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  • 1.
    Bäck, Lena
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Universitet.
    Sjöqvist, Carina
    Östersunds sjukhus.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Developing competence and confidence in midwifery: focus groups with Swedish midwives2017Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, nr 1, s. E32-E38Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Bäck, Lena
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Sharma, Bharati
    Indian Institute of Public Health Gandhinagar, Gujarat, India.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Tunon, Katarina
    Umeå Universitet; Östersunds Sjukhus.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Universitet.
    Professional confidence among Swedish final year midwifery students: A cross-sectional study2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 14, nr December 2017, s. 69-78Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 3.
    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
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 4, s. 560-567Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. 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
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Nystedt, Astrid
    Umeå University, Dept Nursing, Umeå.
    Presence and process of fear of birth during pregnancy - Findings from a longitudinal cohort study2017Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, nr 5, s. E242-E247Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Johansson, Margareta
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Fenwick, Jennifer
    Griffith University, Australia.
    Factors associated with a positive birth experience: An exploration of Swedish women‘s experiences2013Inngår i: International Journal of Childbirth, ISSN 2156-5287, Vol. 3, nr 3, s. 153-164Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 6.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden..
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    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 survey2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, s. 27-32Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Parents' experiences of an instrumental vaginal birth findings from a regional survey in Sweden2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Women’s experiences of labour induction - findings from a Swedish regional study2011Inngår i: Australian and New Zealand journal of obstetrics and gynaecology, ISSN 0004-8666, E-ISSN 1479-828X, Vol. 51, nr 2, s. 151-157Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för omvårdnad. Uppsala universitet.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för omvårdnad.
    Rubertsson, Christine
    Uppsala universitet; Lund universitet.
    Haines, Helen
    Uppsala universitet; University of Melbourne, Wangaratta, Victoria, Australia.
    Women with fear of childbirth might benefit from having a known midwife during labour2019Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, nr 1, s. 58-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time. Methods: A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth. Results: 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not. Conclusions: Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife–woman relationship rather than counseling per se could be the key issue when it comes to fear of birth. 

  • 10.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Nilson, Christina
    Linné Univ, Växjö, Sweden.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Lundgren, Ingela
    Sahlgrenska Akad, Göteborg, Sweden.
    A Longitudinal Survey of Childbirth-related Fear and Associated Factors2012Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, nr S1, s. 87-88Artikkel i tidsskrift (Annet vitenskapelig)
  • 11.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Nilsson, Christina
    Linnéuniversitetet, Växjö, Sweden.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Lundgren, Ingela
    Sahlgrenska Akademin, Göteborgs Universitet, Sweden.
    A Longitudinal Survey of Childbirth-related Fear and Associated Factors2011Inngår i: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 40, nr 5, s. 532-543Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To investigate the prevalence of childbirth-related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth-related fear.

    Design

    A longitudinal regional survey.

    Setting

    Three hospitals in a northern part of Sweden.

    Participants

    Six hundred ninety-seven (697) women who completed four questionnaires.

    Methods

    Data were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times.

    Results

    There was a statistically significant increase in childbirth fear from 12.4% in mid-pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups.

    Conclusion

    Women with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.

  • 12.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för omvårdnad. Uppsala University, Uppsala.
    Rubertsson, Christine
    Uppsala University, Uppsala.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för omvårdnad.
    Haines, Helen
    Uppsala University, Uppsala; University of Melbourne, Wangaratta, Victoria, Australia.
    A known midwife can make a difference for women with fear of childbirth- birth outcome and women's experiences of intrapartum care2019Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21, s. 33-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: There is evidence that continuity of midwifery care is beneficial to women. Women with fear of childbirth in Sweden are offered counselling, but receiving care from a known midwife during labour is unusual, despite its effects in reducing interventions and increasing birth satisfaction. The aim of this study was to describe and compare birth outcome and experience of intrapartum care among women with fear of childbirth who received intrapartum care from a known midwife, versus those who did not. Methods: An experimental study of 70 women referred to counselling due to fear of birth during pregnancy wherein the counselling midwife, when possible, also assisted during labour and birth. Results: Having a known midwife during labour and birth had a positive impact on fearful women's birth experience and their perception of pain, but there was no difference in onset of labour or mode of birth. Women who received care from a known midwife experienced better care with regards to information, participation in decision making and perception of control. Conclusion: This study indicates that having access to a known midwife might have an impact on women's birth experience. This study was limited by its small sample size and further research would need to randomise fearful women to counselling or continuity of care to determine the contribution of each to reducing fear. 

