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Nystedt, A. & Hildingsson, I. (2014). Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment. BMC Pregnancy and Childbirth, 14, Art. no. 233
Open this publication in new window or tab >>Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment
2014 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 14, p. Art. no. 233-Article in journal (Refereed) Published
Abstract [en]

Background: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. Method: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women's feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. Results: Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours. Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P < 0.00). The factors that contributed most strongly to a negative birth experience in women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement 'My birth experience made me decide not to have any more children' (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement 'It was exiting to give birth' (OR 0.13, 95% CI 0.34-0.5). Conclusions: There is need for increased clinical skill in identification and classification of prolonged labour, in order to improve care for all women and their experiences of birthing processes regardless whether they experience a prolonged labour or not.

Keywords
birth experience, dystocia, prolonged labour
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-22601 (URN)10.1186/1471-2393-14-233 (DOI)000339356900001 ()2-s2.0-84904271428 (Scopus ID)
Available from: 2014-08-19 Created: 2014-08-19 Last updated: 2017-12-05Bibliographically approved
Nystedt, A., Kristiansen, L., Ehrenstråle, K. & Hildingsson, I. (2014). Exploring Some Swedish Women’s Experiences of Support During Childbirth. International Journal of Childbirth, 4(3), 183-190(8)
Open this publication in new window or tab >>Exploring Some Swedish Women’s Experiences of Support During Childbirth
2014 (English)In: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 4, no 3, p. 183-190(8)Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Caregivers need to better understand women's experiences of support during childbirth because research suggests that social support positively influences childbirth. AIM: This study describes women's experiences of support given by caregivers during pregnancy and childbirth. METHOD: The study design was inspired by grounded theory. Seven interviews of women were analyzed with an open coding, and different time-related categories related to the childbirth process emerged. The categories were marked by fear and a negative birth experience, being guided on own terms, feel supported, and transformation into courage to give birth. The analysis continued with a selective coding, reflecting the process of mistrust to trust in caregivers. FINDINGS: The mistrust in caregivers began with feelings of fear of birth and a negative birth experience. Through being guided on own terms and feeling supported by the caregivers, a trusting relationship could be established. If the trusting relationship continued during labor, then a woman could transform the fear of birth into the courage to give birth. CONCLUSIONS: Women's experience of support can be seen as a product of earlier experiences from interactions with caregivers. Therefore, caregivers must be sensitive to the potential power and far-reaching consequences their actions can have.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:miun:diva-23777 (URN)10.1891/2156-5287.4.3.183 (DOI)
Available from: 2014-12-15 Created: 2014-12-15 Last updated: 2018-10-15Bibliographically approved
Hildingsson, I., Karlström, A. & Nystedt, A. (2013). Parents' experiences of an instrumental vaginal birth findings from a regional survey in Sweden. Sexual & Reproductive HealthCare, 4(1), 3-8
Open this publication in new window or tab >>Parents' experiences of an instrumental vaginal birth findings from a regional survey in Sweden
2013 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 1, p. 3-8Article in journal (Refereed) Published
Abstract [en]

Objective: An instrumental vaginal birth is known to affect women's birth experience, few studies have explored the fathers' experiences of attending such a birth. The aim of this study is to compare birth outcome and parents' feelings in parents with instrumental vaginal birth or a spontaneous vaginal birth. Methods: A regional survey was conducted of 936 mothers and 827 fathers recruited in mid-pregnancy and followed up 2. months after birth. Data was collected by questionnaires. Crude and adjusted odds ratios with a 95% confidence interval were used in the analysis. Results: The prevalence for instrumental vaginal birth was 9%. Prolonged labour (OR 8.3; 95% CI 5.0-13.9), augmentation with synthetic oxytocin (OR 5.1; 2.9-8.9), and birth complications (OR 2.5; 1.5-2.6) were more common in the instrumental vaginal group. An instrumental vaginal birth was associated with a negative birth experience for mothers (OR 3.2; 1.3-8.1) and fathers (OR 5.2; 1.2-21.5). Mothers who had an instrumental vaginal birth were more likely to report feelings that the baby would be damaged during birth (OR 3.0; 1.7-5.5) and that the birth experience made them decide not to have any more children (OR 3.4; 1.1-10.7). Fathers reported a near-panic feeling when attending an instrumental vaginal birth (OR 5.2; 1.7-15.5). Conclusion: An instrumental vaginal birth was correlated with longer and more complicated births, epidurals and oxytocin augmentation. It affected the birth outcome and parents' feelings and was associated with future reproductive thoughts and a negative birth experience.

