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  • 1.
    Avelin, Pernilla
    et al.
    Akademin för Hälsa, Vård och Välfärd, Mälardalens högskola.
    Erlandsson, Kerstin
    Akademin för Hälsa, Vård och Välfärd, Mälardalens Högskola.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rådestad, Ingela
    Sophiahemmet Univ Coll, Stockholm, Sweden.
    Swedish parents' experiences of parenthood and the need for support to siblings when a baby is stillborn2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 2, p. 150-158Article in journal (Refereed)
    Abstract [en]

    Background:

    It has been argued that having a stillborn baby in the family affects older siblings more than parents realize. The aim of this study was to describe parenthood and the needs of siblings after stillbirth from the parents' perspective.

    Methods:

    Six focus groups were held with 27 parents who had experienced a stillbirth and who had had children before the loss. The discussion concerned parents' support to the siblings, and the sibling's meeting, farewell, and memories of their little sister or brother. Data were analyzed using qualitative content analysis.

    Results:

    The overall theme of the findings was parenthood in a balance between grief and everyday life. In the analysis, three categories emerged that described the construction of the theme: support in an acute situation, sharing the experiences within the family, and adjusting to the situation.

    Conclusions:

    The siblings' situation is characterized by having a parent who tries to maintain a balance between grief and everyday life. Parents are present and engaged in joint activities around the stillbirth together with the siblings of the stillborn baby. Although parents are aware of the sibling's situation, they feel that they are left somewhat alone in their parenthood after stillbirth and therefore need support and guidance from others. (BIRTH 38:2 June 2011).

  • 2.
    Edqvist, Malin
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala.
    Mollberg, Margareta
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
    Lundgren, Ingela
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
    Lindgren, Helena
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg; Karolinska Inst, Stockholm.
    Midwives' Management during the Second Stage of Labor in Relation to Second-Degree Tears: An Experimental Study2017In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 44, no 1, p. 86-94Article in journal (Refereed)
    Abstract [en]

    Introduction: Most women who give birth for the first time experience some form of perineal trauma. Second-degree tears contribute to long-term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second-degree tears among primiparous women. Methods: An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro-iliac joints, and 3) a two-step head-to-body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables. Results: A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second-degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33-0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention. Conclusion: It is possible to reduce second-degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low-and high-risk pregnancies.

  • 3.
    Halfdansdottir, Berglind
    et al.
    Faculty of Nursing School of Health Sciences University of Iceland Reykjavik, Iceland .
    Smarson, Alexander
    School of Health Sciences University of Akureyri Akureyri, Iceland.
    Olafsdottir, Olof Asta
    Faculty of Nursing School of Health Sciences University of Iceland Reykjavik, Iceland .
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Sveinsdottir, Herdis
    Faculty of Nursing School of Health Sciences University of Iceland Reykjavik, Iceland .
    Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: A retrospective cohort study2015In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 42, no 1, p. 16-26Article in journal (Refereed)
    Abstract [en]

    Background: At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland. Methods: The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables. Results: The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score < 7 was the same in the home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated. Conclusions: This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth.

  • 4.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Blix, Ellen
    Res Grp Maternal Reprod & Childrens Hlth, Fac Hlth Sci, Oslo, Norway.;Akershus Univ, Coll Appl Sci, Oslo, Norway..
    Hegaard, Hanne
    Copenhagen Univ Hosp, Rigshosp, Res Unit,Womens & Childrens Hlth, Juliane Marie Ctr Women Children & Reprod, Copenhagen, Denmark..
    Huitfeldt, Anette
    Oslo Univ Hosp, Clin Genet Unit, N-0450 Oslo, Norway..
    Ingversen, Karen
    Reg Sealand Homebirth Assoc, Soro, Denmark..
    Olafsdottir, Olof Asta
    Univ Iceland, Fac Nursing, Dept Midwifery, Reykjavik, Iceland..
    Lindgren, Helena
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, Stockholm, Sweden.;Univ Gothenburg, Dept Hlth & Care Sci, Sahlgrenska Akad, Gothenburg, Sweden..
    How Long Is a Normal Labor?: Contemporary Patterns of Labor and Birth in a Low-Risk Sample of 1,612 Women from Four Nordic Countries2015In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 42, no 4, p. 346-353Article in journal (Refereed)
    Abstract [en]

