes and practices were identified: breast-feeding best but not exclusive, cultural and traditional beliefs, infant feeding as a learning process, factors influencing decision to breast feed, and intention to feed the child.

    Key conclusion and implications for practice: cultural and traditional beliefs and practices, and socio-economic situation, influenced the Vietnamese mothers' breast feeding. Health-care professionals should consider cultural context and socio-economic issues when preparing infant feeding education and intervention programmes. Appropriate knowledge about cultural values should be included in health-care education in order to provide culturally congruent care to Vietnamese mothers in Vietnam as well as in Western countries.

  • 32.
    Lundberg, Pranee C.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Trieu, Thi Ngoc Thu
    Vietnamese women's cultural beliefs and practices related to the postpartum period2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 5, p. 731-736Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe cultural beliefs and practices related to the postpartum period among Vietnamese women in Ho Chi Minh City. DESIGN: a descriptive cross-sectional study using triangulation. SETTING: the Postpartum Clinic, Department of Obstetrics and Gynaecology of a university hospital in Ho Chi Minh City, Vietnam. PARTICIPANTS: 115 Vietnamese women, 95 in the first group and 20 in the second group. DATA COLLECTION AND ANALYSIS: a questionnaire was used with the first group and a semi-structured in-depth interview was used with the second group. Both groups were subjected to the same four open-ended questions. The data obtained were first analysed separately by use of qualitative content analysis and then cross-checked. FINDINGS: four categories were identified: hygiene, behavioural precautions (lying by a fire, keeping warm after birth, staying indoors and resting in bed, and avoiding house work and sexual activity), dietary precautions, and breast feeding and lactation. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE: traditional beliefs and practices, often beneficial to the women and their babies but sometimes potentially harmful, greatly influenced the Vietnamese women during the postpartum period. Therefore, health-care professionals need to give appropriate information and care to the women and their families while paying due attention to the cultural context. These demands make it imperative that knowledge about cultural values be included in their education, not least in Western countries which have become multicultural.

  • 33.
    Lundberg, Pranee
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Gerezgiher, Alganesh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Experiences from pregnancy and childbirth related to female genital mutilation among Eritrean immigrant women in Sweden2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 2, p. 214-225Article in journal (Refereed)
    Abstract [en]

    Objective: to explore Eritrean immigrant women's experiences of female genital mutilation (FGM) during pregnancy, childbirth and the postpartum period. Design: qualitative study using an ethnographic approach. Data were collected via tape-recorded interviews. Setting: interviews in the Eritrean women's homes located in and around Uppsala, Sweden. Participants: 15 voluntary Eritrean immigrant women. Data collection and analysis: Semi-structured interview and open-ended questions were used. The interviews were tape-recorded, transcribed verbatim and then analysed. Findings: six themes of experiences of FGM among Eritrean women during pregnancy and childbirth were identified. They are (1) fear and anxiety, (2) extreme pain and tong-term complications, (3) health-care professionals' knowledge of circumcision and health-care system, (4) support from family, relatives and friends, (5) de-infibulation, and (6) decision against female circumcision of daughters. Key conclusion and implications for practice: the Eritrean women had experiences of FGM and had suffered from its complications during pregnancy, childbirth and the postpartum period. Midwives and obstetricians should have competence in managing women with FGM, and they need increased understanding of cultural epistemology in order to be able to provide quality care to these women. At antenatal centres, circumcised women should be advised to deinfibulate before pregnancy. Special courses about anatomical differences should be offered to these women and their husbands. It is also important to inform them about Swedish law, which prohibits all forms of FGM.

  • 34.
    Lundborg, Louise
    et al.
    Karolinska Univ Hosp & Inst, Dept Med, Clin Epidemiol Unit, Stockholm, Sweden.
    Andersson, Inga-Maj
    Sodersjukhuset KI SOS, Dept Clin Sci & Educ, Stockholm, Sweden.
    Höglund, Berit
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Midwives' responsibility with normal birth in interprofessional teams: A Swedish interview study2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 77, p. 95-100Article in journal (Refereed)
  • 35.
    Lundgren, Ingela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Dahlberg, K
    Midwive's experience of the encounteer with women and their pain during childbirth2002In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 18, no 2, p. 155-164Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe midwives' experience of the encounter with women and their pain during childbirth.

