Mid Sweden University

Background: Midwifery continuity of care (MCoC) has been associated with reduced burnout and increased work satisfaction among midwives. Despite these benefits, MCoC is not common in Sweden. Aim: This study aimed to explore midwives’ profiles based on burnout levels and attitudes towards midwifery continuity of care, considering various background and work-related factors. Methods: A national cross-sectional digital survey was conducted among midwives in Sweden. The questionnaire covered the Copenhagen Burnout Inventory (CBI), attitudes towards MCoC and background variables. Cluster analysis identified a set of profiles, which were then compared by calculating odds ratios and 95 % confidence intervals for various background and work-related factors. Logistic regression examined the factors most associated with each profile. Findings: A three-cluster solution for the 1,983 midwives surveyed was suggested, labelled as Reserved, Visionary, and Sensitive. Midwives in the Reserved cluster exhibited negative attitudes towards MCoC, through negative scores on both components and negative scores on the CBI. Within the Visionary cluster, midwives showed positive scores on the Relational component of MCoC, but negative scores on the Practical and Organisational component and the CBI. In the Sensitive cluster, midwives exhibited the highest scores on the CBI and negative scores on the Practical and Organisational component of MCoC, with just slightly positive scores on the Relational component. Cluster membership was associated with length of work experience (p<0.001) and work domain (p<0.001). Conclusion: Based on the CBI and attitudes towards MCoC, three distinct clusters of midwives were identified, with different factors contributing to membership in each cluster. Understanding how midwives relate to MCoC can facilitate the implementation of the model, potentially improving midwives’ work-related health. 

Background

Mental health problems are increasing among children and adolescents. Parents play a pivotal role in care, and intervention programmes have been introduced directed towards children with mild to moderate mental health problems. Due to long waiting times for specialised psychiatric care, such programmes could serve as means to ease the burden on mental health clinics for children 6-14 years. The aim of this study was to evaluate parents' assessments of the quality of care of an intervention programme and associations with the children's physical and mental health after treatment.

Methods

Parents' assessment of the quality of care was investigated through a questionnaire. Outcome variables were parents' perceptions of the children's physical and mental health after treatment. Explanatory variables were background factors, care organisation and the content of care.

Findings

31% of the parents assessed their child's physical health as less than good, and 46% their child's mental health as less than good, after treatment. Long waiting times (OR 2.50; 1.17-5.30), parents' ability to have private conversations with the therapist (OR 0.45; 0.22-0.94), and deficiencies in the content of care were associated with less good physical health after treatment. Less good mental health after treatment was associated with older age of children (OR 2.01; 1.01-3.99) and deficiencies in care content.

Conclusion

Age of the child, long waiting time, and perceived deficiencies in the content of care were associated with less physical and mental well-being of the child after the intervention. These findings call for improvement of care.

Objective: Despite strong evidence of the benefits, Sweden has limited access to midwifery continuity of care (MCoC), particularly in rural areas. There is a knowledge gap regarding how MCoC would function in a rural Swedish context. Therefore, this study aimed to explore midwives' personal and professional views on a MCoC model and its implementation within a rural context in northern Sweden. Methods: A qualitative interview study using reflexive thematic analysis. Semi-structured interviews were conducted with fourteen midwives working in maternity care. Results: The findings revealed a notable duality to MCoC, consisting of two major themes. In the first theme, 'Internal conditions of midwifery', midwives reported that working in a MCoC model would offer fulfillment but also present significant challenges, which they did not feel prepared to meet. Establishing a relationship of mutual trust with pregnant women emerged as a major positive aspect. The second theme, 'The impact of external forces', highlighted significant challenges, including organisational issues, staffing shortages, and concerns regarding work-life balance. Interprofessional collaboration and rural adaptation were considered key if the implementation of the model is to go ahead. Conclusions: For MCoC to succeed in rural Sweden, it is essential to have a supportive organisation that recognises the benefits of the model, and provides midwives with working conditions that meet their professional and personal needs. Involving midwives in the model's design, fostering interprofessional collaboration, and tailoring the model to rural settings are equally important. Addressing organisational challenges is crucial for establishing a functional and sustainable model.