Keywords
Birth outcome, Instrumental vaginal birth, Parents' birth experiences
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:miun:diva-18641 (URN)10.1016/j.srhc.2012.12.002 (DOI)000316091000002 ()2-s2.0-84874261795 (Scopus ID)
Note

Source: Scopus

Available from: 2013-03-28 Created: 2013-03-27 Last updated: 2017-12-06Bibliographically approved
Karlström, A., Nystedt, A. & Hildingsson, I. (2011). A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth. Sexual and reproductive healthcare, 2(3), 93-99
Open this publication in new window or tab >>A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth
2011 (English)In: Sexual and reproductive healthcare, ISSN 1877-5756, Vol. 2, no 3, p. 93-99Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to compare experiences and feelings during pregnancy and childbirth in women who preferred caesarean section during pregnancy and were delivered by a planned caesarean section, and women who preferred to give birth vaginally and actually had a spontaneous vaginal birth. Design: Longitudinal cohort study where 693 women participated, 420 of whom were multiparas. Methods: Data were collected from questionnaires distributed to women during pregnancy and two months postpartum in a Mid Sweden county. Results: Women who preferred and actually were delivered by caesarean section experienced a fear of childbirth to a higher degree as compared to women with a vaginal birth. Despite a fulfilled request, women who had a caesarean section were not pleased with the decision making process. In addition, women who had a caesarean section on request were less satisfied with antenatal care and had a more negative birth experience, which made them doubt whether they would have more children. Conclusions: This study shows that a fulfilled request on mode of birth does not guarantee a positive birth experience. Antenatal information of all aspects of a caesarean section is vital for women who consider caesarean section where no medical indication is present. More research is needed about the decision making process regarding caesarean section on maternal request. Childbirth related fear is a common reason to request a caesarean birth. More knowledge about how women reason about caesarean section is required, and treatment related to fear of birth needs to be developed.

Keywords
Caesarean section; Childbirth related fear; Experience of childbirth; Maternal request
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-11561 (URN)10.1016/j.srhc.2011.03.002 (DOI)000312281800001 ()2-s2.0-79960134364 (Scopus ID)
Available from: 2010-05-28 Created: 2010-05-28 Last updated: 2014-08-31Bibliographically approved
Karlström, A., Nystedt, A., Johansson, M. & Hildingsson, I. (2011). Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors. Midwifery, 27(5), 620-627
Open this publication in new window or tab >>Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors
2011 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 5, p. 620-627Article in journal (Refereed) Published
Abstract [en]

Objective: to describe the prevalence of women's preference for caesarean section as expressed in mid pregnancy, late pregnancy and one year post partum. An additional aim was to identify associated factors and investigate reasons for the preference. Design: mixed methods. Data were collected from 2007 to 2008 through questionnaires distributed to a Swedish regional cohort of women. The survey was part of a longitudinal study of women's attitudes and beliefs related to childbirth. One open question regarding the reasons for the preferred mode of birth was analysed using content analysis. Setting: three hospitals in the county of Västernorrland in the middle of Sweden. Participants: 1506 women were recruited at the routine ultrasound screening during weeks 17 to 19 of their pregnancy. Findings: a preference for caesarean section was stated by 7.6% of women during mid pregnancy and by 7.0% in late pregnancy. One year post partum 9.8% of the women stated that they would prefer a caesarean section if they were to have another baby. This was related to their birth experience. There were more multiparous women who wished for a caesarean section. Associated factors irrespective of parity were fear of giving birth and a 'strongly disagree' response to the statement regarding that the preferred birth should be as natural as possible. Among multiparous women the strongest predictors were previous caesarean sections, particularly those that were elective, and a previous negative birth experience. Women's comments on their preferred mode of birth revealed five categories: women described caesarean section as their only option relating to obstetrical and/or medical factors; several women stated ambivalent feelings and almost as many described their previous birthing experiences as a reason to prefer a caesarean birth; childbirth-related fear and caesarean section as a safe option were the remaining categories. Key conclusions: rising caesarean section rates seem to be related to factors other than women's preferences. Ambivalence towards a way of giving birth is common during pregnancy. This should be of concern for midwives and obstetricians during antenatal care. Information and counselling should be frequent and comprehensive when a discussion on caesarean section is initiated by the pregnant woman. A negative birth experience is related to a future preference for caesarean section and this should be considered by caregivers providing intrapartum care.

