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  • 1.
    Andersson, Ewa
    et al.
    Inst för Kvinnors och Barns hälsa, Karolinska Institutet.
    Christensson, Kyllike
    Inst för Kvinnors och Barns Hälsa, Karolinska Instituet.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Parents' experiences and perceptions of group-based antenatal care in four clinics in Sweden2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 4, p. 442-448Article in journal (Refereed)
    Abstract [en]

    Background: group-based antenatal care consists of six to nine two-hour sessions in which information is shared and discussed during the first hour and individual examinations are conducted during the second hour. Groups generally consist of six to eight pregnant women. Parent education is built into the programme, which originated in the United States and was introduced in Sweden at the beginning of the year of 2000. Objective: to investigate parents' experiences of group antenatal care in four different clinics in Sweden. Method: a qualitative study was conducted using content analysis five group interviews and eleven individual interviews with parents who experienced group-based antenatal care. An interview guide was used. Settings: the study was set in four antenatal clinics that had offered group-based antenatal care for at least one year. The clinics were located in three different areas of Sweden. Participants: the participants were women and their partners who had experienced group-based antenatal care during pregnancy. Other criteria for participation were mastery of the Swedish language and having followed the care programme. Findings: three themes emerged, 'The care-combining individual physical needs with preparation for parenthood, refers to the context, organisation, and content of care'. Group antenatal care with inbuilt parent education was appreciated, but respondents reported that they felt unprepared for the first few weeks after birth. Their medical needs (for physical assessment and screening) were, however, fulfilled. The theme, 'The group-a composed recipient of care', showed the participants role and experience. The role could be passive or active in groups or described as sharers. Groups helped parents normalise their symptoms. The theme, 'The midwife-a controlling professional', showed midwives are ignorant of gender issues but, for their medical knowledge, viewed as respectable professionals. Key conclusions: in the four clinics studied, group-based antenatal care appeared to meet parents' needs for physical assessment and screening. Parents identified that the groups helped them prepare for birth but not for parenthood. The group model created a forum for sharing experiences and helped participants to normalise their pregnancy symptoms. Implications for practise: the midwife's role in facilitating group-based antenatal care demands new pedagogical strategies and approaches.

  • 2.
    Haines, Helen
    et al.
    University of Melbourne, School of Rural Health, Shepparton, Australia.
    Pallant, Julie
    University of Melbourne, School of Rural Health, Shepparton, Australia.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 560-567Article in journal (Refereed)
    Abstract [en]

    Background: research, conducted predominately in Scandinavian countries, suggests that a substantial number of women experience high levels of fear concerning childbirth which can impact on birth outcomes, the mother-infant relationship and the ongoing mental health of the mother. The prevalence of childbirth-related fear (CBRF) is not well known outside of the Nordic nations. This study aimed to examine the prevalence of CBRF in two rural populations (Sweden and Australia) and to pilot a short, easy-to-administer measurement tool. Methods: a questionnaire assessing a range of childbirth-related issues was administered to women in the first trimester across two rural populations in Sweden (n=386) and Australia (n=123). CBRF was measured using the Fear of Birth Scale (FOBS) a two-item visual analogue scale. Findings: close to 30% of women from the Australian and Swedish samples reported elevated levels of CBRF in the first trimester. A previous negative birth experience and less than positive attitudes to their current pregnancy and birth were predictive of high levels of fear. Swedish women with high levels of fear indicated a preference for caesarean section as the mode of birth in this pregnancy. A higher proportion (19%) of Australian women indicated that they would prefer an elective caesarean section, compared with only 8.8% of the Swedish sample; however, this was not related to high levels of fear. Preference for caesarean section was related to CBRF in the Swedish sample but not in the Australian sample. Conclusion: the high proportion of women identified with CBRF suggests a need for monitoring of women during pregnancy, particularly those with a previous negative birth experience. The FOBS developed for this study could be used as a screening tool to identify women who require further investigation. Further cross-cultural research is needed to explore the role of fear in women's preference for caesarean section.