    Objective: Normal progress of labor is a subject for discussion among professionals. The aim of this study was to assess the duration of labor in women with a planned home birth and spontaneous onset who gave birth at home or in hospital after transfer. Methods: This is a population-based study of home births in four Nordic countries (Denmark, Iceland, Norway, and Sweden). All midwives assisting at a home birth from 2008 to 2013 were asked to provide information about home births using a questionnaire. Results: Birth data from 1,612 women, from Denmark (n = 1,170), Norway (n = 263), Sweden (n = 138), and Iceland (n = 41) were included. The total median duration from onset of labor until the birth of the baby was approximately 14 hours for primiparas and 7.25 hours for multiparas. The duration of the different phases varied between countries. Blood loss more than 1,000 mL and perineal ruptures that needed suturing were associated with a longer pushing phase and the latter with country of residence, parity, single status, and the baby's weight. Conclusion: In this population of healthy women with a low prevalence of interventions, the total duration of labor was fairly similar to what is described in the literature for multiparas, but longer for primiparas. Although the duration of the phases of labor differed among countries, it was to a minor extent associated with severe outcomes. (BIRTH 42:4 December 2015)

  • 5.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rådestad, Ingela
    Akademin för Hälsa, Vård och Välfärd, Mälardalens Högskola.
    Lindgren, Helena
    Högskolan Dalarna.
    Birth preferences that deviate from the norm in Sweden - planned home birth versus planned cesarean section2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 4, p. 288-295Article in journal (Refereed)
    Abstract [en]

    Background:Opting for a home birth or requesting a cesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study was to compare background characteristics of women who chose these very different birth methods and to see how these choices affected factors of care and the birth experience.Methods:This descriptive study employed a secondary data analysis of a sample of women who gave birth from 1997 to 2008, including 671 women who had a planned home birth and 126 women who had a planned cesarean section based on maternal request. Data were collected by means of questionnaires. Logistic regression with crude and adjusted odds ratios (OR) with a 95 percent confidence interval (95% CI) was calculated.Results:Women with a planned home birth had a higher level of education (OR: 2.3; 95% CI: 1.5-3.6), were less likely to have a high body mass index (OR: 0.1; 95% CI: 0.01-0.6), and were less likely to be smokers (OR: 0.2; 95% CI: 0.1-0.4) when compared with women who had planned cesarean sections. When adjusted for background variables, women with a planned home birth felt less threat to the baby's life during birth (OR: 0.1; 95% CI: 0.03-0.4), and were more satisfied with their participation in decision making (OR: 6.0; 95% CI: 3.3-10.7) and the support from their midwife (OR 3.9; 95% CI: 2.2-7.0). They also felt more in control (OR: 3.3; 95% CI: 1.6-6.6), had a more positive birth experience (OR: 2.9; 95% CI: 1.7-5.0), and were more satisfied with intrapartum care (OR: 2.3; 95% CI: 1.3-4.1) compared with women who had a planned cesarean section on maternal request.Conclusions:Women who planned a home birth and women who had a cesarean section based on maternal request are significantly different groups of mothers in terms of sociodemographic background. In a birth context that promotes neither home birth nor cesarean section without medical reasons, we found that those women who had a planned home birth felt more involvement in decision making and had a more positive birth experience than those who had a requested, planned cesarean section.

