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  • 1. Andersson, Ewa
    et al.
    Christensson, Kyllike
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Mothers' satisfaction with group antenatal care versus individual antenatal care: A clinical trial2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 3, s. 113-120Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim of this study was to compare women's satisfaction with group based antenatal care and standard care. Design: A randomised control trial where midwives were randomized to perform either GBAC or standard care. Women were invited to evaluate the two models of care. Data was collected by two questionnaires, in early pregnancy and six months after birth. Crude and adjusted odds ratios with a 95% confidence interval were calculated by model of care. Settings: Twelve antenatal clinics in Sweden between September 2008 and December 2010. Participants: Women in various part of Sweden (n = 700). Findings: In total, 8:16 variables in GBAC versus 9:16 in standard care were reported as deficient. Women in GBAC reported significantly less deficiencies with information about labour/birth OR 0.16 (0.10-0.27), breastfeeding OR 0.58 (0.37-0.90) and time following birth OR 0.61 (0.40-0.94). Engagement from the midwives OR 0.44 (0.25-0.78) and being taken seriously OR 0.55 (0.31-0.98) were also found to be less deficient. Women in GBAC reported the highest level of deficiency with information about pregnancy OR 3.45 (2.03-5.85) but reported less deficiency with time to plan the birth OR 0.61 (0.39-0.96). In addition, women in GBAC more satisfied with care in supporting contact with other parents OR 3.86 (2.30-6.46) and felt more support to initiate breastfeeding OR 1.75 (1.02-2.88). Conclusions: Women in both models of care considered the care as deficient in more than half of all areas. Variables that differed between the two models favoured group based antenatal care.

  • 2.
    Andersson, Ewa
    et al.
    Division for Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Department of Health Science, Mid Sweden University, Sundsvall, Sweden.
    Mother's postnatal stress: an investigation of links to various factors during pregnancy and post-partum2016Inngår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, nr 4, s. 782-789Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Higher levels of parental stress have long-term effects on children's health and could lead to dysfunction in the parent-child interaction. Different background factors can be predictors of high parental stress.

    AIM: The aim of this study was to examine parental stress among Swedish women and identify different factors linked to women's parental stress.

    METHOD: About 702 women were recruited to a clinical study and followed up six months after birth. Data were collected by two questionnaires, and 279 women completed the Swedish Parental Stress Questionnaire (SPSQ).

    FINDINGS: Less than very good mental health and depressive symptoms after birth were strongly associated with parental stress, and the strongest association was found between post-partum depressive symptoms and high levels of stress in the subscale Incompetence. Multiparity was associated with high stress in two subscales, and lower level of education was a protective factor for stress in nearly all subscales.

    CONCLUSIONS: Depressive symptoms and perceived poor mental health post-partum are the most important factors related to high parental stress. The results point to the importance of identifying and supporting mothers with depressive symptoms, since these women have both mental illness and increased stress.

  • 3.
    Angeby, Karin
    et al.
    Cent Hosp Karlstad, Womens Dept, Karlstad, Sweden.;Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, SE-61588 Karlstad, Sweden..
    Wilde-Larsson, Bodil
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, SE-61588 Karlstad, Sweden.;Hedmark Univ Coll, Fac Publ Hlth, Dept Nursing & Mental Hlth, Elverum, Norway..
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Mid Sweden Univ, Sundsvall, Sweden. Karoliniska Inst, Stockholm, Sweden..
    Sandin-Bojo, Ann-Kristin
    Karlstad Univ, Dept Hlth Sci, Fac Hlth Sci & Technol, SE-61588 Karlstad, Sweden.;Univ Boras, Sch Hlth Sci, Boras, Sweden..
    Primiparous women's preferences for care during a prolonged latent phase of labour2015Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, nr 3, s. 145-150Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate primiparous women's preferences for care during a prolonged latent phase of labour. Methods: A qualitative study based on focus groups and individual interviews and analysed with inductive content analysis. Results: Sixteen primiparous women with a prolonged latent phase of labour >18 hours were interviewed in five focus groups (n = 11) or individually (n = 5). One main category emerged "Beyond normality - a need of individual adapted guidance in order to understand and manage an extended latent phase of labour" which covers the women's preferences during the prolonged latent phase. Five categories were generated from the data: "A welcoming manner and not being rejected", "Individually adapted care", "Important information which prepares for reality and coping", "Participation and need for feedback" and "Staying nearby the labour ward or being admitted for midwifery support". Women with a prolonged latent phase of labour sought to use their own resources, but their needs for professional support increased as time passed. A welcoming attitude from an available midwife during the latent phase created a feeling of security, and personally adapted care was perceived positively. Conclusions: Women with a prolonged latent phase of labour preferred woman-centred care. Midwives play an important role in supporting these women. Women's need for midwifery-support increases as the time spent in latent phase increases.

  • 4.
    Bäck, Lena
    et al.
    Mid Sweden Univ, Dept Nursing, Kunskapens Vag 8, S-83140 Ostersund, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Kunskapens Vag 8, S-83140 Ostersund, Sweden.
    Sjoqvist, Carina
    Cty Hosp Ostersund, Matern Unit, Ostersund, Sweden.
    Karlstrom, Annika
    Mid Sweden Univ, Dept Nursing, Kunskapens Vag 8, S-83140 Ostersund, Sweden.
    Developing competence and confidence in midwifery-focus groups with Swedish midwives2017Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, nr 1, s. E32-E38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Midwives have a significant impact on the clinical outcome and the birthing experience of women. However,there has been a lack of research focusing specifically on clinical midwives' learning and development of professional competence. Aim: The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence. Methods: A qualitative study based on focus groups with midwives employed in maternity services. Findings: Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding.The meaning of competence is to feel safe and secure in their professional role.There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident.Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field.The midwives felt they were not seen as individuals, and this system made them feel split between different assignments. Discussion: External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning. Conclusions: Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident.

  • 5.
    Bäck, Lena
    et al.
    Mid Sweden Univ, Dept Nursing, Kunskapens Vag 8, S-83140 Ostersund, Sweden..
    Sharma, Bharati
    Indian Inst Publ Hlth Gandhinagar, Gandhinagar, Gujarat, India..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Holmgatan 10, S-85230 Sundsvall, Sweden..
    Tunon, Katarina
    Umea Univ, Ostersunds Sjukhus, Inst Clin Sci, Kyrkgatan 16, S-83150 Ostersund, Sweden..
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Holmgatan 10, S-85230 Sundsvall, Sweden.
    Professional confidence among Swedish final year midwifery students - A cross-sectional study2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 14, s. 69-78Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Previous international studies have shown that midwifery students do not feel confident in many areas where they are supposed to practice independently. The knowledge about Swedish midwifery students' confidence is fairly under investigated. The purpose of the present study was to explore final years' midwifery students' professional confidence in basic midwifery skills according to ICM competencies and associated factors.