Objectives: Perinatal depressive symptoms affect both maternal and infant well-being and are associated with fear of giving birth. Midwifery continuity of care (MCoC) has shown potential in reducing anxiety and depression, particularly among vulnerable women. The aim of this study was to explore the trajectories of fear of birth and depressive symptoms, in relation to background, attitudes and birth-related data. Methods: A prospective longitudinal study was conducted among women with fear of birth or depressive symptoms who, after a screening procedure were offered care in a MCoC model. Fear of birth and depressive symptoms were assessed with the Fear of Birth Scale (FOBS) and Edinburgh Postnatal Depression Scale (EPDS) and measured at screening, in mid pregnancy and twice after birth. Chi-square tests and analysis of variance were used for comparing groups. Results: The questionnaires were completed by 175 women during pregnancy and by 140 postpartum. During screening 84% presented with fear of birth and 24% with depressive symptoms. The degree of fear of birth and the depressive symptoms changed over time with the highest prevalence during pregnancy and a decline after birth. The trajectory of depressive symptoms was mainly related to women's attitudes, while birth-related variables concerned fear of birth. Conclusion: This study showed that fear of birth as well as depressive symptoms changed over time. These changes may represent natural progression but might be associated with the intervention. Working with women's attitudes might change the trajectories, especially in women with both fear of birth and depressive symptoms. 

Background

Stillbirth occurs at a rate of 3.0 per thousand in Sweden. However, few studies have focused on the initial experiences of parents facing a stillbirth. The aim of this qualitative study is to deepen and broadly explore parents' initial experiences, perceptions, internal processes and strategies from the moment of suspicion or awareness of stillbirth until one month after the event.

Methods

Ten individual in-depth interviews were conducted between 2021 and 2023, and data were evaluated using thematic network analysis.

Results

Two key themes emerged: 'Following the journey - from suspicion to acceptance' and 'Support, structured activities and processes after stillbirth'. These themes captured the significant consequences of a sudden, unexpected and devastating end to pregnancy. The suspicion and eventual diagnosis of stillbirth were initially associated with sudden discomfort, fear, overwhelming grief, and intense pain. Nevertheless, a vaginal birth was regarded as the optimal mode of delivery for both physical and emotional wellbeing. Caring for the stillborn baby through physical proximity for an extended period of time helped parents comprehend and cope with their grief, while also affirming their sense of parenthood.

Conclusions

This study sheds light on the profound and devastating impact of stillbirth on parents who are confronted with the loss of their long-awaited and cherished baby. The intense grief and pain experienced by parents during the first month after stillbirth were described as an ongoing heavy burden, persisting day and night, and reflected in poor/very poor mental health. Despite the immense challenges faced by parents, the study highlights the importance of developing individual coping strategies to deal with this tragic and irreversible life-changing event.

Aim: This study aimed to explore midwifery students’ thoughts on midwifery continuity models of care and the benefits for women and midwives. Background: The World Health Organization recommends continuity of care for pregnant women because it leads to favorable outcomes such as a higher likelihood of having a spontaneous vaginal birth and a positive birth experience. However, midwifery continuity models are rare in Sweden and few midwifery students are exposed to such models during their clinical placements. Therefore, students’ attitudes towards these models are largely unknown. Design: A qualitative Swedish national study. Methods: Digital interviews involving 16 midwifery students were carried out in 2023. Data were analyzed using reflexive thematic content analysis according to Braun and Clark. Results: The study revealed the main theme: “Midwifery continuity models of care are a perfect complement for women, families and midwives in Swedish maternity care”. This main theme was supported by the following themes: Increased knowledge of midwifery continuity of care would strengthen interest; Working in a midwifery continuity model of care should be based on midwives’ preferences; and Convincing evidence of midwifery continuity of care for women. Conclusions: The study highlighted the importance of offering women and midwives the opportunity to participate in a midwifery continuity care model and providing support for midwifery students to feel prepared for this approach. Continuity of care was seen as the future model of care. Midwifery students expressed a desire for better conditions for women in maternity care and a sustainable way of working for midwives. 

