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  • 1.
    Aasheim, Vigdis
    et al.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Nilsen, Roy M.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Vik, Eline Skirnisdottir
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway.;Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway..
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Judith Lumley Ctr, Melbourne, Vic, Australia..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration related factors2020In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 26, article id 100553Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate associations between maternal country of birth and other migration related factors (length of residence, reason for migration, paternal origin) and epidural analgesia for labour pain in nulliparous women in Norway.

    Design: Population-based register study including nulliparous migrant women (n = 75,922) and non-migrant women (n = 444,496) with spontaneous or induced labour. Data were retrieved from the Medical Birth Registry and Statistics Norway, 1990-2013. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression, and adjusted for maternal age, marital status, maternal education, gross income, birth year, hospital size and health region.

    Main outcome: Epidural analgesia for labour pain.

    Results: Epidural analgesia was administered to 38% of migrant women and 31% of non-migrant women. Compared with non-migrants, the odds of having epidural analgesia were lowest in women from Vietnam (adjOR 0.54; CI 0.50-0.59) and Somalia (adjOR 0.63; CI 0.58-0.68) and highest in women from Iran (adjOR 1.32; CI 1.19-1.46) and India (adjOR 1.19; CI 1.06-1.33). Refugees (adjOR 0.83; CI 0.79-0.87) and newly arrived migrants (adjOR 0.92; CI 0.89-0.94) had lower odds of epidural analgesia. Migrant women with a non-migrant partner (adjOR 1.14; CI 1.11-1.17) and those with length of residence >= 10 years (adjOR 1.06; CI 1.02-1.10) had higher odds.

    Conclusion: The use of epidural analgesia varied by maternal country of birth, reason for migration, paternal origin and length of residence. Midwives and obstetricians should pay extra attention to the provision of adequate information about pain relief options for refugees and newly arrived migrants, who had the lowest use.

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  • 2.
    Ahrne, M.
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Adan, A.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Andersson, E.
    Karolinska Inst, Stockholm, Sweden.
    Small, R.
    La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Flacking, R.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Byrskog, U.
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Antenatal care for Somali born women in Sweden - perspectives from mothers, fathers and midwives2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no Supplement: 1, p. 104-104Article in journal (Other academic)
    Publisher's full text
  • 3.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Byrskog, Ulrika
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;La Trobe Univ, Sch Nursing & Midwifery, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Dept Hlth & Caring Sci, Bergen, Norway..
    Group antenatal care compared with standard antenatal care for Somali-Swedish women: a historically controlled evaluation of the Hooyo Project2023In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 1, article id e066000Article in journal (Refereed)
    Abstract [en]

    Objectives: Comparing language-supported group antenatal care (gANC) and standard antenatal care (sANC) for Somali-born women in Sweden, measuring overall ratings of care and emotional well-being, and testing the feasibility of the outcome measures.

    Design: A quasi-experimental trial with one intervention and one historical control group, nested in an intervention development and feasibility study.

    Setting: Midwifery-led antenatal care clinic in a mid-sized Swedish town.

    Participants: Pregnant Somali-born women (<25 gestational weeks); 64women in gANC and 81 in sANC.

    Intervention: Language-supported gANC (2017-2019). Participants were offered seven 60-minute group sessions with other Somali-born women led by one to two midwives, in addition to 15-30min individual appointments with their designated midwife.

    Outcomes: Primary outcomes were women's overall ratings of antenatal care and emotional well-being (Edinburgh Postnatal Depression Scale (EPDS)) in gestational week >= 35and 2 months post partum. Secondary outcomes were specific care experiences, information received, social support, knowledge of pregnancy danger signs and obstetric outcomes.

