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  • 1. Aanesen, Arthur
    et al.
    Westerbotn, Margareta
    Sophiahemmet Högskola.
    Prospective study of a Swedish infertile cohort 2005-08: population characteristics, treatments and pregnancy rates2014Ingår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 31, nr 3, s. 290-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: We here report on results from a prospective study comprising 380 infertile couples undergoing infertility work-up and various treatments for infertility in our clinic. The aim was to investigate the overall birth rate as a result of different treatments, as well as spontaneous pregnancies.

    METHODS: Three hundred and eighty couples were consecutively included between December 2005 and May 2008. All couples underwent a fertility work-up, including hysterosalpingogram, hormonal characterization, clinical examination, screening for infectious diseases and semen analysis. The mean age of the women at the time of inclusion was 33.2 years. The mean duration of infertility prior to inclusion was 1.8 years. And 46.6% (n = 177) of the women had been pregnant prior to their first visit to the clinic and 30.0% (n = 114) had been pregnant earlier in their present relationship.

    RESULTS: As of November 2010, 57.3% (n = 218) of the women had given birth to a child when they were lost to follow up by the study. Spontaneous conception was observed in 11.3% (n = 43) of the women, 14.5% (n = 64) conceived after intrauterine insemination (IUI), 4.2% (n = 16) conceived after ovarian hyperstimulation and ovulation induction (OH/OI) and 28.4% (n = 113) after in vitro fertilization. There were 280 pregnancies and 58 spontaneous abortions (22.3%) in the group. Mean anti-mullerian hormone significantly correlated with antral follicle count and age and was significantly higher in the subgroup that became pregnant after IUI.

    CONCLUSIONS: Spontaneous pregnancies and IUI + OH/OI contributed significantly to the pregnancies observed in the total population. Predictive factors for pregnancy were anti-mullerian hormone in the group undergoing IUI treatment and in the age group ≥38-duration of infertility. Previous pregnancies, body mass index, estradiol, follicle stimulating hormone or having given birth prior to the infertility period were not predictive of pregnancy for the infertile couples in this study.

  • 2.
    Akselsson, Anna
    Sophiahemmet Högskola.
    Awareness of fetal movements and pregnancy outcomes2020Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Fetal movements are one, among others, of the measurable factors indicating wellbeing of the fetus. Decreased fetal movements are associated with intrauterine growth restriction and stillbirth. Women with experience of stillbirth have often noticed decreased and weaker fetal movements preceding the intrauterine death. Further, seeking care for decreased fetal movements is a common reason for unscheduled contact with health care. The aim of this thesis was to investigate whether a method, aimed to increase women’s awareness of the fetal movement pattern, had an effect on pregnancy outcomes. Further, the thesis aimed to study pregnancy outcomes for women seeking care for decreased or altered fetal movements.

    In Study I, 2683 women completed questionnaires when they presented for decreased fetal movements, after an examination of their unborn baby, that did not result in any interventions aimed at ending the pregnancy. In Studies II–IV, we evaluated Mindfetalness, a method aimed to increase women’s awareness of the fetal movement pattern. Women were given a leaflet of how to practise Mindfetalness in third trimester: lie down on your side when the baby is awake and focus on the strength, character and frequency of the movements for about 15 minutes daily (but do not count each movement). Women’s attitudes to and compliance with Mindfetalness were investigated in Study II, comprising 104 women. In studies III-IV we studied the effect of Mindfetalness on pregnancy outcomes and, through cluster-randomisation, 19 639 women in Stockholm were randomised to Mindfetalness and 20 226 to routine care. Study IV comprised a sub-analysis, where we compared women born in Somalia and Sweden.

    Women in the Mindfetalness group (Study III) had spontaneous onset of labour to a higher extent (RR 1.02, CI 1.01–1.03), less cesarean sections (RR 0.95, CI 0.91–0.99) and labour inductions (RR 0.96, CI 0.92–1.00), than women in the Routine-care group. More women in the Mindfetalness group contacted healthcare due to decreased fetal movements (RR 1.72, CI 1.57–1.87). A decreased number of babies born small for gestational age (RR 0.95, CI 0.90–1.00) and those transferred to neonatal care (RR 0.93, CI 0.86–1.00) was seen in the Mindfetalness group. No differences were found in Apgar score <7 at 5 minutes. Women born in Somalia had a higher risk of Apgar score <7 at 5 minutes (RR 2.17, CI 1.19–3.61) and of having a baby small for gestational age (RR 2.19, CI 1.85–2.56), than women born in Sweden (Study IV). The majority of the women had a positive attitude towards Mindfetalness and practised the method daily (Study II). Women contacting healthcare due to decreased fetal movements had labour induction to a higher extent than women not seeking care due to decreased fetal movements (Study I).

