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Hildingsson, Ingegerd
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Publications (10 of 169) Show all publications
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. & 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)
Available from: 2019-08-12 Created: 2019-08-12 Last updated: 2019-08-12Bibliographically 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)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2019-08-07Bibliographically 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)
Available from: 2018-06-01 Created: 2018-06-01 Last updated: 2019-08-07Bibliographically 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
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.
Open this publication in new window or tab >>Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.
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2018 (English)In: JMIR mental health, ISSN 2368-7959, Vol. 5, no 3, article id e10420Article in journal (Refereed) 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).

Keywords
anxiety, cognitive behavioral therapy, fear of birth, internet-based, pregnancy
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34318 (URN)10.2196/10420 (DOI)000449378200001 ()30097422 (PubMedID)2-s2.0-85052907128 (Scopus ID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-03-27Bibliographically approved
Halfdansdottir, B., Hildingsson, I., Smarason, A., Sveinsdottir, H. & Olafsdottir, O. A. (2018). Contraindications in planned home birth in Iceland: A retrospective cohort study. Sexual & Reproductive HealthCare, 15(March), 10-17
Open this publication in new window or tab >>Contraindications in planned home birth in Iceland: A retrospective cohort study
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2018 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, no March, p. 10-17Article in journal (Refereed) Published
Abstract [en]

Objectives

Icelandic national guidelines on place of birth list contraindications for home birth. Few studies have examined the effect of contraindication on home birth, and none have done so in Iceland. The aim of this study was to examine whether contraindications affect the outcome of planned home birth or have a different effect at home than in hospital.

Methods

The study is a retrospective cohort study on the effect of contraindications for home birth on the outcome of planned home (n = 307) and hospital (n = 921) birth in 2005–2009. Outcomes were described for four different groups of women, by exposure to contraindications (unexposed vs. exposed) and planned place of birth (hospital vs. home). Linear and logistic regression analysis was used to evaluate the effect of the contraindications under study and to detect interactions between contraindications and planned place of birth.

Results

The key findings of the study were that contraindications were related to higher rates of adverse maternal and neonatal outcomes, regardless of place of birth; women exposed to contraindications had higher rates of adverse outcomes in planned home birth; and healthy, unexposed women had higher rates of adverse outcomes in planned hospital birth. Contraindications significantly increased the risk of transfer in labour and postpartum haemorrhage in planned home births.

Conclusion

The defined contraindications for home birth had a negative effect on maternal and neonatal outcomes in Iceland, regardless of place of birth. The study results do not contradict the current national guidelines on place of birth.

Keywords
Midwifery, Pregnancy outcome, Home childbirth, Contraindications
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-35238 (URN)10.1016/j.srhc.2017.11.002 (DOI)
Available from: 2018-12-16 Created: 2018-12-16 Last updated: 2018-12-17Bibliographically approved
Hildingsson, I., Rubertsson, C., Karlström, A. & Haines, H. (2018). Emotional well-being and the importance for women with fear of birth to have a known midwife at birth. Journal of Psychology and Mental Health care, 2(1), 1-7
Open this publication in new window or tab >>Emotional well-being and the importance for women with fear of birth to have a known midwife at birth
2018 (English)In: Journal of Psychology and Mental Health care, E-ISSN 2637-8892, Vol. 2, no 1, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Background: Previous research has shown that women with fear of childbirth often suffer from other mental health issues. Continuity of caregiver through a known midwife is best practice for pregnant women, and women with childbirth related fear value continuity of care. In Sweden the maternity care is fragmented and women’s opinion remains under-investigated.

Objective: The aim of this study was to investigate emotional well-being and the importance of having a known midwife during birth in women referred to counselling for childbirth related fear.

Design: Cross sectional study Setting: 3 Swedish hospitals providing counseling for childbirth related fear.

Participants: Women who were referred for counseling due to fear of childbirth. Measures: The importance of having a known midwife at birth, background factors, emotional well-being and attitudes. Results: 77 women referred to counseling consented to participate. The majority of women were likely to present with previous or ongoing emotional distress, high levels of anxiety or depressive symptoms, low Sense of Coherence and Major worries. For the majority of women (71%) it was important to have a known midwife at birth and most important for women with high levels of childbirth fear.

Conclusion: This study highlights that women referred to counseling due to fear of childbirth might need additional support to cope with their emotional distress. The results also indicated that having a known midwife at birth was important to these women, especially for women with higher fear. The option of having a known midwife during birth is rarely accomplished in Sweden due to the fragmentation of care.

Keywords
Continuity models of care, counseling, Emotional Well-being, Fear of childbirth
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-35236 (URN)
Available from: 2018-12-16 Created: 2018-12-16 Last updated: 2018-12-17Bibliographically approved
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