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Hildingsson, Ingegerd
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Publications (10 of 172) Show all publications
Larsson, B., Rubertsson, C. & Hildingsson, I. (2020). A modified caseload midwifery model for women with fear of birth, women's and midwives’ experiences: A qualitative study. Sexual & Reproductive HealthCare, 24, Article ID 100504.
Open this publication in new window or tab >>A modified caseload midwifery model for women with fear of birth, women's and midwives’ experiences: A qualitative study
2020 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 24, article id 100504Article in journal (Refereed) Published
Abstract [en]

Objective: Although fear of birth is common during pregnancy and childbirth, the best treatment for fear of birth in clinical care remain unclear. Strong evidence suggests that continuity models of midwifery care can benefit women and birth outcomes, though such models are rare in Sweden. Because women with fear of birth could benefit from such models, the aim of this qualitative study was to examine how women with fear of birth and their midwives experienced care in a modified caseload midwifery model. Methods: A qualitative interview study using thematic analysis. Participants were recruited from a pilot study in which women assessed to have fear of birth received antenatal and intrapartum care, from a midwife whom they knew. Eight women and four midwives were interviewed. Results: An overarching theme—“A mutual relationship instilled a sense of peace and security”—and three themes—“Closeness, continuity, and trust,” “Preparation and counselling,” and “Security, confidence, and reduced fear”—reflect the views and experiences of women with fear of birth and their midwives after participating in a modified caseload midwifery model. Conclusions: For both women with fear of birth and their midwives, the caseload midwifery model generated trustful woman–midwife relationships, which increased women's confidence, reduced their fear, and contributed to their positive birth experiences. Moreover, the midwives felt better equipped to address women's needs, and their way of working with the women became more holistic. Altogether, offering a continuity model of midwifery care could be an option to support women with fear of birth. 

Keywords
Birth experience, Caseload, Fear of birth, Midwifery, Qualitative
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-38657 (URN)10.1016/j.srhc.2020.100504 (DOI)2-s2.0-85080091572 (Scopus ID)
Available from: 2020-03-16 Created: 2020-03-16 Last updated: 2020-03-16Bibliographically approved
Hildingsson, I., Karlström, A., Rubertsson, C. & Larsson, B. (2020). Birth outcome in a caseload study conducted in a rural area of Sweden-a register based study. Sexual & Reproductive HealthCare, 24, Article ID 100509.
Open this publication in new window or tab >>Birth outcome in a caseload study conducted in a rural area of Sweden-a register based study
2020 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 24, article id 100509Article in journal (Refereed) Published
Abstract [en]

Background: Continuity models of midwifery care are rare in Sweden, despite its well-known positive effects. The aim was to describe pregnancy and birth outcome in women participating in a continuity of care project in a rural area of Sweden. Method: A register-based study of 266 women recruited to the project and a control group of 125 women from the same catchment area. Midwives provided antenatal care and were on-call 7 a.m. to 11 p.m. for birth. Data were collected from the antenatal and birth records. Crude and adjusted odds ratios with 95% confidence intervals were calculated between women in the project and the control group. Results: There were more primiparous women and highly educated women recruited to the project, and fewer foreign-born and single women, compared to the control group. Women in the project met more midwives and were less likely to have a pregnancy complication. During intrapartum care, women recruited to the project were less likely to need labour augmentation and less likely to have an instrumental vaginal birth and elective caesarean section. They had fewer second degree perineal tears and were more likely to fully breastfeed at discharge. No differences were found in neonatal outcome. The continuity of a known midwife at birth was quite low. Conclusion: This study shows that women self-recruited to a continuity of care project in a rural area of Sweden had a higher rate of normal births. There were few differences if having a known midwife or not. Long distances to hospital and lack of staff affected the level of continuity. 

Keywords
Birth records, Caseload midwifery, Continuity of care, Labour outcome, Midwifery, Register-based study
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-38771 (URN)10.1016/j.srhc.2020.100509 (DOI)2-s2.0-85082180696 (Scopus ID)
Available from: 2020-04-01 Created: 2020-04-01 Last updated: 2020-04-01Bibliographically approved
Hildingsson, I., Rubertsson, C., Karlström, A. & Haines, H. (2019). A known midwife can make a difference for women with fear of childbirth- birth outcome and women's experiences of intrapartum care. Sexual & Reproductive HealthCare, 21, 33-38
Open this publication in new window or tab >>A known midwife can make a difference for women with fear of childbirth- birth outcome and women's experiences of intrapartum care
2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, p. 33-38Article in journal (Refereed) Published
Abstract [en]