    Increased maternal awareness of fetal movements by Mindfetalness in the third trimester is advantageous for mother and baby. Spontaneous start of labour increased and interventions, notably cesarean sections, decreased. Fewer babies were born small for gestational age and in need of neonatal care. Women expressed having positive attitudes to the method and feelings of safety and calm, when they practised Mindfetalness.

  • 3.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Cabander, Lisa
    Thorarinsdottir, Steinunn
    Small, Rhonda
    Ternström, Elin
    Language-supported labor ward visits for pregnant migrant women: Staff experiences in a Swedish hospital2022Ingår i: European Journal of Midwifery, E-ISSN 2585-2906, Vol. 6, artikel-id 42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: The aim of this study was to explore midwives' and assistant nurses' experiences of providing extra support to non-Swedish-speaking migrants by offering individual language-supported visits to the labor ward during pregnancy.

    METHODS: Semi-structured interviews were conducted with six guides, midwives or assistant nurses, working in the INFÖR (Individuell förlossningsförberedelse) project at Södertälje hospital in Sweden. INFOR includes a two-hour individual language-supported visit at the labor ward, for non-Swedish speaking pregnant women and their partners. An inductive thematic analysis was conducted.

    RESULTS: The guides described INFOR as being a bridge and creating safety, achieved by meeting with women and providing practical information. The guides felt that they fulfilled an important purpose, they were dedicated and adapted to the women's individual needs. Providing extra language-assisted support to migrant pregnant women was developing and enriching, but the guides highlighted some barriers. Communicating via an interpreter was a challenge and the women were in need of more and extended meetings. The guides wished that INFOR could become a standard part of antenatal care, but the model needs to be further developed, and a better system for recruitment must be introduced.

    CONCLUSIONS: The guides experienced that the INFOR model is valuable in creating safety to pregnant migrant women before birth. The model is appreciated by the expectant couples, midwives and assistant nurses, and could be implemented as standard care. However, it is important to adapt the visits to the women's and their families' needs and goals, and structure needs to be developed before implementation.

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  • 4.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness: A method for systematic observation of fetal movements in late pregnancy2017Konferensbidrag (Övrigt vetenskapligt)
  • 5.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Lindgren, H
    Pettersson, K
    Steineck, G
    Skokic, V
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Mindfetalness and pregnancy outcomes: a randomized controlled trial including 39,337 women2019Konferensbidrag (Övrigt vetenskapligt)
  • 6.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Lindgren, Helena
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness- a method for systematic observation of fetal movements in late pregnancy2017Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, nr 1, artikel-id 359Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness.

    METHODS: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.

    RESULTS: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.

    CONCLUSION: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.

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  • 7.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Linde, Anders
    Sophiahemmet Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Structured daily observation of fetal movements and transfer to neonatal clinic2017Konferensbidrag (Övrigt vetenskapligt)
  • 8.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, H
    Georgsson, S
    Pettersson, K
    Steineck, G
    Skokic, V
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women2020Ingår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, nr 7, s. 829-837Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes.

    DESIGN: Cluster-randomised controlled trial.

    SETTING: Sixty-seven maternity clinics in Stockholm, Sweden.

    POPULATION: Women with singleton pregnancy with birth from 32 weeks' gestation.

    METHODS: Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register.

    MAIN OUTCOME MEASURES: Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery.

    RESULTS: No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99).

    CONCLUSIONS: Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age.

    TWEETABLE ABSTRACT: Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.

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  • 9.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, H
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Pettersson, K
    Skokic, V
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Awareness of fetal movements and pregnancy outcomes among women born in Somalia and Sweden: A cluster-randomised controlled trialManuskript (preprint) (Övrigt vetenskapligt)
  • 10.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Georgsson, Susanne
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Increased labor induction and women presenting with decreased or altered fetal movements: A population-based survey2019Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 14, nr 5, artikel-id e0216216Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Women's awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction.