    DESIGN: qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews.

    SETTING: Sahlgrenska University Hospital, Göteborg, and Karolinska Hospital, Stockholm, Sweden in 2000.

    PARTICIPANTS: nine experienced midwives between 12 and 28 years of midwifery practice.

    KEY FINDINGS: the essential structure was described as a striving to become an 'anchored companion'. 'To be a companion' was to be available to the woman, to listen to and see her situation mirrored in her body, and to share the responsibility of childbirth. To be 'anchored' was to show respect for the limits of the woman's ability as well as one's own professional limits. Five constituents can further describe the essential structure: listening to the woman; giving the woman an opportunity to participate and to be responsible; a trusting relationship; the body expresses the woman's situation; and to follow the woman through the process of childbirth.

    IMPLICATIONS FOR PRACTICE: the basis for maternity care should give an opportunity for midwives to be anchored companions. This could be done by emphasising listening to the woman, participation, responsibility, a trusting relationship and a clear understanding of the professional limits and the limits of the woman's ability.

  • 36.
    Lundgren, Ingela
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Dahlberg, K
    Women's experience of pain during childbirth1998In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 14, no 2, p. 105-110Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe women's experience of pain during childbirth.

    DESIGN: A qualitative study using a phenomenological approach. Data were collected by tape-recorded interviews.

    SETTING: An Alternative Birth Care Centre at a university hospital in Sweden in 1995.

    PARTICIPANTS: Nine women, four primiparous and five multiparous who were two to four days post delivery.

    KEY FINDINGS: Four themes were identified in the meanings of experience: (1) pain is hard to describe and is contradictory; (2) trust in oneself and one's body; (3) trust in the midwife and husband; and (4) transition to motherhood. The essential structure of the studied phenomenon was described as 'being one's body', which includes a non-objectifying view of the body, a presence in the delivery process, and a meaning connected to the transition to motherhood.

    IMPLICATIONS FOR PRACTICE: The women felt that pain was a natural part of the delivery process, and that the strength and power to cope with it came from within the women. A conclusion is that midwives can help birthing women to find their own ability to cope, and should interfere only if the woman asks or if the natural process is disturbed, e.g. by complications. The experience of pain during childbirth, together with the experience of strength during childbirth, gives meaning to the transition to motherhood.

  • 37. Manithip, Chanthanom
    et al.
    Edin, Kerstin
    Sihavong, Amphoy
    Wahlström, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wessel, Hans
    Poor quality of antenatal care services-Is lack of competence and support the reason?: An observational and interview study in rural areas of Lao PDR2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 3, p. 195-202Article in journal (Refereed)
    Abstract [en]

    Objective: to explore the health-care providers' performance and their own perceptions of the ANC services they provide. Design, setting and participants: this cross-sectional exploratory survey was carried out in 2009 at four district hospitals and 18 health centres in Khammouane and Champasack provinces in rural areas of Laos. Measurements and findings: combinations of quantitative and qualitative methods were used: (i) 59 observations of ANC sessions (components performed and equipment used); (ii) 26 semi-structured interviews with health-care providers engaged in ANC services, interpreted through content analysis. The findings indicated an overall poor quality and performance of ANC services in rural health facilities with lack of routines, scarce or insufficient equipment and limited skills among providers. The health-care providers gave an often pessimistic picture of their competence and motivation to work with ANC. Some articulated a resignation due to lack of feedback from the patients and they expressed a need for support from health-care superiors. Compared to the district hospitals, the health centres were less well-equipped and supplied, and the providers had a heavier workload, because all activities including ANC were carried out by the same provider. The average consultation time for each woman was 5 mins. Conclusions: the quality of ANC services in rural health facilities in Laos was poor due to lack of resources, the providers' limited skills concurrent with inadequate routines and insufficient backup from superiors. Implications for practice: to comply with national and international recommendations for ANC services, our suggestion is to improve the quality of the rural health facilities in Laos by providing basic equipment, support from experienced superiors and in-service training.