Background: There is evidence that continuity of midwifery care is beneficial to women. Women with fear of childbirth in Sweden are offered counselling, but receiving care from a known midwife during labour is unusual, despite its effects in reducing interventions and increasing birth satisfaction. The aim of this study was to describe and compare birth outcome and experience of intrapartum care among women with fear of childbirth who received intrapartum care from a known midwife, versus those who did not. Methods: An experimental study of 70 women referred to counselling due to fear of birth during pregnancy wherein the counselling midwife, when possible, also assisted during labour and birth. Results: Having a known midwife during labour and birth had a positive impact on fearful women's birth experience and their perception of pain, but there was no difference in onset of labour or mode of birth. Women who received care from a known midwife experienced better care with regards to information, participation in decision making and perception of control. Conclusion: This study indicates that having access to a known midwife might have an impact on women's birth experience. This study was limited by its small sample size and further research would need to randomise fearful women to counselling or continuity of care to determine the contribution of each to reducing fear. 

Keywords
Birth experience, Continuity, Counseling, Fear of childbirth, Intrapartum care, adult, article, controlled study, decision making, experimental study, female, human, labor onset, major clinical study, midwife, nociception, patient care, pregnancy outcome, sample size
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-36689 (URN)10.1016/j.srhc.2019.06.004 (DOI)000485335500007 ()31395231 (PubMedID)2-s2.0-85067361825 (Scopus ID)
Available from: 2019-07-09 Created: 2019-07-09 Last updated: 2019-11-12Bibliographically approved
Hildingsson, I., Lindgren, H., Karlström, A., Christensson, K., Bäck, L., Mudokwenyu–Rawdon, C., . . . Sharma, B. (2019). African midwifery students’ self-assessed confidence in antenatal care: a multi-country study. Global Health Action, 12(1), Article ID 1689721.
Open this publication in new window or tab >>African midwifery students’ self-assessed confidence in antenatal care: a multi-country study
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2019 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 12, no 1, article id 1689721Article in journal (Refereed) Published
Abstract [en]

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

Keywords
confidence, education, Midwifery students
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-38193 (URN)10.1080/16549716.2019.1689721 (DOI)000497448900001 ()31747850 (PubMedID)2-s2.0-85075428247 (Scopus ID)
Available from: 2020-01-08 Created: 2020-01-08 Last updated: 2020-01-16Bibliographically approved
Hildingsson, I. & Rubertsson, C. (2019). Childbirth experiences among women with fear of birth randomized to internet-based cognitive therapy or midwife counseling. Journal of Psychosomatic Obstetrics and Gynaecology
Open this publication in new window or tab >>Childbirth experiences among women with fear of birth randomized to internet-based cognitive therapy or midwife counseling
2019 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Although women with fear of birth often report negative birth experiences, few studies have focused on their experiences in the long term. The aim of this study was to compare birth experiences a year after childbirth in two groups of women receiving treatment for experiencing fear of birth during pregnancy. Methods: As part of the U-CARE: Pregnancy Trial, a prospective multicenter randomized controlled trial comparing the effects of internet-based cognitive behavioral therapy (iCBT) and standard care among pregnant women with fear of birth. Women were recruited at three Swedish hospitals following a screening procedure that assessed their fear of birth. Data were collected online with the Childbirth Experience Questionnaire (CEQ), one question about the overall birth experience, and questions about personal background, collected before randomization. Results: A total of 181 women responded to the follow-up questionnaire a year after childbirth. Approximately half of participants reported a less positive birth experience. Preferred mode of birth, actual mode of birth, marital status and psychiatric history were associated with the domains of the CEQ. However, no statistically significant differences emerged between the treatment groups. Conclusions: Being randomized to receive iCBT or counseling with midwives for fear of birth was not associated with perceptions of the birth experience assessed a year after birth. Most participants reported less-than-positive birth experiences and scored low on the domain of the CEQ reflecting Own capacity. In response, additional research remains necessary to identify the best model of care that might facilitate positive experiences with giving birth among women with fear of birth. 