  • 3.
    Haines, Helen
    et al.
    Univ Melbourne, Rural Hlth Acad Ctr, Shepparton, Vic, Australia .
    Rubertsson, Chrisitne
    Inst för Kvinnors och Barns hälsa, Uppsala Universitet.
    Pallant, Julie
    University of Melbourne, School of Rural Health, Australia.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Women’s attitudes and beliefs and association with birth preference: A comparison of a Swedish and an Australian sample in mid pregnancy2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, p. E850-E856Article in journal (Refereed)
    Abstract [en]

    Background: the rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event. Objectives: to compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy. Participants: women from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123). Methods: questionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care. Results: the Australian sample was less likely than the Swedish sample to agree that they would like a birth that: 'is as pain free as possible' OR 0.4 (95% CI: 0.2-0.7), 'will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1-0.8), 'will least affect my future sex life' OR 0.3 (95% CI: 0.2-0.6), 'will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2-0.7) and 'is as natural as possible' OR 0.4 (95% CI: 0.2-0.9). They were also less likely to agree that: 'if a woman wants to have a caesarean she should be able to have one under any circumstances' OR 0.4 (95% CI: 0.2-0.7) and 'giving birth is a natural process that should not be interfered with unless necessary' OR 0.3 (95% CI: 0.1-0.7). Four attitudinal subscales were found: 'Personal Impact of Birth', 'Birth as Natural Event', 'Freedom of Choice' and 'Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of 'Birth as a natural event'. Key conclusions: the Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.

  • 4.
    Halfdansdottir, Berglind
    et al.
    Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, Reykjavik, Iceland.
    Olafsdottir, Olof A.
    Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, Reykjavik, Iceland.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Women's and Children's Health, Karolinska Institutet, Solnavagen 1, Stockholm; Department of Women's and Children's Health, Uppsala University, Uppsala.
    Smarason, Alexander Kr.
    Institution of Health Science Research, University of Akureyri, Solborg v/Nordurslod, Akureyri, Iceland.
    Sveinsdottir, Herdis
    Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiriksgata 34, Reykjavik, Iceland.
    Maternal attitudes towards home birth and their effect on birth outcomes in Iceland: A prospective cohort study2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 34, p. 95-104Article in journal (Refereed)
    Abstract [en]

    Objective: to examine the relationship between attitudes towards home birth and birth outcomes, and whether women's attitudes towards birth and intervention affected this relationship. Design: a prospective cohort study. Setting: the study was set in Iceland, a sparsely populated island with harsh terrain, 325,000 inhabitants, high fertility and home birth rates, and less than 5000 births a year. Participants: a convenience sample of women who attended antenatal care in Icelandic health care centres, participated in the Childbirth and Health Study in 2009-2011, and expressed consistent attitudes towards home birth (n=809). Findings: of the participants, 164 (20.3%) expressed positive attitudes towards choosing home birth and 645 (79.7%) expressed negative attitudes. Women who had a positive attitude towards home birth had significantly more positive attitudes towards birth and more negative attitudes towards intervention than did women who had a negative attitude towards home birth. Of the 340 self-reported low-risk women that answered questionnaires on birth outcomes, 78 (22.9%) had a positive attitude towards home birth and 262 (77.1%) had a negative attitude. Oxytocin augmentation (19.2% (n=15) versus 39.1% (n=100)), epidural analgesia (19.2% (n=15) versus 33.6% (n=88)), and neonatal intensive care unit admission rates (0.0% (n=0) versus 5.0% (n=13)) were significantly lower among women who had a positive attitude towards home birth. Women's attitudes towards birth and intervention affected the relationship between attitudes towards home birth and oxytocin augmentation or epidural analgesia. Key conclusions and implications for practice: the beneficial effect of planned home birth on maternal outcome in Iceland may depend to some extent on women's attitudes towards birth and intervention. Efforts to de-stigmatise out-of-hospital birth and de-medicalize women's attitudes towards birth might increase women's use of health-appropriate birth services.