    MATERIAL AND METHODS: A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week's gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks' gestation in 2014 in Stockholm comprises the reference group.

    RESULTS: Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3-1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4-1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more.

    CONCLUSIONS: We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation.

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  • 11.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Mindfetalness - a systematic method for observing fetal movements: A randomized controlled trial2019Konferensbidrag (Övrigt vetenskapligt)
  • 12.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Mindfetalness: A useful tool when informing pregnant women about fetal movements2019Konferensbidrag (Övrigt vetenskapligt)
  • 13.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Mindfetalness: En metod som kan stärka kvinnors uppmärksamhet av fosterrörelser2018Konferensbidrag (Övrigt vetenskapligt)
  • 14.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Georgsson, Susanne
    Pettersson, Karin
    Skokic, Viktor
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area: a population-based study2020Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 13, nr 1, artikel-id 1794107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup.

    OBJECTIVE: We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia.

    METHODS: In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily self-monitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register.

    RESULTS: An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25-3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88-2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29-2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08-0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group.

    CONCLUSIONS: A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.

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  • 15.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Warland, Jane
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study2019Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, s. 32-37, artikel-id S1877-5756(18)30321-5Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Skokic, Viktor
    Rådestad, Ingela
    Sophiahemmet Högskola.
    A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method2020Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, nr 1, artikel-id 577Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Maternal perception of decreased fetal movements is commonly used to assess fetal well-being. However, there are different opinions on whether healthcare professionals should encourage maternal observation of fetal movements, as researchers claim that raising awareness increases unnecessary interventions, without improving perinatal health. We aimed to investigate whether cesarean sections and labor induction increase by raising women's awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care.

    METHODS: In a cluster randomized controlled trial, 67 maternity clinics were allocated to Mindfetalness or routine care. In the Mindfetalness group, midwives distributed a leaflet telling the women to focus on the character, strength and frequency of the fetal movements without counting each movement. The instruction was to do so for 15 min daily when the fetus was awake, from gestational week 28 until birth. In this sub-group analysis, we targeted women born in Sweden giving birth from 32 weeks' gestation. We applied the intention-to-treat principle.

    RESULTS: The Mindfetalness group included 13,029 women and the Routine-care group 13,456 women. Women randomized to Mindfetalness had less cesarean sections (18.4% vs. 20.0%, RR 0.92, CI 0.87-0.97) and labor inductions (19.2% vs. 20.3%, RR 0.95, CI 0.90-0.99) compared to the women in the Routine-care group. Less babies were born small for gestational age (8.5% vs. 9.3%, RR 0.91, CI 0.85-0.99) in the Mindfetalness group. Women in the Mindfetalness group contacted healthcare due to decreased fetal movements to a higher extent than women in the Routine care group (7.8% vs. 4.3%, RR 1.79, CI 1.62-1.97). The differences remain after adjustment for potential confounders.

    CONCLUSIONS: Raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies.

    TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02865759 ). Registered 12 August 2016, www.clinicaltrials.gov .

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  • 17.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Rossen, Jenny
    Sophiahemmet Högskola.
    Storck-Lindholm, Elisabeth
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Prolonged pregnancy and stillbirth among women with overweight or obesity: A population-based study in Sweden including 64,632 women2023Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, artikel-id 21Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The proportion of overweight or obese pregnant women is increasing in many countries and babies born to a mother who is overweight or obese are at higher risk for complications. Our primary objective was to describe sociodemographic and obstetric factors across Body Mass Index (BMI) classifications, with secondary objective to investigate stillbirth and other pregnancy outcomes in relation to BMI classifications and gestational week.

    METHODS: This population-based cohort study with data partly based on a cluster-randomized controlled trial includes 64,632 women with singleton pregnancy, giving birth from 28 weeks' gestation. The time period was January 2016 to 30 June 2018 (2.5 years). Women were divided into five groups according to BMI: below 18.5 underweight, 18.5-24.9 normal weight, 25.0-29.9 overweight, 30.0-34.9 obesity, 35.0 and above, severe obesity.

