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Background

Previously developed instruments measuring the quality of postnatal care, based on women’s experiences and views, are mainly country-specific which makes it important to have studies for specific populations. The aim of this study was to explore validity and reliability evidence of a previously developed postnatal questionnaire for women living in Sweden.

Method

A cross-sectional study based on self-report questionnaire. The questionnaire included the Early Postnatal Questionnaire (EPQ), and was administered to 1061 women who gave birth in two regional hospitals in Swedish during 2017. Validity evidence of the EPQ was undertaken using principal component analysis. Regarding reliability, Cronbach’s alpha was used.

Results

The questionnaire was returned by 483 postnatal women. The analysis resulted in three components: Information, Postnatal Environment and Caring Relationship. The Cronbach alpha values of the components ranged from 0.762 to 0.879. Foreign-born women scored higher (more positively) in all three components, compared to women born in Sweden.

Conclusions

The results of this study suggest that the instrument EPQ is a psychometrically useful tool, suitable for both research and clinical settings. The three-component structure provides researchers with the opportunity to conduct a more detailed exploration of various aspects of postnatal care to develop postnatal care. Further studies focusing on foreign-born women’s experiences of postnatal care are warranted.

Background: Midwifery continuity of care (MCoC) has been associated with reduced burnout and increased work satisfaction among midwives. Despite these benefits, MCoC is not common in Sweden.

Aim: This study aimed to explore midwives' profiles based on burnout levels and attitudes towards midwifery continuity of care, considering various background and work-related factors.

Methods:

A national cross-sectional digital survey was conducted among midwives in Sweden. The questionnaire covered the Copenhagen Burnout Inventory (CBI), attitudes towards MCoC and background variables. Cluster analysis identified a set of profiles, which were then compared by calculating odds ratios and 95 % confidence intervals for various background and work-related factors. Logistic regression examined the factors most associated with each profile.

Findings:

A three-cluster solution for the 1,983 midwives surveyed was suggested, labelled as Reserved, Visionary, and Sensitive. Midwives in the Reserved cluster exhibited negative attitudes towards MCoC, through negative scores on both components and negative scores on the CBI. Within the Visionary cluster, midwives showed positive scores on the Relational component of MCoC, but negative scores on the Practical and Organisational component and the CBI. In the Sensitive cluster, midwives exhibited the highest scores on the CBI and negative scores on the Practical and Organisational component of MCoC, with just slightly positive scores on the Relational component. Cluster membership was associated with length of work experience (p<0.001) and work domain (p<0.001).

Conclusion:

Based on the CBI and attitudes towards MCoC, three distinct clusters of midwives were identified, with different factors contributing to membership in each cluster. Understanding how midwives relate to MCoC can facilitate the implementation of the model, potentially improving midwives' work-related health.

Background

Stillbirth occurs at a rate of 3.0 per thousand in Sweden. However, few studies have focused on the initial experiences of parents facing a stillbirth. The aim of this qualitative study is to deepen and broadly explore parents’ initial experiences, perceptions, internal processes and strategies from the moment of suspicion or awareness of stillbirth until one month after the event.

Methods

Ten individual in-depth interviews were conducted between 2021 and 2023, and data were evaluated using thematic network analysis.

Results

Two key themes emerged: ‘Following the journey – from suspicion to acceptance’ and ‘Support, structured activities and processes after stillbirth’. These themes captured the significant consequences of a sudden, unexpected and devastating end to pregnancy. The suspicion and eventual diagnosis of stillbirth were initially associated with sudden discomfort, fear, overwhelming grief, and intense pain. Nevertheless, a vaginal birth was regarded as the optimal mode of delivery for both physical and emotional wellbeing. Caring for the stillborn baby through physical proximity for an extended period of time helped parents comprehend and cope with their grief, while also affirming their sense of parenthood.

Conclusions

This study sheds light on the profound and devastating impact of stillbirth on parents who are confronted with the loss of their long-awaited and cherished baby. The intense grief and pain experienced by parents during the first month after stillbirth were described as an ongoing heavy burden, persisting day and night, and reflected in poor/very poor mental health. Despite the immense challenges faced by parents, the study highlights the importance of developing individual coping strategies to deal with this tragic and irreversible life-changing event.

Aim: This study aimed to explore midwifery students' thoughts on midwifery continuity models of care and the benefits for women and midwives.

Background: The World Health Organization recommends continuity of care for pregnant women because it leads to favorable outcomes such as a higher likelihood of having a spontaneous vaginal birth and a positive birth experience. However, midwifery continuity models are rare in Sweden and few midwifery students are exposed to such models during their clinical placements. Therefore, students' attitudes towards these models are largely unknown.

Design: A qualitative Swedish national study.

Methods: Digital interviews involving 16 midwifery students were carried out in 2023. Data were analyzed using reflexive thematic content analysis according to Braun and Clark. Results: The study revealed the main theme: "Midwifery continuity models of care are a perfect complement for women, families and midwives in Swedish maternity care". This main theme was supported by the following themes: Increased knowledge of midwifery continuity of care would strengthen interest; working in a midwifery continuity model of care should be based on midwives' preferences; and convincing evidence of midwifery continuity of care for women.