Introduction: Nil per os is a common precautionary practice in emergency departments for patients with suspected need for emergency surgery. However, this practice may lead to prolonged fasting periods, which can negatively affect patient outcomes. This study aimed to evaluate the necessity and appropriateness of nil per os for patients in the emergency department. Methods: A retrospective quantitative observational study was conducted, analyzing 41,983 patient visits from 2 emergency departments in 2023. The study focused on surgical, orthopedic, and neurological chief complaints, where nil per os was commonly implemented. We assessed the negative predictive value of emergency surgery within specified time intervals (<6 hours and <12 hours after arrival) solely based on time from arrival in combination with surgical priorities, chief complaints, and triage priorities according to the Rapid Emergency Triage and Treatment System. Results: Among the 41,983 included patients, 6.1% (n = 2561) underwent emergency surgery. The negative predictive value for emergency surgery within the specified time intervals was highest for Rapid Emergency Triage and Treatment System priorities 3, 4, and 5 (>99%), indicating a very low likelihood of emergency surgery within 6 to 12 hours for these patients. Rapid Emergency Triage and Treatment System priority 1 had the lowest negative predictive value, approximately 80% to 90%. Discussion: The study indicates that the routine practice of nil per os upon arrival at the emergency department is often unwarranted, particularly for those not classified as Rapid Emergency Triage and Treatment System priority 1. These findings highlight the need for updated guidelines to ensure that nil per os protocols are issued based on a clear medical necessity, thereby minimizing unnecessary fasting and its associated risks.

Background: Few parents experience stillbirth in Sweden, and their perspectives on the grieving process remain largely unknown. Objective: To explore parents’ perspectives, memories, reflections and insights in the grieving and recovery process six months after 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 were identified ‘Retained indelible deep memories of the loss and increased insights into the tragic life-changing event’ and ‘The continued grieving process, quality of life and new pregnancy’. These themes captured parents’ ongoing grief and reflections. Six months later, parents reported gaining insights into unforeseen pregnancy abnormalities. Some announced new pregnancies, desiring extended medical checks by both midwives and obstetricians. There was a widespread request for tailored psychological support throughout pregnancy. Qualitative findings were reinforced by the quantitative statements. Conclusions: Stillbirth profoundly affects parents long-term, with deep grief and memories. They develop coping strategies to strengthen their mental health. However, after six months, they begin to see a small glimmer of light at the end of the tunnel. 

Objective: Midwifery students’ need to be confident, and it is important to identify factors that might affect students’ confidence. Achieving registration as a midwife requires academic, clinical and professional competence. In the 1,5-year post-nursing program in Sweden 50% is allocated to clinical practice, and students must assist a minimum of 50 births. There is a lack of knowledge regarding the significance of supervision and to consider both theoretical and practical aspects of midwifery education. This study intends to identify relationships between midwifery students’ confidence in intrapartum care and associated factors. An additional aim was to provide a member check of the validity of the findings. Methods: All midwifery programs in Sweden participated in this cross-sectional study, where 238 (78%) midwifery students completed a questionnaire based on the competency descriptions by the International Confederation of Midwives. Confirmatory interviews were conducted for checking the results relevance. Result: The organization of midwifery education, satisfaction with supervision and theoretical teaching significantly impacted students’ confidence. Few background variables were associated with confidence. Conclusion: Clinical supervision was important. Students preferred lectures and practical demonstrations instead of self-studies. The structure and quality of both practical and theoretical training are crucial for building confidence. Newly graduated midwives qualitatively confirmed the results of the analysis. They also experienced a stressful environment, only focusing on to assist at the required 50 births. 

BackgroundIn Sweden, women often meet with different midwives during antenatal, intrapartum, and postpartum care, due to the structure of maternity care, with few alternatives which provide continuity. This study aims to explore women's interest in having a midwife they know present during labor and birth and to identify the characteristics of women who prefer this option.MethodsA comparative study was conducted involving two Swedish nationwide cohorts of Swedish-speaking pregnant women. The first cohort included 3,061 women, and the second 1,812 women. Descriptive statistics and odds ratios were calculated.ResultsIn total, 4,873 pregnant women completed the survey. Most participants were aged 25-35 years, living with a partner, and born in Sweden. Interest in having a midwife they know increased from 53% in 1999 to 76% in 2024. Key factors associated with this preference included primiparity (OR 3.80; 95% CI 3.27-4.40), being pregnant in 2024 (OR 3.21; 2.70-3.86), being born outside Sweden (OR 2.73; 2.11-3.54), and fear of birth (OR 2.03; 1.56-2.63).ConclusionsInterest in having a known midwife during childbirth has grown significantly in Sweden, highlighting the need for policy changes that promote awareness and expand this option for women.