    Results: Recruitment and retention of participants were challenging. Of eligible women, 39.3% (n=106) declined to participate. No relevant differences regarding overall ratings of antenatal care between the groups were detected (late pregnancy OR 1.42, 95% CI 0.50 to 4.16 and 6-8 weeks post partum OR 2.71, 95% CI 0.88 to 9.41). The reduction in mean EPDS score was greater in the intervention group when adjusting for differences at baseline (mean difference -1.89; 95% CI -3.73 to -0.07). Women in gANC were happier with received pregnancy and birth information, for example, caesarean section where 94.9% (n=37) believed the information was sufficient compared with 17.5% (n=7) in standard care (p<0.001) in late pregnancy.

    Conclusions: This evaluation suggests potential for language-supported gANC to improve knowledge acquisition among pregnant Somali-born women with residence in Sweden <10 years. An adequately powered randomised trial is needed to evaluate the effectiveness of the intervention.

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  • 4.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Byrskog, Ulrika
    Dalarna Univ, Sch Hlth & Welf, Falun, Sweden..
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Group antenatal care (gANC) for Somali-speaking women in Sweden - a process evaluation2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 721Article in journal (Refereed)
    Abstract [en]

    Background Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo ("mother" in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors. Methods A process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8). Results Language-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC. Conclusions The Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the "othering" of women in risk groups should be avoided.

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  • 5.
    Ahrne, Malin
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Haugesund, Norway.
    Andersson, Ewa
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia.
    Adan, Aisha
    Karolinska Inst, Dept Womens & Childrens Hlth, Tomtebodavagen 18A,8th Floor, SE-17177 Stockholm, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Byrskog, Ulrika
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Antenatal care for Somali-born women in Sweden: Perspectives from mothers, fathers and midwives2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 74, p. 107-115Article in journal (Refereed)
    Abstract [en]

    Objective:

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

    Design:

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

    Setting:

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

    Findings:

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

    Key conclusions:

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

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  • 6.
    Byrskog, Ulrika
    et al.
    School of Education, Health and Social sciences, Dalarna University, Falun, Sweden.
    Ahrne, Malin
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Small, Rhonda
    Mother and Child Health Research, La Trobe University, Melbourne, Victoria, Australia.
    Andersson, Ewa
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Essén, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Maternal and Reproductive Health and Migration.
    Adan, Aisha
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Ahmed, Fardosa Hassen
    Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Tesser, Karin
    Antenatal Care Clinic, Domnarvet, Borlänge, Sweden.
    Lidén, Yvonne
    Antenatal Care Clinic, Spånga-Tensta, Sweden.
    Israelsson, Monika
    Antenatal Care Clinic, Spånga-Tensta, Sweden.
    Åhman-Berndtsson, Anna
    Antenatal Care Clinic, Domnarvet, Borlänge, Sweden.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Rationale, development and feasibility of group antenatal care for immigrant women in Sweden: a study protocol for the Hooyo Project2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 7, article id e030314Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Somali-born women comprise a large group of immigrant women of childbearing age in Sweden, with increased risks for perinatal morbidity and mortality and poor experiences of care, despite the goal of providing equitable healthcare for the entire population. Rethinking how care is provided may help to improve outcomes.

    OVERALL AIM: To develop and test the acceptability, feasibility and immediate impacts of group antenatal care for Somali-born immigrant women, in an effort to improve experiences of antenatal care, knowledge about childbearing and the Swedish healthcare system, emotional well-being and ultimately, pregnancy outcomes. This protocol describes the rationale, planning and development of the study.

    METHODS AND ANALYSIS: An intervention development and feasibility study. Phase I includes needs assessment and development of contextual understanding using focus group discussions. In phase II, the intervention and evaluation tools, based on core values for quality care and person-centred care, are developed. Phase III includes the historically controlled evaluation in which relevant outcome measures are compared for women receiving individual care (2016-2018) and women receiving group antenatal care (2018-2019): care satisfaction (Migrant Friendly Maternity Care Questionnaire), emotional well-being (Edinburgh Postnatal Depression Scale), social support, childbirth fear, knowledge of Swedish maternity care, delivery outcomes. Phase IV includes the process evaluation, investigate process, feasibility and mechanisms of impact using field notes, observations, interviews and questionnaires. All phases are conducted in collaboration with a stakeholder reference group.