    Methods: A cross-sectional survey where all midwifery programs in Sweden were invited to participate. Data was collected by a questionnaire that measured midwifery students self-reported assessment of confidence against four selected domains of ICM competencies; antenatal, intrapartum, postpartum and new-born care.

    Result: The main findings of this study showed that Swedish midwifery students were confident in managing normal pregnancy, labour and birth. Midwifery students at a school with a medical faculty were more confident in handling obstetric emergency situations. Some background variables were also associated with confidence.

    Conclusion: This study highlighted some midwifery skills that needs further training and reflection. More training and developing confidence in complicated and emergency situations are needed. There seem to be a need of midwifery education reforms if we believe that high levels of confidence at the time of graduation is equal to competent and skilled midwives in the future.

  • 6.
    Edqvist, Malin
    et al.
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Mollberg, Margareta
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Ingela
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindgren, Helena
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears-An Experimental Study2017Inngår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 44, nr 1, s. 86-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Most women who give birth for the first time experience some form of perineal trauma. Second-degree tears contribute to long-term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second-degree tears among primiparous women.

    METHODS: An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro-iliac joints, and 3) a two-step head-to-body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables.

    RESULTS: A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second-degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33-0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention.

    CONCLUSION: It is possible to reduce second-degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low- and high-risk pregnancies.

  • 7.
    Gerhardsson, Emma
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Mattsson, Elisabet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk psykologi i hälso- och sjukvård.
    Funkquist, Eva-Lotta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Perinatal, neonatal och barnkardiologisk forskning.
    Prospective questionnaire study showed that higher self-efficacy predicted longer exclusive breastfeeding by the mothers of late preterm infants2018Inngår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 5, s. 799-805Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: An important variable that influences breastfeeding outcomes is how confident a woman feels about her ability to breastfeed successfully at an early stage. We investigated breastfeeding self‐efficacy in the mothers of late preterm infants.

    Methods: This was a prospective, comparative study that focused on mothers who had delivered babies at 34 + 0 to 36 + 6 weeks and were recruited in 2012–2015 from a neonatal intensive care unit and a postnatal ward at a Swedish university hospital. The Breastfeeding Self‐Efficacy Scale‐Short Form (BSES‐SF) was used to psychometrically assess the mothers at 40 weeks of postmenstrual age (n = 148) and at three months of corrected age (n = 114).

    Results: The BSES‐SF scores were higher in the 87% of mothers that exclusively breastfed when their babies reached 40 weeks (57.1 out of 70) than those who did not (41.4, p < 0.001), indicating better self‐efficacy. The figures remained higher in the 68% of exclusive breastfeeding mothers at three months of corrected age (60.9 versus 51.7).

    Conclusion: Self‐efficacy was an important predictor of the length of breastfeeding in mothers of late preterm infants, and the BSES‐SF can be used to detect low self‐efficacy that could lead to early breastfeeding cessation.

  • 8.
    Gerhardsson, Emma
    et al.
    Pediatric Specialist Outpatient Department, University Hospital, Uppsala, Sweden.
    Nyqvist, Kerstin Hedberg
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Mattsson, Elisabet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Volgsten, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Funkquist, Eva-Lotta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    The Swedish Version of the Breastfeeding Self-Efficacy Scale-Short Form: Reliability and Validity Assessment2014Inngår i: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, nr 3, s. 340-345Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Among Swedish mothers, breastfeeding duration has been declining in recent years. An instrument for early identification of women at risk for shorter breastfeeding duration may be useful in reversing this trend.

    Objectives:

    The aims of this study were to translate and psychometrically test the Swedish version of the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), examine the relationship between breastfeeding self-efficacy and demographic variables, and evaluate associations with breastfeeding continuation plans in Swedish mothers.

    Methods:

    The BSES-SF was translated into Swedish using forward and back translation. The sample consisted of 120 mothers who, during the first week postpartum, came for a routine follow-up visit at the postnatal unit in a university hospital. The mothers were compared based on demographic data and their future breastfeeding plans.

    Results:

    The Cronbach's alpha coefficient for internal consistency for the BSES-SF was 0.91 and the majority of correlation coefficients exceeded 0.3. A 1-factor solution was found that explained 46% of the total variance. There was no difference in confidence in breastfeeding between mothers with early hospital discharge and mothers who received postnatal care at the hospital. Primiparas who stayed longer at the hospital were less confident in breastfeeding than primiparas who had a shorter hospital stay. Breastfeeding mothers who planned to partially breastfeed in the near future had lower BSES-SF scores, compared to those who planned to continue exclusive breastfeeding.

    Conclusion:

    The Swedish version of the BSES-SF has good reliability, validity, and agreement with mothers' plans regarding breastfeeding continuation and exclusivity.

  • 9.
    Haines, Helen
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Pallant, Julie F
    The University of Melbourne, Rural Health Academic Centre .
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    The Role of Women’s Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care2013Inngår i: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, nr 4, s. 428-441Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Objective

    To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. 

    Design

    Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth.

    Setting

    Two hospitals in Sweden and Australia. 

    Participants

    Five hundred and five (505) pregnant women from one hospital in Vasternorrland, Sweden (n=386) and one in northeast Victoria, Australia (n=123). 

    Results 

    Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. 

    Conclusions 

    Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.

  • 10.
    Haines, Helen M.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Pallant, Julie F.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth2012Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, s. 55-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored.

    Methods: Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes.

    Results: Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 - 20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02-2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0).

    Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

  • 11.
    Haines, Helen
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Pallant, Julie F
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy2012Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, nr 6, s. e850-e856Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 12.
    Halfdansdottir, Berglind
    et al.
    Univ Iceland, Fac Nursing, Eiriksgata 34, IS-101 Reykjavik, Iceland..
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Smarason, Alexander Kr.
    Univ Akureyri, Inst Hlth Sci Res, IS-600 Akureyri, Iceland..
    Sveinsdottir, Herdis
    Univ Iceland, Fac Nursing, Eiriksgata 34, IS-101 Reykjavik, Iceland..
    Olafsdottir, Olof A.
    Univ Iceland, Fac Nursing, Eiriksgata 34, IS-101 Reykjavik, Iceland..
    Contraindications in planned home birth in Iceland: A retrospective cohort study2018Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, s. 10-17Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: Icelandic national guidelines on place of birth list contraindications for home birth. Few studies have examined the effect of contraindication on home birth, and none have done so in Iceland. The aim of this study was to examine whether contraindications affect the outcome of planned home birth or have a different effect at home than in hospital.

    Methods: The study is a retrospective cohort study on the effect of contraindications for home birth on the outcome of planned home (n = 307) and hospital (n = 921) birth in 2005-2009. Outcomes were described for four different groups of women, by exposure to contraindications (unexposed vs. exposed) and planned place of birth (hospital vs. home). Linear and logistic regression analysis was used to evaluate the effect of the contraindications under study and to detect interactions between contraindications and planned place of birth.