Keywords
Caesarean section; Maternal preference; Mixed method
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10437 (URN)10.1016/j.midw.2010.05.005 (DOI)000295690300015 ()20630634 (PubMedID)2-s2.0-80052664250 (Scopus ID)
Available from: 2009-11-29 Created: 2009-11-29 Last updated: 2017-12-12Bibliographically approved
Hildingsson, I., Karlström, A. & Nystedt, A. (2011). Women’s experiences of labour induction - findings from a Swedish regional study. Australian and New Zealand journal of obstetrics and gynaecology, 51(2), 151-157
Open this publication in new window or tab >>Women’s experiences of labour induction - findings from a Swedish regional study
2011 (English)In: Australian and New Zealand journal of obstetrics and gynaecology, ISSN 0004-8666, E-ISSN 1479-828X, Vol. 51, no 2, p. 151-157Article in journal (Refereed) Published
Abstract [en]

Background: Induction of labour is common in modern obstetrics but its impact on women's birth experiences is inconclusive.

Aim: The aim of the present study was to explore the prevalence of induction in a Swedish region and reasons for labour induction. A second aim was to compare the experience of spontaneous labour and birth for women to the experience of induction of labour. A third aim was to explore the difference in labour in relation to the length of pregnancy.

Methods: A one-year cohort of 936 women was included in a longitudinal Swedish survey in which data were collected by questionnaires, two months after birth. The main outcome was a set of data recording women's birth experiences.

Results: Labour induction was performed in 17% of births and mostly performed for medical reasons. Women who were induced used more epidurals (OR 2.3; 95% CI 1.4-3.8) for pain relief and used bath/shower less frequently for pain relief (OR 0.3; 95% CI 0.2-0.5). Labour induction was associated with a less positive birth experience (OR 1.5; 95% CI 1.0-2.3), and women who were induced were more likely to totally agree that they were frightened that the baby would be damaged during birth (OR 2.1; 95% CI 1.2-3.9), but the assessment of feelings during birth differed with regard to length of pregnancy.

Conclusion: Labour induction affects women's experiences of birth and is related to length of pregnancy.

Keywords
birth experience; labour induction; survey
National Category
Nursing Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:miun:diva-11808 (URN)10.1111/j.1479-828X.2010.01.262.x (DOI)000289248700011 ()21466518 (PubMedID)2-s2.0-79953799716 (Scopus ID)
Available from: 2010-07-01 Created: 2010-07-01 Last updated: 2017-12-12Bibliographically approved
Karlström, A., Rådestad, I., Eriksson, C., Rubertsson, C., Nystedt, A. & Hildingsson, I. (2010). Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study. Birth, 37(1), 11-20
Open this publication in new window or tab >>Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study
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2010 (English)In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 1, p. 11-20Article in journal (Refereed) Published
Abstract [en]

Background:

Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code.

Methods:

Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data.

Results:

The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p < 0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables.

Conclusions:

The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.

Keywords
midwifery, omvårdnad
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-8909 (URN)10.1111/j.1523-536X.2009.00373.x (DOI)000274924800003 ()20402717 (PubMedID)2-s2.0-77649129123 (Scopus ID)
Projects
Caesarean section- emergency exit or shortcut?
Available from: 2009-05-10 Created: 2009-05-10 Last updated: 2017-12-13Bibliographically approved
Hildingsson, I., Thomas, J., Karlström, A., Engström-Olofsson, R. & Nystedt, A. (2010). Childbirth thoughts in mid-pregnancy: Prevalence and associated factors in prospective parents.. Sexual and Reproductive HealthCare, 1(2), 45-53
Open this publication in new window or tab >>Childbirth thoughts in mid-pregnancy: Prevalence and associated factors in prospective parents.
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2010 (English)In: Sexual and Reproductive HealthCare, ISSN 0195-9255, Vol. 1, no 2, p. 45-53Article in journal (Refereed) Published
Abstract [en]