  • 38.
    Mattsson, Elisabet
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
    Funkquist, Eva-Lotta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Wickström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Nyqvist, Kerstin Hedberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 426-431Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to compare the influence of supplementary artificial milk feeds on breast feeding and certain clinical parameters among healthy late preterm infants given regular supplementary artificial milk feeds versus being exclusively breast fed from birth.

    DESIGN: a comparative study using quantitative methods. Data were collected via a parental diary and medical records.

    METHODS: parents of 77 late preterm infants (34 5/7-36 6/7 weeks), whose mothers intended to breast feed, completed a diary during the infants׳ hospital stay.

    FINDINGS: infants who received regular supplementary artificial milk feeds experienced a longer delay before initiation of breast feeding, were breast fed less frequently and had longer hospital stays than infants exclusively breast fed from birth. Exclusively breast-fed infants had a greater weight loss than infants with regular artificial milk supplementation. A majority of the mothers (65%) with an infant prescribed artificial milk never expressed their milk and among the mothers who used a breast-pump, milk expression commenced late (10-84 hours after birth). At discharge, all infants were breast fed to some extent, 43% were exclusively breast fed.

    KEY CONCLUSIONS: clinical practice and routines influence the initiation of breast feeding among late preterm infants and may act as barriers to the mothers׳ establishment of exclusive breast feeding.

  • 39.
    Mbekenga, Columba K.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Lugina, Helen I.
    Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Christensson, Kyllike
    Division of Reprductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Postpartum experiences of first-time fathers in a Tanzanian suburb: A qualitative interview study2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 2, p. 174-180Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to explore postpartum experiences of first-time fathers in a multicultural, low-income, suburban Tanzanian setting. DESIGN, SETTING AND PARTICIPANTS: individual qualitative interviews with ten first-time fathers, four to ten weeks post partum in Ilala suburb, Dar es Salaam, Tanzania. FINDINGS: these first-time fathers enjoyed fatherhood and revealed a sincere concern for the well-being of the mother and infant during the postpartum period. They described themselves as active in mother and infant care and household chores; however, they were limited by breadwinning responsibilities. The families were supported by relatives or laypersons. The mothers' and infants' nutrition had high priority but poverty was an obstacle. Timing of resumption of sex after childbirth was problematic as traditions prescribed abstinence while the woman is breast feeding. The risk of contracting HIV to the family was a concern. Reproductive and child health care often excluded fathers and gave unclear information. CONCLUSION: these new fathers struggled to gain confidence and experience while engaging in family matters during post partum. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers' concerns for family health and needs for support. RECOMMENDATIONS: these findings call for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers' active participation and responsibilities in parenting, family health and their relations with their partners. Such programmes should not only target people in childbearing age but also their potential support persons. Health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum.

  • 40.
    Omer-Salim, Amal
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Whom can I rely on? Mothers' approaches to support for feeding: An interview study in suburban Dar es Salaam, Tanzania.2007In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 2, p. 172-183Article in journal (Refereed)
    Abstract [en]

    Objective

    to explore and describe mothers’ perceptions of baby feeding and approaches to support for baby feeding.

    Design

    individual qualitative semi-structured interviews conducted with mothers. Method used for analysis was qualitative content analysis.

    Setting

    suburban Dar es Salaam, Tanzania.

    Participants

    8 mothers with babies under 6 months of age.

    Findings

    the study revealed four categories of mothers’ perceptions of baby feeding: (1) baby feeding, housework and paid work have to adjust to each other; (2) breast feeding has many benefits; (3) water or breast milk can be given to quench baby's thirst; and (4) crying provides guidance for baby feeding. Four different themes describing approaches to support emerged from the data: (1) adhering to diverse sources; (2) relying wholeheartedly on a mother figure; (3) working as a parental team; and (4) making arrangements for absence from the child.