    RESULTS: Data was obtained for 61,800 women. Women who were overweight/obese/severely obese had lower educational levels, were to a lesser extent employed, were more often multiparas, tobacco users and had maternal diseases to a higher extent than women with normal weight. From 40 weeks' gestation, overweight women had a double risk of stillbirth compared to women of normal weight (RR 2.06, CI 1.01-4.21); the risk increased to almost four times higher for obese women (RR 3.97, CI 1.6-9.7). Women who were obese or severely obese had a higher risk of almost all pregnancy outcomes, compared to women of normal weight, such as Apgar score < 7 at 5 min (RR1.54, CI 1.24-1.90), stillbirth (RR 2.16, CI 1.31-3.55), transfer to neonatal care (RR 1.38, CI 1.26-1.50), and instrumental delivery (RR 1.26, CI 1.21-1.31).

    CONCLUSIONS: Women who were obese or severely obese had a higher risk of almost all adverse pregnancy outcomes and from gestational week 40, the risk of stillbirth was doubled. The findings indicate a need for national guidelines and individualized care to prevent and reduce negative pregnancy outcomes in overweight/obese women. Preventive methods including preconception care and public health policies are needed to reduce the number of women being overweight/obese when entering pregnancy.

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  • 18.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Fostrets rörelser2022Ingår i: Reproduktiv hälsa: Barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2022, 2, s. 374-380Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 19.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Improving outcomes for women with decreased fetal movement: An interactive educational workshop2021Konferensbidrag (Övrigt vetenskapligt)
  • 20.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Westholm, Lena
    Small, Rhonda
    Westholm, Lena
    Midwives’ communication with non-Swedish-speaking women giving birth: A survey from a multicultural setting in Sweden2022Ingår i: European Journal of Midwifery, E-ISSN 2585-2906, Vol. 6Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
    fulltext
  • 21.
    Andrén, Anna
    et al.
    Sophiahemmet Högskola.
    Akselsson, Anna
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Ali, Salma Burhan
    Lindgren, Helena
    Sophiahemmet Högskola.
    Osman, Hodan Mohamoud
    Erlandsson, Kerstin
    Miscommunication influences how women act when fetal movements decrease: An interview study with Swedish Somali migrant women2023Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 126, artikel-id 103796Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To explore how Swedish Somali migrant women perceive fetal movements, process information about fetal movements, and take actions if decreased fetal activity occurs.

    DESIGN: A qualitative study based on individual semi-structured interviews. The interviews were analysed using content analysis.

    SETTING: The study was conducted in Sweden.

    PARTICIPANTS: Swedish Somali migrant women (n=15) pregnant in their third trimester or recently given birth.

    FINDINGS: The analysis led to the main category: tailored information about fetal movements enhances the possibility to seek care if the movements decrease. The results are described in the generic categories: explanatory models determine action; and understand and interpret information.

    KEY CONCLUSIONS: Miscommunication on fetal movements can be a hurdle for Swedish Somali migrant women that may have impact on stillbirth prevention and the quality of care. Improved communication and information tailored to individual needs is essential to achieve equality for women and their newborns.

    IMPLICATIONS FOR PRACTICE: The midwife can be used as a hub for reassuring that adequate information about fetal movements reaches each individual woman in antenatal care. Individualised information on fetal movements based on the women's own understanding is suggested to increase the possibility that the pregnant woman will seek care if the movements decrease. Somali women's verbal communication can be used to spread accurate information in the Somali community on the importance of seeking care if fetal movements decrease.

    Ladda ner fulltext (pdf)
    fulltext
  • 22.
    Andrén, Anna
    et al.
    Sophiahemmet Högskola.
    Akselsson, Anna
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Ali, Salma Burhan
    Lindgren, Helena
    Sophiahemmet Högskola.
    Osman, Hodan Mohamoud
    Erlandsson, Kerstin
    Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women2023Konferensbidrag (Övrigt vetenskapligt)
  • 23.
    Andrén, Anna
    et al.
    Sophiahemmet Högskola.
    Akselsson, Anna
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Ali, Salman Burhan
    Lindgren, Helena
    Sophiahemmet Högskola.
    Osman, Hodan Mohamoud
    Erlandsson, Kerstin
    Brister i kommunikationen påverkar hur kvinnor agerar vid minskade fosterrörelser: En intervjustudie med svensksomaliska kvinnor2023Konferensbidrag (Övrigt vetenskapligt)
  • 24.
    Andrén, Anna
    et al.
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Lindgren, Helena
    Sophiahemmet Högskola.
    Erlandsson, Kerstin
    Akselsson, Anna
    Sophiahemmet Högskola.
    Ökad uppmärksamhet av fosterrörelser och graviditetsutfall: Ett projekt riktat mot svensksomaliska kvinnor2023Konferensbidrag (Övrigt vetenskapligt)
  • 25. Armuand, Gabriela
    et al.
    Grandahl, Maria
    Volgsten, Helena
    Stern, Jenny
    Sophiahemmet Högskola.
    Characteristics of good contraceptive counselling: An interview study2024Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, artikel-id 100948Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective.

