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  • 1.
    Andersson, Sara
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Arvén, Madeléne
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Kvinnors upplevelser samt behov av omvårdnad vid inducerad abort2008Student thesis
    Abstract [sv]

    Bakgrund: Ordet abort kommer från det latinska ordet aboriri som betyder att förgås eller att gå ned. Ungefär hälften av alla kvinnor i Sverige gör någon gång en abort. Enligt den svenska abortlagen har kvinnan ett fritt val till abort och måste själv komma fram till det bästa beslutet. I denna process förtjänar hon stöd och respekt, oavsett hur hon valt att hantera sitt moderskap. Syfte: Syftet med denna litteraturstudie var att belysa kvinnors upplevelser samt behov av omvårdnad vid inducerad abort. Metod: Studien genomfördes som en litteraturstudie där 16 artiklar inkluderades och som granskades. Resultat: Resultatet visade att de vanligaste orsakerna till att kvinnor genomförde en inducerad abort var på grund av ekonomiska skäl, en ostabil relation och arbetsförhållanden. Kvinnors upplevelser vid inducerad abort var att de kände både positiva och negativa känslor. De positiva var bland annat; lättnad, ökad självkänsla och personlig mognad. De negativa känslorna var bland andra; skuld, oro och nedstämdhet. När det gällde behovet av stöd från vårdpersonalen kände de att personalen var stöttande och informativa men även att de kunde vara kalla och ignorerande. Slutsats: Det behövs mer forskning inom området, behov av stöd till kvinnor som genomgår en inducerad abort, för att vårdpersonalen ska kunna bemöta kvinnorna på bästa möjliga sätt.

  • 2.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    HPV-Vaccination av svenska flickor; HPV-Vaccination av vuxna kvinnor och män: [HPV-vaccination of Swedish girls; HPV-vaccination of adult women and men].2011Report (Other academic)
  • 3.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Paracetamol till barn och gravida – försiktighetsprincipen bör råda: Var återhållsam med paracetamol medan riskerna för adhd och astma utreds2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 34-35, p. 1350-Article in journal (Refereed)
  • 4.
    Erixon, Caroline
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Holm, Sara
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Förlossningsrädsla: Stöd till kvinnor med förlossningsrädsla2008Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    De senaste åren har antalet kejsarsnitt på humanitär indikation ökat i Sverige. Den vanligaste bidragande orsaken till detta är förlossningsrädsla. Med förlossningsrädsla menas att man känner ångest och fruktan inför sin förlossning.

    Syftet med denna litteraturstudie är att belysa faktorer som kan påverka upplevelsen av förlossningsrädsla samt vilket behov av stöd förlossningsrädda kvinnor behöver. Metoden som användes var en systematisk litteraturstudie som omfattade 16 vetenskapliga artiklar. Vid granskningen av dessa artiklar bildades två huvudkategorier, dessa var; upplevelser och stöd. Resultatet visade att den vanligaste upplevelsen vid förlossningsrädsla var rädsla för smärta och oron för sin och sitt barns hälsa och välmående. Förlossningsförloppet var också något som orsakade rädsla hos vissa kvinnor. Mest utsatta för förlossningsrädsla var kvinnor som led av dålig självkänsla och tvivlade på sin prestationsförmåga. Kvinnans tidigare erfarenheter spelade en stor roll vid upplevelsen av förlossningen. Den bästa vård förlossningsrädda kvinnor kan få är stöd från sin omgivning och vårdpersonal. Den mest framgångsrika behandlingsmetod enligt denna litteraturstudie var terapi.

    En slutsats blev att det är viktigt att upptäcka kvinnans förlossningsrädsla i ett tidigt stadium och att omvårdnaden är individualiserad.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    Karlström, Annika
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Lindgren, Helena
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Maternal and infant outcome after caesarean section without recorded medical indication: Findings from a Swedish case-control study2013In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 4, p. 479-486Article in journal (Refereed)
    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.

  • 11.
    Khalife, Natasha
    et al.
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Glover, Vivette
    Univ London Imperial Coll Sci Technol & Med, Inst Reprod & Dev Biol, London, England.
    Taanila, Anja
    Univ Oulu, Inst Hlth Sci, Oulu, Finland.
    Ebeling, Hanna
    Univ Oulu, Clin Child Psychiat, Inst Clin Med, Oulu, Finland.
    Jarvelin, Marjo-Riitta
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Prenatal Glucocorticoid Treatment and Later Mental Health in Children and Adolescents2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. Art. no. e81394-Article in journal (Refereed)
    Abstract [en]