    ETHICS AND DISSEMINATION: The study is approved by the Regional Ethical Review Board, Stockholm, Sweden. Participants receive information about the study and their right to decline/withdraw without consequences. Consent is given prior to enrolment. Findings will be disseminated at antenatal care units, national/international conferences, through publications in peer-reviewed journals, seminars involving stakeholders, practitioners, community and via the project website. Participating women will receive a summary of results in their language.

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  • 7.
    Byrskog, Ulrika
    et al.
    Dalarna Univ, Sch Educ Hlth & Social Sci, Falun, Sweden.
    Small, Rhonda
    La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic 3086, Australia; Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavägen 18a, S-17177 Stockholm, Sweden.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavägen 18a, S-17177 Stockholm, Sweden; Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Mollendalsveien 6,Postboks 7030, N-5020 Bergen, Norway.
    Community-based bilingual doulas for migrant women in labour and birth: findings from a Swedish register-based cohort study2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 721Article in journal (Refereed)
    Abstract [en]

    Background

    Community-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals.

    Methods

    Register study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education.

    Results

    Migrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64).

    Conclusions

    CBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed.

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  • 8.
    Helena, Lindgren
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden..
    Amani, Eltayb
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden..
    Anna, Wahlberg
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden..
    Nataliia, Tsekhmestruk
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden..
    Rhonda, Small
    La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic 3086, Australia..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Tomtebodavagen 18a, S-17177 Stockholm, Sweden.;Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Mollendalsveien 6,Postboks 7030, N-5020 Bergen, Norway..
    Multi-tasking community-based bilingual doulas are bridging gaps-Despite standing on fragile ground: A qualitative study of doulas' experiences in Sweden2022In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 112, article id 103231Article in journal (Refereed)
    Abstract [en]

    Introduction: Community-based Bilingual Doulas (CBDs) are women from migrant communities trained to support and comfort migrant women during labour and birth, and to facilitate linguistic and cultural communication between women, their partners and staff. The aim of the study was to describe CBDs' experiences of supporting migrant women during labour and birth, working alongside caregivers, and to explore CBDs perceptions of their work situation in a Swedish setting. Methods: As part of an ongoing randomised trial of CBD support in XX, Sweden, semi-structured individual interviews were conducted with nine of the 35 participating CBDs. The interviews were conducted in each CBD's first language (Arabic, Somali, Tigrinya, Russian, Polish) or in Swedish, and were audio recorded, transcribed verbatim and translated into English. Thematic analysis of data identified, analysed, interpreted and reported patterns and themes across the data. Results: The overarching theme which emerged was "Multi-tasking bilingual doulas bridging gaps - despite standing on fragile ground". To reach out a helping hand and receive appreciation from the women when their needs were met, motivated the CBDs to continue despite the constraints related to roles, working conditions and boundaries. The CBDs felt proud of being acknowledged, although they did also feel a need for more supervision and education. Conclusions: The CBDs experienced their doula tasks as meaningful and emotionally rewarding, which mostly outweighed the challenges of their work which they saw as insecure, exhausting and underpaid. If CBDs are implemented on a larger scale, the scope of their role (including boundaries), education, access to supervision and working conditions all need to be better addressed.

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  • 9.
    Hesselman, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Ctr Clin Res, Falun, Sweden.
    Högberg, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Råssjö, Eva-Britta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Shytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Jonsson, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Prevalence and risk factors of abdominal adhesions after caesarean section2017In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 124, no S1, p. 108-108Article in journal (Other academic)
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  • 10.
    Maeland, Karolina S.
    et al.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Morken, Nils-Halvdan
    Univ Bergen, Dept Clin Sci, Bergen, Norway.;Norwegian Inst Publ Hlth, Ctr Fertil & Hlth, Oslo, Norway.;Haukeland Hosp, Dept Obstet & Gynecol, Bergen, Norway..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway.;Karolinska Inst, Dept Womens & Childrens Hlth, Solna, Sweden..
    Aasheim, Vigdis
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Nilsen, Roy M.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Placental abruption in immigrant women in Norway: A population-based study2021In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 100, no 4, p. 658-665Article in journal (Refereed)
    Abstract [en]