    Key conclusions and implications for practice

    knowledge of the different approaches to support for baby feeding described in this study can help define counselling and promotional strategies in order to reach mothers with more effective messages and support for optimal baby-feeding practices.

  • 41.
    Omer-Salim, Amal
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Suri, Shoba
    Dadhich, Jai Prakash
    Faridi, MohammadMoonis Akbar
    Olsson, Pia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    ‘Negotiating the tensions of having to attach and detach concurrently’: A qualitative study on combining breastfeeding and employment in public education and health sectors in New Delhi, India2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 473-481Article in journal (Refereed)
    Abstract [en]

    Objective: the aim of this study was to explore the factors involved in combining breastfeeding and employment in the context of six months of maternity leave in India.

    Design: qualitative semi-structured interviews were conducted and analysed using a Grounded Theory approach.

    Setting: Health and Education sectors in New Delhi, India,

    Participants: 20 first-time mothers with one 8-12 month-old infant and who had returned to work after SIX months maternity leave.

    Measurements and findings: the interviews followed a pre-tested guide with a vignette, one key question and six thematic areas; intentions, strategies, barriers, facilitators, actual experiences and appraisal of combining breastfeeding and employment. Probing covered pre-pregnancy, pregnancy, maternity leave, the transition and return to work. This study revealed a model of how employed women negotiate the tensions of concurrently having to attach and detach from their infant, work, and family. Women managed competing interests to ensure trusted care and nutrition at home; facing workplace conditions; and meeting roles and responsibilities in the family. In order to navigate these tensions, they used various satisficing actions of both an anticipatory and troubleshooting nature.

    Key conclusion: in spite of a relatively generous maternity leave of six months available to these women, several individual, familial and workplace factors interacted to both hinder and facilitate the process of combining breastfeeding and employment. Tension, negotiation and compromise are inherent to the process.

    Implications for practice: antenatal and postnatal interventions providing information and support for working mothers need to address factors at the individual, family and workplace levels in addition to the provision of paid maternity leave to enable the successful combination of breastfeeding and employment.

  • 42.
    Påfs, Jessica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Musafili, Aimable
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Finnema, Pauline Binder
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Allvin, Marie Klingberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Rulisa, Stephen
    Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, School of Medicine, University of Rwanda, Kigali, Rwanda.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    'They would never receive you without a husband': Paradoxical barriers to antenatal care scale-up in Rwanda.2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 12, p. 1149-1156Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore perspectives and experiences of antenatal care and partner involvement among women who nearly died during pregnancy ('near-miss').

    DESIGN: a study guided by naturalistic inquiry was conducted, and included extended in-community participant observation, semi-structured interviews, and focus group discussions. Qualitative data were collected between March 2013 and April 2014 in Kigali, Rwanda.

    FINDINGS: all informants were aware of the recommendations of male involvement for HIV-testing at the first antenatal care visit. However, this recommendation was seen as a clear link in the chain of delays and led to severe consequences, especially for women without engaged partners. The overall quality of antenatal services was experienced as suboptimal, potentially missing the opportunity to provide preventive measures and essential health education intended for both parents. This seemed to contribute to women's disincentive to complete all four recommended visits and men's interest in attending to ensure their partners' reception of care. However, the participants experienced a restriction of men's access during subsequent antenatal visits, which made men feel denied to their increased involvement during pregnancy.

    CONCLUSIONS: 'near-miss' women and their partners face paradoxical barriers to actualise the recommended antenatal care visits. The well-intended initiative of male partner involvement counterproductively causes delays or excludes women whereas supportive men are turned away from further health consultations. Currently, the suboptimal quality of antenatal care misses the opportunity to provide health education for the expectant couple or to identify and address early signs of complications IMPLICATIONS FOR PRACTICE: these findings suggest a need for increased flexibility in the antenatal care recommendations to encourage women to attend care with or without their partner, and to create open health communication about women's and men's real needs within the context of their social situations. Supportive partners should not be denied involvement at any stage of pregnancy, but should be received only upon consent of the expectant mother.