  • 13.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala University.
    Rubertsson, Christine
    Uppsala University.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Haines, Helen
    Uppsala University; University of Melbourne, Victoria, Australia.
    Caseload midwifery for women with fear of birth is a feasible option2018Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, s. 50-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. Methods: A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. Result: Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. Conclusion: Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided. 

  • 14.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala University, Uppsala, Sweden.
    Rubertsson, Christine
    Uppsala University, Uppsala, Sweden.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Haines, Helen
    University of Melbourne.
    Emotional well-being and the importance for women with fear of birth to have a known midwife at birth2018Inngår i: Journal of Psychology and Mental Health care, E-ISSN 2637-8892, Vol. 2, nr 1, s. 1-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Previous research has shown that women with fear of childbirth often suffer from other mental health issues. Continuity of caregiver through a known midwife is best practice for pregnant women, and women with childbirth related fear value continuity of care. In Sweden the maternity care is fragmented and women’s opinion remains under-investigated.

    Objective: The aim of this study was to investigate emotional well-being and the importance of having a known midwife during birth in women referred to counselling for childbirth related fear.

    Design: Cross sectional study Setting: 3 Swedish hospitals providing counseling for childbirth related fear.

    Participants: Women who were referred for counseling due to fear of childbirth. Measures: The importance of having a known midwife at birth, background factors, emotional well-being and attitudes. Results: 77 women referred to counseling consented to participate. The majority of women were likely to present with previous or ongoing emotional distress, high levels of anxiety or depressive symptoms, low Sense of Coherence and Major worries. For the majority of women (71%) it was important to have a known midwife at birth and most important for women with high levels of childbirth fear.

    Conclusion: This study highlights that women referred to counseling due to fear of childbirth might need additional support to cope with their emotional distress. The results also indicated that having a known midwife at birth was important to these women, especially for women with higher fear. The option of having a known midwife during birth is rarely accomplished in Sweden due to the fragmentation of care.

  • 15.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala University, Uppsala.
    Rubertsson, Christine
    Uppsala University, Uppsala; Lund University, Lund.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Haines, Helen
    Uppsala University, Uppsala; University of Melbourne, Victoria, Australia.
    Exploring the Fear of Birth Scale in a mixed population of women of childbearing age-A Swedish pilot study2018Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, nr 5, s. 407-413Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: The aim of this pilot study was to explore the Fear of Birth Scale in a mixed sample of women of childbearing age, by investigating the levels of childbirth fear and the content of women's thoughts when completing the scale. Methods: A cross-sectional mixed method study of 179 women who completed a short questionnaire and a think aloud interview. Results: The mean score of the Fear of Birth Scale was 40.80 (SD 27.59) and 28.5% were classified as having fear of childbirth (≥60). The internal consistency showed a Cronbach's α. >. 0.92, and a mean inter-item correlation of 0.85.The highest scores were found in women younger than 25 years (mean 60.10), foreign-born women (mean 54.30) and women who did not have any previous children (48.72). The lowest scores were found in women who had recently given birth (mean 34.82) and women older than 35 years (mean 34.85). The content analysis categorization matrix clearly accommodated all 436 statements into the five pre-existing categories. The largest categories were: the content of fear and worry with 138 statements and strategies to cope with fear or worry (122 statements). Conclusion: The Fear of Birth Scale seems to be a useful instrument for different subgroups of women. The construct of fear of childbirth may be universally understood and experienced by women of childbearing age irrespective of whether they are currently pregnant, have recently given birth or do not have children. Identifying fear of birth is important in clinical practice in order to support women's reproductive needs. 