    Results: The key findings of the study were that contraindications were related to higher rates of adverse maternal and neonatal outcomes, regardless of place of birth; women exposed to contraindications had higher rates of adverse outcomes in planned home birth; and healthy, unexposed women had higher rates of adverse outcomes in planned hospital birth. Contraindications significantly increased the risk of transfer in labour and postpartum haemorrhage in planned home births.

    Conclusion: The defined contraindications for home birth had a negative effect on maternal and neonatal outcomes in Iceland, regardless of place of birth. The study results do not contradict the current national guidelines on place of birth.

  • 13.
    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 universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. 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 study2016Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 34, s. 95-104Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 14.
    Halfdansdottir, Berglind
    et al.
    Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Smarason, Alexander Kr
    School of Health Sciences, University of Akureyri, Akureyri, Iceland.
    Olafsdottir, Olof A
    Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Hildingsson, Ingegerd
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Sveinsdottir, Herdis
    Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Outcome of Planned Home and Hospital Births among Low-Risk Women in Iceland in 2005-2009: A Retrospective Cohort Study.2015Inngår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 42, nr 1, s. 16-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland.

    METHODS: The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables.

    RESULTS: The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score < 7 was the same in the home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated.

    CONCLUSIONS: This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth.

  • 15.
    Halfdansdottir, Berglind
    et al.
    University of Iceland, Eirberg, Reykjavik, Iceland.
    Wilson, Margaret E
    University of Nebraska Medical Center, Omaha, Nebraska.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Olafsdottir, Olof A
    University of Iceland, Eirberg, Reykjavik, Iceland.
    Smarason, Alexander Kr
    University of Akureyri, Akureyri, Iceland.
    Sveinsdottir, Herdis
    University of Iceland, Eirberg, Reykjavik, Iceland.
    Autonomy in place of birth: a concept analysis2015Inngår i: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 18, nr 4, s. 591-600Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This article examines one of the relevant concepts in the current debate on home birth-autonomy in place of birth-and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.

  • 16.
    Hauck, Yvonne L.
    et al.
    Curtin Univ, Sch Nursing Midwifery & Paramed, GPO Box U1987, Perth, WA 6845, Australia.;King Edward Mem Hosp, Dept Nursing & Midwifery Educ & Res, Bagot Rd, Subiaco, WA 6008, Australia..
    Blixt, Ingrid
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Gallagher, Louise
    Trinity Coll Dublin, Sch Nursing & Midwifery, 24 DOlier St, Dublin, Ireland..
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Thomson, Brooke
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Curtin Univ, Sch Nursing Midwifery & Paramed, GPO Box U1987, Perth, WA 6845, Australia..
    Lewis, Lucy
    Curtin Univ, Sch Nursing Midwifery & Paramed, GPO Box U1987, Perth, WA 6845, Australia.;King Edward Mem Hosp, Dept Nursing & Midwifery Educ & Res, Bagot Rd, Subiaco, WA 6008, Australia..
    Australian, Irish and Swedish women's perceptions of what assisted them to breastfeed for six months: exploratory design using critical incident technique2016Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 16, artikkel-id 1067Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Breastfeeding initiation rates in some developed countries are high (98 % in Sweden and 96 % in Australia) whereas in others, they are not as favourable (46 % to 55 % in Ireland). Although the World Health Organization recommends exclusively breastfeeding for six months, 15 % of Australian women, 11 % of Swedish women and less than 7 % of Irish women achieve this goal. Awareness of what women in different countries perceive as essential breastfeeding support is a gap in our knowledge.

    Methods

    Our aim was to explore Australian, Irish and Swedish women's perceptions of what assisted them to continue breastfeeding for six months. An exploratory design using critical incident techniques was used. Recruitment occurred through advertisements in local newspapers and on social networking platforms. Initial sampling was purposive, followed by snowball sampling. Telephone interviews were conducted with 64 Irish, 139 Swedish and 153 Australian women who responded to one question "what has assisted you to continue breastfeeding for at least six months?" Content analysis was conducted and common categories determined to allow comparison of frequencies and priority ranking.

    Results

    Categories reflected the individual mother, her inner social network, her outer social network (informal support either face to face or online), and societal support (health professionals, work environment and breastfeeding being regarded as the cultural norm). Categories ranked in the top five across the three countries were 'informal face to face support' and 'maternal determination'. Swedish and Australian women ranked "health professional support" higher (first and third respectively) than Irish women who ranked 'informal online support' as second compared to ninth and tenth for Swedish and Australian women.

    Conclusions

    The support required to assist breastfeeding women is complex and multi-faceted. Although common international categories were revealed, the ranking of these supportive categories varied. We must recognize how the cultural context of breastfeeding support can vary for women in differing countries and acknowledge the resourcefulness of women who embrace innovations such as social media where face to face formal and informal support are not as accessible.

  • 17.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Sense of coherence in pregnant and new mothers - A longitudinal study of a national cohort of Swedish speaking women2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, s. 91-96Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous research shows inconsistent results about the stability of SOC during the childbearing period, and few studies have focused on longitudinal measures. There are contradictory results regarding the association between SOC and birth outcome. The link between levels of SOC and parental stress needs to be further explored. Aim: The aim of this study was to investigate changes in SOC from early pregnancy to one year after birth and associations with background characteristics, birth outcome and parental stress. Methods: A longitudinal survey of a national cohort of Swedish speaking women during 3 weeks in 1999-2000. Data were collected by questionnaires in early pregnancy, 2 months and 1 year after birth. Results: SOC increased from pregnancy to 2 months after birth but decreased 1 year after birth. SOC was associated with women's background characteristics, emotional wellbeing and attitudes, but not with labour outcome. Women with low SOC reported higher parental stress after one year. Conclusion: Sense of coherence is not stable during the childbearing period and is associated with women's sociodemographic background, emotional health and attitudes, but not with reproductive history or birth outcome. Parental stress is negatively correlated with SOC, and some important characteristics are similar in women having low SOC and high parental stress. Identifying women with low SOC in early pregnancy could be a means to prevent later parental stress.

  • 18.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Swedish couples’ attitudes towards birth, childbirth fear and birth preferences and relation to mode of birth: A longitudinal cohort study2014Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 2, s. 75-80Artikkel i tidsskrift (Fagfellevurdert)
  • 19.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Women's birth expectations, are they fulfilled?: Findings from a longitudinal Swedish cohort study2015Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, nr 2, s. e7-e13Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The importance of women's expectations on the experience of birth has shown contradictory results regarding fulfilment. The aim of this study was to describe pregnant women's expectations of birth and to investigate if these expectations were fulfilled. An additional aim was to determine if unfulfilled expectations were related to the mode of birth, use of epidural and the birth experience.

