miun.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Hildingsson, Ingegerd
Alternative names
Publications (10 of 161) Show all publications
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.
Show others...
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)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-12-04Bibliographically approved
Hildingsson, I., Rubertsson, C., Karlström, A. & Haines, H. (2018). Exploring the Fear of Birth Scale in a mixed population of women of childbearing age-A Swedish pilot study. Women and Birth, 31(5), 407-413
Open this publication in new window or tab >>Exploring the Fear of Birth Scale in a mixed population of women of childbearing age-A Swedish pilot study
2018 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, no 5, p. 407-413Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this pilot study was to explore the Fear of Birth Scale in a mixed sample of women of childbearing age, by investigating the levels of childbirth fear and the content of women's thoughts when completing the scale. Methods: A cross-sectional mixed method study of 179 women who completed a short questionnaire and a think aloud interview. Results: The mean score of the Fear of Birth Scale was 40.80 (SD 27.59) and 28.5% were classified as having fear of childbirth (≥60). The internal consistency showed a Cronbach's α. >. 0.92, and a mean inter-item correlation of 0.85.The highest scores were found in women younger than 25 years (mean 60.10), foreign-born women (mean 54.30) and women who did not have any previous children (48.72). The lowest scores were found in women who had recently given birth (mean 34.82) and women older than 35 years (mean 34.85). The content analysis categorization matrix clearly accommodated all 436 statements into the five pre-existing categories. The largest categories were: the content of fear and worry with 138 statements and strategies to cope with fear or worry (122 statements). Conclusion: The Fear of Birth Scale seems to be a useful instrument for different subgroups of women. The construct of fear of childbirth may be universally understood and experienced by women of childbearing age irrespective of whether they are currently pregnant, have recently given birth or do not have children. Identifying fear of birth is important in clinical practice in order to support women's reproductive needs. 

Keywords
Childbearing, Childbirth fear, FOBS pilot study, Scale validation, Think aloud interview
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-32760 (URN)10.1016/j.wombi.2017.12.005 (DOI)000445117700018 ()29249331 (PubMedID)
Available from: 2018-01-30 Created: 2018-01-30 Last updated: 2018-10-16Bibliographically approved
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.
Open this publication in new window or tab >>Factors influencing decision-making for caesarean section in Sweden - a qualitative study
Show others...
2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 377Article in journal (Refereed) 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.

Keywords
Caesarean section, Decision-making, Midwives, Obstetricians, Normal birth, Nulliparous, Qualitative, Midwife-led care
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34727 (URN)10.1186/s12884-018-2007-7 (DOI)000444858800003 ()30223780 (PubMedID)2-s2.0-85053412368 (Scopus ID)
Available from: 2018-10-16 Created: 2018-10-16 Last updated: 2018-10-16
Rondung, E., Ekdahl, J., Hildingsson, I., Rubertsson, C. & Sundin, Ö. (2018). Heterogeneity in childbirth related fear or anxiety. Scandinavian Journal of Psychology, 59(6), 634-643
Open this publication in new window or tab >>Heterogeneity in childbirth related fear or anxiety
Show others...
2018 (English)In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 59, no 6, p. 634-643Article in journal (Refereed) Published
Abstract [en]

Many pregnant women experience fear, worry or anxiety relating to the upcoming childbirth. The aim of this cross-sectional study was to investigate possible subgroups in a sample of 206 pregnant women (mean age 29.4 years), reporting fear of birth in mid-pregnancy. Comparisons were made between nulliparous and parous women. In a series of cluster analyses, validated psychological instruments were used to cluster women based on their psychological profiles. A five-cluster solution was suggested, with the clusters characterized by: overall low symptom load, general high symptom load, medium symptom load with high performance-based self-esteem, blood- and injection phobic anxiety, and specific anxiety symptoms. Nulliparous women were more likely to report clinically relevant levels of blood- and injection phobia (OR = 2.57, 95% CI 1.09–6.01), while parous women more often reported previous negative experiences in health care (OR 1.93, 95% CI 1.09–3.39) or previous trauma (OR 2.90, 95% CI 1.58–5.32). The results indicate that women reporting fear of birth are a heterogeneous group. In order to individualize treatment, psychological characteristics may be of greater importance than parity in identifying relevant subgroups. 

Keywords
anxiety, fear, childbirth, pregnancy, cluster analysis, blood- and injection phobia
National Category
Applied Psychology
Identifiers
urn:nbn:se:miun:diva-34320 (URN)10.1111/sjop.12481 (DOI)000449851300009 ()30176051 (PubMedID)
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2018-12-04Bibliographically approved
Åhlund, S., Zwedberg, S., Hildingsson, I., Edqvist, M. & Lindgren, H. (2018). Midwives experiences of participating in a midwifery research project: A qualitative study. Women and Birth, 31(2), e115-e122
Open this publication in new window or tab >>Midwives experiences of participating in a midwifery research project: A qualitative study
Show others...
2018 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, no 2, p. e115-e122Article in journal (Refereed) Published
Abstract [en]