  • 16.
    Hildingsson, Ingegerd
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap. Karolinska Inst, Dept Women & Child Hlth, Stockholm, Sweden.
    Thomas, Jan
    Kenyon college, Gambier, Ohio.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap. Sundsvall Hosp, Dept Obstet & Gynaecol, Sundsvall, Sweden.
    Engström-Olofsson, Regina
    Sundsvall Hosp, Dept Obstet & Gynaecol, Sundsvall, Sweden.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Childbirth thoughts in mid-pregnancy: Prevalence and associated factors in prospective parents.2010Inngår i: Sexual and Reproductive HealthCare, ISSN 0195-9255, Vol. 1, nr 2, s. 45-53Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 17.
    Johansson, Margareta
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Rådestad, Ingela
    Department of Caring Sciences, Sophiahemmet University College.
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Few fathers-to-be prefer caesarean section for the birth of their baby2009Konferansepaper (Fagfellevurdert)
  • 18.
    Johansson, Margareta
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Rådestad, Ingela
    Institutionen för vård- och folkhälsovetenskap, School of Health, Care and Welfare, Mälardalens Högskola.
    Rubertsson, Christine
    Kvinnor och barns hälsa, Department of Women's and Children's Health, Uppsala universitet.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Few fathers-to-be prefer caesarean section for the birth of their baby2010Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 117, nr 6, s. 761-764Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to investigate prospective fathers' preferences for caesarean section and associated factors. Data were collected by means of a questionnaire given in mid-pregnancy to 1105 fathers-to-be in northern Sweden. In total, 6.4% of fathers preferred a caesarean section. The factors associated with a preference for caesarean section were a wish to plan the date of the baby's birth [prevalence ratio (PR) 6.0], a previous negative birth experience (PR 8.6) and previous experience of a caesarean section (PR 5.7).

  • 19.
    Johansson, Margareta
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Rådestad, Ingela
    Department of Caring Sciences, Sophiahemmet University College.
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Pappors önskemål om kejsarsnitt2009Konferansepaper (Fagfellevurdert)
  • 20.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Kejsarsnitt utan medicinsk indikation: Attityder, förekomst och önskemål2010Doktoravhandling, med artikler (Annet vitenskapelig)
  • 21.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Women's self-reported experience of unplanned caesarean section: Results of a Swedish study2017Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 50, s. 253-258Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 22.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Engström-Olofsson, Regina
    Norbergh, Karl-Gustaf
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Sjöling, Mats
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Postoperative pain after cesarean birth affects breastfeeding and infant care2007Inngår i: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 36, nr 5, s. 430-440Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study women's experience of postoperative pain and pain relief after cesarean birth and factors associated with pain assessment and the birth experience. DESIGN: Descriptive patient survey. Data were collected through a questionnaire. The outcome variables were assessments of pain using a Visual Analog Scale and women's birth experience measured on a seven-point Likert scale. SETTING: Central Swedish county hospital, maternity unit. PATIENTS/PARTICIPANTS: The sample consisted of 60 women undergoing cesarean birth. RESULTS: Women reported high levels of experienced pain during the first 24 hours. Seventy-eight percent of the women scored greater than or equal to 4 on the Visual Analog Scale, which can be seen as inadequately treated pain. There was no difference between elective and emergency cesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. The risk of a negative birth experience was 80% higher for women undergoing an emergency cesarean birth compared with elective cesarean birth. Postoperative pain negatively affected breastfeeding and infant care. CONCLUSIONS: There is a need for individual and adequate pain treatment for women undergoing cesarean birth, as high levels of pain interfere with early infant care and breastfeeding.

  • 23.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Engström-Olofsson, Regina
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Sjöling, Mats
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Women's postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesareansection2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 9-10, s. 1326-1334Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim.

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

    Background.

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

    Design.

    Comparative patient survey.