  • 5.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    How much influence do women in Sweden have on caesarean section?: A follow-up study of women's preferences in early pregnancy.2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 1, p. 46-54Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to investigate factors associated with having a caesarean section, with special emphasis on women's preferences in early pregnancy. DESIGN: a cohort study using data from questionnaires in early pregnancy and 2 months after childbirth, and data from the Swedish Medical Birth Register. SETTING: women were recruited from 97% of all antenatal clinics in Sweden at their booking visit during 3 weeks between 1999 and 2000, and followed up 2 months after birth. PARTICIPANTS: a total of 2878 Swedish-speaking women were included in the study (87% of those who consented to participate and 63% of all women eligible for the study). FINDINGS: Of 236 women who wished to have their babies delivered by caesarean section when asked in early pregnancy, 30.5% subsequently had an elective caesarean section and 14.8% an emergency caesarean section. The logistic regression analyses showed that, a preference for caesarean section in early pregnancy (odds ratio [OR] 9.63, 95% confidence interval [CI] 5.94-15.59), a medical diagnosis (OR 9.03, 95% CI 5.68-14.34), age (OR 1.08, 95% CI 1.03-1.13), parity (OR 0.58, 95% CI 0.37-0.91), a previous elective caesarean section (OR 15.11, 95% CI 6.83-33.41) and a previous emergency caesarean section (OR 18.29, 95% CI 10.00-33.44) was associated with having an elective caesarean section. Having an emergency caesarean section was associated with a preference for a caesarean section (OR 2.59, 95% 1.61 to 4.18), a medical diagnosis (OR 4.12, 95% CI 2.91-5.88), age (OR 1.08, 95% CI 1.05-1.12), primiparity (OR 3.34, 95% CI 1.78-6.27), a previous emergency caesarean section (OR 10.69, 95% CI 6.03-18.94), and a previous elective caesarean section (OR 7.21, 95% CI 2.90-17.92). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a woman's own preference about caesarean section was associated with the subsequent mode of delivery. Asking women about their preference regarding mode of delivery in early pregnancy may increase the opportunity to provide adequate support and possibly also to reduce the caesarean section rate.

  • 6.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
    Gamble, J.
    Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia.
    Sidebotham, M.
    Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia.
    Creedy, D. K.
    Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia.
    Guilliland, K.
    New Zealand College of Midwives, New Zealand.
    Dixon, L.
    Research Development, New Zealand College of Midwives, New Zealand.
    Pallant, J.
    Menzies Health Institute Queensland, Griffith University, Australia.
    Fenwick, J.
    Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Australia.
    Midwifery empowerment: National surveys of midwives from Australia, New Zealand and Sweden2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 62-69Article in journal (Refereed)
    Abstract [en]

    Background: the predicted midwifery workforce shortages in several countries have serious implications for the care of women during pregnancy, birth and post partum. There are a number of factors known to contribute to midwifery shortages and work attrition. However, midwives assessment of their own professional identity and role (sense of empowerment) are perhaps among the most important. There are few international workforce comparisons. Aim: to compare midwives' sense of empowerment across Australia, New Zealand and Sweden using the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Method: a self-administered survey package was distributed to midwives through professional colleges and networks in each country. The surveys asked about personal, professional and employment details and included the Perceptions of Empowerment in Midwifery Scale-R (PEMS-Revised). Descriptive statistics for the sample and PEMS were generated separately for the three countries. A series of analysis of variance with posthoc tests (Tukey's HSD) were conducted to compare scale scores across countries. Effect size statistics (partial eta squared) were also calculated. Results: completed surveys were received from 2585 midwives (Australia 1037; New Zealand 1073 and Sweden 475). Respondents were predominantly female (98%), aged 50-59 years and had significant work experience as a midwife (+20 years). Statistically significant differences were recorded comparing scores on all four PEMS subscales across countries. Moderate effects were found on Professional Recognition, Skills and Resources and Autonomy/Empowerment comparisons. All pairwise comparisons between countries reached statistical significance (p<.001) except between Australia and New Zealand on the Manager Support subscale. Sweden recorded the highest score on three subscales except Skills and Resources which was the lowest score of the three countries. New Zealand midwives scored significantly better than both their Swedish and Australian counterparts in terms of these essential criteria. Discussion/conclusions: midwives in New Zealand and Sweden had a strong professional identity or sense of empowerment compared to their Australian counterparts. This is likely the result of working in more autonomous ways within a health system that is primary health care focused and a culture that constructs childbirth as a normal but significant life event. If midwifery is to reach its full potential globally then developing midwives sense of autonomy and subsequently their empowerment must be seen as a critical element to recruitment and retention that requires attention and strengthening.