    Background: Animal studies demonstrate a clear link between prenatal exposure to glucocorticoids (GC) and altered offspring brain development. We aim to examine whether prenatal GC exposure programs long-term mental health in humans. Methods: Using propensity-score-matching, children prenatally exposed to synthetic glucocorticoids (sGC), n=37, and controls, n=185, were balanced on important confounders related to sGC treatment - gestational age and pre-pregnancy BMI. We also used mixed-effects modeling to analyse the entire cohort - matching each sGC case, n=37, to all possible controls, n=6079, on gestational age and sex. We obtained data from the Northern Finland Birth Cohort 1986 at four waves - pregnancy, birth, 8 and 16 years. Data on pregnancy and birth outcomes came from medical records. Mental health was assessed at 8 years by teachers with the Rutter B2 scale, and at 16 years by parents with the Strengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) scale and adolescents by the Youth Self-Report (YSR) scale. Results: Prenatal sGC treatment was consistently associated with adverse mental health in childhood and adolescence, as shown by both the propensity-score method and mixed-effects model. Using the propensity-score-matched subsample, linear multiple regression showed prenatal sGC was significantly linked with general psychiatric disturbance (B=8.34 [95% CI: .23-16.45]) and inattention (B=.97 [95% CI:. 16-1.80]) at 8 years after control for relevant confounders. Similar findings were obtained at 16 years, but did not reach statistical significance. Mediation by birthweight/placental weight was not detected. Conclusions: This study is the first to prospectively investigate the long-term associations between prenatal exposure to sGC treatment and mental health in children and adolescents. We report an association between prenatal exposure to sGC and child mental health, supportive of the idea that sGC has a programming effect on the fetal brain.

  • 12.
    Larsson, Birgitta
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Treatment för childbirth fear with a focus on midwife-led counselling: A national overview, women´s birth preferences and experiences of counselling2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being.

    Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling.

    MethodsStudy I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy.

    Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden.

    Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.  

  • 13.
    Samuelsson, Eva
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Victor, Arne
    Svärdsudd, Kurt
    Determinants of urinary incontinence in a population of young and middle-aged women2000In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 79, no 3, p. 208-215Article in journal (Refereed)
    Abstract [en]

    Background. Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population-based sample of young and middle-aged women. Methods. Of 641 eligible women aged 20-59 years in a primary health care district, 487 (76%) responded to a questionnaire and accepted an invitation to a gynecological examination. The examination included digital assessment of the pelvic floor muscle strength (PFMS). Genital prolapse presence (cystocele, rectocele, uterine prolapse or absence of the urethrovesical crease) was graded in relation to the vaginal introitus. Results. The prevalence of urinary incontinence was 28%, 3.5% having daily leakage. Stress urinary incontinence was the dominant type. The odds ratio (OR) of having incontinence increased From 1 to 3.5 with increasing age and From 1 to 2.7 with increasing parity. The OR also increased with decreasing PFMS; from 1 in the group with the best PI;MS to 3.4 in the group unable to contract their pelvic musculature. In addition. women with cystocele and/or absence of the urethrovesical crease had a 2.5-fold increased OR of incontinence (95% CI 1.5-4.2), smoking increased the OR 1.9 times (95% CI 1.1-3.2) and estrogen replacement therapy (ERT) increased the OR 2.9 times (95% CI 1.4-5.9). There were no significant correlations with the presence of chronic disease, episiotomy or the birth weights of children but small non-significant correlations with performed hysterectomy and the woman's weight. Conclusions. Urinary incontinence is a frequent symptom in the female general population and related to age, pelvic floor muscle strength, genital prolapse, smoking, parity and estrogen replacement therapy.

  • 14.
    Thomtén, Johanna
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden .
    Living with genital pain: Sexual function, satisfaction, and help-seeking among women living in Sweden2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 1, p. 19-25Article in journal (Refereed)
    Abstract [en]

