Mid Sweden University

Background Exclusive breastfeeding during the first six months of life is a global public health recommendation and offers well-established and significant benefits for infant health and development, as well as health benefits for women. Most breastfeeding research focuses on the early postpartum period, despite the WHO recommendations to continue breastfeeding for up to two years or longer. Investigating factors associated with breastfeeding at one year may inform healthcare practices aimed at supporting women to sustain breastfeeding over time. Therefore, the aim of this study was to explore breastfeeding duration and factors associated with breastfeeding at one year after birth, in primiparous women given birth vaginally. Methods This study is a longitudinal cohort based on follow-up data from a multicentre randomized controlled trial at five obstetric units in Sweden. Data were derived from questionnaires sent to women at one month and one year postpartum. Multivariable logistic regression analysis was used to analyze factors associated with breastfeeding at one year after birth, and Kaplan-Meier analysis estimated breastfeeding duration. Results The prevalence of breastfeeding at one year after birth was 31% in this cohort of 1739 women who gave birth vaginally to their first child. The mean duration of breastfeeding was 5.62 months. Exclusive breastfeeding during the first four months (aOR; 2.85; 2.25-3.62), not having Swedish as native language (aOR; 1.69; 1.30-2.18), experiencing a very positive first breastfeeding session (aOR; 1.67; 1.34-2.08) and having a university education (aOR; 1.53 1.17-1.99), were associated with breastfeeding at one year. Conclusions This study highlights the importance of providing breastfeeding support to ensure a very positive first breastfeeding experience, avoiding introduction of formula or solids before four months of age unless medically indicated and including social background factors. Knowledge about factors associated with breastfeeding at one year can inform healthcare interventions aiming to increase breastfeeding in line with national and international recommendations. These factors should be implemented in future breastfeeding support strategies.

Background/Aims

Treatment for fear of birth during pregnancy demonstrates inconsistent results. Continuity models of care show promise in this area. The aim of this study was to evaluate satisfaction with treatment for fear of birth in a midwifery continuity model compared to standard counselling in Sweden.

Methods

A total of 175 purposively sampled women who received care using a continuity of care model between 2021 and 2023 and a historical cohort of 467 women in previous studies who received counselling completed questionnaires about their experiences. Differences between groups were calculated using odds ratios.

Results

Women with fear of birth who experienced the continuity model were more likely to be satisfied with counselling (adjusted odds ratio: 2.26; P=0.043) and report that their fear disappeared or decreased (adjusted odds ratio: 4.03; P=0.002). These women also rated medical (adjusted odds ratio: 2.06; P=0.034) and emotional (adjusted odds ratio: 2.45; P=0.007) aspects of intrapartum care higher than those who received standard counselling.

Conclusions

Women were more satisfied with care received in the continuity model compared to standard counselling.

Implications for practice

Women who fear birth may benefit from receiving care in midwifery continuity models during pregnancy and childbirth. Implementation of such models is encouraged.

Background: The World Health Organization recommends models with midwifery continuity of care for pregnant women, as they have been shown to result in positive outcomes. While some initiatives have been taken to introduce such models into Swedish maternity care, they have not been fully implemented. Therefore, this study aimed to investigate midwifery students' views on implementing midwifery continuity of care within the current maternity healthcare organization in Sweden. Methods: A Swedish national interview study involving 16 midwifery students was conducted in 2023. The data were analyzed using Reflexive Thematic Analysis following Braun and Clarke's method. Results: The midwifery students ranged in age between 27 and 45 years and were in their second or third semester. Their views on implementing midwifery continuity of care within the current Swedish maternity healthcare organization were described by the following themes: Integrating evidence-based midwifery continuity into maternity care; Providing maternity care that respects women's needs for quality care; and Societal and financial prioritization of midwifery continuity of care is crucial. Conclusion: Although the midwifery students held a positive attitude towards implementing midwifery continuity of care within the current Swedish maternity healthcare organization, they also highlighted essential factors that need to be addressed to support increased implementation. 

Introduction: Few parents face stillbirth in Sweden, and knowledge of their long-term grieving and recovery process is limited. The aim of the study was to explore parents' memories, perspectives, reflections, and insights regarding the grieving and recovery process one year after stillbirth.

Methods: This is a mixed-methods study involving nine in-depth interviews and responses to eleven quantitative statements in convergent succession. Data were analyzed using descriptive statistics and thematic network analysis.