  • 7.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
    Haines, H.
    Melbourne Medical School, Rural Health Academic Centre, The University of Melbourne, Australia.
    Johansson, M.
    Södersjukhuset, Stockholm, Sweden.
    Rubertsson, C.
    Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
    Fenwick, J.
    School of Nursing and Midwifery, Maternity and Family, Centre for Health Practice Innovation (HPI), Griffith Health Institute, Griffith University, Australia.
    Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 248-254Article in journal (Refereed)
    Abstract [en]

    Objective: to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear. Design: a longitudinal regional survey. Data were collected by three questionnaires. Setting: three hospitals in the middle-north part of Sweden. Participants: 1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth. Measurements: childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear). Findings: expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2-2.8) and mental (OR 3.0; 1.8-5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4-3.0), and the forthcoming birth (OR 4.3; 2.9-6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience. Key conclusions: expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress. Implications for practice: this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term. © 2013 Elsevier Ltd.

  • 8.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Häggström, Terttu
    Umeå Universitet, Inst för Omvårdnad.
    Midwives’ lived experiences of being supportive to prospective mothers/parents during pregnancy1999In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 15(2) , no 2, p. 82-91Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To elucidate midwives' narrated experiences of being supportive to prospective mothers or parents during pregnancy. DESIGN: Phenomenological hermeneutic analysis of transcribed text from seven tape-recorded interviews. SETTING: Midwifery clinics in five health centres in the context of Swedish primary health care. PARTICIPANTS: Seven midwives working in antenatal care. FINDINGS: The interpretation of the text showed that through perception and intuition the midwives seemed to become aware that some women needed increased support. The situations of these prospective mothers were often characterised by difficult social problems or fears. The prospective fathers were mostly absent in the narratives. The midwives acted on both a personal and a professional level with ethical perspectives in mind, when they were advocating their clients' rights to receive proper care. The comprehensive understanding of the interpretation revealed that the midwife sometimes perceived herself as being metaphorically 'The Good Mother'. KEY CONCLUSIONS: Having the role of 'The Good Mother' could be understood as a way for the midwife to establish a fruitful relationship with prospective mothers/parents. IMPLICATIONS FOR PRACTICE: The findings provide a basis for reflection on the mothering and supportive function of midwives when providing antenatal care.

     

     

  • 9.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Johansson, Margareta
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Fenwick, Jennifer
    Griffith University, Gold Coast Hospital, Australia .
    Haines, Helen
    Rural Health Academic Centre, Melbourne University, Australia.
    Rubertsson, Christine
    Inst för Kvinnors och Barns hälsa, Uppsala Universitet.
    Childbirth fear in expectant fathers: findings from a regional Swedish cohort study.2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 2, p. 242-247Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

    DESIGN:

    a regional cohort study. Data was collected by a questionnaire.

    SETTING:

    three hospitals in the middle-north part of Sweden PARTICIPANTS: 1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

    MEASUREMENTS:

    prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

    FINDINGS:

    the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2-5.2), country of birth other than Sweden (OR 2.8; 1.3-6.1), a preference for a caesarean birth (OR 2.1; 1.7-4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1-2.0) and expecting the first baby (OR 1.8; 1.2-2.6).

    KEY CONCLUSIONS:

    high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

    IMPLICATIONS FOR PRACTICE:

    engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.