    Introduction Placental abruption is a serious complication in pregnancy. Its incidence varies across countries, but the information of how placental abruption varies in immigrant populations is limited. The aims of this study were to estimate the incidence of placental abruption in immigrant women compared with non-immigrants by maternal country and region of birth, reason for immigration, and length of residence. Material and methods We conducted a nationwide population-based study using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study sample included 1 558 174 pregnancies, in which immigrant women accounted for 245 887 pregnancies and 1 312 287 pregnancies were to non-immigrants. Crude and adjusted odds ratios with 95% CI for placental abruption in immigrant women compared with non-immigrants were estimated by logistic regression with robust standard error estimations (accounting for within-mother clustering). Adjustment variables included year of birth, maternal age, parity, multiple pregnancies, chronic hypertension, and level of education. Results The incidence of placental abruption decreased during the study period for both immigrants (from 0.68% to 0.44%) and non-immigrants (from 0.80% to 0.34%). Immigrant women from sub-Saharan Africa had an adjusted odds ratio of 1.35 (95% CI 1.15-1.58) compared with non-immigrants for placental abruption, whereas immigrant women from Ethiopia had an adjusted odds ratio of 2.39 (95% CI 1.67-3.41). We found a small variation in placental abruption incidence by other countries or regions of birth, length of residence, and reason for immigration. Conclusions Immigrant women from sub-Saharan Africa, especially Ethiopia, have increased odds for placental abruption when giving birth in Norway. Reason for immigration and length of residence had little impact on the incidence of placental abruption.

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  • 11.
    Nilsen, Roy M.
    et al.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Daltveit, Anne K.
    Univ Bergen, Dept Global Publ Hlth & Primary Care, Kalfarveien 31, N-5018 Bergen, Norway;Norwegian Inst Publ Hlth, Div Hlth Data & Digitalisat, Zander Kaaesgate 7, N-5018 Bergen, Norway.
    Iversen, Marjolein M.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Sandberg, Marit G.
    Haukeland Hosp, Dept Obstet & Gynecol, Jonas Lies Vei 72, N-5053 Bergen, Norway.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, S-17177 Stockholm, Sweden.
    Strandberg, Ragnhild B.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Vik, Eline S.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway;Univ Bergen, Dept Global Publ Hlth & Primary Care, Kalfarveien 31, N-5018 Bergen, Norway.
    Aasheim, Vigdis
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Preconception Folic Acid Supplement Use in Immigrant Women (1999-2016)2019In: Nutrients, E-ISSN 2072-6643, Vol. 11, no 10, article id 2300Article in journal (Refereed)
    Abstract [en]

    This study examines how preconception folic acid supplement use varied in immigrant women compared with non-immigrant women. We analyzed national population-based data from Norway from 1999-2016, including 1,055,886 pregnancies, of which 202,234 and 7,965 were to 1st and 2nd generation immigrant women, respectively. Folic acid supplement use was examined in relation to generational immigrant category, maternal country of birth, and length of residence. Folic acid supplement use was lower overall in 1st and 2nd generation immigrant women (21% and 26%, respectively) compared with Norwegian-born women (29%). The lowest use among 1st generation immigrant women was seen in those from Eritrea, Ethiopia, Morocco, and Somalia (around 10%). The highest use was seen in immigrant women from the United States, the Netherlands, Denmark, and Iceland (>30%). Folic acid supplement use increased with increasing length of residence in immigrant women from most countries, but the overall prevalence was lower compared with Norwegian-born women even after 20 years of residence (adjusted odds ratio: 0.63; 95% confidence interval: 0.60-0.67). This study suggests that immigrant women from a number of countries are less likely to use preconception folic acid supplements than non-immigrant women, even many years after settlement.