    METHODS:

    This research investigated a prospective regional cohort study of 1042 Swedish-speaking women who completed a questionnaire about birth expectations in late pregnancy and were followed up with two months after birth. Five areas were under study: support from partner, support from midwife, control, participation in decision making and the midwife's presence during labour and birth. An index combining expectations and experiences was created.

    RESULTS:

    Certain background characteristics were associated with expectations as well as experiences. Statistically significant differences were shown between expectations and experiences in support from midwife (mean 3.41 vs 3.32), support from partner (mean 3.70 vs 3.77), and midwife's presence (mean 3.00 vs 3.39). Experiences 'worse than expected' regarding decision making and control were associated with modes of birth other than vaginal and four out of five areas were associated with a less positive birth experience.

    CONCLUSION:

    Some women had high birth expectations of which some were fulfilled. An expectation on support from the midwife was less likely to be achieved, while support from partner and the midwives' presence were fulfilled. If the woman's expectations were not fulfilled, e.g. became 'worse than expected' this was associated with a less positive overall birth experience as well as with instrumental or surgical mode of birth.

  • 20.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Andersson, Ewa
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Christensson, Kyllike
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Swedish women’s expectations about antenatal care and change overtime: A comparative study of two cohorts of women2014Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 2, s. 51-57Artikkel i tidsskrift (Fagfellevurdert)
  • 21.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Mid Sweden Univ, Dept Nursing, Holmgatan 12, S-85170 Sundsvall, Sweden..
    Blix, Ellen
    Res Grp Maternal Reprod & Childrens Hlth, Fac Hlth Sci, Oslo, Norway.;Akershus Univ, Coll Appl Sci, Oslo, Norway..
    Hegaard, Hanne
    Copenhagen Univ Hosp, Rigshosp, Res Unit,Womens & Childrens Hlth, Juliane Marie Ctr Women Children & Reprod, Copenhagen, Denmark..
    Huitfeldt, Anette
    Oslo Univ Hosp, Clin Genet Unit, N-0450 Oslo, Norway..
    Ingversen, Karen
    Reg Sealand Homebirth Assoc, Soro, Denmark..
    Olafsdottir, Olof Asta
    Univ Iceland, Fac Nursing, Dept Midwifery, Reykjavik, Iceland..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden.;Univ Gothenburg, Dept Hlth & Care Sci, Sahlgrenska Akad, Gothenburg, Sweden..
    How Long Is a Normal Labor?: Contemporary Patterns of Labor and Birth in a Low-Risk Sample of 1,612 Women from Four Nordic Countries2015Inngår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 42, nr 4, s. 346-353Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Normal progress of labor is a subject for discussion among professionals. The aim of this study was to assess the duration of labor in women with a planned home birth and spontaneous onset who gave birth at home or in hospital after transfer. Methods: This is a population-based study of home births in four Nordic countries (Denmark, Iceland, Norway, and Sweden). All midwives assisting at a home birth from 2008 to 2013 were asked to provide information about home births using a questionnaire. Results: Birth data from 1,612 women, from Denmark (n = 1,170), Norway (n = 263), Sweden (n = 138), and Iceland (n = 41) were included. The total median duration from onset of labor until the birth of the baby was approximately 14 hours for primiparas and 7.25 hours for multiparas. The duration of the different phases varied between countries. Blood loss more than 1,000 mL and perineal ruptures that needed suturing were associated with a longer pushing phase and the latter with country of residence, parity, single status, and the baby's weight. Conclusion: In this population of healthy women with a low prevalence of interventions, the total duration of labor was fairly similar to what is described in the literature for multiparas, but longer for primiparas. Although the duration of the phases of labor differed among countries, it was to a minor extent associated with severe outcomes.

  • 22.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Dalén,, Kristina
    Department of Women and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden.
    Sarenfelt, Lena
    Department of Women and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden.
    Ransjö-Arvidson, Anna-Berit
    Department of Women and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden.
    First-Time Parents’ Perception of Antenatal Education in Sweden2013Inngår i: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 3, nr 1, s. 28-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Antenatal parent education is one part of the parenthood support program and is offered to all firsttime parents in Sweden. The aim was to explore first-time parents' experiences of antenatal education and its helpfulness in preparation for birth and early parenthood. Eight hundred ten first-time parents completed questionnaires. The antenatal education was a positive experience for 56% and 62% of women and men, respectively. Antenatal education was helpful during birth for 68% of women and 63% of men. Forty-seven percent of women and 44% of men found it helpful for early parenthood. High level of education was the only background variable associated with being satisfied with antenatal education. Satisfaction was lower than reported in previous studies and indicates room for change and improvement in antenatal parent education.

  • 23.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Mid Sweden Univ, Dept Nursing, SE-85170 Sundsvall, Sweden..
    Fenwick, Jennifer
    Griffith Univ, Griffith Hlth Inst, Hlth Practice Innovat, Brisbane, Qld 4111, Australia.;Gold Coast Univ Hosp, Southport, Qld, Australia..
    Swedish midwives' perception of their practice environment - A cross sectional study2015Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, nr 3, s. 174-181Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There is a shortage of midwives in Sweden. Evidence suggests that the work environment is likely to play a part in retention and attrition rates. Objective: To explore the practice environment of Swedish midwives and factors associated with the perception of an unfavorable work environment. Methods: 475/1000 (48.6%) members of the Swedish Midwifery association completed a questionnaire including the Practice Environment Scale (PES). Differences in mean scores were calculated for the subscales of PES and midwives' background characteristics. Logistic regression was used to investigate factors most strongly associated with unfavorable working environment. Results: The two domains that showed significant differences in terms of participant characteristics were the Staffing and resources adequacy subscale and the Foundations of quality care subscale. Midwives younger than 40 years, those with less than 10 years' experience and those with an additional academic degree rated these two domains more unfavorably. Protective factors for assessing the work environment unfavorable were mainly internal such as high quality of life and high self-efficacy. Swedish midwives were most satisfied with the midwife-doctor relationship and least satisfied with their participation in work place or hospital affairs. Midwives suffering from burnout, those who provided hospital based care and those without leadership position were more likely to assess their work environment as unfavorable. Conclusions: This study identified personal factors as well as work related factors to be associated with midwives' assessment of their practice work environment. Establishing healthy work places where midwives feel recognized and valued could prevent midwives from leaving the profession.

  • 24.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. 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 Sweden2016Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, s. 62-69Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 25.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Cross, Maddalena
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Pallant, Julie F
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Women's satisfaction with antenatal care: Comparing women in Sweden and Australia2013Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, nr 1, s. e9-e14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    Satisfaction with antenatal care could differ depending on the organisation and the context of care.

    AIM:

    To compare antenatal care in Australia and Sweden, to identify deficiencies in the content of antenatal care and what aspects contributed most in dissatisfaction with antenatal care.

    METHODS:

    A longitudinal survey of 123 Australian and 386 Swedish women recruited during one year in regional hospitals in Sweden and Australia. Data collected by three questionnaires.