  • 10.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Sandin-Bojö, Fia
    Division for Health and Caring Sciences, Karlstad University, SE 651 88 Karlstad, Sweden.
    What is could indeed be better-Swedish women’s perceptions on postnatal care2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 5, p. 737-744Article in journal (Refereed)
    Abstract [en]

    Background: studies have shown that women are more likely to be satisfied with intrapartum rather than postpartum care. The structure and organisation of care seems to be a barrier to good-quality postpartum treatment. Objective: to explore the perceived reality and the subjective importance of early postnatal care provided in hospital, and to study women's satisfaction with different models of early postnatal care and the factors that are most strongly associated with being 'very satisfied' with the postnatal care received. Method: a regional survey was conducted with 1240 women recruited in mid-pregnancy and followed-up two months after childbirth. Results: a statistically significant difference existed between the subjective importance and the perceived reality for all studied variables, with a greater subjective importance than perceived reality for all statements. The length of postnatal stay and the content of care were related to satisfaction, while the model of postnatal care was not. The most important variables for being 'very satisfied' with postnatal care were that the infant received the best possible check-ups/medical care, and that the woman received sufficient support from staff. Conclusion: further studies are needed to assess the best model of postnatal care that gives the best opportunities to provide satisfactory care for women and their families.

  • 11.
    Johansson, Margareta
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Fenwick, Jennifer
    School of Nursing and Midwifery, Maternity and Family Unit, Griffith University, Meadowbrook, Queensland, Australia.
    Important factors working to mediate Swedish fathers' experiences of a caesarean section2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1041-1049Article in journal (Refereed)
    Abstract [en]

    Objective: to describe and explore fathers' experiences of theirpartner's caesarean section birth.Design: a qualitative descriptive design was employed. A self-selectedsample of 22 Swedish fathers who had experienced an elective oremergency caesarean section agreed to participate. Men were interviewedby telephone seven to 16 months after the birth of their baby. Thematicanalysis and the techniques of constant comparison were used to analysethe data.Findings: men were generally worried about the health and well-being oftheir baby and partner regardless of birth mode. As the reality of thecaesarean section approached men's anxiety escalated and remained highduring the procedure. The rapid nature of surgical birth was thereforeconsidered as an advantage; once the baby was born and cried men's feardissipated. Four factors were identified that mediated the men'sexperience. Men's perceptions of control, preparedness and how thehealth-care team behaved and interacted with them were integral to theirexperience. Knowing the date and time of birth also mediated theexperience by providing a sense of certainty to men's experiences of thecaesarean birth.Key conclusions: caesarean section was considered as a routine and safeprocedure that offered most fathers a sense of certainty, control andsafety lessening their sense of responsibility over ensuring a healthybaby. The communication patterns of staff played a key role in ensuringa positive caesarean birth experience.Implications for practice: ensuring that men have a positive birthexperience, regardless of birth mode, is important for familyfunctioning. However the findings also lend insight into how men mayreframe caesarean birth as normal and safe. This may have implicationsfor decision making around birth mode in a subsequent pregnancy furtherimpacting on rising repeat caesarean section rates. Health-careprofessionals need to provide balanced information about the risksassociated with caesarean birth. Any potential benefits need to becontextualised to the pregnant woman's own individual situation. Wherepossible, and appropriate, professional discourses should supportvaginal birth as the safest option for a woman and her baby.

  • 12.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Women's self-reported experience of unplanned caesarean section: Results of a Swedish study2017In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 50, p. 253-258Article in journal (Refereed)
    Abstract [en]