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  • 12.
    Nilsen, Roy M.
    et al.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Vik, Eline S.
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Rasmussen, Svein A.
    Univ Bergen, Dept Clin Sci, Bergen, Norway.
    Small, Rhonda
    La Trobe Univ, Sch Nursing & Midwifery, Judith Lumley Ctr, Melbourne, Vic, Australia;Karolinska Inst, Dept Womens & Childrens Hlth, Reprod Hlth, Stockholm, Sweden.
    Moster, Dag
    Haukeland Hosp, Dept Paediat, Bergen, Norway;Univ Bergen, Dept Global Publ Hlth & Primary Care, Bergen, Norway.
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Reprod Hlth, Stockholm, Sweden.
    Aasheim, Vigdis
    Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Inndalsveien 28, N-5063 Bergen, Norway.
    Preeclampsia by maternal reasons for immigration: a population-based study2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, article id 423Article in journal (Refereed)
    Abstract [en]

    Background:

    To investigate whether the occurrence of preeclampsia varied by maternal reasons for immigration.

    Methods:

    We included 1,287,270 singleton pregnancies (163,508 to immigrant women) in Norway during 1990-2013. Individual data were obtained through record linkage between the Medical Birth Registry of Norway and Statistics Norway. Analyses were performed for preeclampsia overall and in combination with preterm birth < 37 and < 34 weeks of gestation, referred to as preterm and very preterm preeclampsia. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression with robust standard errors, adjusted for relevant covariates, including maternal income and education.

    Results:

    Preeclampsia was reported in 3.5% of Norwegian women and 2.5% of immigrants. Compared with Norwegian women, the adjusted OR for preeclampsia was lowest in labour immigrants (adjusted OR 0.55 [95% CI 0.49-0.62]), followed by family immigrants (0.62 [0.59-0.65]), immigrant students (0.75 [0.65-0.86]), refugees (0.81 [0.75-0.88]), and immigrants from other Nordic countries (0.87 [0.80-0.94]). Compared with Norwegian women, labour immigrants also had lower adjusted odds of preterm and very preterm preeclampsia, whereas refugees had increased adjusted odds of preterm and very preterm preeclampsia (< 37 weeks: 1.18 [1.02-1.36], and < 34 weeks: 1.41 [1.15-1.72]).

    Conclusions:

    The occurrence of preeclampsia was lower overall in immigrants than in non-immigrants, but associations varied by maternal reasons for immigration. Maternity caregivers should pay increased attention to pregnant women with refugee backgrounds due to their excess odds of preterm preeclampsia.

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  • 13.
    Purandare, Radhika
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Ådahl, Kajsa
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Stillerman, Maria
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Schytt, Erica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Western Norway Univ Appl Sci Norway, Fac Hlth & Social Sci, Bergen, Norway..
    Tsekhmestruk, Nataliia
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Sophiahemmet Univ, Dept Hlth Promot, Stockholm, Sweden..
    Migrant women ' s experiences of community-based doula support during labor and childbirth in Sweden: A mixed methods study2024In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 41, article id 101000Article in journal (Refereed)
    Abstract [en]

    Objective:

    To describe migrant women's experiences of bilingual community-based doulas (CBD) contribution to care in relation to labor and birth.

    Methods:

    Mixed methods study combining quantitative data from 82 women who received CBD-support within a randomized controlled trial and qualitative data from semi-structured interviews with a sub-sample of 12 women from the same study arm. Descriptive analyses were used for quantitative data and content analysis for the manifest and latent content of the qualitative data. Quantitative findings were categorized according to qualitative findings.