  • 43. Radestad, Ingela
    et al.
    Malm, Mari-Cristin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Lindgren, Helena
    Pettersson, Karin
    Larsson, Lise-Lotte Franklin
    Being alone in silence - Mothers' experiences upon confirmation of their baby's death in utero2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 3, p. E91-E95Article in journal (Refereed)
    Abstract [en]

    Objective: to explore mothers' experiences of the confirmation of ultrasound examination results and how they were told that their baby had died in-utero. Design: in-depth interviews. Setting: Sweden. Participants: 26 mothers of stillborn babies. Measurement: narratives were analysed using a qualitative content analysis with an inductive approach. Findings: the mothers experienced that silence prevailed during the entire process of confirming the ultrasound results. Typically all present in the ultrasound room were concentrating and focusing on what they observed on the screen, no one spoke to the mother. The mothers had an instinctive feeling that their baby might be dead based on what they observed on the ultrasound screen and on their interpretation of the body language of the clinicians and midwives. Some mothers reported a time delay in receiving information about their baby's death. Experiencing uncertainty about the information received was also noticed. Conclusion: mothers emphasised an awareness of silence and feelings of being completely alone while being told of the baby's death. Implication for practice: the prevalence of silence during an ultrasound examination may in certain cases cause further psychological trauma for the mother of a stillborn baby. One way to move forward given these results may be to provide obstetric personnel sufficient training on how difficult information might be more effectively and sensitively provided in the face of an adverse pregnancy outcome. (c) 2013 Elsevier Ltd. All rights reserved.

  • 44.
    Rubertsson, Christine
    et al.
    Department of Caring and Public Sciences, Mälardalen University, Västerås, Sweden.
    Hildingsson, Ingegerd
    Department of Caring and Public Sciences, Mälardalen University, Västerås, Sweden.
    Rådestad, Ingela
    Disclosure and police reporting of intimate partner violence postpartum: a pilot study2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 1, p. e1-e5Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    intimate partner violence is a significant health problem. Fear of retaliation and shame may prevent women from telling anyone about the violence. This study investigated the prevalence of disclosure and police reporting of intimate partner violence during the first year postpartum.

    DESIGN:

    a prospective longitudinal Swedish cohort study based on information from 2563 women who answered a postal questionnaire in early pregnancy and 12 months postpartum.

    FINDINGS:

    of 52 women who had been exposed to violence by their partner during the first year postpartum, four (8%) had filed a police report while 19 (37%) had not told anyone about the violence. All single women in the study had disclosed the violence to a friend, a relative or filed a police report.

    KEY CONCLUSIONS:

    few women file a police report when they are being hit by their partner during the year after childbirth. Many women do not tell anyone that they have been hit.

    IMPLICATIONS FOR PRACTICE:

    these data may encourage health professionals to undertake sensitive questioning about violence, giving an opening for support.

  • 45.
    Sahlin, M
    et al.
    Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Carlander-Klint, A-K
    Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Department of Health Science, Sweden.
    Wiklund, I
    Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    First-time mothers' wish for a planned caesarean section: deeply rooted emotions.2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: international estimates suggest that caesarean section on maternal request range from 4% to 18% of all caesarean section. An increasing number of surveys have investigated women's reasons for a caesarean section in the absence of a medical indication but few studies have solely studied first-time mothers motivation for this request.

    OBJECTIVE: to describe the underlying reasons for the desire for a caesarean section in the absence of medical indication in pregnant first-time mothers.

    METHOD: a qualitative descriptive study, with content analysis of interviews with 12 first-time mothers.

    FINDINGS: the overarching theme formulated to illustrate the central interpreted meaning of the underlying desire for a planned caesarean section was based on deeply rooted emotions'. Four categories were identified as related to the request for a caesarean section on maternal request. The categories was identified as 'always knowing that there are no other options than a caesarean section', 'caesarean section as a more controlled and safe way of having a baby', own negative experiences of health care and having problems dealing with other people's reaction about their mode of delivery.