Background: Parents' thoughts about childbirth during pregnancy are important for the adjustment process but little is known about factors associated with such thoughts. Objectives: To describe and study background characteristics, feelings and support in relation to thoughts about childbirth in mid-pregnancy, in women and their partners and to analyze which factors are most important for having thoughts and feelings about childbirth. Method: A cross-sectional study of 1212 women and 1105 men recruited shortly after the routine ultra sound examination in pregnancy weeks 17-19. Data was collected by a questionnaire in mid-pregnancy. Data were analyzed using relative risks with 95% confidence interval and logistic regression. Results: A high proportion of women (75%) and men (67%) reported having thoughts about childbirth. In women childbirth related fear Odds Ratio (OR) 2.7; [95% CI 1.62-4.37], high level of education (OR 1.8, [95% CI 1.32-2.34] and major emotional changes OR 1.5, [95% CI 1.0-2.1] were the most important factors associated with having thoughts about childbirth. In men, high level of education OR 1.1 [95% CI 1.41-2.52], getting the opportunity to ask question at prenatal visits OR 1.6 [95% CI 1.17-2.07], and expecting the first baby OR 1.6 [1.17-2.07] contributed most to the model. Discussion: This study shows that the majority of prospective parents think about the birth of their baby in mid-pregnancy. Some factors are common for both parents, but women's thoughts are more based on emotional and physical changes and fears while men's are more based on the social situation such as expecting the first baby and organizational issues in prenatal care, and instrumental issues such as finances. Further studies are needed about the content of the parents' thoughts.

Place, publisher, year, edition, pages
Elsevier, 2010
Keywords
Adjustment process; Childbirth; Parents; Thoughts
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-10396 (URN)10.1016/j.srhc.2009.11.003 (DOI)000208559700003 ()21122596 (PubMedID)2-s2.0-77951529832 (Scopus ID)
Available from: 2009-11-26 Created: 2009-11-26 Last updated: 2014-08-29Bibliographically approved
Nystedt, A., Kristiansen, L. & Hildingsson, I. (2010). Exploring some Swedish womens´ experiences of support during childbirth. Paper presented at Monthly Seminar La trobe University, Melbourne Australia 2010 03 24.
Open this publication in new window or tab >>Exploring some Swedish womens´ experiences of support during childbirth
2010 (English)Conference paper, Published paper (Refereed)
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-12785 (URN)
Conference
Monthly Seminar La trobe University, Melbourne Australia 2010 03 24
Available from: 2010-12-15 Created: 2010-12-15 Last updated: 2010-12-15Bibliographically approved
Karlström, A., Engström-Olofsson, R., Nystedt, A., Sjöling, M. & Hildingsson, I. (2010). Women's postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesareansection. Journal of Clinical Nursing, 19(9-10), 1326-1334
Open this publication in new window or tab >>Women's postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesareansection
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2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 9-10, p. 1326-1334Article in journal (Refereed) Published
Abstract [en]

Aim.

The aim was to evaluate a new anaesthetic routine and to study the effect of spinal opioids for caesarean section on postoperative pain, expectations of pain, satisfaction with pain treatment, breastfeeding, infant care and length of hospital stay.

Background.

Inadequate postoperative pain relief is a problem among hospitalised patients. Women undergoing caesarean section have been shown to experience high levels of pain during the first days after operation. Women are expected to breastfeed and care for their newborn while recovering from major abdominal surgery and sufficient pain relief are of importance.

Design.

Comparative patient survey.

Methods.

Data were collected through a questionnaire distributed to two independent samples of women undergoing elective and emergency caesarean section before and after the introduction of an additive of opioids in obstetric spinal anaesthesia. Chi-square tests were performed, and risk ratios were used for bivariate analysis. Logistic regression modelling was used for multivariate analysis.

Results.

The group of women undergoing caesarean section with opioids added to the spinal anaesthesia reported significantly lower levels of experienced pain. High pain levels irrespective of mode of caesarean section affected breastfeeding and infant care. Length of hospital stay for caesarean women was shortened and the consumption of analgesics was reduced.

Conclusions.

Women receiving an additive of opioids in spinal anaesthesia experienced lower levels of pain. Low pain levels facilitate breastfeeding and infant care and are of relevance for financial considerations.

Relevance to clinical practice.

The results of this study indicate that spinal opioids for women undergoing caesarean section have a positive effect on the postoperative pain experience. Women undergoing caesarean section and have high pain levels are in special need of attention and care because of a higher risk of a decreased ability to breastfeed and to take care of their newborn.

National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-8908 (URN)10.1111/j.1365-2702.2010.03213.x (DOI)000276503500017 ()2-s2.0-77955868201 (Scopus ID)
Projects
Caesrean section- emergency exit or shortcut?
Available from: 2009-05-10 Created: 2009-05-10 Last updated: 2017-12-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-4067-2357

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