    RESULTS:

    Women in Australia had more antenatal visits, less continuity of midwife caregiver but were more satisfied with antenatal education and the emotional aspects of antenatal care. Although the overall satisfaction was high, deficiencies were found in more than half of the studied variables in the content of care. Women in Sweden were more dissatisfied with information about labour and birth (OR 3.1; 1.8-5.3) and information about the time following birth (OR 3.8; 2.2-6.3), but more satisfied with the involvement of the father (OR 0.3; 0.2-0.6). Factors that contributed most to dissatisfaction with antenatal care overall were deficiency in information about pregnancy related issues (OR 3.4; 1.3-8.7) and not being taken seriously by the midwife (OR 4.1; 1.6-10.1).

    CONCLUSION:

    Satisfaction with antenatal care was high in both groups of women. Australian women were more satisfied than the Swedish women with the emotional aspects of care. Deficiencies were found in more than half of the variables measured relating to the specific aspects of care. Lack of information and not being treated seriously were important factors for not being satisfied.

  • 26.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Johansson, Margareta
    Södersjukhuset, Stockholm, Sweden.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    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 health2014Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, nr 2, s. 248-254Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 27.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Nystedt, Astrid
    Umea Univ, Dept Nursing, Umea, Sweden..
    Presence and process of fear of birth during pregnancy: Findings from a longitudinal cohort study2017Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, nr 5, s. E242-E247Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The prevalence of fear of birth has been estimated between 8-30%, but there is considerable heterogeneity in research design, definitions, measurement tools used and populations. There are some inconclusive findings about the stability of childbirth fear.

    Aim: to assess the prevalence and characteristics of women presenting with scores >= 60 on FOBS-The Fear of Birth Scale, in mid and late pregnancy, and to study change in fear of birth and associated factors.

    Methods: A prospective longitudinal cohort study of a one-year cohort of 1212 pregnant women from a northern part of Sweden, recruited in mid pregnancy and followed up in late pregnancy. Fear of birth was assessed using FOBS-The fear of birth scale, with the cut off at >= 60.

    Findings: The prevalence of fear of birth was 22% in mid pregnancy and 19% in late pregnancy, a statistically significant decrease. Different patterns were found where some women presented with increased fear and some with decreased fear. The women who experienced more fear or less fear later in pregnancy could not be differentiated by background factors.

    Conclusions: More research is needed to explore factors important to reduce fear of childbirth and the optimal time to measure it.

  • 28.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Johansson, Margareta
    Mid Sweden University, Department of Health Science, Sundsvall, Sweden.
    Fenwick, Jennifer
    Griffith University, Gold Coast Hospital, Australia.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study2014Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, nr 2, s. 242-247Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 29.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Johansson, Margareta
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Karlström, Annika
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Fenwick, Jennifer
    Griffith Health Institute, School of Nursing and Midwifery, Griffith University, Logan Brisbane, Australia and Gold Coast Hospital.
    Factors Associated With a Positive Birth Experience: An Exploration of Swedish Women’s Experiences2013Inngår i: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 3, nr 3, s. 153-164Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND:

    The birth of a baby is a powerful life event that has implications for a woman's wellbeing and future health. A positive birth experience promotes a sense of achievement, enhances feeling of self-worth, and facilitates confidence—all of which are important for a healthy adaptation to motherhood and psychological growth. Understanding what constitutes a positive birth experience is critical to providing maternity care that meets childbearing women's individual needs, preferences, and priorities.

    OBJECTIVE:

    To explore the prevalence of Swedish women reporting a very positive birth experience 2 months and 1 year after childbirth and identify factors associated with this experience. In addition, the study aimed to identify whether women's assessment of their birth experience changed over time.

    METHOD:

    A prospective, longitudinal study where the main outcome variable was perceptions of a very positive birth experience. The study was undertaken in a Northern region of Sweden in 2007. Women were recruited at their ultrasound examination in midpregnancy. Data was collected via questionnaires. There were 928 women who responded to questions about their birth experience at 2 months postpartum. Nearly 83% of these women (n = 763) also completed the questionnaire package 1 year after birth. Descriptive statistics were used together with Friedman's test to detect changes over time. Logistic regression analysis was performed to reveal which factors contributed most to a very positive birth experience.

    RESULT:

    More than a third of the women reported a very positive birth experience. Women's assessment of birth changed over time with 22% of the women becoming more positive and 15% more negative. Important associated factors for a very positive birth experience included positive feelings about the approaching birth as well as feeling in control, using no or only cognitive forms of pain management, and achieving a spontaneous vaginal birth. Furthermore, how women rated their midwifery care was also shown to affect their assessment of their birth experience.

    CONCLUSION:

    This study found that women's birth experiences changed over time and most becoming more positive after 1 year. Factors associated with a very positive birth experience were related to women's prenatal attitudes, intrapartum procedures, pain relief used, and care received during labor and birth. Respectful individualized midwifery care that remains focused on the woman and keeping birth normal increases positive perceptions of the birth experience.

  • 30.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Karlstrom, Annika
    Nystedt, Astrid
    Parents' experiences of an instrumental vaginal birth findings from a regional survey in Sweden2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: An instrumental vaginal birth is known to affect women's birth experience, few studies have explored the fathers' experiences of attending such a birth. The aim of this study is to compare birth outcome and parents' feelings in parents with instrumental vaginal birth or a spontaneous vaginal birth. Methods: A regional survey was conducted of 936 mothers and 827 fathers recruited in mid-pregnancy and followed up 2 months after birth. Data was collected by questionnaires. Crude and adjusted odds ratios with a 95% confidence interval were used in the analysis. Results: The prevalence for instrumental vaginal birth was 9%. Prolonged labour (OR 8.3; 95% CI 5.0-13.9), augmentation with synthetic oxytocin (OR 5.1; 2.9-8.9), and birth complications (OR 2.5; 1.5-2.6) were more common in the instrumental vaginal group. An instrumental vaginal birth was associated with a negative birth experience for mothers (OR 3.2; 1.3-8.1) and fathers (OR 5.2; 1.2-21.5). Mothers who had an instrumental vaginal birth were more likely to report feelings that the baby would be damaged during birth (OR 3.0; 1.7-5.5) and that the birth experience made them decide not to have any more children (OR 3.4; 1.1-10.7). Fathers reported a near-panic feeling when attending an instrumental vaginal birth (OR 5.2; 1.7-15.5). Conclusion: An instrumental vaginal birth was correlated with longer and more complicated births, epidurals and oxytocin augmentation. It affected the birth outcome and parents' feelings and was associated with future reproductive thoughts and a negative birth experience.