    Methods.

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

    Results.

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

    Conclusions.

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

    Relevance to clinical practice.

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

  • 24.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Engström-Olofsson, Regina
    Thomas, Jan
    Kenyon college, Department of sociology.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Swedish caregivers’ attitudes towards caesarean section on maternal request2009Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 22, nr 2, s. 57-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Caesarean section (CS) is not an option that women in Sweden can chose themselves, although the rise in CS rate has been attributed to women. This study describes obstetricians’ and midwives’ attitudes towards CS on maternal request. Methods A qualitative descriptive study, with content analysis of 5 focus group discussions where 16 midwives and 9 obstetricians participated. Results The overarching theme was identified as “Caesarean section on maternal request—a balance between resistance and respect”. On the one hand, CS was viewed as a risky project; on the other hand, request for a CS was understood and respected when women had had a previous traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear. Five categories were related to the theme. Overall, our findings indicate that caregivers blamed the women for the increase, they considered the management of CS on maternal request difficult, and they suggested preventive methods to reduce CS and means to strengthen their professional roles. Key conclusions and implication for practice Both midwives and obstetricians considered the management of CS on maternal request difficult, and the result showed that they balanced between resistance and respect. The result also showed that the participants stressed the importance of professionals advocating natural birth with evidence-based knowledge and methods to prevent maternal requests. Ongoing discussions among health professionals on attitudes and practice would strengthen their professional roles and lead to a decrease in CS rates in Sweden.

     

     

     

     

    Background:

     

     

    Caesarean section (CS) is not an option that women in Sweden can chose themselves,

    although the rise in CS rate has been attributed to women. This study describes

    obstetricians’ and midwives’ attitudes towards CS on maternal request.

     

    Methods:

     

     

    A qualitative descriptive study, with content analysis of 5 focus group discussions where

    16 midwives and 9 obstetricians participated.

     

    Results:

     

     

    The overarching theme was identified as ‘‘Caesarean section on maternal request–—a

    balance between resistance and respect’’. On the one hand, CS was viewed as a risky project; on the

    other hand, request for a CS was understood and respected when women had had a previous

    traumatic birth experience. Still, a CS was not really seen as a solution for childbirth related fear.

    Five categorieswere related to the theme.Overall, our findings indicate that caregivers blamed the

    women for the increase, they considered the management of CS on maternal request difficult, and

    they suggested preventive methods to reduce CS and means to strengthen their professional roles.

     

    Key conclusions and implication for practice:

     

     

    Both midwives and obstetricians considered the

     

     

  • 25.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Lindgren, Helena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Maternal and infant outcome after caesarean section without recorded medical indication: Findings from a Swedish case-control study2013Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, nr 4, s. 479-486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To compare maternal complications and infant outcomes for women undergoing elective caesarean sections based on a maternal request and without recorded medical indication with those of women who underwent spontaneous onset of labour with the intention to have a vaginal birth. Design Retrospective register study. Setting Sweden; Medical Birth Register used for data collection. Methods A case-control study of 5877 birth records of women undergoing caesarean sections without medical indication and a control group of 13 774 women undergoing births through spontaneous onset of labour. The control group was further divided into women who actually had a vaginal birth and women who ended up with an emergency caesarean section. Results Maternal complications occurred more frequently among women undergoing caesarean section with odds ratios (OR) for bleeding complications of 2.5 (95% CI 2.1-3.0) in the elective caesarean group and 2.0 (95% CI 1.5-2.6) in the emergency caesarean group. The OR for infections was 2.6 in both groups. Breastfeeding complications were most common in women having an elective caesarean section: 6.8 (95% CI 3.2-14.5). Infant outcomes showed a higher incidence of respiratory distress with an OR of 2.7 (95% CI 1.8-3.9) in the elective caesarean section group compared with infants born by emergency caesarean section. The risk of hypoglycaemia was at least twice as high for infants in the caesarean group. Conclusions Caesarean sections without medical indication as well as emergency caesarean sections were associated with higher risks for maternal and infant morbidity.

