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Background

Pregnant women who experience migration often have significant health problems because of difficulties in accessing health and social care in their host country. Language difficulties have reduced their ability to receive maternity care compared to native-born women. A cultural doula may enable safe and equitable maternity care for pregnant migrant women. The aim of this study was to explore antenatal care midwives’ experiences of caring for pregnant migrant women when offering them cultural doula support.

Methods

This study used a reflexive, qualitative, descriptive design. Pregnant migrant women in one of six healthcare regions in Sweden were offered cultural doula support for two to three meetings during pregnancy and two follow-up meetings after childbirth, but not during actual labour and birth. Interviews were conducted with 14 antenatal care midwives individually, in pairs, or in groups at six different antenatal care clinics in a Swedish university city. Data was analysed through reflexive thematic analysis according to Braun and Clarke.

Results

The main theme that was explored, Antenatal care midwives emphasized the importance of having an open mind to cultural differences when caring for pregnant migrant women, was described through the three sub-themes: Midwives sincerely wanted to understand migrant women’s needs, which made midwifery practice both satisfying and challenging; Migrant women were often reluctant to accept the midwives’ offer of cultural doula support; and Midwives expressed a desire for better communication with the cultural doulas and more information about their responsibilities.

Conclusions

These findings suggest that antenatal care midwives may benefit from additional education in intercultural competence. The midwives also recommended that cultural doulas provide complementary support to ensure that pregnant migrant women receive equal care.

Objective: To investigate pregnancy, birth, and neonatal outcomes among primiparous women below 20 years of age in Sweden between 2010 and 2022.

Methods: A nationwide cohort study, encompassing all births among primiparous below 30 years. The risk of adverse perinatal outcomes was compared among teenagers and those in the 20-29-year age group. Logistic regression was used to estimate crude and adjusted odds ratios, along with 95% confidence intervals.

Results: In crude analyses, teenage mothers had an increased risk of placental abruption (OR 1.39, 95% CI 1.05-1.85), though this association became non-significant after adjustment (aOR 1.22, 95% CI 0.91-1.63). Teenagers had lower odds of labour induction and instrumental delivery, but an elevated risk of postpartum sepsis (OR 1.41, 95% CI 1.12-1.79). Infants of teenage mothers had higher risks of preterm birth before 34 weeks (OR 1.26, 95% CI 1.11-1.42) and before 37 weeks (OR 1.13, 95% CI 1.05-1.22). The crude risks of SGA and neonatal mortality were increased (OR 1.41, 95% CI 1.30-1.54; and OR 1.71, 95% CI 1.16-2.52) respectively, but became no longer significant after adjustments.

Conclusions: Teenage mothers have increased risks of preterm birth and postpartum sepsis, while the risks of most pregnancy complications are lower or comparable to those of older mothers. Continued efforts are warranted to address the social and biological vulnerabilities of teenage mothers and to ensure equitable access to high-quality perinatal care.

Background

The advantages of midwifery continuity models of care during pregnancy, birth, and the postnatal period demonstrated in ‘low-risk’ women may also benefit those with fear of birth. The purpose of the study was to explore women’s assessment of the quality of intrapartum care when participating in a midwifery continuity of care (MCoC) project in a rural area of Sweden. An additional aim was to explore if the care differed between women who had a known midwife during labour and birth, versus not.

Methods

A prospective longitudinal cohort study including 142 women with fear of birth who participated in an MCoC project was performed. Data was collected via two online questionnaires, gathering background data and birth related information. The instrument ‘Quality from the Patients’ Perspective’ was used to assess the perceived reality and the subjective importance of intrapartum care content.

Results

Deficiencies between perceived reality and subjective importance were found in the following aspects of intrapartum care: perception of control (50%), involvement in decision-making (26%), access to preferred pain relief (26%), breastfeeding support (23%), and information about labour progress (22%). The midwife’s presence, involvement of the partner, possibilities to talk through the birth and breastfeeding support was rated better than expected. No major differences were found in the quality of intrapartum care, in relation to continuity.

A total of 75% had a known midwife during labour and birth and were more likely to have had labour induced (aOR 5.31, 95% CI 1.68–16.79), to have used the method ‘Give birth without fear’ (aOR 3.21, 95% CI 1.05–9.83), and to have received an epidural (aOR 3.85, 95% CI 1.51–9.82), compared to women without a known midwife assisting.

