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Larsson, Birgitta
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Larsson, B., Hildingsson, I., Ternström, E., Rubertsson, C. & Karlström, A. (2019). Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study. Women and Birth, 32(1), e88-e94
Öppna denna publikation i ny flik eller fönster >>Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study
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2019 (Engelska)Ingår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, nr 1, s. e88-e94Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women's views about counselling for childbirth fear. Aim: To explore women's experiences of midwife-led counselling for childbirth fear. Method: A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth. Findings: The overarching theme ‘Midwife-led counselling brought positive feelings and improved confidence in birth’ was identified. This consisted of four themes describing ‘the importance of the midwife’ and ‘a mutual and strengthening dialogue’ during pregnancy. ‘Coping strategies and support enabled a positive birth’ represent women's experiences during birth and ‘being prepared for a future birth’ were the women's thoughts of a future birth. Conclusions: In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable. 

Nyckelord
Childbirth fear, Counselling, Experience, Midwifery, Qualitative research
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:miun:diva-33693 (URN)10.1016/j.wombi.2018.04.008 (DOI)000455681800012 ()29709431 (PubMedID)
Tillgänglig från: 2018-06-01 Skapad: 2018-06-01 Senast uppdaterad: 2019-08-07Bibliografiskt granskad
Rondung, E., Ternström, E., Hildingsson, I., Haines, H. M., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2018). Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.. JMIR mental health, 5(3), Article ID e10420.
Öppna denna publikation i ny flik eller fönster >>Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.
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2018 (Engelska)Ingår i: JMIR mental health, ISSN 2368-7959, Vol. 5, nr 3, artikel-id e10420Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.

OBJECTIVE: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.

METHODS: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.

RESULTS: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03).

CONCLUSIONS: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).

Nyckelord
anxiety, cognitive behavioral therapy, fear of birth, internet-based, pregnancy
Nationell ämneskategori
Tillämpad psykologi
Identifikatorer
urn:nbn:se:miun:diva-34318 (URN)10.2196/10420 (DOI)000449378200001 ()30097422 (PubMedID)2-s2.0-85052907128 (Scopus ID)
Tillgänglig från: 2018-08-31 Skapad: 2018-08-31 Senast uppdaterad: 2019-03-27Bibliografiskt granskad
Panda, S., Daly, D., Begley, C., Karlström, A., Larsson, B., Bäck, L. & Hildingsson, I. (2018). Factors influencing decision-making for caesarean section in Sweden - a qualitative study. BMC Pregnancy and Childbirth, 18(1), Article ID 377.
Öppna denna publikation i ny flik eller fönster >>Factors influencing decision-making for caesarean section in Sweden - a qualitative study
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2018 (Engelska)Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, nr 1, artikel-id 377Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. Methods: A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo (c) and thematically analysed. Ethical approval was granted by Trinity College Dublin. Results: The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but ...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. Conclusion: Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.

Nyckelord
Caesarean section, Decision-making, Midwives, Obstetricians, Normal birth, Nulliparous, Qualitative, Midwife-led care
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:miun:diva-34727 (URN)10.1186/s12884-018-2007-7 (DOI)000444858800003 ()30223780 (PubMedID)2-s2.0-85053412368 (Scopus ID)
Tillgänglig från: 2018-10-16 Skapad: 2018-10-16 Senast uppdaterad: 2018-10-16
Ternström, E., Hildingsson, I., Haines, H., Karlström, A., Sundin, Ö., Ekdahl, J., . . . Rubertsson, C. (2017). A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol. Sexual & Reproductive HealthCare, 13, 75-82
Öppna denna publikation i ny flik eller fönster >>A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol
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2017 (Engelska)Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, s. 75-82Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:miun:diva-31379 (URN)10.1016/j.srhc.2017.06.001 (DOI)000411305800011 ()28844361 (PubMedID)2-s2.0-85021645169 (Scopus ID)
Anmärkning

Available online 15 June 2017

Tillgänglig från: 2017-08-11 Skapad: 2017-08-11 Senast uppdaterad: 2018-12-05Bibliografiskt granskad
Larsson, B., Karlström, A., Rubertsson, C., Ternström, E., Ekdahl, J., Segebladh, B. & Hildingsson, I. (2017). Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial. Women and Birth, 30(6), 460-467
Öppna denna publikation i ny flik eller fönster >>Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial
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2017 (Engelska)Ingår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, nr 6, s. 460-467Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason. The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment. Methods: Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n = 258) were recruited at one university hospital and two regional hospitals over one year. The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n = 127) or standard care (face-to-face counselling) (n = 131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth. Results: Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience. Conclusion: Women's birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research.