  • 6.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Waldenström, Ulla
    Karolinska Institutet, Inst för kvinnors och barns hälsa.
    Rådestad, Ingela
    Mälardalens högskola, Inst för Vård och folkhälsovetenskap.
    Swedish women's interest in homebirth and in- hospital birth center care2003In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 30, no 1, p. 11-22Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to determine women's interest in home birth and in-hospital birth center care in Sweden, and to describe the characteristics of these women. METHODS: Three questionnaires, completed after the first booking visit in early pregnancy, at 2 months, and 1 year after the birth, asked about the women's interest in two alternative birth options. RESULTS: One percent of participants consistently expressed an interest in home birth on all three occasions, and 8 percent expressed an interest in birth center care. A regression analysis showed five factors that were associated with an interest in home birth: a wish to have the baby's siblings (OR 20.2; 95% CI 6.2-66.5) and a female friend (OR 15.2; 95% CI 6.2-37.4) present at the birth, not wanting pharmacological pain relief during labor and birth (OR 4.7; 95% CI 1.4-15.3), low level of education (OR 4.5; 95% CI 1.8-11.4), and dissatisfaction with medical aspects of intrapartum care (OR 3.6; 95% CI 1.4-9.2). An interest in birth center care was associated with experience of being in control during labor and birth (OR 8.3; 95% CI 3.2-21.6), not wanting pharmacological pain relief (OR 2.3; 95% CI 1.3-4.1), and a preference to have a known midwife at the birth (OR 2.2; 95% CI 1.6-2.9). CONCLUSION: If Swedish women were offered free choice of place of birth, the home birth rate would be 10 times higher, and the 20 largest hospitals would need to have a birth center. Women interested in alternative models of care view childbirth as a social and natural event, and their needs should be considered.

  • 7.
    Karlström, Annika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rådestad, Ingela
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Eriksson, Carola
    Inst. för allmänmecicin, Umeå Universitet.
    Rubertsson, Christine
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Nystedt, Astrid
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 1, p. 11-20Article in journal (Refereed)
    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.

  • 8. Lindgren, Helena
    et al.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Christensson, Kyllike
    Rådestad, Ingela
    Transfers in planned home births related to midwife availability and continuity:: a nationwide population-based study2008In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 35, no 1, p. 9-15Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. METHODS: A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. RESULTS: Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8-3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1-9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1-9.4) and multiparas (RR 3.4; 95% CI 1.3-9.0). CONCLUSIONS: The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife's unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred.

  • 9.
    Rondung, Elisabet
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Ekdahl, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Sundin, Örjan
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology and Social Work.
    Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty.2019In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 46, no 1, p. 61-68Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross-sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women.

    METHODS: A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure.

    RESULTS: Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17-5.61) and OR 3.25 (95% CI 2.00-5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model.

    CONCLUSIONS: Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.

  • 10.
    Sjöblom, I.
    et al.
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Idvall, E.
    Faculty of Health and Society, Malmö University, Malmö, Sweden.
    Lindgren, H.
    Department of Health and Caring Science, Sahlgrenska Academy University of Gothenburg, Sweden.
    Blix, E.
    Troms̈o, University Hospital, Norway.
    Kjaergaard, H.
    Juliane Marie Research Centre, Denmark .
    Olofsdottir, O.
    Reykjavik University, Iceland.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Thies-Lagergren, L.
    Helsingborg General Hospital, Sweden.
    Radestad, I.
    Sophiahemmet University College, Sweden.
    Lundgren, I.
    Sahlgrenska Academy, University of Gothenburg, Sweden.
    Creating a Safe Haven-Women's Experiences of the Midwife's Professional Skills During Planned Home Birth in Four Nordic Countries2014In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 41, no 1, p. 100-107Article in journal (Refereed)
    Abstract [en]

    Objective: The midwife assisting a birth has a considerable influence on the woman's experience of the birth. The aim of this study was to investigate the experience of the midwife's professional skills among women in Norway, Denmark, Iceland, and Sweden who chose a planned home birth. Design and Setting: All known home birth midwives were asked to inform the mothers about the project and invite them to complete a questionnaire about different aspects of their home birth experience. Method: The women were asked to assess 10 different aspects of the midwives' professional skills on a 4-graded scale below the main question: What was your experience of the midwife who assisted the labor? Furthermore, the mothers' experiences with the attending midwives were identified in the free text birth stories. The chosen method was a mixed method design. Findings: The home birth midwives' professional skills were generally high scored. No statistically significant differences were found with respect to the assessment of the midwife. The content analyses yielded one overarching theme: The competence and presence of the midwife creates a safe haven, and three categories, midwife's safe hand, midwife's caring approach, and midwife's peaceful presence. Conclusion: Women choosing a home birth in the four Nordic countries experienced that their midwives were highly skilled and they found the presence of the midwives valuable in helping them to feel safe and confident during birth. Despite differences in organization and guidelines for home births, the women's experience of the midwife's professional skills did not differ between the four countries. © 2014, Wiley Periodicals, Inc.

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