    Background and aims: Female genital pain is a debilitating problem that negatively affects several aspects of the life of women. Several studies present figures of prevalence indicating that the problem affects nearly 20% of young women. However, many women fail to consult health care and the estimated prevalence therefore remains insecure. Historically, genital pain was commonly viewed as either physiological or psychosexual. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, less is known about the manifestation of the problem in everyday life and the experience of seeking health care among afflicted women. The objectives of the present study was to examine genital pain in a general female population living in Sweden cross-sectionally in terms of prevalence, sexual function, sexual satisfaction and help seeking, and to identify possible predictors of genital pain among women. Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18--35). Of these 944 (response rate: 23%) took part in the study. Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain more commonly reported fungal infections, other pain problems, sexual dysfunctions and symptoms of anxiety than pain-free women and in addition lower sexual satisfaction. There were no differences in sexual frequency. Pain was most commonly reported during sexual intercourse, but many women also experienced pain during non-sexual activities, with pain durations of several hours after the pain eliciting activity was interrupted. Of those reporting pain, 50% had sought care for their pain. The most common was to counsel a doctor and to receive topical treatment. However, the experienced effects of the treatments were on average low. In the explanatory model, fungal infections, and sexual dysfunctions were associated with genital pain. Conclusions: The study had a low response rate, but still indicates that genital pain is common and negatively affects several aspects of women' life, not just sexual activities. Although many women report pro-longed pain experiences, many fail to consult health care and among those who seek care the effects of treatment are on average poor. There are strong associations between sexual dysfunctions (lack of sexual arousal, vaginal muscle tension hindering intercourse) and genital pain that, based on previous findings in this field of research, might be viewed in terms of circular maintaining processes. Implications: Female genital pain is not just limited to the sexual context, but often negatively affects several situations in women' life. The size of the problem calls for immediate development of preventive interventions and treatment programs that focus on sexual education and to encourage a healthy sexuality among women and their partners. There is a need to identify methods in order to assemble evidence based interventions of female genital pain. Such methods are currently lacking, resulting in poor treatment options for women with pain. © 2013 Scandinavian Association for the Study of Pain.

  • 15.
    Thomtén, Johanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Center for Health and Medical Psychology (CHAMP), School of Law, Psychology and Social Work, Örebro University, Sweden.
    Karlsson, Andreas
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Psychological factors in genital pain: The role of fear-avoidance, pain catastrophizing and anxiety sensitivity among women living in Sweden2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 3, p. 193-199Article in journal (Refereed)
    Abstract [en]

    Objectives: One in five women under the age of 30 report recurrent genital pain and pain during sexual intercourse. Female genital pain negatively affects sexual and general health, as well as dyadic function and quality of life. Although the current field of research and clinical expertise in general agree upon a biopsychosocial conceptualization, there is still a lack of theoretical models describing the psychosocial mechanisms involved in the development of genital pain. Originally developed to outline the transition from acute to chronic back pain, the fear avoidance (FA) model has lately been proposed as a possible tool in illustrating the mechanisms involved in genital pain. However, only few studies have empirically tested the components of the FA model empirically. The aim of the present study is to examine fear avoidance beliefs, pain catastrophizing, and symptoms of depression and anxiety among women reporting genital pain, and to relate these concepts to sexual satisfaction/function and the characteristics of pain. Methods: The study was a population-based study using a postal questionnaire administered to 4052 women (age 18-35). Of these 944 (response rate: 23%) took part in the study. Results: Genital pain of six months duration was reported by 16.1% of the women. Women with pain reported elevated levels of symptoms of anxiety, fear avoidance beliefs, pain catastrophizing and anxiety sensitivity. Symptoms of anxiety also predicted pain in the explanatory model together with vaginal tension and fungal infection. Vaginal tension has previously been described as a fear-response to painful intercourse and the results thereby seem to give further support to viewing genital pain from a fear avoidance perspective. Furthermore, fear avoidance beliefs seem to be of similar importance as lack of desire for the experience of sexual satisfaction and could also predict pain during specific activities among women with pain. The results also indicate that sexual satisfaction is related to a specific pain-related fear, rather than a heightened level of general anxiety. Conclusions: The study had a low response rate, but still indicates that genital pain is common and is associated with several aspects of fear and avoidance. In sum, the results support the FA model by giving strong support for fear reactions (vaginal tension) and fear avoidance beliefs, and moderate support for negative affect. In the model negative affect drives pain catastrophizing. Implications: It seems that the experience of genital pain among women in the general population is common and could be associated with increased levels of anxiety and fear-avoidance beliefs. However, the associations should not be understood in isolation from physiological mechanisms but seem to indicate interactions between, e.g. fungal infections, negative appraisals of pain and symptoms, lack of sexual function and satisfaction and increased pain experience. It is possible that psychological mechanisms work in the transition from acute physiological pain to chronic psychologically maintained pain in terms of secondary reactions to, e.g. repeated fungal infections by adding emotional distress, fear of pain and avoidance behaviours. © 2014 Scandinavian Association for the Study of Pain.