  • 26.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    A comparative study of the experience of childbirth between women who preferred and had a caesarean section and women who preferred and had a vaginal birth2011Inngår i: Sexual and reproductive healthcare, ISSN 1877-5756, Vol. 2, nr 3, s. 93-99Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 27.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Nystedt, Astrid
    Umea Univ, Dept Nursing, Umea, Sweden.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    The meaning of a very positive birth experience: focus groups discussions with women2015Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, nr 1, artikkel-id 251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The experience of giving birth has long-term implications for a woman’s health and wellbeing. The birth experience and satisfaction with birth have been associated with several factors and emotional dimensions of care and been shown to influence women’s overall assessment. Individualized emotional support has been shown to empower women and increase the possibility of a positive birth experience. How women assess their experience and the factors that contribute to a positive birth experience are of importance for midwives and other caregivers. The aim of this study was to describe women’s experience of a very positive birth experience.

    Method

    The study followed a qualitative descriptive design. Twenty-six women participated in focus group discussions 6–7 years after a birth they had assessed as very positive. At the time of the birth, they had all taken part in a large prospective longitudinal cohort study performed in northern Sweden. In the present study, thematic analysis was used to review the transcribed data.

    Results

    All women looked back very positively on their birth experience. Two themes and six sub-themes were identified that described the meaning of a very positive birth experience. Women related their experience to internal (e.g., their own ability and strength) and external (e.g., a trustful and respectful relationship with the midwife) factors. A woman’s sense of trust and support from the father of the child was also important. The feeling of safety promoted by a supportive environment was essential for gaining control during birth and for focusing on techniques that enabled the women to manage labour.

    Conclusion

    It is an essential part of midwifery care to build relationships with women where mutual trust in one another’s competence is paramount. The midwife is the active guide through pregnancy and birth and should express a strong belief in a woman’s ability to give birth. Midwives are required to inform, encourage and to provide the tools to enable birth, making it important for midwives to invite the partner to be part of a team, in which everyone works together for the benefit of the woman and child.

  • 28.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Johansson, Margareta
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Behind the myth - few women prefer caesarean section in the absence of medical or obstetrical factors2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 5, s. 620-627Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 29.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Rising Holmström, Malin
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Parental  groups during pregnacy and the child's first year: Swedish parents' experiences2019Inngår i: The Journal of Perinatal Education, ISSN 1058-1243, Vol. 28, nr 1, s. 19-27Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 30.
    Karlström, Annika
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Rådestad, Ingela
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Eriksson, Carola
    Inst. för allmänmecicin, Umeå Universitet.
    Rubertsson, Christine
    Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Nystedt, Astrid
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study2010Inngår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, nr 1, s. 11-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background:

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

    Methods:

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

    Results:

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

    Conclusions:

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

  • 31.
    Kristiansen, Lisbeth
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Rising Holmström, Malin
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Boman, Niklas
    Jonsson, Cathrin
    Olofsson, Niclas
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    A health promotion intervention strengthening Swedish high school students' wellbeing: A feasibility study2018Inngår i: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827, Vol. 13, nr 6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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

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

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

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

  • 32.
    Larsson, Birgitta
    et al.
    Uppsala University; Sundsvall Hospital.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för omvårdnad. Uppsala University.
    Ternström, Elin
    Uppsala University.
    Rubertsson, Christine
    Uppsala University; Lund University.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för omvårdnad.
    Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study2019Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, nr 1, s. e88-e94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women's views about counselling for childbirth fear. Aim: To explore women's experiences of midwife-led counselling for childbirth fear. Method: A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth. Findings: The overarching theme ‘Midwife-led counselling brought positive feelings and improved confidence in birth’ was identified. This consisted of four themes describing ‘the importance of the midwife’ and ‘a mutual and strengthening dialogue’ during pregnancy. ‘Coping strategies and support enabled a positive birth’ represent women's experiences during birth and ‘being prepared for a future birth’ were the women's thoughts of a future birth. Conclusions: In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable. 