    CONCLUSION: the results show that for these first-time mothers deeply rooted emotions described as stronger than fear of birth were behind their wish for a planned caesarean section.

  • 46. Sandin-Bojö, Ann-Kristin
    et al.
    Larsson, Bodil Wilde
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hall-Lord, Marie Louise
    Intrapartal care documented in a Swedish maternity unit and considered in relation to World Health Organization recommendations for care in normal birth2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 3, p. 207-217Article in journal (Refereed)
    Abstract [en]

    Objectives: to describe documented intrapartal care in relation to the World Health Organization (WHO) recommendations for care in normal birth, and to compare intrapartal care for pregnant women at low and high risk in a conventional maternity unit.

    Design: retrospective examination of 212 consecutive childbirth records using an audit instrument developed from WHO's recommendations.

    Setting: a conventional maternity unit in Western Sweden.

    Findings: practices that are demonstrably useful and should be encouraged were mostly documented, except for physical assessments, such as pulse and temperature and emotional aspects. Vaginal examinations were carried out more often than recommended, and fetal heart rates were seldom monitored intermittently. Practices classified as harmful, practices with insufficient evidence and practices frequently used inappropriately, were used to a large extent. There were high rates of interventions regardless of the women's risk level. The interventions were carried out without a rational documented indication. According to the documentation, only two-thirds of the women were in active labour on admission to the labour ward.

    Conclusion and implications for practice: the recommendations from WHO were only partly adhered to. The instrument is considered useful for systematic audit of documented intrapartal care, and may help to identify areas in need of improvement. Improvements suggested by this study were as follows: inclusion of emotional aspects in the documentation, differentiation in cardiotocographic (CTG) surveillance for women at low and high risk, documentation of explicit indications for interventions and guidelines for admission to the maternity unit.

  • 47. Sandin-Bojö, Ann-Kristin
    et al.
    Louise Hall-Lord, Marie
    Axelsson, Ove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsson, Bodil Wilde
    Intrapartal care in a Swedish maternity unit after a quality-improvement programme2007In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 2, p. 113-122Article in journal (Refereed)
    Abstract [en]

    Objectives

    to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births.

    Design

    an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period.

    Setting

    a conventional maternity unit in Western Sweden.

    Findings

    an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage.

    Conclusion and implications for practice

    a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.

  • 48.
    Sharma, Bharati
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;Indian Inst Publ Hlth Gandhinagar, Gandhinagar Chiloda Rd,CRPF PO, Gandhinagar 382042, Gujarat, India.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Johansson, Eva
    Karolinska Inst, Global Hlth, Stockholm, Sweden.
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Self-assessed confidence of students on selected midwifery skills: Comparing diploma and bachelors programmes in one province of India2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 12-17Article in journal (Refereed)
    Abstract [en]

    Objective: There are two integrated pre-service education programmes for nurses and midwives in India; a diploma in General Nursing and Midwifery (GNM) and bachelor's in nursing (B.Sc. nursing). This study assessed and compared confidence of final-year students from these two programmes for selected midwifery skills from the list of midwifery competencies given by the International Confederation of Midwives (ICM).

    Design: A cross-sectional survey.

    Participants: 633 final-year students, from 25 educational institutions randomly selected, stratified by the type of programme (diploma/bachelor), and ownership (private/government) from the Gujarat province.

    Data collection and analysis: Students assessed their confidence on a 4-point scale, in four midwifery competency domains-antepartum, intrapartum, postpartum, and newborn care. Skill statements were reduced to subscales for each competency domain separately through Principle Component Analysis. Crude and adjusted odds ratios with 95% CI were calculated for students with high confidence (>= 75th percentile on each subscale) and not high (all others) between diploma and bachelor students.

    Findings: The diploma students were 2-4 times more likely to have high confidence on all subscales under antepartum, intrapartum, postpartum and newborn care compared to the bachelor students. Though both groups had less hands-on clinical practice during their education, more diploma students could fulfil the requirements of attending recommended number of births compared to the bachelor students.