    Results:

    The women expressed how CBDs played an essential role in the response to their basic emotional, informational, and physical support needs, when no other female family member was available. Three main categories emerged from the analysis of interviews: The doulas help women feel safe and calm - providing support before, during and after childbirth; The doulas' support role fills the void left by a deeply missed family, mother or sister; and The doulas assist women in achieving autonomy through communication support and advocacy. More than half of women reported feeling involved during labor and birth (56.8%), most valued CBD positively (such as being competent, calm, secure, considerate, respectful, encouraging, supportive) (40.8%-80.3%), that CBD had interpreted (75.6%), facilitated communication with the midwife (60,3%), comforted the woman (57.7%) and reduced anxiety (48,7%). Few reported negative CBD-characteristics (1.3-9.2%). Nevertheless, 61.7% of women felt frightened sometime during labor and birth, which made it even more important to them that the doula was there. Few women (21.8%) reported that the CBD had supported her partner but expressed so in the interviews.

    Conclusion:

    Through an essential contribution in responding to migrant women's basic emotional, informational, and physical needs, bilingual community-based doulas have the potential to improve migrant women's experience of care during labour and birth. However, more focus on the quality of CBD-support to partners seem necessary.

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  • 14.
    Schytt, Erica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Karolinska Inst, Womens & Childrens Hlth, Stockholm, Sweden..
    Wahlberg, Anna
    Karolinska Inst, Womens & Childrens Hlth, Stockholm, Sweden..
    Eltayb, Amani
    Karolinska Inst, Womens & Childrens Hlth, Stockholm, Sweden..
    Small, Rhonda
    Karolinska Inst, Womens & Childrens Hlth, Stockholm, Sweden.;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Tsekhmestruk, Nataliia
    Karolinska Inst, Womens & Childrens Hlth, Stockholm, Sweden..
    Lindgren, Helena
    Karolinska Inst, Womens & Childrens Hlth, Stockholm, Sweden..
    Community-based doula support for migrant women during labour and birth: study protocol for a randomised controlled trial in Stockholm, Sweden (NCT03461640)2020In: BMJ Open, E-ISSN 2044-6055, Vol. 10, no 2, article id e031290Article in journal (Refereed)
    Abstract [en]

    Introduction Migrant women consistently rate their care during labour and birth more negatively than non-migrant women, due to communication difficulties, lack of familiarity with how care is provided, and discrimination and prejudicial staff attitudes. They also report being left alone, feeling fearful, unsafe and unsupported, and have poorer birth outcomes than non-migrant women. Community-based doulas (CBDs) are bilingual women from migrant communities who are trained in childbirth and labour support, and who facilitate communication between woman-partner-staff during childbirth. This study protocol describes the design, rationale and methods of a randomised controlled trial that aims to evaluate the effectiveness of CBD support for improving the intrapartum care experiences and postnatal well-being of migrant women giving birth in Sweden. Methods and analysis A randomised controlled trial. From six antenatal care clinics in Stockholm, Sweden, we aim to recruit 200 pregnant Somali, Arabic, Polish, Russian and Tigrinya-speaking women who cannot communicate fluently in Swedish, are 18 years or older and with no contraindications for vaginal birth. In addition to standard labour support, women are randomised to CBD support (n=100) or no such support during labour (n=100). Trained CBDs meet with women once or twice before the birth, provide emotional, physical and communication support to women throughout labour and birth in hospital, and then meet with women once or twice after the birth. Women's ratings of the intrapartum care experiences and postnatal well-being are assessed at 6-8 weeks after the birth using selected questions from the Migrant Friendly Maternity Care Questionnaire and by the Edinburgh Postnatal Depression Scale. The intervention group will be compared with the control group using intention-to-treat analyses. ORs and 95% CIs will be estimated and adjustments made if key participant characteristics differ between trial arms. Ethics and dissemination The study was approved by the Regional Ethical Review Board in Stockholm (approval number: 2018/12 - 31/2).

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  • 15.
    Schytt, Erica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden.;Western Norway Univ Appl Sci Norway, Fac Hlth & Social Sci, Bergen, Norway..
    Wahlberg, Anna
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    Eltayb, Amani
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    Tsekhmestruk, Nataliia
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden.;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    Community-based bilingual doula support during labour and birth to improve migrant women's intrapartum care experiences and emotional well-being-Findings from a randomised controlled trial in Stockholm, Sweden2022In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 11, article id e0277533Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate the effectiveness of community-based bilingual doula (CBD) support for improving the intrapartum care experiences and postnatal wellbeing of migrant women giving birth in Sweden.