  • 33.
    Larsson, Birgitta
    et al.
    Uppsala Univ, Dept Womens & Childrens Hlth Obstet & Gynecol, S-75185 Uppsala, Sweden.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Mid Sweden Univ, Dept Nursing Sci, S-85170 Sundsvall, Sweden..
    Rubertsson, Christine
    Uppsala Univ, Dept Womens & Childrens Hlth Obstet & Gynecol, S-75185 Uppsala, Sweden.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Univ, Dept Womens & Childrens Hlth Obstet & Gynecol, S-75185 Uppsala, Sweden.
    Counseling for childbirth fear - a national survey2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, s. 82-87Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Counseling by experienced midwives is offered to women with childbirth fear in most obstetric clinics in Sweden, but information about the content of such counseling is lacking. Aim: To study comprehensiveness, content and organization of the midwife-led counseling for childbirth fear in all obstetric clinics in Sweden. Methods: In this cross-sectional study, data were collected using a questionnaire sent to all obstetric clinics in Sweden (n =45); a total of 43 clinics responded. Descriptive and one-way ANOVA was used in the analysis. Results: All responding obstetric clinics in Sweden offer midwife-led counseling to women with childbirth fear. Major differences were found regarding the time allocated to counseling, with a range between 5.7 and 47.6 minutes per childbirth. Supplementary education for midwives and the availability of treatment options varied at the different clinics and were not associated with the size of the clinic. Conclusion: The midwife-led counseling conducted at the different Swedish obstetric clinics showed considerable disparities. Women with childbirth fear would benefit from care on equal terms irrespective of place of residence. Consequently, it would be valuable to develop a national healthcare program for childbirth fear.

  • 34.
    Larsson, Birgitta
    et al.
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Rubertsson, Christine
    Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    The effects of counseling on fear of childbirth2015Inngår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, nr 6, s. 629-636Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    ObjectiveTo investigate women's experiences of attending existing counseling programs for childbirth-related fear and the effect of this counseling over time. DesignA longitudinal survey. SettingThree hospitals in the central north of Sweden. SampleA selected sample of 936 women. Of these, 70 received counseling due to fear of childbirth (study-group). MethodsData were collected with questionnaires 2months and 1year after giving birth with background data collected during midpregnancy. Comparisons were made between women with or without counseling. Crude and adjusted odds ratios (OR) were calculated. Main outcome measuresSelf-reported childbirth fear, experience of counseling, birth experience and preferred mode of birth. ResultsWomen in the counseling group reported higher childbirth fear 1year after giving birth (OR 5.0, 95% confidence interval (95% CI) 2.6-9.3), they had a more negative birth experience that did not change over time (OR 2.1, 95% CI 1.2-3.9) and they preferred cesarean section to a greater extent (OR 12.0, 95% CI 5.1-28.1) in the case of another birth. Also, they were more often delivered by planned cesarean section (OR 4.7, 95% CI 2.4-9.1). However, 80% were satisfied with the given support. ConclusionAlthough women were satisfied with the treatment, this study shows that counseling had a minor effect on fear of childbirth, birth experiences or cesarean section rates. To help women with their fear of childbirth, more effective methods of treatment are needed.

  • 35.
    Larsson, Birgitta
    et al.
    Uppsala University, Uppsala; Sundsvall Hospital.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Rubertsson, Christine
    Uppsala University, Uppsala.
    Ternström, Elin
    Uppsala University, Uppsala.
    Ekdahl, Johanna
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Segebladh, Birgitta
    Uppsala University, Uppsala.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala University, Uppsala.
    Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial2017Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, nr 6, s. 460-467Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason. The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment. Methods: Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n = 258) were recruited at one university hospital and two regional hospitals over one year. The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n = 127) or standard care (face-to-face counselling) (n = 131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth. Results: Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience. Conclusion: Women's birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research.