  • 31.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Karlstrom, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Lund Univ, Dept Hlth Sci, Fac Med, Lund, Sweden.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa. Univ Melbourne, Dept Rural Hlth, Wangaratta, Vic, Australia.
    Women with fear of childbirth might benefit from having a known midwife during labour2019Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, nr 1, s. 58-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

  • 32.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia. Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden..
    Johansson, Margareta
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Swedish women's interest in models of midwifery care - Time to consider the system?: A prospective longitudinal survey2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, s. 27-32Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Sweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care. Methods: A prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated. Results: Approximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife. Conclusions: Continuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.

  • 33.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Bäck, Lena
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Mudokwenyu-Rawdon, Christina
    White Ribbon Alliance Zimbabwe, Harare, Zimbabwe.
    Maimbolwa, Margaret C.
    Univ Zambia, Sch Nursing Sci, Lusaka, Zambia.
    Laisser, Rose Mjawa
    Catholic Univ Hlth & Allied Sci, Archbishop Antony Malaya Sch Nursing, Mwanza, Tanzania.
    Omoni, Grace
    Univ Nairobi, Sch Nursing Sci, Nairobi, Kenya.
    Chimwaza, Angela
    Univ Malawi, Kamuzu Coll Nursing, Lilongwe, Malawi.
    Mwebaza, Enid
    LAMRN, Kampala, Uganda.
    Kiruja, Jonah
    Hargeisa Univ, Coll Hlth Sci & Med, Fac Nursing & Midwifery, Hargeisa, Solomon Islands;Dalarna Univ, Dept Nursing, Falun, Sweden.
    Sharma, Bharati
    Indian Inst Publ Hlth, Gandhinagar, India.
    African midwifery students' self-assessed confidence in antenatal care: a multi-country study2019Inngår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, nr 1, artikkel-id 1689721Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Evidence-based antenatal care is one cornerstone in Safe Motherhood and educated and confident midwives remain to be optimal caregivers in Africa. Confidence in antenatal midwifery skills is important and could differ depending on the provision of education among the training institutions across Africa. Objective: The aim of the study was to describe and compare midwifery students' confidence in basic antenatal skills, in relation to age, sex, program type and level of program. Methods: A survey in seven sub-Saharan African countries was conducted. Enrolled midwifery students from selected midwifery institutions in each country presented selfreported data on confidence to provide antenatal care. Data were collected using a selfadministered questionnaire. The questionnaire consisted of 22 antenatal skills based on the competency framework from the International Confederation of Midwives. The skills were grouped into three domains; Identify fetal and maternal risk factors and educate parents; Manage and document emergent complications and Physical assessment and nutrition. Results: In total, 1407 midwifery students from seven Sub-Saharan countries responded. Almost one third (25-32%) of the students reported high levels of confidence in all three domains. Direct entry programs were associated with higher levels of confidence in all three domains, compared to post-nursing and double degree programs. Students enrolled at education with diploma level presented with high levels of confidence in two out of three domains. Conclusions: A significant proportion of student midwives rated themselves low on confidence to provide ANC. Midwifery students enrolled in direct entry programs reported higher levels of confidence in all domains. It is important that local governments develop education standards, based on recommendations from the International Confederation of midwives. Further research is needed for the evaluation of actual competence.

  • 34.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Lund Univ, Dept Nursing, Lund, Sweden.
    Karlstrom, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia.
    Exploring the Fear of Birth Scale in a mixed population of women of childbearing age: A Swedish pilot study2018Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, nr 5, s. 407-413Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 35.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Univ Melbourne, Dept Rural Hlth, Wangaratta, Vic, Australia.
    A known midwife can make a difference for women with fear of childbirth-birth outcome and women's experiences of intrapartum care2019Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, s. 33-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There is evidence that continuity of midwifery care is beneficial to women. Women with fear of childbirth in Sweden are offered counselling, but receiving care from a known midwife during labour is unusual, despite its effects in reducing interventions and increasing birth satisfaction. The aim of this study was to describe and compare birth outcome and experience of intrapartum care among women with fear of childbirth who received intrapartum care from a known midwife, versus those who did not.

    Methods: An experimental study of 70 women referred to counselling due to fear of birth during pregnancy wherein the counselling midwife, when possible, also assisted during labour and birth.

    Results: Having a known midwife during labour and birth had a positive impact on fearful women’s birth experience and their perception of pain, but there was no difference in onset of labour or mode of birth. Women who received care from a known midwife experienced better care with regards to information, participation in decision making and perception of control.

    Conclusion: This study indicates that having access to a known midwife might have an impact on women’s birth experience. This study was limited by its small sample size and further research would need to randomise fearful women to counselling or continuity of care to determine the contribution of each to reducing fear.

     

  • 36.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia.
    Caseload midwifery for women with fear of birth is a feasible option2018Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, s. 50-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 37.
    Hildingsson, Ingegerd
    et al.
    Department of Nursing, Karolinska Institute, Stockholm, Sweden.
    Rådestad, Ingela
    Rubertsson, Christine
    Department of Nursing, Karolinska Institute, Stockholm, Sweden.
    Waldenström, Ulla
    Few women wish to be delivered by caesarean section2002Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 109, nr 6, s. 618-623Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.

    Design

    National survey.

    Setting

    Swedish antenatal clinics.

    Population

    3283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999–2000).

    Methods

    A questionnaire was mailed shortly after the first antenatal visit.

    Main outcome measures

    Women's preferences for mode of delivery.

    Results

    3061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience.

    Conclusions

    Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.

  • 38.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Thomas, Jan
    Departmentn of Sociology, Kenyon College, Gambier, Ohio, USA.
    Parental stress in mothers and fathers one year after birth2014Inngår i: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 32, nr 1, s. 41-56Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:

    The aim was to compare prenatal feelings and parental stress in parents one year after birth. An additional aim was to study associations between parental stress and several explanatory factors in mothers and fathers.

    Background:

    The birth of a baby brings many changes to the lives of parents and families. Existing research on gender differences in parental stress levels is somewhat inconclusive.

    Method:

    A longitudinal Swedish survey of a one-year cohort of 783 women and 671 male partners recruited in mid pregnancy and followed up one year after birth. Data were collected using three questionnaires where different aspects of stress arising from the parenting role measured by the Swedish Parental Stress Questionnaire (SPSQ) were investigated. Results: Women and men differed in age and level of education. Women had more negative feelings towards pregnancy, birth and the early parenthood compared to men. Women reported higher levels of parental stress than men in three out of five subscales in the SPSQ (Role Restriction, Social Isolation and Spouse Relationship). The subscales were moderately correlated with background variables but strongly correlated with prenatal feelings. Prenatal negative feelings about the pregnancy, the upcoming birth and the first weeks with a newborn baby were strongly correlated with parental stress for both mothers and fathers.

    Conclusion:

    Assessing parents' feelings and prenatal attitudes is important for understanding parental stress one year after birth. Health care providers should discuss these issues with both parents during pregnancy in order to help them cope with the normal stresses of parenting.