    Design: Randomised controlled trial.

    Setting: Six antenatal care clinics and five hospitals in Stockholm, Sweden.

    Participants: 164 pregnant Somali-, Arabic-, Polish-, Russian- and Tigrinya-speaking women who could not communicate fluently in Swedish, were >= 18 years and had no contra-indications for vaginal birth.

    Intervention: In addition to standard labour support, women were randomised to CBD support (n = 88) or no such support during labour (n = 76). Trained CBDs met with women prior to labour, provided support by telephone after labour had started, then provided emotional, physical and communication support to women throughout labour and birth in hospital, and then met again with women after the birth.

    Primary outcomes: Women's overall ratings of the intrapartum care experiences (key question from the Migrant Friendly Maternity Care Questionnaire) and postnatal wellbeing (mean value of Edinburgh Postnatal Depression Scale) at 6-8 weeks after birth.

    Results: In total, 150 women remained to follow-up; 82 women (93.2%) randomised to receive CBD support and 68 women (89.5%) randomised to standard care (SC). Of women allocated CBD support, 60 (73.2%) received support during labour. There were no differences between the groups regarding women's intrapartum care experiences (very happy with care: CBD 80.2% (n = 65) vs SC 79.1% (n = 53); OR 1.07 CI 95% 0.48-2.40) or emotional wellbeing (EPDS mean value: CBD 4.71 (SD 4.96) vs SC 3.38 (SD 3.58); mean difference 1.33; CI 95% - 0.10-2.75).

    Conclusions: Community-based doula support during labour and birth for migrant women neither increased women's ratings of their care for labour and birth nor their emotional well-being 2 months postpartum compared with receiving standard care only. Further studies on the effectiveness of CBD powered to evaluate obstetric outcomes are needed. Trial registration Trial registration at ClinicalTrial.gov NCT03461640

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  • 16.
    Schytt, Erica
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden.;Western Norway Univ Appl Sci, Fac Hlth & Social Sci, Bergen, Norway..
    Wahlberg, Anna
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    Small, Rhonda
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden.;La Trobe Univ, Judith Lumley Ctr, Melbourne, Vic, Australia..
    Eltayb, Amani
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden..
    The community-based bilingual doula-A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences2021In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 28, article id 100614Article in journal (Refereed)
    Abstract [en]

    Objectives: To explore midwives & rsquo; and obstetricians & rsquo; views about community-based bilingual doula (CBD) support during migrant women & rsquo;s labour and birth and their experiences of collaborating with CBDs.

    Study design: A qualitative study with semi-structured individual interviews with 7 midwives and 4 obstetricians holding clinical positions in labour care in Stockholm, Sweden, who all had experiences of working with a CBD. Data analysis followed the framework of thematic analysis.

    Results: The overarching theme was A new actor filling gaps in labour care & ndash; With appropriate boundary setting, CBDs can help improve care for migrant women. One year after the introduction of CBDs, the midwives and obstetricians had mainly positive experiences of CBDs who were considered to fill important gaps in maternity care for migrant women, being with the woman and simultaneously being part of the care team and this made providing high quality care easier. The CBDs & rsquo; main contribution was to help migrant women navigate the maternity care system, to bridge language and cultural divides, and guarantee continuous labour and birth support. However, midwives and obstetricians sometimes experienced CBDs interfering with their professional assessments and decisions and the role of the CBD was somewhat unclear to them.

    Conclusions: Community-based bilingual doula support was viewed as improving migrant women & rsquo;s well-being during labour and birth and as increasing the possibilities for midwives and obstetricians to provide good and safe care, however, some ambivalence remained about the CBD's role and boundaries.

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  • 17.
    Strandberg, Ragnhild B.