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  • 1.
    Andersson, Ewa
    et al.
    Karolinska Institutet, Institutionen för Kvinnor och barns hälsa.
    Christensson, Kyllike
    Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, SE-171770 Stockholm, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Karolinska Inst, Dept Womens & Childrens Hlth, Div Reprod Hlth, SE-171770 Stockholm, Sweden.
    Mothers’ satisfaction with group antenatal care versus individual antenatal care: A clinical trial2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 3, p. 113-120Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to compare women's satisfaction with group based antenatal care and standard care.

    Design A randomised control trial where midwives were randomized to perform either GBAC or standard care. Women were invited to evaluate the two models of care. Data was collected by two questionnaires, in early pregnancy and six months after birth. Crude and adjusted odds ratios with a 95% confidence interval were calculated by model of care.

    Settings Twelve antenatal clinics in Sweden between September 2008 and December 2010.

    Participants Women in various part of Sweden (n=700).

    Findings In total, 8:16 variables in GBAC versus 9:16 in standard care were reported as deficient. Women in GBAC reported significantly less deficiencies with information about labour/birth OR 0.16 (0.10–0.27), breastfeeding OR 0.58 (0.37–0.90) and time following birth OR 0.61 (0.40–0.94). Engagement from the midwives OR 0.44 (0.25–0.78) and being taken seriously OR 0.55 (0.31–0.98) were also found to be less deficient. Women in GBAC reported the highest level of deficiency with information about pregnancy OR 3.45 (2.03–5.85) but reported less deficiency with time to plan the birth OR 0.61 (0.39–0.96). In addition, women in GBAC more satisfied with care in supporting contact with other parents OR 3.86 (2.30–6.46) and felt more support to initiate breastfeeding OR 1.75 (1.02–2.88).

    Conclusions Women in both models of care considered the care as deficient in more than half of all areas. Variables that differed between the two models favoured group based antenatal care.

  • 2.
    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.

  • 3.
    Andersson, Ewa
    et al.
    Karolinska Institutet, Institutionen för Kvinnor och barns hälsa.
    Christensson, Kyllike
    Karolinska Institutet.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Swedish midwives' perspectives on group based antenatal care.2014In: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 4, p. 240-249Article in journal (Refereed)
  • 4.
    Andersson, Ewa
    et al.
    Karolinska Institutet, Stockholm.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala University, Uppsala.
    Mother's postnatal stress: an investigation of links to various factors during pregnancy and post-partum2016In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 30, no 4, p. 782-789Article in journal (Refereed)
    Abstract [en]

    Background: Higher levels of parental stress have long-term effects on children's health and could lead to dysfunction in the parent–child interaction. Different background factors can be predictors of high parental stress. Aim: The aim of this study was to examine parental stress among Swedish women and identify different factors linked to women's parental stress. Method: About 702 women were recruited to a clinical study and followed up six months after birth. Data were collected by two questionnaires, and 279 women completed the Swedish Parental Stress Questionnaire (SPSQ). Findings: Less than very good mental health and depressive symptoms after birth were strongly associated with parental stress, and the strongest association was found between post-partum depressive symptoms and high levels of stress in the subscale Incompetence. Multiparity was associated with high stress in two subscales, and lower level of education was a protective factor for stress in nearly all subscales. Conclusions: Depressive symptoms and perceived poor mental health post-partum are the most important factors related to high parental stress. The results point to the importance of identifying and supporting mothers with depressive symptoms, since these women have both mental illness and increased stress.

  • 5.
    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.
    Davidsson Bremborg, Anna
    Lunds Universitet.
    Rådestad, Ingela
    Sofiahemmet Högskola.
    Make the stillborn baby and the loss real for the siblings-parents’ advice on how the siblings of a stillborn baby can be supported2012In: Journal of Perinatal Eduction, ISSN 1548-8519, Vol. 21, p. 1-9Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate parents' advice to other parents on the basis of their own experiences of siblings' taking leave of a stillborn sister or brother. The study was a Web questionnaire study of 411 parents. The thematic content analysis resulted in two categories: “Make the stillborn baby and the loss real for the siblings“ and “Take the siblings' resources and prerequisites into account.“ Parents' advised that siblings should see and hold the stillborn baby and, thus, be invited and included into the leave-taking process with respect to the siblings' feelings, resources, and prerequisites. Based on these findings, professional caregivers can usefully be proactive in their approach to facilitate and encourage the involvement of siblings.

  • 6.
    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).