  • 39. Hildingsson, Ingegerd
    et al.
    Tingvall, Maria
    Rubertsson, Christine
    Mälardalen University, Department of Caring and Public Health Science, Västerås, Sweden.
    Partner support in the childbearing period: a follow up study2008Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 21, nr 4, s. 141-148Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Social support is important during pregnancy and childbirth and the partner is usually the main source of support. Lack of partner support is associated with less emotional well-being and discontinuation of breastfeeding.

    Research problem

    The purpose of the study was to investigate the proportion of women dissatisfied with partner support in early pregnancy, and to identify risk factors associated with dissatisfaction through a follow up 2 months and 1 year after childbirth.

    Participants and methods

    A national cohort of 2430 Swedish speaking women recruited in early pregnancy and followed up 2 months and 1 year postpartum. Data were collected by means of three postal questionnaires.

    Results

    Five percent of women were dissatisfied with partner support in early pregnancy. Women dissatisfied with partner support were more likely to be multiparas, not living with their partner in early pregnancy and to report unfavorable timing of pregnancy. They experienced more physical symptoms, and less emotional well-being in terms of more depressive symptoms, more major worries and a lower sense of coherence. One year after childbirth a higher rate of divorces and disappointment with the partner's participation in childcare and household chores and understanding from partner was found in women being dissatisfied in early pregnancy.

    Discussion and conclusions

    This study shows that it might be possible to identify women who are lacking partner support already in early pregnancy. Women's social network and their support from partner should be investigated by health care providers and women in need of additional support should be refereed to available community resources.

  • 40.
    Hildingsson, Ingegerd
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Westlund, Kajsa
    Wiklund, Ingela
    Burnout in Swedish midwives2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 3, s. 87-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: In many countries midwives tend to leave their profession. Factors associated with workforce attrition include high workload, stress, poor management and a lack of promotional opportunities. The aim of the study was to investigate Swedish midwives' levels of burnout and their attitudes towards leaving the profession. Method: A random sample of 1000 midwives who are members of the Swedish Midwifery Association were sent a questionnaire. Burnout was measured using the Copenhagen Burnout Inventory. In addition the midwives were asked if they had experienced any situation that made them consider leaving their work and to give a comment about the reason. Results: 475 of 978 Eligible midwives (48.6%) returned the questionnaire. The Cronbach alpha values ranged from 0.81 to 0.93 for the burnout subscales. One hundred and eighty four (39.5%) scored high in the subscale Personal burnout, while Work burnout and Client burnout was around 15%. The strongest associations between Burnout and midwives' characteristics were age <40, work and work experience <10 years. One in three midwives had considered leaving the profession. Lack of staff and resources and a stressful work environment was associated with all three subscales of midwives' burnout. Other important explanatory variables were conflict with work mates and/or mangers and worries about the future and own health. Conclusion: More than one third of the midwives included in this survey reported some kind of burnout. Paying attention to midwives work is important in order to maintain a healthy, motivated midwifery workforce that will continue serving women and their families.

  • 41.
    Höglund, Berit
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Radestad, Ingela
    Sophiahemmet Univ, Stockholm, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning. Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden.
    Few women receive a specific explanation of a stillbirth - an online survey of women's perceptions and thoughts about the cause of their baby's death2019Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, artikkel-id 139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In Sweden, three to four out of every 1000 pregnancies end in stillbirth each year. The aim of this study was to investigate whether women who had experienced stillbirth perceived that they had received an explanation of the death and whether they believed that healthcare professionals were responsible for the death of the baby.

    Methods: An online survey of 356 women in Sweden who had experienced a stillbirth from January 2010 to April 2014. A mixed-methods approach with qualitative content analysis was used to examine the women's responses.

    Results: Nearly half of the women (48.6%) reported that they had not received any explanation as to why their babies had died. Of the women who reported that they had received an explanation, 84 (23.6%) had a specific explanation, and 99 (27.8%) had a vague explanation. In total, 73 (30.0%) of the 243 women who answered the question Do you believe that healthcare personnel were responsible for the stillbirth? stated Yes. The women reported that the healthcare staff had not acknowledged their intuition that the pregnancy was proceeding poorly. Furthermore, they perceived that the staff met them with nonchalance and arrogance. Additionally, the midwife had ignored or normalised the symptoms that could indicate that their pregnancy was proceeding poorly. Some women added that neglect and avoidance among the healthcare staff could have led to a lack of monitoring, which could have been crucial for the outcome of the pregnancy.

    Conclusions: Half of the women surveyed reported that they had not received an explanation of their baby's death, and more than one-fourth held healthcare professionals responsible for the death.

  • 42. Johansson, M.
    et al.
    Radestad, I.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Karlstrom, A.
    Hildingsson, Ingegerd
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Few fathers-to-be prefer caesarean section for the birth of their baby2010Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 6, s. 761-764Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to investigate prospective fathers' preferences for caesarean section and associated factors. Data were collected by means of a questionnaire given in mid-pregnancy to 1105 fathers-to-be in northern Sweden. In total, 6.4% of fathers preferred a caesarean section. The factors associated with a preference for caesarean section were a wish to plan the date of the baby's birth [prevalence ratio (PR) 6.0], a previous negative birth experience (PR 8.6) and previous experience of a caesarean section (PR 5.7).

  • 43.
    Johansson, Margareta
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Intrapartum care could be improved according to Swedish fathers: Mode of birth matters for satisfaction2013Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, nr 3, s. 195-201Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Intrapartum care is expected to be shaped by parents' need and preferences. Aim: The aim was to explore Swedish fathers' intrapartum care quality experiences, with a specific focus on care deficiencies in relation to birth mode. A secondary aim was to explore which issues of quality that contributed most to dissatisfaction with the overall assessment of the care. Methods: Cross-sectional design, part of a prospective longitudinal survey in Sweden. A quality of care index was developed, based on perceived reality and subjective importance of given intrapartum care. Two months after birth 827 fathers answered nine questions related to quality of care. Descriptive statistics and logistic regression analysis were used. Results: Dissatisfaction with overall intrapartum care was related to deficiencies in partner's medical care (OR 5.6; 2.7-11.2), involvement in decision-making during childbirth (OR 2.6; 1.3-4.9), midwives presence in the labour room (OR 2.4; 1.2-4.7), and ability to discuss the birth afterwards (OR 2.0; 1.1-3.8). After emergency caesarean section 46% judged the partner's medical intrapartum care as most deficient (OR 1.73; 1.05-2.86), and after elective caesarean section 40% of the fathers judged involvement in decision-making as deficient (OR 4.07; 1.95-8.50). When the fathers had participated in a spontaneous vaginal birth they were dissatisfied with the presence of the midwife in the labour room (OR 1.72; 1.03-2.87). Conclusions: Deficiencies existed in the intrapartum care and were judged differently depending on mode of birth. The fathers needed to feel secure about the women's medical care, and wanted to be involved and supported.

