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Ulfsdottir, H., Saltvedt, S. & Georgsson, S. (2020). Testing the waters: A cross-sectional survey of views about waterbirth among Swedish health professionals. Women and Birth, 33(2), 186-192, Article ID S1871-5192(18)31645-7.
Open this publication in new window or tab >>Testing the waters: A cross-sectional survey of views about waterbirth among Swedish health professionals
2020 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 33, no 2, p. 186-192, article id S1871-5192(18)31645-7Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: For women with low risk births, waterbirth is an alternative that is requested and provided in approximately a hundred countries. However, in some countries, including Sweden, waterbirth is not generally available.

AIM: To explore the experiences, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynaecologists and neonatologists.

METHODS: A cross-sectional study was conducted in Sweden, using a web-based survey distributed via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016. The respondents (n = 1609) answered a combination of Likert-scale and open-ended questions. The responses were analysed with descriptive statistics and quantitative content analyses.

FINDINGS: Both midwives and physicians stated a lack of experience, knowledge and clinical guidelines related to attending and assisting waterbirths. Overall, midwives had more positive attitudes to waterbirth (38.8% vs 4.5%) as well as towards providing and implementing waterbirth, compared to physicians (71.0% vs 14.9%). Midwives stated significantly more benefits and fewer risks for women and babies, compared to physicians who requested more evidence.

CONCLUSIONS: Opinions regarding waterbirth are to some extent based on attitudes rather than actual experience and knowledge. There are diverse interpretations of the strength of evidence and a lack of updating in the research field of waterbirth. As waterbirth is requested by women, health professionals need to update their knowledge in this topic in order to give coherent and evidence-based information and care to prospective parents.

Keywords
Birth, Midwifery, Training, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3306 (URN)10.1016/j.wombi.2019.04.003 (DOI)31054879 (PubMedID)
Available from: 2019-05-09 Created: 2019-05-09 Last updated: 2021-03-24Bibliographically approved
Akselsson, A., Lindgren, H., Georgsson, S., Warland, J., Pettersson, K. & Rådestad, I. (2019). Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study. Sexual & Reproductive HealthCare, 20, 32-37, Article ID S1877-5756(18)30321-5.
Open this publication in new window or tab >>Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study
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2019 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 32-37, article id S1877-5756(18)30321-5Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.

METHODS: A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.

RESULTS: There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.

CONCLUSIONS: Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.

Keywords
Awareness, Decreased fetal movements, Pregnancy, Pregnancy outcome, Reduced fetal movements
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3314 (URN)10.1016/j.srhc.2019.02.002 (DOI)31084815 (PubMedID)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2020-06-02Bibliographically approved
Ulfsdottir, H., Saltvedt, S., Ekborn, M. & Georgsson, S. (2019). Like an empowering micro-home: A qualitative study of women's experience of giving birth in water. In: : . Paper presented at NJF Congress, Reykjavik, Island, 2-4 maj 2019.
Open this publication in new window or tab >>Like an empowering micro-home: A qualitative study of women's experience of giving birth in water
2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3404 (URN)
Conference
NJF Congress, Reykjavik, Island, 2-4 maj 2019
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2020-06-02Bibliographically approved
Akselsson, A., Lindgren, H., Georgsson, S., Pettersson, K. & Rådestad, I. (2019). Mindfetalness - a systematic method for observing fetal movements: A randomized controlled trial. In: : . Paper presented at NJF Congress, Reykjavik, Island, 2-4 maj 2019.
Open this publication in new window or tab >>Mindfetalness - a systematic method for observing fetal movements: A randomized controlled trial
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2019 (English)Conference paper, Oral presentation only (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3316 (URN)
Conference
NJF Congress, Reykjavik, Island, 2-4 maj 2019
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2020-06-02Bibliographically approved
Akselsson, A., Georgsson, S., Lindgren, H., Pettersson, K., Steineck, G., Skokic, V. & Rådestad, I. (2019). Mindfetalness and pregnancy outcomes: a randomized controlled trial including 39,337 women. In: : . Paper presented at International Stillbirth Alliance (ISA), Madrid, Spanien, 5-6 oktober 2019.
Open this publication in new window or tab >>Mindfetalness and pregnancy outcomes: a randomized controlled trial including 39,337 women
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2019 (English)Conference paper, Oral presentation only (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3550 (URN)
Conference
International Stillbirth Alliance (ISA), Madrid, Spanien, 5-6 oktober 2019
Available from: 2020-01-10 Created: 2020-01-10 Last updated: 2020-06-02Bibliographically approved
Akselsson, A., Lindgren, H., Georgsson, S., Pettersson, K. & Rådestad, I. (2019). Mindfetalness: A useful tool when informing pregnant women about fetal movements. In: : . Paper presented at NJF Congress, Reykjavik, Island, 2-4 maj 2019.
Open this publication in new window or tab >>Mindfetalness: A useful tool when informing pregnant women about fetal movements
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2019 (English)Conference paper, Oral presentation only (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3315 (URN)
Conference
NJF Congress, Reykjavik, Island, 2-4 maj 2019
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2020-06-02Bibliographically approved
Ulfsdottir, H., Saltvedt, S. & Georgsson, S. (2019). Women's experiences of waterbirth compared with conventional uncomplicated births. Midwifery, 79, Article ID 102547.
Open this publication in new window or tab >>Women's experiences of waterbirth compared with conventional uncomplicated births
2019 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 79, article id 102547Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To compare childbirth experiences between women having a waterbirth and women having an uncomplicated conventional birth.