  • 7. Berglund, Anna
    et al.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hälsovård för den gravida kvinnan är mer än bara medicinska kontroller2002In: Läkartidningen, ISSN 0023-7205, Vol. 99, p. 2028-2030Article in journal (Refereed)
  • 8.
    Bogren Jungmarker, Emily
    et al.
    Högskolan Dalarna.
    Lindgren, Helena
    Högskolan Dalarna.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Playing second fiddle is Okay-Swedish Fathers' experiences of prenatal care2010In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 55, no 5, p. 421-429Article in journal (Refereed)
    Abstract [en]

    Introduction: In Sweden, prospective fathers are encouraged and welcome to attend prenatal visits, and pregnant women assess their partners' involvement in prenatal care as very important. The aim of this study was to describe expectant fathers' experiences of and involvement in prenatal care in Sweden. Methods: Data were drawn from a 1-year cohort study of 827 Swedish-speaking fathers recruited during their partners' midpregnancy and followed up 2 months after childbirth. Results: The participants reported that the most important issues in prenatal care were the woman's physical and emotional well-being and the support she received from her midwife. However, care was identified as deficient in nearly all aspects of information, medical care, and fathers' involvement. "Excessive" care was also reported and related to how the father was treated by the midwife, mainly in terms of attention to his emotional well-being. Discussion: Although fathers prioritize the needs of their pregnant partners, it is important for caregivers to assess fathers' needs and incorporate a family-oriented approach to prenatal care.

  • 9.
    Bäck, Lena
    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. Uppsala Universitet.
    Sjöqvist, Carina
    Östersunds sjukhus.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Developing competence and confidence in midwifery: focus groups with Swedish midwives2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 1, p. E32-E38Article in journal (Refereed)
    Abstract [en]

    Background

    Midwives have a significant impact on the clinical outcome and the birthing experience of women. However, there has been a lack of research focusing specifically on clinical midwives’ learning and development of professional competence.

    Aim

    The objective of the study was to describe how midwives reflect on learning and the development of professional competence and confidence.

    Methods

    A qualitative study based on focus groups with midwives employed in maternity services.

    Findings

    Four categories describe the results: (1) Feelings of professional safety evolve over time; (2) Personal qualities affect professional development; (3) Methods for expanding knowledge and competence; and (4) Competence as developing and demanding. The meaning of competence is to feel safe and secure in their professional role. There was a link between the amount of hands-on intrapartum experience and increasing confidence that is, assisting many births made midwives feel confident. Internal rotation was disliked because the midwives felt they had less time to deepen their knowledge and develop competence in a particular field. The midwives felt they were not seen as individuals, and this system made them feel split between different assignments.

    Discussion

    External factors that contribute to the development of knowledge and competence include the ability to practise hands-on skills in an organisation that is supportive and non-threatening. Internal factors include confidence, self-efficacy, and a curiosity for learning.

    Conclusions

    Midwives working within an organisation should be supported to develop their professional role in order to become knowledgeable, competent and confident.

  • 10.
    Bäck, Lena
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Sharma, Bharati
    Indian Institute of Public Health Gandhinagar, Gujarat, India.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Tunon, Katarina
    Umeå Universitet; Östersunds Sjukhus.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Universitet.
    Professional confidence among Swedish final year midwifery students: A cross-sectional study2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 14, no December 2017, p. 69-78Article in journal (Refereed)
    Abstract [en]

    Objective

    Previous international studies have shown that midwifery students do not feel confident in many areas where they are supposed to practice independently.

    The knowledge about Swedish midwifery students’ confidence is fairly under investigated. The purpose of the present study was to explore final years’ midwifery students’ professional confidence in basic midwifery skills according to ICM competencies and associated factors.

    Methods

    A cross-sectional survey where all midwifery programs in Sweden were invited to participate. Data was collected by a questionnaire that measured midwifery students self-reported assessment of confidence against four selected domains of ICM competencies; antenatal, intrapartum, postpartum and new-born care.

    Result

    The main findings of this study showed that Swedish midwifery students were confident in managing normal pregnancy, labour and birth. Midwifery students at a school with a medical faculty were more confident in handling obstetric emergency situations. Some background variables were also associated with confidence.

    Conclusion

    This study highlighted some midwifery skills that needs further training and reflection. More training and developing confidence in complicated and emergency situations are needed. There seem to be a need of midwifery education reforms if we believe that high levels of confidence at the time of graduation is equal to competent and skilled midwives in the future.

  • 11.
    Edqvist, Malin
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Arvid Wallgrens Backe Hus 1,Box PO 457405 30, Gothenburg, Sweden.
    Blix, Ellen
    Oslo & Akershus Univ, Fac Hlth Sci, Res Grp Maternal Reprod & Childrens Hlth, Coll Appl Sci, Oslo, Norway.
    Hegaard, Hanne K.
    Copenhagen Univ Hosp, Rigshosp, Juliane Marie Ctr Women Children & Reprod, Res Unit,Womens & Childrens Hlth, Copenhagen, Denmark.
    Olafsdottir, Olof Asta
    Univ Iceland, Fac Nursing, Dept Midwifery, Reykjavik, Iceland.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Ingversen, Karen
    Homebirth Assoc Sealand, Copenhagen, Denmark.
    Mollberg, Margareta
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Arvid Wallgrens Backe Hus 1,Box PO 457405 30, Gothenburg, Sweden.
    Lindgren, Helena
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Arvid Wallgrens Backe Hus 1,Box PO 457405 30, Gothenburg, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, article id 196Article in journal (Refereed)
    Abstract [en]

    Background: Whether certain birth positions are associated with perineal injuries and severe perineal trauma (SPT) is still unclear. The objective of this study was to describe the prevalence of perineal injuries of different severity in a low-risk population of women who planned to give birth at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries. Methods: A population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data. Results: Two thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included. The prevalence of SPT was 0.7 % and the prevalence of episiotomy was 1.0 %. There were differences between the countries regarding all maternal characteristics. No association between flexible sacrum positions and sutured perineal injuries was found (OR 1.02; 95 % CI 0.86-1.21) or SPT (OR 0.68; CI 95 % 0.26-1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10-0.54). Conclusion: A low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.