Conclusion

The quality of intrapartum care was assessed both deficient and excessive. Few differences were found between women who had a known midwife or not, but women with fear of childbirth who experienced continuity with a known midwife were exposed to more interventions, following Swedish regime to encourage women to have a vaginal birth. Aligning care content with women’s needs and values remains essential to improve satisfaction and outcomes in intrapartum care.

Aim: To investigate midwifery students' interests and views towards MCoC models and to validate an instrument measuring these views. Background: Midwifery continuity of care (MCoC) is widely recognised for its benefits to maternal and neonatal health. Despite this, access to MCoC models remains limited in Sweden and midwifery students receive minimal clinical exposure to this model of care. Design: Mixed-methods cross-sectional study Methods: Data were collected from a national sample of 115 midwifery students in Sweden using an online questionnaire between 2022 and 2023. Descriptive statistics were used to present students' characteristics and interests in MCoC. Questions about students' views of MCoC models were subjected to a principal component analysis (PCA). For associations between PCA components and students' socio-demographic characteristics, Analysis of Variance was performed. Free-text responses were thematically analysed. Results: Midwifery students held strong and positive views about the importance of MCoC and many were interested in working in such a model. However, some expressed concerns about work-life balance. The PCA resulted in two components: Relational aspects and Practical aspects, with Cronbach's alpha values of 0.735 and 0.751, respectively. The free-text responses confirmed the content of the components, with the themes Developing confidence in the professional role, Enhancing midwifery skills and expertise, Stronger relational bond and Challenging work conditions. Few socio-demographic characteristics were associated with the components. Conclusions: Working within a MCoC model was generally perceived as appealing by the midwifery students. Authorities and educational institutions must facilitate providing education and opportunities for MCoC models in Sweden.

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.

Objective: Despite strong evidence of the benefits, Sweden has limited access to midwifery continuity of care (MCoC), particularly in rural areas. There is a knowledge gap regarding how MCoC would function in a rural Swedish context. Therefore, this study aimed to explore midwives' personal and professional views on a MCoC model and its implementation within a rural context in northern Sweden.

Methods: A qualitative interview study using reflexive thematic analysis. Semi-structured interviews were conducted with fourteen midwives working in maternity care.

Results: The findings revealed a notable duality to MCoC, consisting of two major themes. In the first theme, 'Internal conditions of midwifery', midwives reported that working in a MCoC model would offer fulfillment but also present significant challenges, which they did not feel prepared to meet. Establishing a relationship of mutual trust with pregnant women emerged as a major positive aspect. The second theme, 'The impact of external forces', highlighted significant challenges, including organisational issues, staffing shortages, and concerns regarding work-life balance. Interprofessional collaboration and rural adaptation were considered key if the implementation of the model is to go ahead.

Conclusions: For MCoC to succeed in rural Sweden, it is essential to have a supportive organisation that recognises the benefits of the model, and provides midwives with working conditions that meet their professional and personal needs. Involving midwives in the model's design, fostering interprofessional collaboration, and tailoring the model to rural settings are equally important. Addressing organisational challenges is crucial for establishing a functional and sustainable model.

Objectives: Perinatal depressive symptoms affect both maternal and infant well-being and are associated with fear of giving birth. Midwifery continuity of care (MCoC) has shown potential in reducing anxiety and depression, particularly among vulnerable women. The aim of this study was to explore the trajectories of fear of birth and depressive symptoms, in relation to background, attitudes and birth-related data.

Methods: A prospective longitudinal study was conducted among women with fear of birth or depressive symptoms who, after a screening procedure were offered care in a MCoC model. Fear of birth and depressive symptoms were assessed with the Fear of Birth Scale (FOBS) and Edinburgh Postnatal Depression Scale (EPDS) and measured at screening, in mid pregnancy and twice after birth. Chi-square tests and analysis of variance were used for comparing groups.

Results: The questionnaires were completed by 175 women during pregnancy and by 140 postpartum. During screening 84% presented with fear of birth and 24% with depressive symptoms. The degree of fear of birth and the depressive symptoms changed over time with the highest prevalence during pregnancy and a decline after birth. The trajectory of depressive symptoms was mainly related to women's attitudes, while birth-related variables concerned fear of birth.