Nyckelord
Caesarean section, Childbirth fear, Counselling, Internet based cognitive behavioural therapy, Randomised controlled trial
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:miun:diva-31044 (URN)10.1016/j.wombi.2017.04.004 (DOI)000418296300007 ()28495462 (PubMedID)2-s2.0-85019011965 (Scopus ID)
Anmärkning

Available online 8 May 2017

Tillgänglig från: 2017-06-28 Skapad: 2017-06-28 Senast uppdaterad: 2018-12-05Bibliografiskt granskad
Larsson, B. (2017). Treatment för childbirth fear with a focus on midwife-led counselling: A national overview, women´s birth preferences and experiences of counselling. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Öppna denna publikation i ny flik eller fönster >>Treatment för childbirth fear with a focus on midwife-led counselling: A national overview, women´s birth preferences and experiences of counselling
2017 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being.

Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling.

MethodsStudy I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy.

Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden.

Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.  

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2017. s. 77
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1341
Nyckelord
Birth experience, caesarean section, childbirth fear, internet-based cognitive behaviour therapy, midwife-led counselling, treatment
Nationell ämneskategori
Reproduktionsmedicin och gynekologi
Identifikatorer
urn:nbn:se:miun:diva-35945 (URN)978-91-513-0003-0 (ISBN)
Disputation
2017-09-08, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-04-04 Skapad: 2019-04-04 Senast uppdaterad: 2019-04-04Bibliografiskt granskad
Larsson, B., Karlström, A., Rubertsson, C. & Hildingsson, I. (2016). Counseling for childbirth fear - a national survey. Sexual & Reproductive HealthCare, 8, 82-87
Öppna denna publikation i ny flik eller fönster >>Counseling for childbirth fear - a national survey
2016 (Engelska)Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, s. 82-87Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Counseling by experienced midwives is offered to women with childbirth fear in most obstetric clinics in Sweden, but information about the content of such counseling is lacking. Aim: To study comprehensiveness, content and organization of the midwife-led counseling for childbirth fear in all obstetric clinics in Sweden. Methods: In this cross-sectional study, data were collected using a questionnaire sent to all obstetric clinics in Sweden (n =45); a total of 43 clinics responded. Descriptive and one-way ANOVA was used in the analysis. Results: All responding obstetric clinics in Sweden offer midwife-led counseling to women with childbirth fear. Major differences were found regarding the time allocated to counseling, with a range between 5.7 and 47.6 minutes per childbirth. Supplementary education for midwives and the availability of treatment options varied at the different clinics and were not associated with the size of the clinic. Conclusion: The midwife-led counseling conducted at the different Swedish obstetric clinics showed considerable disparities. Women with childbirth fear would benefit from care on equal terms irrespective of place of residence. Consequently, it would be valuable to develop a national healthcare program for childbirth fear.

Nyckelord
Childbirth fear, Cesarean section, Counseling, National survey, Treatment
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:miun:diva-28479 (URN)10.1016/j.srhc.2016.02.008 (DOI)000376839500013 ()27179382 (PubMedID)2-s2.0-84959874177 (Scopus ID)
Tillgänglig från: 2016-07-21 Skapad: 2016-07-21 Senast uppdaterad: 2018-12-05Bibliografiskt granskad
Larsson, B., Karlström, A., Rubertsson, C. & Hildingsson, I. (2015). The effects of counseling on fear of childbirth. Acta Obstetricia et Gynecologica Scandinavica, 94(6), 629-636
Öppna denna publikation i ny flik eller fönster >>The effects of counseling on fear of childbirth
2015 (Engelska)Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 6, s. 629-636Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

ObjectiveTo investigate women's experiences of attending existing counseling programs for childbirth-related fear and the effect of this counseling over time. DesignA longitudinal survey. SettingThree hospitals in the central north of Sweden. SampleA selected sample of 936 women. Of these, 70 received counseling due to fear of childbirth (study-group). MethodsData were collected with questionnaires 2months and 1year after giving birth with background data collected during midpregnancy. Comparisons were made between women with or without counseling. Crude and adjusted odds ratios (OR) were calculated. Main outcome measuresSelf-reported childbirth fear, experience of counseling, birth experience and preferred mode of birth. ResultsWomen in the counseling group reported higher childbirth fear 1year after giving birth (OR 5.0, 95% confidence interval (95% CI) 2.6-9.3), they had a more negative birth experience that did not change over time (OR 2.1, 95% CI 1.2-3.9) and they preferred cesarean section to a greater extent (OR 12.0, 95% CI 5.1-28.1) in the case of another birth. Also, they were more often delivered by planned cesarean section (OR 4.7, 95% CI 2.4-9.1). However, 80% were satisfied with the given support. ConclusionAlthough women were satisfied with the treatment, this study shows that counseling had a minor effect on fear of childbirth, birth experiences or cesarean section rates. To help women with their fear of childbirth, more effective methods of treatment are needed.

Nyckelord
Birth experience, childbirth fear, cesarean section, counseling, support
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:miun:diva-25664 (URN)10.1111/aogs.12634 (DOI)000354398300012 ()25772528 (PubMedID)2-s2.0-84929144778 (Scopus ID)
Tillgänglig från: 2015-08-28 Skapad: 2015-08-18 Senast uppdaterad: 2018-12-05Bibliografiskt granskad
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