  • 12.
    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.

  • 13.
    Gerhardsson, Emma
    et al.
    Uppsala Universitet.
    Hedberg Nyqvist, Kerstin
    Uppsala Universitet.
    Mattsson, Elisbeth
    Uppsala Universitet.
    Volgsten, Helena
    Uppsala Universitet.
    Hildingsson, Ingegerd
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden..
    Funkquist, Eva-Lotta
    Uppsala Universitet.
    The Swedish version of the Breastfeeding Self-Efficacy-Short-Form (BSES_SF): reliability and validity assessment2014In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 30, no 3, p. 340-345Article in journal (Refereed)
  • 14.
    Haines, Helen M.
    et al.
    Melbourne Medical School, Rural Health Academic Centre, University of Melbourne, Shepparton,VA, Australia .
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Women's and Children's Health,, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden .
    Pallant, Julie F.
    Melbourne Medical School, Rural Health Academic Centre, University of Melbourne, Shepparton,VA, Australia .
    Rubertsson, Christine
    Department of Women's and Children's Health,, Obstetrics and Gynaecology, Uppsala University, Uppsala, Sweden .
    The Role of Women's Attitudinal Profiles in Satisfaction with the Quality of their Antenatal and Intrapartum Care2013In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 4, p. 428-441Article in journal (Refereed)
    Abstract [en]

    Objective To compare perceptions of antenatal and intrapartum care in women categorized into three profiles based on attitudes and fear. Design Prospective longitudinal cohort study using self-report questionnaires. Profiles were constructed from responses to the Birth Attitudes Profile Scale and the Fear of Birth Scale at pregnancy weeks 18 to 20. Perception of the quality of care was measured using the Quality from Patient's Perspective index at 34 to 36 weeks pregnancy and 2 months after birth. Setting Two hospitals in Sweden and Australia. Participants Five hundred and five (505) pregnant women from one hospital in Vasternorrland, Sweden (n=386) and one in northeast Victoria, Australia (n=123). Results Women were categorized into three profiles: self-determiners, take it as it comes, and fearful. The self-determiners reported the best outcomes, whereas the fearful were most likely to perceive deficient care. Antenatally the fearful were more likely to indicate deficiencies in medical care, emotional care, support received from nurse-midwives or doctors and nurse-midwives'/doctors' understanding of the woman's situation. They also reported deficiencies in two aspects of intrapartum care: support during birth and control during birth. Conclusions Attitudinal profiling of women during pregnancy may assist clinicians to deliver the style and content of antenatal and intrapartum care to match what women value and need. An awareness of a woman's fear of birth provides an opportunity to offer comprehensive emotional support with the aim of promoting a positive birth experience.

  • 15.
    Haines, Helen M.
    et al.
    Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85, Uppsala, Sweden.
    Rubertsson, Christine
    Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, 751 85, Uppsala, Sweden.
    Pallant, Julie F.
    Rural Health Academic Centre, University of Melbourne, 49 Graham St, Shepparton, VIC, Australia.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    The influence of women's fear, attitudes and beliefs of childbirth on mode and experience of birth2012In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 12, p. Art. no. 55-Article in journal (Refereed)
    Abstract [en]