Conclusions: The study highlighted the importance of offering women and midwives the opportunity to participate in a midwifery continuity care model and providing support for midwifery students to feel prepared for this approach. Continuity of care was seen as the future model of care. Midwifery students expressed a desire for better conditions for women in maternity care and a sustainable way of working for midwives.

Background: Few parents experience stillbirth in Sweden, and their perspectives on the grieving process remain largely unknown. Objective: To explore parents' perspectives, memories, reflections and insights in the grieving and recovery process six months after stillbirth.

Methods: A mixed-method study involving nine in-depth interviews and responses to eleven quantitative statements. Data were analysed using descriptive statistics and thematic network analysis.

Results: Two themes were identified 'Retained indelible deep memories of the loss and increased insights into the tragic life-changing event' and 'The continued grieving process, quality of life and new pregnancy'. These themes captured parents' ongoing grief and reflections. Six months later, parents reported gaining insights into unforeseen pregnancy abnormalities. Some announced new pregnancies, desiring extended medical checks by both midwives and obstetricians. There was a widespread request for tailored psychological support throughout pregnancy. Qualitative findings were reinforced by the quantitative statements.

Conclusions: Stillbirth profoundly affects parents long-term, with deep grief and memories. They develop coping strategies to strengthen their mental health. However, after six months, they begin to see a small glimmer of light at the end of the tunnel.

Background: In Sweden, women often meet with different midwives during antenatal, intrapartum, and postpartum care, due to the structure of maternity care, with few alternatives which provide continuity. This study aims to explore women's interest in having a midwife they know present during labor and birth and to identify the characteristics of women who prefer this option.

Methods: A comparative study was conducted involving two Swedish nationwide cohorts of Swedish-speaking pregnant women. The first cohort included 3,061 women, and the second 1,812 women. Descriptive statistics and odds ratios were calculated.

Results: In total, 4,873 pregnant women completed the survey. Most participants were aged 25-35 years, living with a partner, and born in Sweden. Interest in having a midwife they know increased from 53% in 1999 to 76% in 2024. Key factors associated with this preference included primiparity (OR 3.80; 95% CI 3.27-4.40), being pregnant in 2024 (OR 3.21; 2.70-3.86), being born outside Sweden (OR 2.73; 2.11-3.54), and fear of birth (OR 2.03; 1.56-2.63).

Conclusions: Interest in having a known midwife during childbirth has grown significantly in Sweden, highlighting the need for policy changes that promote awareness and expand this option for women.

Background: Midwifery continuity models are highly recommended. Women with fear of birth living in rural areas might have difficulties accessing such care. Technology can play a role in enhancing contact with midwives during pregnancy and childbirth for these women.

Objective: The aim of this study was to elucidate women's experiences of participating in a digital continuity of care model designed for pregnant women with fear of birth.

Methods: A qualitative interview design, employing interviews with 15 women participating in a midwifery continuity project directed towards women with fear of birth. The participants used e-health tools for communication with midwives during their pregnancy and childbirth. Reflexive thematic analysis was used.

Results: The analysis resulted in an overarching theme: 'A digital continuity model of midwifery care for women with fear of birth in a rural area is attractive'. The model created positive outcomes in terms of sustainability and use of resources. The women reported enhanced autonomy and reduced stress. Continuity of care fostered confidence and security throughout childbirth for the women, supported by a strong relationship with their midwives. The individualised care, which addressed mental health challenges and fears stemming from past childbirth experiences, led to positive outcomes.

Conclusion: A model with continuity using digital e-health could be a solution to meet women's needs in rural areas during childbirth, who suffer from fear of birth or have mental health problems. Care models need to be tailored to regional conditions, considering factors such as midwifery availability and geographical challenges.

Background

Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth.

Methods

A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women’s background variables.

Results

A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping.

Conclusions

Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.

Objective: To identify clusters of women based on anxiety, depression, fear of birth, and childbirth self-efficacy and factors associated with the clusters.

Design: Cross-sectional survey.

Setting: Online in Sweden.

Participants: Pregnant women (N = 1,419).

Methods: We collected data through online questionnaires. We included scales to measure anxiety, depression, worries about and fear of birth, and self-efficacy in a kappa-means cluster analysis. We calculated odds ratios with 95% confidence intervals between clusters and background variables.

Results: We identified 4 clusters based on severity: Resourceful-Robust, Resourceful-Fearful, Vulnerable-Fearful, and Fragile-Fearful. Participants in the Resourceful-Fearful and Vulnerable-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Vulnerable-Fearful and Fragile-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Fragile-Fearful cluster were more likely to be multiparous, report that their pregnancy was not normal, and prefer cesarean birth than those in the Resourceful-Robust cluster.

Conclusions: Women with childbirth fear may be vulnerable to anxiety and depression during the perinatal period, although the severity might vary. Self-efficacy might be a mediator against mental health problems. Findings demonstrated levels of severity, and the one-size-fits-all approach in Swedish health care may benefit from a more targeted approach for women with fear of childbirth.

Problem

Midwives’ levels of burnout seem to be increasing worldwide.

Background

Previous research show a high prevalence of burnout in midwives.

Aim

To compare levels of burnout in two national Swedish samples of midwives completing a similar survey.

Methods

A comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used.

Findings

The sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience.

Discussion

The highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical.

Conclusion

This study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.