Results: Two themes were identified: 1) 'Impossible to close the heavy door to indelible memories of the stillborn baby', and 2) 'The balance of personal and social factors and internal processes enables increased quality of life'. These themes captured parents' individual and ongoing processes of grieving and reflection. One year later, parents affirmed increasing stability in their memories and feelings, although more than half described their mental health as partly good/not good. Some parents disclosed new pregnancies and live births, which, per se, called for increased, structured, safe, and respectful professional healthcare that acknowledges previous experiences of stillbirth. The quantitative statements reinforced qualitative findings and showed that parents usually responded positively to holding the baby, and highlighted the importance of knowing the reason behind the stillbirth.

Conclusions: Bereaved parents experience individual recovery processes, characterized by gradual improvements in quality of life while maintaining a sense of loss for their stillborn baby, one year after the event.

Aim

National guidelines in Sweden suggest that certain ‘priority’ groups of pregnant women, including women with fear of childbirth (FOC), may benefit from increased continuity in midwifery care. Although comorbidity indeed exists between FOC and mental health problems, it might also be mediated by individual resources. The purpose of the study was to identify profiles of women based on FOC, depressive symptoms, major worries and sense of coherence (SOC) and to study those profiles in relation to women’s perceptions of changes occurring during pregnancy.

Methods

A longitudinal cohort study was conducted on 171 pregnant women with FOC or depressive symptoms in a rural area of Sweden, whose care was following a midwifery continuity of care (MCoC) model. After collecting data using two online questionnaires (in mid-pregnancy and 2 months after birth), addressing background and including validated instruments measuring FOC, depressive symptoms, major worries and SOC, a k-means cluster analysis was conducted to define profiles of women.

Results

The three identified clusters: Emotionally healthy, Fearful with resources and Emotionally fragile, showed no differences in socio-demographic background or type of MCoC model. However, major differences did emerge in women’s feelings and perceptions of changes during pregnancy, along with minor differences in health-related variables. Women in the Emotionally fragile cluster had less positive scores for most questionnaire items.

Conclusion

The results indicate levels of vulnerability within certain priority groups. In response, healthcare professionals should examine pregnant women’s backgrounds beyond screening in order to more fully understand their emotional states.

Background: Previously developed instruments measuring the quality of postnatal care, based on women’s experiences and views, are mainly country-specific which makes it important to have studies for specific populations. The aim of this study was to explore validity and reliability evidence of a previously developed postnatal questionnaire for women living in Sweden. Method: A cross-sectional study based on self-report questionnaire. The questionnaire included the Early Postnatal Questionnaire (EPQ), and was administered to 1061 women who gave birth in two regional hospitals in Swedish during 2017. Validity evidence of the EPQ was undertaken using principal component analysis. Regarding reliability, Cronbach’s alpha was used. Results: The questionnaire was returned by 483 postnatal women. The analysis resulted in three components: Information, Postnatal Environment and Caring Relationship. The Cronbach alpha values of the components ranged from 0.762 to 0.879. Foreign-born women scored higher (more positively) in all three components, compared to women born in Sweden. Conclusions: The results of this study suggest that the instrument EPQ is a psychometrically useful tool, suitable for both research and clinical settings. The three-component structure provides researchers with the opportunity to conduct a more detailed exploration of various aspects of postnatal care to develop postnatal care. Further studies focusing on foreign-born women’s experiences of postnatal care are warranted.

Background

The advantages of midwifery continuity models of care during pregnancy, birth, and the postnatal period demonstrated in ‘low-risk’ women may also benefit those with fear of birth. The purpose of the study was to explore women’s assessment of the quality of intrapartum care when participating in a midwifery continuity of care (MCoC) project in a rural area of Sweden. An additional aim was to explore if the care differed between women who had a known midwife during labour and birth, versus not.

Methods

A prospective longitudinal cohort study including 142 women with fear of birth who participated in an MCoC project was performed. Data was collected via two online questionnaires, gathering background data and birth related information. The instrument ‘Quality from the Patients’ Perspective’ was used to assess the perceived reality and the subjective importance of intrapartum care content.

Results

Deficiencies between perceived reality and subjective importance were found in the following aspects of intrapartum care: perception of control (50%), involvement in decision-making (26%), access to preferred pain relief (26%), breastfeeding support (23%), and information about labour progress (22%). The midwife’s presence, involvement of the partner, possibilities to talk through the birth and breastfeeding support was rated better than expected. No major differences were found in the quality of intrapartum care, in relation to continuity.

A total of 75% had a known midwife during labour and birth and were more likely to have had labour induced (aOR 5.31, 95% CI 1.68–16.79), to have used the method ‘Give birth without fear’ (aOR 3.21, 95% CI 1.05–9.83), and to have received an epidural (aOR 3.85, 95% CI 1.51–9.82), compared to women without a known midwife assisting.