    Background: Women's fears and attitudes to childbirth may influence the maternity care they receive and the outcomes of birth. This study aimed to develop profiles of women according to their attitudes regarding birth and their levels of childbirth related fear. The association of these profiles with mode and outcomes of birth was explored. Methods: Prospective longitudinal cohort design with self report questionnaires containing a set of attitudinal statements regarding birth (Birth Attitudes Profile Scale) and a fear of birth scale (FOBS). Pregnant women responded at 18-20 weeks gestation and two months after birth from a regional area of Sweden (n = 386) and a regional area of Australia (n = 123). Cluster analysis was used to identify a set of profiles. Odds ratios (95% CI) were calculated, comparing cluster membership for country of care, pregnancy characteristics, birth experience and outcomes. Results: Three clusters were identified - 'Self determiners' (clear attitudes about birth including seeing it as a natural process and no childbirth fear), 'Take it as it comes' (no fear of birth and low levels of agreement with any of the attitude statements) and 'Fearful' (afraid of birth, with concerns for the personal impact of birth including pain and control, safety concerns and low levels of agreement with attitudes relating to women's freedom of choice or birth as a natural process). At 18 - 20 weeks gestation, when compared to the 'Self determiners', women in the 'Fearful' cluster were more likely to: prefer a caesarean (OR = 3.3 CI: 1.6-6.8), hold less than positive feelings about being pregnant (OR = 3.6 CI: 1.4-9.0), report less than positive feelings about the approaching birth (OR = 7.2 CI: 4.4-12.0) and less than positive feelings about the first weeks with a newborn (OR = 2.0 CI 1.2-3.6). At two months post partum the 'Fearful' cluster had a greater likelihood of having had an elective caesarean (OR = 5.4 CI 2.1-14.2); they were more likely to have had an epidural if they laboured (OR = 1.9 CI 1.1-3.2) and to experience their labour pain as more intense than women in the other clusters. The 'Fearful' cluster were more likely to report a negative experience of birth (OR = 1.7 CI 1.02-2.9). The 'Take it as it comes' cluster had a higher likelihood of an elective caesarean (OR 3.0 CI 1.1-8.0). Conclusions: In this study three clusters of women were identified. Belonging to the 'Fearful' cluster had a negative effect on women's emotional health during pregnancy and increased the likelihood of a negative birth experience. Both women in the 'Take it as it comes' and the 'Fearful' cluster had higher odds of having an elective caesarean compared to women in the 'Self determiners'. Understanding women's attitudes and level of fear may help midwives and doctors to tailor their interactions with women.

  • 16.
    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.

  • 17.
    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.

  • 18.
    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.

  • 19.
    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.

  • 20.
    Halfdansdottir, Berglind
    et al.
    Univ Iceland, IS-101 Reykjavik, Iceland..
    Wilson, Margaret E.
    Univ Nebraska Med Ctr, Omaha, NE USA..
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Karolinska Inst, Stockholm, Sweden.
    Olafsdottir, Olof A.
    Univ Iceland, IS-101 Reykjavik, Iceland..
    Smarason, Alexander Kr.
    Univ Akureyri, Akureyri, Iceland..
    Sveinsdottir, Herdis
    Univ Iceland, IS-101 Reykjavik, Iceland..
    Autonomy in place of birth: a concept analysis2015In: Medicine, Health care and Philosophy, ISSN 1386-7423, E-ISSN 1572-8633, Vol. 18, no 4, p. 591-600Article in journal (Refereed)
    Abstract [en]

    This article examines one of the relevant concepts in the current debate on home birth-autonomy in place of birth-and its uses in general language, ethics, and childbirth health care literature. International discussion on childbirth services. A concept analysis guided by the model of Walker and Avant. The authors suggest that autonomy in the context of choosing place of birth is defined by three main attributes: information, capacity and freedom; given the antecedent of not harming others, and the consequences of accountability for the outcome. Model, borderline and contrary cases of autonomy in place of birth are presented. A woman choosing place of birth is autonomous if she receives all relevant information on available choices, risks and benefits, is capable of understanding and processing the information and choosing place of birth in the absence of coercion, provided she intends no harm to others and is accountable for the outcome. The attributes of the definition can serve as a useful tool for pregnant women, midwives, and other health professionals in contemplating their moral status and discussing place of birth.

  • 21.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hemförlossning- Det ansvarstagande avståndstagandet1998Report (Other scientific)
    Abstract [en]

    Hildingsson I. . Allmänmedicinsk rapportsamling 2/1998. Institutionen för folkhälsa och klinisk medicin, Umeå Universitet, 1998.

  • 22.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Hemmafödande kvinnors sociala situation och hälsa: Stipendiatrapport, FAS, 20062006Report (Other scientific)
  • 23.
    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.

  • 24.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kejsarsnitt2009In: Lärobok för Barnmorskor / [ed] Kaplan A, Hogg B, Hildingsson I, Lundgren I, Lund: Studentlitteratur, 2009, 3, p. 350-352Chapter in book (Other academic)
  • 25.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kvinnors förväntningar på mödrahälsovården2003Other (Other (popular science, discussion, etc.))
  • 26.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kvinnors upplevelser av barnafödande: En förstudie rörande hälsa, stöd och egna resurser2001Report (Other scientific)
  • 27.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Mental training during pregnancy. Feelings and experiences during pregnancy and birth and parental stress one year after birth -A pilot study2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 31-36Article in journal (Refereed)
    Abstract [en]

    Background: Parental stress has been recognized as a problem despite governmental support of parent education programs aiming to prepare parents for parenthood. Aim: to compare parents who underwent a mental training program during pregnancy with a control group to measure feelings and experiences during pregnancy and birth and perceived parental stress. Methods: A comparative pilot study of 46 self-selected parents who underwent a mental training program during pregnancy, and 1408 parents living in the same catchment area (control group). Data was collected in mid-pregnancy, 2 months and 1 year after birth. The main outcome was parental stress. Results: Parents in the mental training group were more often expecting their first baby and had a higher level of education compared to parents in the control group. Parents participating in the mental training program had less positive feelings about expecting a baby (OR 14.0; 6.7-29.3), the upcoming birth (OR 2.0; 1.1-3.8) and the newborn baby (OR 3.1; 1.6-6.2). Parents who attended the mental training program attended an antenatal parent education to a higher degree (OR 2.0; 1.6-2.4) and were more likely to stay in contact with other participants in the antenatal education (OR 4.1; 1.9-8.6). Mothers in the mental training program used psycho prophylaxis to a higher extent (OR 3.0; 1.2-7.1) There was no difference in the birth experience or the perceived parental stress. Conclusion: Participating in a mental training program for birth and parenthood was not associated with the birth experience or the assessment of parental stress 1 year after birth.