    Background women´s experience of emergency caesarean section is often described as less positive compared to a vaginal birth or a planned caesarean section. Midwifery care for women where deviations from a normal birth process are present is a challenge. The aim of study was to compare self-reported birth outcomes for women undergoing birth through spontaneous onset of labour between those who actually had a vaginal birth and those who eventually had an emergency caesarean section. Design and setting the study was part of a prospective longitudinal cohort study of parents’ experiences, attitudes, and beliefs related to childbirth. Method and findings questionnaires were answered by 870 women in midpregnancy, two months postpartum and one year after birth. 766 women (88%) had a vaginal birth, and 104 (12%) had an emergency caesarean section. The most common indications of emergency caesarean section were dystocia, foetal distress, and malpresentation. Women in the emergency caesarean group were more likely to be primiparous (59.6%) and have a body mass index > 30 (10.7%). Childbirth fear was twice as common among these women, and they were more likely to have preferred a caesarean delivery when asked about birth preference in the middle of pregnancy (OR 3.7, Cl 1.8–7.5). Induction of labour (OR 2.5, Cl 1.6–4.0), the use of oxytocin for augmentation (OR 1.9, Cl 1.3–2.9), and the use of epidural as pain relief during labour (OR 5.6, Cl 3.6–8.7) were more common among women having an emergency caesarean section. Transport of the new-born to a neonatal intensive care unit was three times as common. More than a third (37%) of the women in the caesarean group preferred a caesarean section in case of another birth. Childbirth fear was more common one year after birth with 32% of these women describing their fear as moderate or strong (OR 3.6, CI 2.1–6.0). Key conclusions women undergoing emergency caesarean section are more likely to experience fear and to have a negative birth experience. It is essential for the midwife to promote a sense of control, involve the woman in the procedure, and create security in a threatening situation. This is made possible in relationship characterized by mutuality, trust, on-going dialogue, shared responsibility, and enduring presence.

  • 13.
    Karlström, Annika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Nystedt, Astrid
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Johansson, Margareta
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 5, p. 620-627Article in journal (Refereed)
    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.

  • 14.
    Lindgren, Helena
    et al.
    Mälardalens högskola, Inst för Vård och folkhälsovetenskap.
    Rådestad, Ingela
    Mälardalens högskola, Inst för Vård och folkhälsovetensk.
    Christensson, Kyllike
    Karolinska Institutet, Inst för kvinnors och barns hälsa.
    Wally-Byström, K
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Perceptions of risk and risk management among 735 women who opted for a home birth2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 2, p. 163-172Article in journal (Refereed)
    Abstract [en]

    Objective: home birth is not included in the Swedish health-care system and the rate for planned home births is less than one in a thousand. The aim of this study was to describe women’s perceptions of risk related to childbirth and the strategies for managing these perceived risks. Design and setting: a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. Participants: a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. Measurements: two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis. Findings: regarding perceived risks about hospital birth, three categories, all related to loss of autonomy, were identified: (1) being in the hands of strangers; (2) being in the hands of routines and unnecessary interventions; and (3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help: (1) worst-case scenario; and (2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour, and by avoiding discussions concerning risks with health-care professionals. Conclusion: women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health-care professionals. Implications for practice: to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so.

  • 15.
    Nystedt, Astrid
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Högberg, Ulf
    Lundman, Berit
    Some Swedish women's experiences of prolonged labour.2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 1, p. 56-65Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to elucidate women's experiences of prolonged labour. DESIGN: qualitative research interviews were conducted and thematic content analysis was applied. PARTICIPANTS: 10 primiparae who, 1-3 months previously, had a prolonged labour with assisted vaginal or caesarean delivery. FINDINGS: the narratives about giving birth were interpreted and formulated into three themes and six sub-themes. The first theme, 'being caught up in labour', described the sense of not making progress during labour. The second theme was 'being out of control', and was related to the women's insufficient control of their own bodily processes, and consisted of descriptions of exhaustion and powerlessness. The third theme was 'being dependent on others', and described the women's dependence on care and on the support of the caregivers, and included descriptions of caregivers' assistance with birth as an experience of being relieved from pain and distress. KEY CONCLUSIONS: the experience of giving birth was not the experience of a healthy woman in labour, but one of severe labour pains that seemed to go on forever. The experience of prolonged labour could be understood as an experience of suddenly falling ill or finding oneself in a life-threatening condition associated with intractable pain, dependence on others and an overwhelming fear of losing oneself. IMPLICATIONS FOR PRACTICE: women with prolonged labour are more dependent on their caregivers than are women without prolonged labour. They have a special need for extra support and encouragement during the delivery as well as increased nursing and midwifery care.