    METHODS: A qualitative study with a phenomenological approach. Twenty-four women aged 15-45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis.

    RESULTS: One overall theme emerged, person-centred contraceptive counselling - an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place.

    CONCLUSIONS: The healthcare provider's attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women's descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.

    Ladda ner fulltext (pdf)
    fulltext
  • 26.
    Asplin, Nina
    Sophiahemmet Högskola.
    Women's experiences and reactions when a fetal malformation is detected by ultrasound examination2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Second trimester ultrasound examination among pregnant women in Sweden is almost universal. The detection of a fetal malformation on ultrasound puts health care providers and pregnant women in a difficult and precarious situation. What information and how it is communicated is crucial to women’s decision-making about continuing or terminating at pregnancy. The main aim of this thesis was to describe and analyze women’s experiences and reactions following the detection of a fetal malformation on an ultrasound scan. Methods: Two semi-structured in-depth interviews were performed, with women informed of a fetal malformation following an ultrasound scan. A total of 27 women took part in the first round of interviews: women continuing their pregnancy were interviewed, either in gestational week 30 or three weeks after the diagnosis; those terminating their pregnancy were interviewed two to four weeks after termination (Paper I). A second interview with 11 women who terminated their pregnancy was conducted six months after termination (Paper III). Two questionnaires were also administered. The first, answered by 99 women (Paper II) and comprising 22 study- specific questions along with emotional well-being and socio-demographics variables and medical and obstetric history, was conducted at the same time as the first stage of interviews. The other questionnaire, answered by 56 women incorporated common self- report instruments and was performed three times: first in gestational week 30, and then two respectively six months postpartum (Paper IV). Qualitative data were analyzed through content analysis, and quantitative data were analyzed through descriptive statistics. Results: The timing, duration, and manner of women’s initial counseling and ongoing support were shown to be important in the interaction between women and caregivers. Positive interactions improved the women’s ability to understand the information and fostered feelings of trust and safety, which in turn reduced their anxiety. Most of the women who expected a baby with an abnormality expressed their need for information on several occasions to help them make this difficult decision. They also wished for information from different specialists and continuity of care. These needs were even stronger in women who chose to terminate their pregnancy. We found women continuing their pregnancy to be at high risk of depressive symptoms, major worries, and high anxiety levels, both in mid-pregnancy, and at two months and one year postpartum. Despite these findings, the results of the maternal-fetal attachment scale for women who continued their pregnancy with a fetus diagnosed with a malformation indicated a high level of attachment. Conclusions and Clinical Implications: Effective communication, empathy and compassion, and consistent follow-up routines are important to ensure good treatment and care of this group of women. Taking these results into account may improve caregivers’ ability to counsel these vulnerable patients and to ensure that their needs are properly met.

  • 27.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Dellgren, Annika
    Conner, Peter
    Education in obstetrical ultrasound - an important factor for increasing the prenatal detection of congenital heart disease2013Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, nr 7, s. 804-808Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease. SETTING: Tertiary care center. POPULATION: Experienced and less experienced midwives performing ultrasound scans. METHODS: Number of fetuses and live born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound. MAIN OUTCOME MEASURES: The prenatal detection rate of complex congenital heart malformations. RESULTS: The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p<0.05). Following education, we observed a significant increase in detection rates (21 vs. 67%, p<0.01) among experienced midwives. In the group of less experienced midwives, we found a positive effect of training with considerably higher detection rates compared to results achieved by their more experienced colleagues prior to the program (40 vs. 21%). CONCLUSION: There is a clear improvement in the prenatal detection rates of complex heart malformations following a postgraduate education in obstetrical ultrasound. Similar training should be offered to both midwives and doctors performing routine scans to increase the standards of antenatal screening for congenital heart disease. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  • 28. Asplin, Nina
    et al.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected2015Ingår i: Sexual & Reproductive Healthcare, ISSN 1877-5756, Vol. 6, nr 3, s. 191-195Artikel i tidskrift (Refereegranskat)
  • 29.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care2014Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, nr 6, s. 620-627Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE:

    to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.