  • 28.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Nyblivna föräldrars upplevelser av BB-vården. Del 2 Rapport över projektarbete, Landstinget Västernorrland2007Report (Other scientific)
  • 29.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Nyblivna föräldrars upplevelser av vården efter förlossning (BB-vård). Landstinget Västernorrland, Maj 2006.: Rapport över projektarbete2006Report (Other scientific)
  • 30.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala University, Uppsala.
    Sense of coherence in pregnant and new mothers – A longitudinal study of a national cohort of Swedish speaking women2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, p. 91-96Article in journal (Refereed)
    Abstract [en]

    Background Previous research shows inconsistent results about the stability of SOC during the childbearing period, and few studies have focused on longitudinal measures. There are contradictory results regarding the association between SOC and birth outcome. The link between levels of SOC and parental stress needs to be further explored. Aim The aim of this study was to investigate changes in SOC from early pregnancy to one year after birth and associations with background characteristics, birth outcome and parental stress. Methods A longitudinal survey of a national cohort of Swedish speaking women during 3 weeks in 1999–2000. Data were collected by questionnaires in early pregnancy, 2 months and 1 year after birth. Results SOC increased from pregnancy to 2 months after birth but decreased 1 year after birth. SOC was associated with women's background characteristics, emotional wellbeing and attitudes, but not with labour outcome. Women with low SOC reported higher parental stress after one year. Conclusion Sense of coherence is not stable during the childbearing period and is associated with women's sociodemographic background, emotional health and attitudes, but not with reproductive history or birth outcome. Parental stress is negatively correlated with SOC, and some important characteristics are similar in women having low SOC and high parental stress. Identifying women with low SOC in early pregnancy could be a means to prevent later parental stress.

  • 31.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Självpaplation av brösten2009In: Lärobok för Barnmorskor / [ed] Kaplan A, Hogg B, Hildingsson I, Lundgren I, Lund: Studentlitteratur, 2009, 3, p. 614-616Chapter in book (Other academic)
  • 32.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Swedish couples' attitudes towards birth, childbirth fear and birth preferences and relation to mode of birth - A longitudinal cohort study2014In: Sexual and Reproductive Healthcare, ISSN 1877-5764, Vol. 5, no 2, p. 75-80Article in journal (Refereed)
    Abstract [en]

    Objective: Little is known if couples hold similar or different attitudes towards birth or what impact these have on the actual mode of birth. The aim of this study was to compare couples' personal and general attitudes towards birth. An additional aim was to study the relationship between attitudes, birth preferences, and fear of birth in relation to mode of birth. Methods: This study is part of a longitudinal cohort study of 1074 pregnant women and their partners recruited during one year in three hospitals in the middle-north part of Sweden. Data was collected by questionnaires. Chi-square test, t-tests and multinominal regression analysis were used in the analyses. Results: Women held stronger attitudes about the importance of a safe and less stressful birth for the baby, while their partners were most concerned about the woman's health. Women who preferred a caesarean section and reported childbirth fear often prioritized a safe and stressful birth for themselves, wanted to avoid pain, plan the date, and decide about birth themselves and did not view birth as natural. Some of these attitudes were also found in partners who preferred a caesarean section. Birth preference and fear were strongly associated with mode of birth. Conclusion: Special attention should be directed towards parents with a caesarean section preference and parents with childbirth related fear as they have certain attitudes to birth and are more likely to have caesarean section for the birth of the baby. © 2014 Elsevier B.V.

  • 33.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Vad betyder kvinnors förväntningar?: Presentation av två delarbeten om kejsarsnitt. Svenska Barnmorskeförbundets konferens Reproduktiv hälsa, Stockholm, november 2005.2005Conference paper (Other scientific)
  • 34.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth Obstet & Gynaecol, S-75185 Uppsala, Sweden.
    Women's birth expectations, are they fulfilled?: Findings from a longitudinal Swedish cohort study2015In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, no 2, p. E7-E13Article in journal (Refereed)
    Abstract [en]