  • 44.
    Johansson, Margareta
    et al.
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Maternity and Family Unit, Research Centre for Clinical and Community Practice Innovation (RCCCPI), Griffith Health Institute, Griffith University, Meadowbrook, Queensland, Australia f Gold Coast Hospital, Australia.
    'As long as they are safe - Birth mode does not matter' Swedish fathers' experiences of decision-making around caesarean section2014Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 27, nr 3, s. 208-213Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Decision-making in childbirth involves considerations about both the mother and her unborn baby's wellbeing. For men the safety of both is paramount. Aim: To explore and describe Swedish fathers' beliefs and attitudes around the decision for a caesarean section. Methods: Qualitative descriptive study. Twenty one Swedish men whose partners had experienced elective or emergency caesarean participated in a telephone interview. Thematic data analysis was used. Findings: The theme, 'Childbirth is Risky', included "Caesarean birth has lots of advantages" and "Birth mode does not matter". In the context of having experienced a caesarean section male partners considered birth mode to be irrelevant. The majority considered caesarean to be a quick and efficient way of giving birth which equated to being safer. Most men could articulate some risks associated with caesarean but these were mainly minimised. The second theme, 'Simply a matter of trust: Birth mode is not my decision', reflected men's belief that they had little to contribute to the decisions made around birth mode. The decision for a caesarean section was considered to lie with the medical practitioner. Conclusion: Mode of birth was regarded as unimportant. The recommendation for a caesarean section was readily accepted and appreciated, and shifted responsibility for birth to the medical practitioner. Involving men in the decision-making process by means of giving them information was valued. Men's limited knowledge about the risks of a caesarean may contribute to birth mode decisions. Professionals need to provide balanced and correct information within the context of individual circumstances. (C) 2014 Australian College of Midwives.

  • 45.
    Johansson, Margareta
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Griffith University, Australia.
    Fathers want to stay close to their partner and new baby in the early postnatal period: The importance of being able to room in after a surgical birth2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 1, s. 35-36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The early postnatal period can be challenging for new fathers especially when their partner has experienced a caesarean section. The aim of this study was to describe men's perceptions and feelings of staying with their partner and new baby in the context of having experienced a surgical birth. Thematic analysis was employed" to analyse telephone interviews collected from 21 Swedish fathers who had experienced elective or emergency caesarean section. Being involved, receiving support and providing support were main reasons men considered it important they be facilitated to stay with their partners. Postnatal care should be oriented towards the whole family.

  • 46. Johansson, Margareta
    et al.
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Fenwick, Jennifer
    Important factors working to mediate Swedish fathers' experiences of a caesarean section2013Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, nr 9, s. 1041-1049Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 47. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Improvements of postnatal care are required by Swedish fathers2013Inngår i: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, nr 5, s. 465-480Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE:

    This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    DESIGN/METHODOLOGY/APPROACH:

    This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    FINDINGS:

    In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    PRACTICAL IMPLICATIONS:

    Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    ORIGINALITY/VALUE:

    The paper provides knowledge about postnatal service quality including fathers' needs.

  • 48.
    Johansson, Margareta
    et al.
    Karolinska Inst, Dept Clin Sci & Educ, Sjukhusbacken 10, SE-11883 Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden..
    Thomas, Jan
    Kenyon Coll, Dept Sociol, Gambier, OH 43022 USA..
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden.;Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Haines, Helen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Karolinska Inst, Dept Womens & Childrens Hlth, SE-11883 Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia..
    Swedish fathers contemplate the difficulties they face in parenthood2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, s. 55-62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The aim was to explore what concerns Swedish fathers had about parenting difficulties at two months after the birth of their baby. Methods: Self-report questionnaires were used and data were analyzed with mixed methods. Results: Thirty percent of the 827 fathers reported concerns about the difficulties of parenthood. The theme 'Managing the demands of being a father' emerged and was based on concerns about how to raise the baby, having enough money, health issues, lack of time and finding balance in the new family pattern. Financial worries, feeling less positive about expecting a baby, and self-reported poor emotional health were related to fathers who perceived parenthood as difficult. Conclusion: Experienced fathers as well as new fathers expressed similar concerns about parenthood. Preparation classes for reassurance and skills coaching about child raising may provide important support for fathers. This is especially important for fathers who may have poor emotional health or who may not be feeling positive about expecting a baby. Policy-makers and health care providers should recognize that offering support for all fathers benefits not only men, but also their children, and their partners and can help encourage egalitarian practices at home and work.

  • 49.
    Karlstrom, Annika
    et al.
    Mid Sweden Univ, Dept Nursing, SE-70 Sundsvall, Sweden..
    Nystedt, Astrid
    Umea Univ, Dept Nursing, Umea, Sweden..
    Hildingsson, Ingegerd
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi. Mid Sweden Univ, Dept Nursing, SE-70 Sundsvall, Sweden..
    The meaning of a very positive birth experience: focus groups discussions with women2015Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, artikkel-id 251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The experience of giving birth has long-term implications for a woman's health and wellbeing. The birth experience and satisfaction with birth have been associated with several factors and emotional dimensions of care and been shown to influence women's overall assessment. Individualized emotional support has been shown to empower women and increase the possibility of a positive birth experience. How women assess their experience and the factors that contribute to a positive birth experience are of importance for midwives and other caregivers. The aim of this study was to describe women's experience of a very positive birth experience. Method: The study followed a qualitative descriptive design. Twenty-six women participated in focus group discussions 6-7 years after a birth they had assessed as very positive. At the time of the birth, they had all taken part in a large prospective longitudinal cohort study performed in northern Sweden. In the present study, thematic analysis was used to review the transcribed data. Results: All women looked back very positively on their birth experience. Two themes and six sub-themes were identified that described the meaning of a very positive birth experience. Women related their experience to internal (e.g., their own ability and strength) and external (e.g., a trustful and respectful relationship with the midwife) factors. A woman's sense of trust and support from the father of the child was also important. The feeling of safety promoted by a supportive environment was essential for gaining control during birth and for focusing on techniques that enabled the women to manage labour. Conclusion: It is an essential part of midwifery care to build relationships with women where mutual trust in one another's competence is paramount. The midwife is the active guide through pregnancy and birth and should express a strong belief in a woman's ability to give birth. Midwives are required to inform, encourage and to provide the tools to enable birth, making it important for midwives to invite the partner to be part of a team, in which everyone works together for the benefit of the woman and child.

  • 50. Karlström, Annika
    et al.
    Rådestad, Ingela
    Eriksson, Carola
    Rubertsson, Christine
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Obstetrik & gynekologi.
    Nystedt, Astrid
    Hildingsson, Ingegerd
    Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study2010Inngår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, nr 1, s. 11-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

    Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code.

    Methods:

    Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data.

    Results:

    The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p < 0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables.

    Conclusions:

    The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.

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