Conclusion: This study showed that fear of birth as well as depressive symptoms changed over time. These changes may represent natural progression but might be associated with the intervention. Working with women's attitudes might change the trajectories, especially in women with both fear of birth and depressive symptoms.

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

For migrant women, it may feel unsafe to give birth in a new, unfamiliar country. This group of women has an increased risk for adverse outcomes for mothers and children. Migrant women may experience stress and they have a higher likelihood of childbirth fear, childbirth complications, and maternal death.

Aim

To explore migrant women's experiences of cultural doula support during pregnancy and after childbirth as a complement to midwifery care.

Methods

A qualitative exploratory study design was adopted, using Braun and Clarke's theoretical thematic analysis process. A total of 21 migrant women from non-European countries in Sweden were interviewed via female language interpreters.

Findings

The overarching theme ‘Cultural doula support facilitates migrant women's transition into motherhood in a new country’ was explored. The theme was described by: The offer of cultural doula support was initially not always fully understood; The support replaced the lack of family and friends; The support developed women's understanding of maternity care; The support increased women's knowledge of childbirth and parental role; and The support facilitated women's integration into a new country.

Conclusion

The migrant women valued being supported by cultural doulas because this facilitated their transition into motherhood in an unfamiliar social context. Therefore, migrant women with limited language knowledge and understanding of becoming mothers in a new country should be offered support from a cultural doula as a complement to midwifery care.

Background: Early labor is often managed at home without professional support. The Birth App (Birth by Heart) is an app designed to support women during early labor. A pilot study revealed that women found the app's exercises simple, understandable, and practical. The app was perceived as useful and appreciated by women, although areas for improvement were identified, primarily related to technical issues. After the development and test period, the updated app was tested in a randomized controlled trial.

Objective: This study aims to investigate whether women using the Birth App during pregnancy and childbirth experience less distress during early labor compared to those receiving standard antenatal care.

Methods: We used online recruiting in a nonblinded 3-part blended care model with 1:1:1 randomization: group 1 (Birth App intervention); group 2 (Birth App Plus, combining the app with in-person additional midwifery contacts); and group 3 (control group receiving standard antenatal care). Pregnant nulliparous women were invited via social media. Eligibility criteria were nulliparity, planning a vaginal birth, from gestational week 25+0 to 35+6 weeks, proficiency in understanding Swedish, and having access to a smartphone or tablet. Data were analyzed with descriptive statistics, chi-square tests, and ANOVA.

Results: A total of 391 women completed the baseline questionnaire and were included in the study (group 1, n=118; group 2, n=114; group 3, n=118). Of these, 335 women responded to the questionnaire 1 month postpartum, yielding a response rate of 85.6%. Most participants experienced a spontaneous onset of labor (group 1: 67/103, 65%; group 2: 81/114, 71%; and group 3: control group, 86/118, 73%), with no statistically significant differences between groups. During early labor, women in group 1 remained at home for a mean of 16.76 (SD 20.45) hours, group 2 for a mean of 14.47 (SD 16.82) hours, and the control group for a mean of 12.90 (SD 15.99) hours (P=.32). For the primary and secondary outcomes, only women with spontaneous onset of labor (n=234) were included in the analysis. The primary outcome, emotional distress, showed similar mean values across all groups. No statistically significant differences were identified in the secondary outcomes: childbirth experience, pain relief, and support from the partner. However, for the secondary outcome fear of future birth, a pairwise testing from baseline to follow-up revealed a statistically significant mean difference for the intervention groups (group 1: mean 13.53, 95% CI 5.12-21.92, P=.002; group 2: mean 14.59, 95% CI 7.75-21.42, P<.001) with a medium effect size (Cohen d=.40 vs d=.47). For group 3, the mean was 6.78 (95% CI -.95 to 14.53; P=.08).

Conclusions: The Birth App, in conjunction with additional midwifery support, can be a valuable tool for pregnant women and their partners during pregnancy and childbirth. The observed reduction in fear of forthcoming childbirth associated with the Birth App warrants further investigation.

Trial Registration: ClinicalTrials.gov NCT05122390; https://clinicaltrials.gov/study/NCT05122390