Conclusion

The quality of intrapartum care was assessed both deficient and excessive. Few differences were found between women who had a known midwife or not, but women with fear of childbirth who experienced continuity with a known midwife were exposed to more interventions, following Swedish regime to encourage women to have a vaginal birth. Aligning care content with women’s needs and values remains essential to improve satisfaction and outcomes in intrapartum care.

Background: Few parents in Sweden experience stillbirth, and knowledge of their longterm recovery is limited.

Objective: To explore bereaved parents’ memories, reflections and insights into their recovery two years after a stillbirth.

Methods: A mixed-method study involving nine in-depth interviews and responses to eleven quantitative statements. Data were analysed using descriptive statistics and thematic network analysis.

Results: Two themes emerged: ‘Recalled memories and matured reflections of the stillbirth in hindsight’ and ‘Enhancing quality of life during recovery’. These themes captured the parents’ individual experiences of recovery two years after a stillbirth. The bereaved parents described thoughtful and well-formed insights into the loss of their stillborn baby, alongside strategies for enhancing quality of life. One-third of the parents reported their mental health was worse than before the stillbirth, although relationships with partners were still strong and stable, and work was considered highly important. Some parents had subsequently had live births under fortunate circumstances. Despite this, parents expressed a strong belief that the healthcare system should provide individually tailored examinations and check-ups, offering a sense of security and trust through high-quality medical and psychological support for all future pregnancies and births. The qualitative findings were reinforced by the quantitative statements.

Conclusion: Bereaved parents described a process of reconciliation with the stillbirth, accompanied by an enhanced quality of life, which may help mitigate the long-term trauma associated with the loss of their baby, even two years after the event. © 2026

Aim: To investigate midwifery students’ interests and views towards MCoC models and to validate an instrument measuring these views.

Background: Midwifery continuity of care (MCoC) is widely recognised for its benefits to maternal and neonatal health. Despite this, access to MCoC models remains limited in Sweden and midwifery students receive minimal clinical exposure to this model of care.

Design: Mixed-methods cross-sectional study Methods: Data were collected from a national sample of 115 midwifery students in Sweden using an online questionnaire between 2022 and 2023. Descriptive statistics were used to present students' characteristics and interests in MCoC. Questions about students’ views of MCoC models were subjected to a principal component analysis (PCA). For associations between PCA components and students’ socio-demographic characteristics, Analysis of Variance was performed. Free-text responses were thematically analysed.

Results: Midwifery students held strong and positive views about the importance of MCoC and many were interested in working in such a model. However, some expressed concerns about work-life balance. The PCA resulted in two components: Relational aspects and Practical aspects, with Cronbach's alpha values of 0.735 and 0.751, respectively. The free-text responses confirmed the content of the components, with the themes Developing confidence in the professional role, Enhancing midwifery skills and expertise, Stronger relational bond and Challenging work conditions. Few socio-demographic characteristics were associated with the components.

Conclusions: Working within a MCoC model was generally perceived as appealing by the midwifery students. Authorities and educational institutions must facilitate providing education and opportunities for MCoC models in Sweden. 

Problem: Women who experience fear of birth during pregnancy are more likely to report negative birth experiences.

Background: Fear of birth and depressive symptoms may negatively influence women's birth experiences. Midwifery continuity of care (MCoC) models have been shown to improve satisfaction and may help mitigate fear and mental health challenges. Aim: To identify profiles of women based on birth experiences and emotional wellbeing after childbirth within MCoC models, and to examine associations with background characteristics, attitudes, and birth outcomes.

Methods: A longitudinal cohort study was conducted in rural Sweden, including 378 women participating in MCoC models, with high priority on women with fear of birth. Data were collected via questionnaires in midpregnancy and two months postpartum. A k-means cluster analysis was performed using the Childbirth Experience Questionnaire (CEQ), Fear Of Birth Scale (FOBS), and Edinburgh Postnatal Depression Scale (EPDS).

Findings: Three distinct profiles of women emerged based on the instruments included in the cluster analysis. The clusters differed in self-reported health, fear of birth, prenatal attitudes, continuity of care, and mode of birth. Women's attitudes and operative births were the strongest predictors of cluster membership. Continuity with a known midwife distinguished profiles characterised by elevated fear of birth and depressive symptoms.

Discussion: Women's birth experiences and emotional wellbeing cluster into distinct profiles shaped by psychological, relational, and contextual factors. Attitudes during pregnancy and mode of birth are key determinants, while continuity with a known midwife enhances the perception of professional support. Conclusion: Tailoring MCoC models to these profiles may promote more individualized, equitable, and positive care for diverse groups of women.