    Conclusion: Overall the students of the general nursing and midwifery (GNM) programme have higher confidence in skills for antepartum, intrapartum, newborn and postpartum care. One important reason is more hands-on clinical practice for the diploma compared to the bachelor students.

  • 49.
    Ternström, Elin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Hildingsson, Ingegerd
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Haines, Helen
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Rubertsson, Christine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Higher prevalence of childbirth related fear in foreign born pregnant women: Findings from a community sample in Sweden2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 445-450Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate the prevalence of childbirth related fear (CBRF) in early pregnancy among both Swedish born and foreign born women living in Sweden.

    DESIGN:

    a cross sectional prevalence study. Data was collected by a questionnaire, which was available in Swedish and eight other languages.

    SETTING:

    a university hospital in the middle of Sweden.

    PARTICIPANTS:

    the recruitment took place during a two month period where the participating women completed the Fear of Birth Scale (FOBS) in mid-pregnancy.

    MEASUREMENTS:

    prevalence of CBRF, the cut-point of 60 and above. Odds ratios with a 95% confidence interval were calculated between women born in Sweden and women born in a foreign country. Stratified analyses were also performed separately for Swedish born and foreign born women.

    FINDINGS:

    in total 606 women completed the survey, 78% were born in Sweden and 22% were born in a foreign country. About 22% of the total sample scored 60 or more on the FOBS-scale. Almost 18% (n=85) of the women born in Sweden reported CBRF whereas 37 % (n=49) of the foreign born women reported CBRF. Being born outside Sweden (OR 2.7; CI 1.7-4.0) and expecting the first baby (OR 1.9; CI 1.3-2.8) were associated with CBRF. There were no differences in age, civil status or level of education between women with or without FOBS≥60. However, a stratified analysis showed that primiparas born in a foreign country (OR 3.8; CI 1.8-8.0) were more likely to score 60 or more on the FOBS-scale compared to multiparas born in a foreign country.

    KEY CONCLUSIONS:

    childbirth related fear was almost three times as common among foreign born women when compared to Swedish women. Foreign born childbearing women are an extremely vulnerable group who need culturally sensitive and targeted support from caregivers. Further research is needed to clearly identify the components of women׳s childbirth related fear in various ethnic groups.

  • 50.
    Thies-Lagergren, Li
    et al.
    Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden.
    Kvist, Linda J
    Department of Obstetrics and Gynaecology, Helsingborg Hospital, Sweden.
    Sandin-Bojö, Ann-Kristin
    Department of Nursing, Faculty of Social and Life Sciences, Karlstad University, Sweden.
    Christensson, Kyllike
    Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet, Stockholm, Sweden.
    Labour augmentation and fetal outcomes in relation to birth positions: a secondary analysis of an RCT evaluating birth seat births.2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: the aim of this study was to compare the use of synthetic oxytocin for augmentation, duration of labour and birth and infant outcomes in nulliparous women randomised to birth on a birth seat or any other position.

    STUDY DESIGN: a randomised controlled trial in Sweden where 1002 women were randomised to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The outcome measurements included synthetic oxytocin augmentation, duration of the second stage of labour and fetal outcome. Analysis was by intention to treat.

    SETTING: southern Sweden.

    FINDINGS: the main findings of this study were that women randomised to the experimental group had a statistically significant shorter second stage of labour than women randomised to the control group. There were no differences between the groups for use of synthetic oxytocin augmentation or for neonatal outcomes.

    CONCLUSIONS: women allocated to the birth seat had a significantly shorter second stage of labour despite similar numbers of women subjected to synthetic oxytocin augmentation in the study groups. The adverse neonatal outcomes did not differ between groups. The birth seat can be suggested as non-medical intervention used to reduce duration of second stage labour and birth. The birth seat can be suggested as a non-medical intervention that may facilitate reduced duration of the second stage of labour. Furthermore it is recommended that caregivers, both midwives and midwifery students, should learn skills to assist women in using a variety of birth positions.

    TRIAL REGISTRATION: unique Protocol ID: Dnr 2009/739 (register.clinicaltrials.gov).

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