Problem and background: In an earlier research project midwives were asked to perform women-centered care focusing on the assumption that the physiological process in the second stage of labour could be trusted and that the midwives role should be encouraging and supportive rather than instructing. There is no knowledge about how midwives participating in such a research project, uses their skills and experience from the study in their daily work. Aim: The aim in this study was to investigate how midwives experienced implementing woman-centered care during second stage of labour. Methods: A qualitative study was designed. Three focus groups and two interviews were conducted. The material was analysed using content analysis. Findings: The participating midwives' experiences were understood as increased awareness of their role as midwives. The overarching theme covers three categories 1) establishing a new way of working, 2) developing as midwife, 3) being affected by the prevailing culture. The intervention was experienced as an opportunity to reflect and strengthen their professional role, and made the midwives see the women and the birth in a new perspective. Conclusions: Implementing woman-centered care during second stage of labour gave the midwives an opportunity to develop in their professional role, and to enhance their confidence in the birthing women and her ability to have a physiological birth. To promote participation in, as well as conduct midwifery research, can enhance the development of the midwives professional role as well as contribute new knowledge to the field. 

Keywords
Birth, Midwives, Professional role, Qualitative research, Woman-centered care
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-32194 (URN)10.1016/j.wombi.2017.07.004 (DOI)000427813500007 ()28781066 (PubMedID)
Available from: 2017-11-29 Created: 2017-11-29 Last updated: 2018-05-07Bibliographically approved
Ängeby, K., Wilde-Larsson, B., Hildingsson, I. & Sandin-Bojö, A.-K. (2018). Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population. Journal of midwifery & women's health, 63(1), 33-44
Open this publication in new window or tab >>Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population
2018 (English)In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 63, no 1, p. 33-44Article, review/survey (Refereed) Published
Abstract [en]

IntroductionThe prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase. MethodsA descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013-2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables. ResultsA prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26). DiscussionBased on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

Keywords
intrapartum care, labor, first stage; obstetric complications, quantitative research
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-33298 (URN)10.1111/jmwh.12704 (DOI)000424649100005 ()29419927 (PubMedID)
Available from: 2018-03-19 Created: 2018-03-19 Last updated: 2018-07-02Bibliographically approved
Sharma, B., Hildingsson, I., Johansson, E. & Christensson, K. (2018). Self-assessed confidence of students on selected midwifery skills: Comparing diploma and bachelors programmes in one province of India. Midwifery, 67, 12-17
Open this publication in new window or tab >>Self-assessed confidence of students on selected midwifery skills: Comparing diploma and bachelors programmes in one province of India
2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 12-17Article in journal (Refereed) Published
Abstract [en]

Objective: There are two integrated pre-service education programmes for nurses and midwives in India; a diploma in General Nursing and Midwifery (GNM) and bachelor's in nursing (B.Sc. nursing). This study assessed and compared confidence of final-year students from these two programmes for selected midwifery skills from the list of midwifery competencies given by the International Confederation of Midwives (ICM). Design: A cross-sectional survey. Participants: 633 final-year students, from 25 educational institutions randomly selected, stratified by the type of programme (diploma/bachelor), and ownership (private/government) from the Gujarat province. Data collection and analysis: Students assessed their confidence on a 4-point scale, in four midwifery competency domains-antepartum, intrapartum, postpartum, and newborn care. Skill statements were reduced to subscales for each competency domain separately through Principle Component Analysis. Crude and adjusted odds ratios with 95% CI were calculated for students with high confidence (≥75th percentile on each subscale) and not high (all others) between diploma and bachelor students. Findings: The diploma students were 2–4 times more likely to have high confidence on all subscales under antepartum, intrapartum, postpartum and newborn care compared to the bachelor students. Though both groups had less hands-on clinical practice during their education, more diploma students could fulfil the requirements of attending recommended number of births compared to the bachelor students. Conclusion: Overall the students of the general nursing and midwifery (GNM) programme have higher confidence in skills for antepartum, intrapartum, newborn and postpartum care. One important reason is more hands-on clinical practice for the diploma compared to the bachelor students. 

Keywords
Confidence, India, Low and middle income countries, Midwifery skills, Nurses
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-34607 (URN)10.1016/j.midw.2018.08.015 (DOI)000447751500002 ()30216749 (PubMedID)2-s2.0-85053077740 (Scopus ID)
Available from: 2018-10-03 Created: 2018-10-03 Last updated: 2018-11-19Bibliographically approved
Sharma, B., Hildingsson, I. & Christensson, K. (2018). The association of teaching-learning methods and self-confidence of nurse-midwives. A survey from one province in India. Women and Birth
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
2018 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed) Epub ahead of print
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)
Note

Available online 8 August 2018

Available from: 2018-10-01 Created: 2018-10-01 Last updated: 2018-10-01Bibliographically approved
Hildingsson, I., Karlström, A., Rubertsson, C. & Haines, H. (2018). Women with fear of childbirth might benefit from having a known midwife during labour. Women and Birth
Open this publication in new window or tab >>Women with fear of childbirth might benefit from having a known midwife during labour
2018 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed) Epub ahead of print
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)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-07-04Bibliographically approved
Organisations

Search in DiVA

Show all publications