    Background: The importance of women's expectations on the experience of birth has shown contradictory results regarding fulfilment. The aim of this study was to describe pregnant women's expectations of birth and to investigate if these expectations were fulfilled. An additional aim was to determine if unfulfilled expectations were related to the mode of birth, use of epidural and the birth experience. Methods: This research investigated a prospective regional cohort study of 1042 Swedish-speaking women who completed a questionnaire about birth expectations in late pregnancy and were followed up with two months after birth. Five areas were under study: support from partner, support from midwife, control, participation in decision making and the midwife's presence during labour and birth. An index combining expectations and experiences was created. Results: Certain background characteristics were associated with expectations as well as experiences. Statistically significant differences were shown between expectations and experiences in support from midwife (mean 3.41 vs 3.32), support from partner (mean 3.70 vs 3.77), and midwife's presence (mean 3.00 vs 3.39). Experiences 'worse than expected' regarding decision making and control were associated with modes of birth other than vaginal and four out of five areas were associated with a less positive birth experience. Conclusion: Some women had high birth expectations of which some were fulfilled. An expectation on support from the midwife was less likely to be achieved, while support from partner and the midwives' presence were fulfilled. If the woman's expectations were not fulfilled, e.g. became 'worse than expected' this was associated with a less positive overall birth experience as well as with instrumental or surgical mode of birth. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

  • 35.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Andersson, E.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Christensson, K.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Swedish women's expectations about antenatal care and change over time - A comparative study of two cohorts of women2014In: Sexual and Reproductive Healthcare, ISSN 1877-5764, Vol. 5, no 2, p. 51-57Article in journal (Refereed)
    Abstract [en]

    A decade ago a national cohort of Swedish-speaking women were surveyed about their expectations on antenatal care. Today, antenatal care in Sweden still operates under similar circumstances while changes have occurred in society and the pregnant population. Objective: To compare expectations of antenatal care in pregnant women recruited 2009-2010 to those of pregnant women from a national cohort in 1999-2000. An additional aim was to compare antenatal expectations in women recruited to a clinical trial and subsequently received group based or standard antenatal care. Methods: A cross-sectional pre-study of 700 women recruited to a clinical trial and a historical cohort of 3061 women from a Swedish national survey. Data was collected by a questionnaire in early pregnancy for both cohorts and before the clinical trial started. Results: In early pregnancy 79% of the women in the study sample reported a preference for the recommended number of visits, which is slightly higher than in the national cohort (70%). Continuity of the caregiver was still important with 95% vs 97% of the women rated it important to meet the same midwife at subsequent antenatal visits. The content of care rank order showed a change over time with lower expectations in health check-ups and emotional content and higher expectations in information needs, respect and partner involvement. Conclusion: Women approached in early pregnancy had lower expectations about medical and emotional check-ups and parent education but higher expectations regarding information, being met with respect and the involvement of the partner compared to women 10. years ago. Continuity of a midwife caregiver was still important and women seem more willing to follow the recommended number of antenatal visits. Clinical implications: Asking women about their expectations regarding antenatal care could be a means to individualize the care. © 2014 Elsevier B.V.

  • 36.
    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)

  • 37.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Cederlöf, Linnéa
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm.
    Widén, Sara
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm.
    Fathers' birth experience in relation to midwifery care2011In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 24, no 3, p. 129-136Article in journal (Refereed)
    Abstract [en]

    The aim was to identify the proportion of fathers having a positive experience of a normal birth and to explore factors related to midwifery care that were associated with a positive experience. Background: Research has mainly focused on the father's supportive role during childbirth rather than his personal experiences of birth. Methods: 595 new fathers living in a northern part of Sweden, whose partner had a normal birth, were included in the study. Data was collected by questionnaires. Odds Ratios with 95% confidence interval and logistic regression analysis were used. Results: The majority of fathers (82%) reported a positive birth experience. The strongest factors associated with a positive birth experience were midwife support (OR 4.0; 95 CI 2.0-8.1), the midwife's ongoing presence in the delivery room (OR 2.0; 1.1-3.9), and information about the progress of labour (OR 3.1; 1.6-5.8). Conclusion: Most fathers had a positive birth experience. Midwifery support, the midwife's presence and sufficient information about the progress of labour are important aspects in a father's positive birth experience. The role of the midwife during birth is important to the father, and his individual needs should be considered in order to enhance a positive birth experience.

  • 38.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Dalén, Kristina
    Inst för Kvinnors och Barns Hälsa, Karolinska Institutet.
    Sarenfelt, Lena
    Inst för Kvinnors och Barns Hälsa, Karolinska Institutet.
    Ransjö-Arvidson, Anna-Berit
    Inst för Kvinnors och Barns Hälsa, Karolinska Institutet.
    First-time parents′ perception of antenatal education in Sweden2013In: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 3, no 1, p. 28-38Article in journal (Refereed)
    Abstract [en]

    Antenatal parent education is one part of the parenthood support program and is offered to all firsttime parents in Sweden. The aim was to explore first-time parents' experiences of antenatal education and its helpfulness in preparation for birth and early parenthood. Eight hundred ten first-time parents completed questionnaires. The antenatal education was a positive experience for 56% and 62% of women and men, respectively. Antenatal education was helpful during birth for 68% of women and 63% of men. Forty-seven percent of women and 44% of men found it helpful for early parenthood. High level of education was the only background variable associated with being satisfied with antenatal education. Satisfaction was lower than reported in previous studies and indicates room for change and improvement in antenatal parent education.