    METHOD:

    an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.

    SETTING:

    four fetal care referral centres in Stockholm, Sweden.

    PARTICIPANTS:

    11 women opting for pregnancy termination due to fetal malformation.

    FINDINGS:

    in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.

    CONCLUSION AND IMPLICATIONS FOR PRACTICE:

    The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.

  • 30.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan2012Ingår i: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 3, nr 2, s. 73-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.

    METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.

    RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.

    CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.

  • 31.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination2013Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 2, s. 79-84Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives

    The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.

    Design

    Descriptive study.

    Setting

    Four fetal care referral centres in Stockholm, Sweden.

    Population

    Pregnant women with a detected fetal malformation.

    Methods

    Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.

    Results

    Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).

    Conclusion

    The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

  • 32. Avelin, Pernilla
    et al.
    Erlandsson, Kerstin
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Swedish parents' experiences of parenthood and the need for support to siblings when a baby is stillborn2011Ingår i: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, nr 2, s. 150-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: It has been argued that having a stillborn baby in the family affects older siblings more than parents realize. The aim of this study was to describe parenthood and the needs of siblings after stillbirth from the parents' perspective.

    METHODS: Six focus groups were held with 27 parents who had experienced a stillbirth and who had had children before the loss. The discussion concerned parents' support to the siblings, and the sibling's meeting, farewell, and memories of their little sister or brother. Data were analyzed using qualitative content analysis.

    RESULTS: The overall theme of the findings was parenthood in a balance between grief and everyday life. In the analysis, three categories emerged that described the construction of the theme: support in an acute situation, sharing the experiences within the family, and adjusting to the situation.

    CONCLUSIONS: The siblings' situation is characterized by having a parent who tries to maintain a balance between grief and everyday life. Parents are present and engaged in joint activities around the stillbirth together with the siblings of the stillborn baby. Although parents are aware of the sibling's situation, they feel that they are left somewhat alone in their parenthood after stillbirth and therefore need support and guidance from others.

  • 33. Avelin, Pernilla
    et al.
    Hildingsson, Ingegerd
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Make the stillborn baby and the loss real for the siblings: parents' advice on how the siblings of a stillborn baby can be supported2012Ingår i: Journal of Perinatal Education, ISSN 1058-1243, EISSN 1548-8519, Vol. 21, nr 2, s. 90-98Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to investigate parents' advice to other parents on the basis of their own experiences of siblings' taking leave of a stillborn sister or brother. The study was a Web questionnaire study of 411 parents. The thematic content analysis resulted in two categories: "Make the stillborn baby and the loss real for the siblings" and "Take the siblings' resources and prerequisites into account." Parents' advised that siblings should see and hold the stillborn baby and, thus, be invited and included into the leave-taking process with respect to the siblings' feelings, resources, and prerequisites. Based on these findings, professional caregivers can usefully be proactive in their approach to facilitate and encourage the involvement of siblings.

  • 34. Avelin, Pernilla
    et al.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Säflund, Karin
    Wredling, Regina
    Erlandsson, Kerstin
    Parental grief and relationships after the loss of a stillborn baby2013Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, nr 6, s. 668-673Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN: a postal questionnaire at three months, one year and two years after stillbirth. SETTING: a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS: 55 parents, 33 mothers and 22 fathers. FINDINGS: mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS: experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE: anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.

  • 35. Barimani, M
    et al.
    Jonas, W
    Zwedberg, Sofia
    Sophiahemmet Högskola.
    Parents' experiences when students are present during labour and childbirth: A cross-sectional survey of parents in Sweden2019Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 77, s. 130-136, artikel-id S0266-6138(19)30188-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Various student groups participate in clinical intrapartum care, but limited data are available on parents' perceptions of student presence during labour and childbirth. This study explored parents' experiences of having a student present during labour and childbirth.