  • 36.
    Nilsson, Christina
    et al.
    Linnéuniversitetet.
    Lundgren, Ingela
    Sahlgrenska Akademin, Göteborgs Universitet.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Institutionen för hälsovetenskap.
    Self reported fear of childbirth and its association with women's birth experience and mode of delivery: A longitudinal population based study2012Inngår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 25, nr 3, s. 114-121Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore fear of childbirth (FOC) during pregnancy and one year after birth and its association to birth experience and mode of delivery. Design: A longitudinal population-based study. Population: Pregnant women who were listed for a routine ultrasound at three hospitals in the middle-north part of Sweden. Method: Differences between women who reported FOC and who did not were calculated using risk ratios with a 95% confidence interval. In order to explain which factors were most strongly associated to suffer from FOC during pregnancy and one year after childbirth, multivariate logistic regression analyses were used. Results: FOC during pregnancy in multiparous women was associated with a previous negative birth experience (RR 5.1, CI 2.5-10.4) and a previous emergency caesarean section (RR 2.5, CI 1.2-5.4). Associated factors for FOC one year after childbirth were: a negative birth experience (RR 10.3, CI 5.1-20.7), fear of childbirth during pregnancy (RR 7.1, CI 4.4-11.7), emergency caesarean section (RR 2.4, CI 1.2-4.5) and primiparity (RR 1.9, CI 1.2-3.1). Conclusion: FOC was associated with negative birth experiences. Women still perceived the birth experience as negative a year after the event. Women's perception of the overall birth experience as negative seems to be more important for explaining subsequent FOC than mode of delivery. Maternity care should focus on women's experiences of childbirth. Staff at antenatal clinics should ask multiparous women about their previous experience of childbirth. So that FOC is minimized, research on factors that create a positive birth experience for women is required. © 2011 Australian College of Midwives.

  • 37.
    Panda, Sunita
    et al.
    Trinity College Dublin, School of Nursing & Midwifery, Dublin, Ireland.
    Daly, Deirdre
    Trinity College Dublin, School of Nursing & Midwifery, Dublin, Ireland.
    Begley, Cecily
    Trinity College Dublin, School of Nursing & Midwifery, Dublin, Ireland; Univ Gothenburg, Sahlgrenska Acad, Gothenburg.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Larsson, Birgitta
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Bäck, Lena
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala.
    Factors influencing decision-making for caesarean section in Sweden - a qualitative study2018Inngår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, nr 1, artikkel-id 377Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. Methods: A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo (c) and thematically analysed. Ethical approval was granted by Trinity College Dublin. Results: The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but ...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. Conclusion: Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.

  • 38.
    Rondung, Elisabet
    et al.
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Ternström, Elin
    Uppsala University.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala University.
    Haines, Helen M
    The University of Melbourne, Victoria, Australia.
    Sundin, Örjan
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Ekdahl, Johanna
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Larsson, Birgitta
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Segeblad, Birgitta
    Uppsala University.
    Baylis, Rebecca
    Uppsala University.
    Rubertsson, Christine
    Uppsala University; Lund University.
    Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial.2018Inngår i: JMIR mental health, ISSN 2368-7959, Vol. 5, nr 3, artikkel-id e10420Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care.

    OBJECTIVE: This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth.

    METHODS: This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale.

    RESULTS: We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03).

    CONCLUSIONS: Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).

  • 39.
    Ternström, Elin
    et al.
    Uppsala University, Uppsala.
    Hildingsson, Ingegerd
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad. Uppsala University, Uppsala.
    Haines, Helen
    University of Melbourne, Victoria, Australia.
    Karlström, Annika
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Sundin, Örjan
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Ekdahl, Johanna
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Segeblad, Birgitta
    Uppsala University Hospital, Uppsala.
    Larsson, Birgitta
    Uppsala University, Uppsala; Sundsvall Hospital, Sundsvall.
    Rondung, Elisabet
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för psykologi.
    Rubertsson, Christine
    Uppsala University, Uppsala.
    A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth – A study protocol2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, s. 75-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

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