  • 16.
    Rubertsson, Christine
    et al.
    Mälardalens Högskola, inst för Vård och folkhälsovetenskap.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Rådestad, Ingela
    Mälardalens Högskola, inst för Vård och folkhälsovetenskap.
    Disclosure and police reporting of intimate partner violence postpartum: a pilot study2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, no 26, p. 1-5Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: intimate partner violence is a significant health problem. Fear of retaliation and shame may prevent women from telling anyone about the violence. This study investigated the prevalence of disclosure and police reporting of intimate partner violence during the first year postpartum. DESIGN: a prospective longitudinal Swedish cohort study based on information from 2563 women who answered a postal questionnaire in early pregnancy and 12 months postpartum. FINDINGS: of 52 women who had been exposed to violence by their partner during the first year postpartum, four (8%) had filed a police report while 19 (37%) had not told anyone about the violence. All single women in the study had disclosed the violence to a friend, a relative or filed a police report. KEY CONCLUSIONS: few women file a police report when they are being hit by their partner during the year after childbirth. Many women do not tell anyone that they have been hit. IMPLICATIONS FOR PRACTICE: these data may encourage health professionals to undertake sensitive questioning about violence, giving an opening for support.

     

     

     

     

    Objective:

     

     

    intimate partner violence is a significant health problem. Fear of retaliation and shame may prevent women from telling anyone about the violence. This study investigated the prevalence of disclosure and police reporting of intimate partner violence during the first year postpartum.Design: a prospective longitudinal Swedish cohort study based on information from 2563 women who answered a postal questionnaire in early pregnancy and 12 months postpartum. Findings: of 52 women who had been exposed to violence by their partner during the first year postpartum, four (8%) had filed a police report while 19 (37%) had not told anyone about the violence. All single women in the study had disclosed the violence to a friend, a relative or filed a police report. Key conclusions: few women file a police report when they are being hit by their partner during the year after childbirth. Many women do not tell anyone that they have been hit. Implications for practice: these data may encourage health professionals to undertake sensitive questioning about violence, giving an opening for support.

     

     

  • 17.
    Sahlin, Maria
    et al.
    Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden .
    Klint-Carlander, Karin
    Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden .
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Wiklund, Ingela
    Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden .
    First-time mothers' wish for a planned caesarean section: A deeply rooted emotion2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 5, p. 447-452Article in journal (Refereed)
    Abstract [en]

    Background: international estimates suggest that caesarean section on maternal request range from 4% to 18% of all caesarean section. An increasing number of surveys have investigated women's reasons for a caesarean section in the absence of a medical indication but few studies have solely studied first-time mothers motivation for this request. Objective: to describe the underlying reasons for the desire for a caesarean section in the absence of medical indication in pregnant first-time mothers. Method: a qualitative descriptive study, with content analysis of interviews with 12 first-time mothers. Findings: the overarching theme formulated to illustrate the central interpreted meaning of the underlying desire for a planned caesarean section was based on deeply rooted emotions'. Four categories were identified as related to the request for a caesarean section on maternal request. The categories was identified as 'always knowing that there are no other options than a caesarean section', 'caesarean section as a more controlled and safe way of having a baby', own negative experiences of health care and having problems dealing with other people's reaction about their mode of delivery. Conclusion: the results show that for these first-time mothers deeply rooted emotions described as stronger than fear of birth were behind their wish for a planned caesarean section.

  • 18.
    Sharma, Bharati
    et al.
    Karolinska Institutet; Indian Institute of Public Health Gandhinagar, Gujarat, India.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Karolinska Institutet.
    Johansson, Eva
    Karolinska Institutet.
    Christensson, Kyllike
    Karolinska Institutet.
    Self-assessed confidence of students on selected midwifery skills: Comparing diploma and bachelors programmes in one province of India2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 12-17Article in journal (Refereed)
    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. 