    DESIGN AND PARTICIPANTS: Qualitative study based on an analysis of 362 parents' responses to one open-ended question from a cross-sectional survey.

    RESULTS: When they experienced students as interactive and supportive, parents reacted positively to student participation. Parents displayed clear willingness to contribute to students' learning. Some parents, however, reported unexpected, uncomfortable, or inappropriate experiences that they attributed to insufficient autonomy or undergoing many vaginal examinations.

    KEY CONCLUSIONS: Parents, clinical supervisors, and students can benefit from clinical learning situations, but women's needs must be prioritised and student involvement balanced with women's right to choose who is with them during labour and childbirth.

  • 36. Barimani, Mia
    et al.
    Zwedberg, Sofia
    Sophiahemmet Högskola.
    Ulfsdottir, Hanna
    Open dialogue: A grounded theory study on peer learning at birthing units2022Ingår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 111, artikel-id 103355Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Peer learning in clinical settings is supported in nursing research but has rarely been studied in the context of student midwives at birthing units.

    AIM: To create a theoretical model of peer learning in the context of birthing units.

    SETTINGS: Four hospitals and maternity units in Stockholm, Sweden.

    METHODS: A Straussian approach to grounded theory was applied. Data consisted of interviews with fifteen final-term student midwives and 21 preceptors. Further, six peer learning seminars were held with approximately 200 midwives. At these, data was collected from fourteen preceptors presenting their experiences of working with peer learning.

    FINDINGS: The core of the action emerging was the Open dialogue describing the communication between the pair of students, between students-preceptor and students-becoming parents, that developed skills in communication, participation and reduced prestige and hierarchy. It facilitated social interaction and reinforced a dynamic way of learning and teaching midwifery.

    CONCLUSIONS: With preparation and a clear framework, peer learning can be used with midwifery students at birthing units. The open dialogue includes the becoming family in decision making and fits in a woman centered care providing support, safety, and participation. The pedagogical benefits are consistent with previous studies on nursing students.

  • 37. Björklund, Ulla
    et al.
    Marsk, Anna
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Does an information film about prenatal testing in early pregnancy affect women's anxiety and worries?2013Ingår i: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, nr 1, s. 9-14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Objective: To explore if an information film about prenatal examinations affects pregnant women's worry and anxiety. Methods: Randomized controlled study. The intervention was an information film about prenatal examinations. Data was collected in gestational week 26 by a questionnaire including the STAI (State-Trait Anxiety Inventory) instrument and further questions about worry. A total of 184 women in the intervention group and 206 in the control group filled in the questionnaire. Results: There were no statistically significant differences between the groups neither in state nor trait anxiety. Regarding worry about the possibility of something being wrong with the baby and worry about giving birth, there were no statistically significant differences between the groups. The women stated that to see the film increased their worry rather than decreased it. Conclusion: An informational film as additional information to complement written and verbal information about prenatal testing does not appear to increase women's anxiety and worries. However, the informational film may cause worry at the time of viewing which should be taken into consideration.

  • 38. Björklund, Ulla
    et al.
    Marsk, Anna
    Levin, Charlotta
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Audiovisual information affects informed choice and experience of information in antenatal Down syndrome screening: a randomized controlled trial2012Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 86, nr 3, s. 390-395Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of an information film on making an informed choice regarding Down syndrome screening, and women's knowledge and experiences of information. METHODS: Randomized controlled trial including 184 women in the intervention group and 206 controls recruited from maternity units in Stockholm, Sweden. The intervention was an information film presented as a complement to written and verbal information. Data were collected via a questionnaire in gestational week 27. Three different measures were combined to measure informed choice: attitudes towards Down syndrome screening, knowledge about Down syndrome and Down syndrome screening, and uptake of CUB (combined ultrasound and biochemical screening). RESULTS: In the intervention group 71.5% made an informed choice versus 62.4% in the control group. Women in the intervention group had significantly increased knowledge, and to a greater extent than the control group, experienced the information as being sufficient, comprehensible, and correct. CONCLUSIONS: An information film tended to increase the number of women who made an informed choice about Down syndrome screening. Participants were more satisfied with the information received. PRACTICE IMPLICATIONS: Access to correct, nondirective, and sufficient information is essential when making a choice about prenatal diagnostics. It is essential with equivalent information to all women.