  • 16.
    Thomtén, Johanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden .
    Linton, S. J.
    Center for Health and Medical Psychology (CHAMP), Örebro University, Sweden .
    When sex hurts: Female genital pain with sexual consequences deserves attention: A position paper2014In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 5, no 3, p. 202-205Article in journal (Refereed)
    Abstract [en]

    Background and aims: The problem of sexual pain is an area that has been shamefully ignored by both the pain community and the health service authorities. Although about 40% of women report such pain and 30% report it during their last intercourse, sexual pain has historically not even been considered a pain problem. The objectives of the present study was to present a background to the problem of female sexual pain, further elaborate on the problem and offer some direction for how advances might be concretely made. Discussion: Genital pain is common and many women describe pain during several non-sexual activities. Therefore describing the pain strictly as a sexual problem, threatens to lose important information about the experience of pain which will be misleading both in assessment and treatment. Instead, seeing the problem as a multidimensional pain condition with debilitating sexual consequences is suggested. It has become apparent that although biological aspects are central in the experience of genital pain, psychological and social aspects may play a major role. The fear avoidance model which has played a major role in our understanding of the development of chronic musculoskeletal pain, also seems to be applicable in genital pain conditions. However, one has to be aware of certain differences when comparing genital pain from musculoskeletal conditions. In addition, there is a lack of established guidelines for assessing or treating unexplained genital pain conditions, and there is a risk of not acknowledging the role of socio-cultural context on how female sexuality is viewed. The problem of recurrent sexual pain is a highly volatile, personal, and socially weighted experience. Because of the lack of understanding of the mechanisms, it is a risk of over-emphasizing the role of vaginal penetration in the assessment and treatment of female sexual pain and clinicians may simply fail to investigate sexual function from a broader perspective. Conclusions and implications: There is a growing interest in the problem of female genital pain and associated problems with sexual pain. However, research predominately refers to the field of sex research, and the involvement from the pain community has to date been relatively low. There is an immediate need to identify the psychosocial mechanisms involved in the transition from acute to chronic genital pain in women and to address these components in treatment using established methods. Since sexual pain is far more than pain during vaginal penetration, there is a risk of treatment interventions being oriented towards performance in terms of a narrowly defined sexual behavior instead of focusing on valued activities, meaning and pleasure for the individual. Assessment and treatment have to include a broad perspective on pain and on sex. © 2014 Scandinavian Association for the Study of Pain.

  • 17.
    Tidsjö, Sanna
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Öhman, Emelie
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Förlossningsvård när barnmorskan och kvinnan talar olika språk.: Undersökning bland barnmorskor vid förlossningskliniker i Sverige.2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    People migrating to Sweden has increased during the last decades and as a result of this more women from other countries are giving birth at maternity wards in Sweden. Previous research show that foreign-born women are at greater risk of complications during childbirth and language barrier has been shown to be a contributing factor. The aim of this study was to describe midwives´ experiences of childbirth when the midwife and the women speak different languages. A quantitative method was used and 61 midwives from 11 maternity wards in Sweden answered an online questionnaire. The data was analyzed through descriptive and comparing statistics and was presented in five categories; Resources and tools, The communication, The presence, The care and The prerequisites. The result show that telephone interpreter and relative interpreter was the most commonly used resources by the midwives and that the midwives wanted more resources and tools at their maternity wards. They experienced that communication was a problem and that the women did not get access to equivalent information. They stated that it was more time consuming and harder to estimate the women's need for care and pain relief. They did not think that the women got equivalen care but they believed that the care they were giving was good and that they felt safe in their profession during childbirth. Thru factor analysis the questionnaire can be developed to an instrument that can be used in further studies. Promoting and evolving methods to achieve adequate communication between the midwife and the women can create prerequisites forequivalent care.

  • 18.
    Wiklund, I.
    et al.
    Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Andolf, E.
    Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Lilja, H.
    Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Hildingsson, Ingegerd
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Indications for cesarean section on maternal request - Guidelines for counseling and treatment2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 3, p. 99-106Article, review/survey (Refereed)
    Abstract [en]

    Aim: The aim was to find scientific evidence and, based on this, to develop national medical guidelines in Sweden for cesarean section on mother's request. Background: More than 17% of all births in Sweden in 2008 were cesarean sections, compared to 5% at the beginning of the 1970s. About 8% of the cesarean sections were performed at mother's request. The predominant reason for this preference is fear of childbirth. When deciding whether to perform an elective cesarean section, the obstetrician must emphasize the long- and short-term health consequences for the mother and her baby, as well as weigh the risks associated with the procedure itself against not performing the procedure. Clarification is needed to determine for which conditions it is appropriate to comply with the mother's request. Materials and method: A literature review was conducted to identify factors that were relevant as an argument to meet the request for cesarean section on maternal request. The authors analyzed these factors individually to determine. Findings: The guidelines suggest that it is appropriate to comply with a woman's request for cesarean section if the reason for her request is deemed sufficiently serious and if, after participating in a counseling program, the woman persists in her request for cesarean section. Conclusion: A request for cesarean section where no medical indication is present should not be met without considerations concerning the safety of the mother and her baby, while also weighing the risk of adverse outcomes for mother and baby. © 2012 Elsevier B.V..

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