  • 19.
    Ternström, Elin
    et al.
    Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85 Uppsala, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85 Uppsala, Sweden.
    Haines, Helen
    Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
    Rubertsson, Christine
    Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85 Uppsala, Sweden.
    Higher prevalence of childbirth related fear in foreign born pregnant women - Findings from a community sample in Sweden2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 4, p. 445-450Article in journal (Refereed)
    Abstract [en]

    Objective

    To investigate the prevalence of childbirth related fear (CBRF) in early pregnancy among both Swedish born and foreign born women living in Sweden.

    Design

    A cross sectional prevalence study. Data was collected by a questionnaire, which was available in Swedish and eight other languages.Setting: a university hospital in the middle of Sweden.

    Participants

    The recruitment took place during a two month period where the participating women completed the Fear of Birth Scale (FOBS) in mid-pregnancy.

    Measurements

    Prevalence of CBRF, the cut-point of 60 and above. Odds ratios with a 95% confidence interval were calculated between women born in Sweden and women born in a foreign country. Stratified analyses were also performed separately for Swedish born and foreign born women.

    Findings

    In total 606 women completed the survey, 78% were born in Sweden and 22% were born in a foreign country. About 22% of the total sample scored 60 or more on the FOBS-scale. Almost 18% (n=85) of the women born in Sweden reported CBRF while 37 % (n=49) of the foreign born women reported CBRF. Being born outside Sweden (OR 2.7; CI 1.7-4.0) and expecting the first baby (OR 1.9; CI 1.3-2.8) were associated with CBRF. There were no differences in age, civil status or level of education between women with or without FOBS ≥60. However, a stratified analysis showed that primiparas born in a foreign country (OR 3.8; CI 1.8-8.0) were more likely to score 60 or more on the FOBS-scale compared to multiparas born in a foreign country.

    Key conclusions

    Childbirth related fear was almost three times as common among foreign born women when compared to Swedish women. Foreign born childbearing women are an extremely vulnerable group who need culturally sensitive and targeted support from caregivers. Further research is needed to clearly identify the components of women's childbirth related fear in various ethnic groups.

  • 20.
    Thies-Lagergren, Li
    et al.
    Inst för Kvinnors och Barns hälsa, Karolinska Institutet.
    Kvist, Linda
    Lund Univ, Dept Hlth Sci, S-22100 Lund.
    Sandin- Bojö, Ann-Kristine
    Karlstad Univ, Dept Nursing, Fac Social & Life Sci, Karlstad.
    Christensson, Kyllike
    Institutionen för Kvinnors och Barns hälsa, Karolinska Institutet.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Labour augmentation and fetal outcomes in relation to birth positions: a secondary analyis of a randomized controlled trial evaluating birth seat births2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 4, p. 344-350Article in journal (Refereed)
    Abstract [en]

    Objective: the aim of this study was to compare the use of synthetic oxytocin for augmentation, duration of labour and birth and infant outcomes in nulliparous women randomised to birth on a birth seat or any other position.Study design: a randomised controlled trial in Sweden where 1002 women were randomised to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The outcome measurements included synthetic oxytocin augmentation, duration of the second stage of labour and fetal outcome. Analysis was by intention to treat.Setting: southern Sweden.Findings: the main findings of this study were that women randomised to the experimental group had a statistically significant shorter second stage of labour than women randomised to the control group. There were no differences between the groups for use of synthetic oxytocin augmentation or for neonatal outcomes.Conclusions: women allocated to the birth seat had a significantly shorter second stage of labour despite similar numbers of women subjected to synthetic oxytocin augmentation in the study groups. The adverse neonatal outcomes did not differ between groups. The birth seat can be suggested as non-medical intervention used to reduce duration of second stage labour and birth. The birth seat can be suggested as a non-medical intervention that may facilitate reduced duration of the second stage of labour. Furthermore it is recommended that caregivers, both midwives and midwifery students, should learn skills to assist women in using a variety of birth positions.

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