  • 39.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Engström-Olofsson, Regina
    Thomas, Jan
    Kenyon college, Department of sociology.
    Nystedt, Astrid
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Still behind the glass wall? Swedish fathers’ experiences with postnatal care2009In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 38, no 3, p. 280-289Article in journal (Refereed)
    Abstract [en]

    To describe new fathers' satisfaction with postnatal care after the introduction of a more family-centered model and to study factors related to fathers' overall satisfaction with postnatal care. Two cohorts of fathers who had a live-born baby during a 15 weeks period in 2004 and 2006. A Swedish hospital. Postnatal care options were traditional postnatal ward, early discharge, cocare at neonatal ward, and from 2006 a family suite on a hotel ward. Two hundred and eighty-four fathers whose babies were born in 2004 and 356 fathers whose babies were born in 2006. Data were collected using a questionnaire and descriptive statistical odds ratios with 95% confidence interval and logistic regression analyses were used. Six hundred and forty (64%) fathers completed the questionnaire. There was no improvement between the 2 years in satisfaction with the content of postnatal care, although fathers who stayed in the family suite on the hotel ward were more satisfied with the postnatal care over all. The following factors were most significant for predicting dissatisfaction with postnatal care: no support from staff, not being treated nicely, dissatisfaction with the environment, lack of medical check-ups for the mother, and visiting hours. A true family perspective should be applied in postnatal care and the new parents viewed as a family unit, not as medical cases only. Staff working in postnatal wards should be given the opportunity to involve fathers in postnatal care.

  • 40.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Fenwick, J.
    Griffith Health Institute, Health Practice Innovation, Griffith University, Brisbane, QLD, Australia .
    Swedish midwives' perception of their practice environment - A cross sectional study2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 174-181Article in journal (Refereed)
    Abstract [en]

    Background: There is a shortage of midwives in Sweden. Evidence suggests that the work environment is likely to play a part in retention and attrition rates. Objective: To explore the practice environment of Swedish midwives and factors associated with the perception of an unfavorable work environment. Methods: 475/1000 (48.6%) members of the Swedish Midwifery association completed a questionnaire including the Practice Environment Scale (PES). Differences in mean scores were calculated for the subscales of PES and midwives' background characteristics. Logistic regression was used to investigate factors most strongly associated with unfavorable working environment. Results: The two domains that showed significant differences in terms of participant characteristics were the Staffing and resources adequacy subscale and the Foundations of quality care subscale. Midwives younger than 40 years, those with less than 10 years' experience and those with an additional academic degree rated these two domains more unfavorably. Protective factors for assessing the work environment unfavorable were mainly internal such as high quality of life and high self-efficacy. Swedish midwives were most satisfied with the midwife-doctor relationship and least satisfied with their participation in work place or hospital affairs. Midwives suffering from burnout, those who provided hospital based care and those without leadership position were more likely to assess their work environment as unfavorable. Conclusions: This study identified personal factors as well as work related factors to be associated with midwives' assessment of their practice work environment. Establishing healthy work places where midwives feel recognized and valued could prevent midwives from leaving the profession. © 2015 Elsevier B.V.

  • 41.
    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.

  • 42.
    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.

  • 43.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Haines, Helen
    University of Melbourne, School of Rural Health, Australia.
    Cross, Maddalena
    University of Melbourne, School of Rural Health, Australia.
    Pallant, Julie
    University of Melbourne, School of Rural Health, Australia.
    Rubertsson, Christine
    Inst för Kvinnors och Barns hälsa, Uppsala Universitet.
    Women's satisfaction with antenatal care: Comparing women in Sweden and Australia2013In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 26, no 1, p. e9-e14Article in journal (Refereed)
    Abstract [en]

    Background: Satisfaction with antenatal care could differ depending on the organisation and the context of care. Aim: To compare antenatal care in Australia and Sweden, to identify deficiencies in the content of antenatal care and what aspects contributed most in dissatisfaction with antenatal care. Methods: A longitudinal survey of 123 Australian and 386 Swedish women recruited during one year in regional hospitals in Sweden and Australia. Data collected by three questionnaires. Results: Women in Australia had more antenatal visits, less continuity of midwife caregiver but were more satisfied with antenatal education and the emotional aspects of antenatal care. Although the overall satisfaction was high, deficiencies were found in more than half of the studied variables in the content of care. Women in Sweden were more dissatisfied with information about labour and birth (OR 3.1; 1.8-5.3) and information about the time following birth (OR 3.8; 2.2-6.3), but more satisfied with the involvement of the father (OR 0.3; 0.2-0.6). Factors that contributed most to dissatisfaction with antenatal care overall were deficiency in information about pregnancy related issues (OR 3.4; 1.3-8.7) and not being taken seriously by the midwife (OR 4.1; 1.6-10.1). Conclusion: Satisfaction with antenatal care was high in both groups of women. Australian women were more satisfied than the Swedish women with the emotional aspects of care. Deficiencies were found in more than half of the variables measured relating to the specific aspects of care. Lack of information and not being treated seriously were important factors for not being satisfied.

