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Karlström, Annika
Publications (10 of 41) Show all publications
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
Karlström, A. & Rising Holmström, M. (2019). Parental  groups during pregnacy and the child's first year: Swedish parents' experiences. The Journal of Perinatal Education, 28(1), 19-27
Open this publication in new window or tab >>Parental  groups during pregnacy and the child's first year: Swedish parents' experiences
2019 (English)In: The Journal of Perinatal Education, ISSN 1058-1243, Vol. 28, no 1, p. 19-27Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to assess parents' experience of parental support given before and after childbirth in a mid-Sweden region. A coherent education program implemented in a mid-Sweden region was evaluated. Data from two different samples of parents was collected through questionnaires. From the antenatal classes 563 women and men took part in the study. The other sample consisted of 176 parents from the child health care classes. The vast majority of parents from both groups were content with the sessions and their overall view was very positive. Both men and women felt strengthened before birth and in their parental role. New knowledge about breastfeeding and children's needs were gained. New thoughts about equal parenting and children's needs and development were achieved to a limited extent.

Keywords
parents' experience, perinatal education groups, quantitative research
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-35210 (URN)10.1891/1058-1243.28.1.19 (DOI)000460023400004 ()
Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2020-05-20Bibliographically 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
Kristiansen, L., Karlström, A., Rising Holmström, M., Boman, N., Jonsson, C. & Olofsson, N. (2018). A health promotion intervention strengthening Swedish high school students' wellbeing: A feasibility study. British Journal of School Nursing, 13(6)
Open this publication in new window or tab >>A health promotion intervention strengthening Swedish high school students' wellbeing: A feasibility study
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2018 (English)In: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827, Vol. 13, no 6Article in journal (Refereed) Published
Abstract [en]

The majority of Swedish school children enjoy a general good health. Still, mental health problems are increasing among young people in Sweden. According to Swedish law all school staff members (teachers and student health professionals) have mutual responsibility to provide a safe school environment and health. Since 2010, there is an emphasis on health promotion in schools. The aim of this study is to describe the feasibility and pilot outcomes of a health promoting intervention targeting healthy high school students (the Strengthening Adolescent Wellbeing [SAW] project).

A descriptive design was used with an intervention group that was assessed before and after the implementation of the programme using quantitative methods. The study was based on the Medical Research Council Framework. The study and the data collection were performed during the autumnof 2016 and the early spring of 2017.

Public high school students' health professionals, that is school nurses, student counselors and specialist educators, facilitated a research-based intervention consisting of eight sessions with education and mind-body practices. Pre- and post-testing were carried out.

The main findings showed enhanced levels of wellbeing among the participating students and the student-related measures all showed improvements.

The intervention seems to have been feasible in this context. Findings from this study indicate that the SAW methodology contributed to an improvement in high school students' wellbeing. The study will provide a base for a full-scale evaluation study intended to evaluate the effect of this health-promoting programme.

Keywords
Acceptability, Feasibility, Intervention, Wellbeing, Process evaluation
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-35211 (URN)10.12968/bjsn.2018.13.6.288 (DOI)
Available from: 2018-12-14 Created: 2018-12-14 Last updated: 2020-01-16Bibliographically 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
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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