Keywords
birth experience, counseling, Fear of birth, Internet-based cognitive therapy, midwifery
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-36823 (URN)10.1080/0167482X.2019.1634047 (DOI)2-s2.0-85068190258 (Scopus ID)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2020-02-20Bibliographically approved
Höglund, B., Rådestad, I. & Hildingsson, I. (2019). Few women receive a specific explanation of a stillbirth - an online survey of women's perceptions and thoughts about the cause of their baby's death. BMC Pregnancy and Childbirth, 19(1), Article ID 139.
Open this publication in new window or tab >>Few women receive a specific explanation of a stillbirth - an online survey of women's perceptions and thoughts about the cause of their baby's death
2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 139Article in journal (Refereed) Published
Abstract [en]

Background

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

Methods

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

Results

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

Conclusions

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

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-36547 (URN)10.1186/s12884-019-2289-4 (DOI)000466991400001 ()31027483 (PubMedID)2-s2.0-85064980523 (Scopus ID)
Available from: 2019-06-28 Created: 2019-06-28 Last updated: 2019-07-08Bibliographically approved
Sharma, B., Hildingsson, I. & Christensson, K. (2019). The association of teaching-learning methods and self-confidence of nurse-midwives. A survey from one province in India. Women and Birth, 32(3), e376-e383
Open this publication in new window or tab >>The association of teaching-learning methods and self-confidence of nurse-midwives. A survey from one province in India
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 3, p. e376-e383Article in journal (Refereed) Published
Abstract [en]

Background: This study aimed to investigate the association between self-confidence of final-year students in selected midwifery skills and teaching-learning methods used in the two formally recognized education programs for nurse-midwives in India. Design: A cross-sectional survey Participants: 633 final-year students, from 25 educational institutions randomly selected, stratified by type of program (diploma/bachelor), and ownership (private/government) in Gujarat. Data collection and analysis: Students assessed their confidence on a 4-point scale, in four midwifery competency domains-antepartum, intrapartum, postpartum, and newborn care recommended by the International Confederation of Midwives (ICM). Explorative factor analysis was used to reduce skill statements into subscales separately for each domain. Odds ratios with 95% CI were calculated for students with high confidence (≥75th percentile on each subscale) and not high confidence (all others) between diploma and bachelor students. Results: Classroom teaching was the most practiced method. ‘Laboratory demonstrations’, ‘Practice on models’, ‘Demonstrations at clinical sites’, ‘Births Attended’ (Hands-on clinical practice), and ‘Satisfaction with clinical supervision’ were practiced less, lesser in the bachelor's compared to the diploma program. High confidence was associated with ‘Births Attended’ (Hands-on clinical practice), ‘Practice on models’, and ‘Satisfaction with clinical supervision’ for all subscales of all four domains of competencies. Conclusions: Hands on skills practice in the laboratory and supervised clinical practice during clinical placements were associated with high confidence for basic clinical midwifery skills amongst students. The diploma program followed better pedagogoical approaches than the bachelor's program. 

Keywords
Confidence, Education, India, Midwifery skills, Teaching methods
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34566 (URN)10.1016/j.wombi.2018.07.015 (DOI)000470848100010 ()30098978 (PubMedID)2-s2.0-85051054458 (Scopus ID)
Note

Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2019-07-08Bibliographically approved
Hildingsson, I., Karlström, A., Rubertsson, C. & Haines, H. (2019). Women with fear of childbirth might benefit from having a known midwife during labour. Women and Birth, 32(1), 58-63
Open this publication in new window or tab >>Women with fear of childbirth might benefit from having a known midwife during labour
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 1, p. 58-63Article in journal (Refereed) Published
Abstract [en]

Aim: Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time. Methods: A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth. Results: 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not. Conclusions: Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife–woman relationship rather than counseling per se could be the key issue when it comes to fear of birth. 

Keywords
Continuity, Counseling, Fear of childbirth, Intrapartum care, Pregnancy
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34108 (URN)10.1016/j.wombi.2018.04.014 (DOI)000455681800026 ()29773474 (PubMedID)2-s2.0-85047095727 (Scopus ID)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2020-02-20Bibliographically approved
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
Open this publication in new window or tab >>Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study
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2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 1, p. e88-e94Article in journal (Refereed) 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. 

Keywords
Childbirth fear, Counselling, Experience, Midwifery, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-33693 (URN)10.1016/j.wombi.2018.04.008 (DOI)000455681800012 ()29709431 (PubMedID)2-s2.0-85046132339 (Scopus ID)
Available from: 2018-06-01 Created: 2018-06-01 Last updated: 2020-02-19Bibliographically approved
Hildingsson, I., Rubertsson, C., Karlström, A. & Haines, H. (2018). Caseload midwifery for women with fear of birth is a feasible option. Sexual & Reproductive HealthCare, 16, 50-55
Open this publication in new window or tab >>Caseload midwifery for women with fear of birth is a feasible option
2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, p. 50-55Article in journal (Refereed) Published
Abstract [en]

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

Keywords
Caseload, Fear of birth, Intrapartum care, Midwifery, Pregnancy
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-33382 (URN)10.1016/j.srhc.2018.02.006 (DOI)000440877700009 ()29804775 (PubMedID)2-s2.0-85043499616 (Scopus ID)
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-09-26Bibliographically approved
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