  • 44.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala University, Dept Womens & Childrens Hlth, Uppsala.
    Haines, Helen
    Uppsala University, Dept Womens & Childrens Hlth, Uppsala; Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Australia.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Nystedt, Astrid
    Umeå University, Dept Nursing, Umeå.
    Presence and process of fear of birth during pregnancy - Findings from a longitudinal cohort study2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 5, p. E242-E247Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of fear of birth has been estimated between 8-30%, but there is considerable heterogeneity in research design, definitions, measurement tools used and populations. There are some inconclusive findings about the stability of childbirth fear. Aim: to assess the prevalence and characteristics of women presenting with scores >= 60 on FOBS-The Fear of Birth Scale, in mid and late pregnancy, and to study change in fear of birth and associated factors. Methods: A prospective longitudinal cohort study of a one-year cohort of 1212 pregnant women from a northern part of Sweden, recruited in mid pregnancy and followed up in late pregnancy. Fear of birth was assessed using FOBS-The fear of birth scale, with the cut off at >= 60. Findings: The prevalence of fear of birth was 22% in mid pregnancy and 19% in late pregnancy, a statistically significant decrease. Different patterns were found where some women presented with increased fear and some with decreased fear. The women who experienced more fear or less fear later in pregnancy could not be differentiated by background factors. Conclusions: More research is needed to explore factors important to reduce fear of childbirth and the optimal time to measure it.

  • 45.
    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.

     

     

  • 46.
    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.

  • 47.
    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.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Fenwick, Jennifer
    Griffith University, Australia.
    Factors associated with a positive birth experience: An exploration of Swedish women‘s experiences2013In: International Journal of Childbirth, ISSN 2156-5287, Vol. 3, no 3, p. 153-164Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The birth of a baby is a powerful life event that has implications for a woman's wellbeing and future health. A positive birth experience promotes a sense of achievement, enhances feeling of self-worth, and facilitates confidence—all of which are important for a healthy adaptation to motherhood and psychological growth. Understanding what constitutes a positive birth experience is critical to providing maternity care that meets childbearing women's individual needs, preferences, and priorities. OBJECTIVE: To explore the prevalence of Swedish women reporting a very positive birth experience 2 months and 1 year after childbirth and identify factors associated with this experience. In addition, the study aimed to identify whether women's assessment of their birth experience changed over time. METHOD: A prospective, longitudinal study where the main outcome variable was perceptions of a very positive birth experience. The study was undertaken in a Northern region of Sweden in 2007. Women were recruited at their ultrasound examination in midpregnancy. Data was collected via questionnaires. There were 928 women who responded to questions about their birth experience at 2 months postpartum. Nearly 83% of these women (n = 763) also completed the questionnaire package 1 year after birth. Descriptive statistics were used together with Friedman's test to detect changes over time. Logistic regression analysis was performed to reveal which factors contributed most to a very positive birth experience. RESULT: More than a third of the women reported a very positive birth experience. Women's assessment of birth changed over time with 22% of the women becoming more positive and 15% more negative. Important associated factors for a very positive birth experience included positive feelings about the approaching birth as well as feeling in control, using no or only cognitive forms of pain management, and achieving a spontaneous vaginal birth. Furthermore, how women rated their midwifery care was also shown to affect their assessment of their birth experience. CONCLUSION: This study found that women's birth experiences changed over time and most becoming more positive after 1 year. Factors associated with a very positive birth experience were related to women's prenatal attitudes, intrapartum procedures, pain relief used, and care received during labor and birth. Respectful individualized midwifery care that remains focused on the woman and keeping birth normal increases positive perceptions of the birth experience.

  • 48.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Haines, Helen
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Univ Melbourne, Rural Hlth Acad Ctr, Melbourne Med Sch, Northeast Hlth Wangaratta Educ & Res Unit, Melbourne, Vic, Australia. Karolinska Inst, Dept Clin Sci & Educ, Stockholm, Sweden..
    Johansson, Margareta
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden..
    Swedish women's interest in models of midwifery care - Time to consider the system?: A prospective longitudinal survey2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, p. 27-32Article in journal (Refereed)
    Abstract [en]

    Background: Sweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care. Methods: A prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated. Results: Approximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife. Conclusions: Continuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way. (C) 2015 Elsevier B.V. All rights reserved.

  • 49.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Nystedt, Astrid
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Parents' experiences of an instrumental vaginal birth findings from a regional survey in Sweden2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 1, p. 3-8Article in journal (Refereed)
    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.

  • 50.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Karlström, Annika
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Nystedt, Astrid
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Women’s experiences of labour induction - findings from a Swedish regional study2011In: 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)
    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.

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