DESIGN: A prospective cohort study using the validated Childbirth Experience Questionnaire (CEQ) six weeks postpartum. The 22-item questionnaire assesses four domains of the childbirth experience; Own capacity, Professional support, Perceived safety and Participation. These four domains constituted the main outcome of the study. Further, supplementary questions about the second stage of labour were added to the web-questionnaire.

SETTING: One city-located hospital in Stockholm and one small-town hospital in Southern Sweden offering waterbirth to low risk women.

PARTICIPANTS: 215 women; 99 nulli- and 116 multiparas. 111 gave birth in water and 104 had an uncomplicated conventional birth.

MEASUREMENTS AND FINDINGS: The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, "Own capacity" and lower in the domain, "Professional support". Women having a waterbirth rated less pain and higher scores of being in control in the second stage of labour.

KEY CONCLUSIONS: A waterbirth seems to empower and enhance women's capacity for those who choose this alternative. Waterbirth can improve their birth experience and can possibly make women less dependent on the midwife.

IMPLICATIONS FOR PRACTICE: To provide waterbirth could be a way of empowering women and giving them a positive birth experience.

Keywords
Childbirth Experience Questionnaire (CEQ), Experience of childbirth, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3484 (URN)10.1016/j.midw.2019.102547 (DOI)31610362 (PubMedID)
Available from: 2019-10-25 Created: 2019-10-25 Last updated: 2020-06-02Bibliographically approved
Ulfsdottir, H., Saltvedt, S., Ekborn, M. & Georgsson, S. (2018). Like an empowering micro-home: A qualitative study of women's experience of giving birth in water. Midwifery, 67, 26-31, Article ID S0266-6138(18)30277-8.
Open this publication in new window or tab >>Like an empowering micro-home: A qualitative study of women's experience of giving birth in water
2018 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 26-31, article id S0266-6138(18)30277-8Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe women´s experiences and perceptions of giving birth in water.

DESIGN: A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made.

SETTING: One city-located hospital in Stockholm, offering waterbirth to low risk women.

PARTICIPANTS: 20 women, 12 primiparas and 8 multiparas, aged 27-39.

MEASUREMENTS AND FINDINGS: The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant".

KEY CONCLUSIONS: The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women.

IMPLICATIONS FOR PRACTICE: This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.

Keywords
Birth, Content Analyses, Empowerment, Experience of childbirth, Water immersion, Waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3116 (URN)10.1016/j.midw.2018.09.004 (DOI)30223104 (PubMedID)
Available from: 2018-09-18 Created: 2018-09-18 Last updated: 2020-06-02Bibliographically approved
Akselsson, A., Lindgren, H., Georgsson, S., Pettersson, K. & Rådestad, I. (2018). Mindfetalness: En metod som kan stärka kvinnors uppmärksamhet av fosterrörelser. In: : . Paper presented at Reproduktiv hälsa, Stockholm, 15-16 maj 2018.
Open this publication in new window or tab >>Mindfetalness: En metod som kan stärka kvinnors uppmärksamhet av fosterrörelser
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2018 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-3207 (URN)
Conference
Reproduktiv hälsa, Stockholm, 15-16 maj 2018
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2020-06-02Bibliographically approved
Ulfsdottir, H., Saltvedt, S. & Georgsson, S. (2018). Waterbirth in Sweden - a comparative study. Acta Obstetricia et Gynecologica Scandinavica, 97(3), 341-348
Open this publication in new window or tab >>Waterbirth in Sweden - a comparative study
2018 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 341-348Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.

MATERIAL AND METHODS: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.

RESULTS: Women giving birth in water had a lower risk of second-degree perineal tears (adj. OR 0.6 [95% CI 0.4-0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.

CONCLUSIONS: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. This article is protected by copyright. All rights reserved.

Keywords
birth, experience of childbirth, perineal tears, water immersion, waterbirth
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:shh:diva-2868 (URN)10.1111/aogs.13286 (DOI)29288489 (PubMedID)
Available from: 2018-01-15 Created: 2018-01-15 Last updated: 2020-06-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-2626-2335

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