  • 39. Bodin, Maja
    et al.
    Käll, Lisa
    Tydén, Tanja
    Stern, Jenny
    Sophiahemmet Högskola.
    Drevin, Jennifer
    Larsson, Margareta
    Exploring men's pregnancy-planning behaviour and fertility knowledge: a survey among fathers in Sweden2017Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 122, nr 2, s. 127-135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Research about pregnancy-planning behaviour mostly focuses on women, even though pregnancy planning usually also concerns men. The purpose of this study was to investigate how men plan for family, and to measure their fertility knowledge after having become fathers.

    MATERIAL AND METHODS: Data were collected in 2014 as part of a Swedish longitudinal pregnancy-planning study. Men were recruited through their female partner one year after childbirth. Participants were asked to fill out a questionnaire about pregnancy planning, lifestyles, and fertility.

    RESULTS: Of the 796 participants, 646 (81%) stated that the pregnancy had been very or fairly planned, and 17% (n = 128) had made a lifestyle adjustment before pregnancy to improve health and fertility. The most common adjustments were to reduce/quit the consumption of alcohol, cigarettes, or snuff, and to exercise more. First-time fathers and those who had used assisted reproductive technology to become pregnant were more likely to have made an adjustment. Fertility knowledge varied greatly. Men with university education had better fertility knowledge than men without university education.

    CONCLUSION: Our findings indicate that there is variation in how men plan and prepare for pregnancy. Most men did not adjust their lifestyle to improve health and fertility, while some made several changes. Both pregnancy-planning behaviour and fertility knowledge seem to be related to level of education and mode of conception. To gain deeper understanding of behaviour and underlying factors, more research is needed.

  • 40. Bradford, Billie F
    et al.
    Cronin, Robin S
    Warland, Jane
    Akselsson, Anna
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Heazell, Alexander Ep
    McKinlay, Christopher J D
    Stacey, Tomasina
    Thompson, John M D
    McCowan, Lesley M E
    Fetal movements: A framework for antenatal conversations2023Ingår i: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 36, nr 3, s. 238-246, artikel-id S1871-5192(22)00321-3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Presentations for decreased fetal movements comprise a significant proportion of acute antenatal assessments. Decreased fetal movements are associated with increased likelihood of adverse pregnancy outcomes including stillbirth. Consensus-based guidelines recommend pregnant women routinely receive information about fetal movements, but practice is inconsistent, and the information shared is frequently not evidence-based. There are also knowledge gaps about the assessment and management of fetal movement concerns. Women have indicated that they would like more accurate information about what to expect regarding fetal movements.

    DISCUSSION: Historically, fetal movement information has focussed on movement counts. This is problematic, as the number of fetal movements perceived varies widely between pregnant women, and no set number of movements has been established as a reliable indicator of fetal wellbeing. Of late, maternity care providers have also advised women to observe their baby's movement pattern, and promptly present if they notice a change. However, normal fetal movement patterns are rarely defined. Recently, a body of research has emerged relating to maternal perception of fetal movement features such as strength, presence of hiccups, and diurnal pattern as indicators of fetal wellbeing in addition to frequency.

    CONCLUSION: Sharing comprehensive and gestation-appropriate information about fetal movements may be more satisfying for women, empowering women to identify for themselves when their baby is doing well, and importantly when additional assessment is needed. We propose a conversational approach to fetal movement information sharing, focusing on fetal movement strength, frequency, circadian pattern, and changes with normal fetal development, tailored to the individual.

  • 41. Bradford, Billie F
    et al.
    Hayes, Dexter J L
    Damhuis, Stefanie
    Shub, Alexis
    Akselsson, Anna
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Heazell, Alexander E P
    Flenady, Vicki
    Gordijn, Sanne J
    Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop.2023Ingår i: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Maternal reports of decreased fetal movement (DFM) are a common reason to present to maternity care and are associated with stillbirth and other adverse outcomes. Promoting awareness of fetal movements and prompt assessment of DFM has been recommended to reduce stillbirths. However, evidence to guide clinical management of such presentations is limited. Educational approaches to increasing awareness of fetal movements in pregnant women and maternity care providers with the aim of reducing stillbirths have recently been evaluated in a several large clinical trials internationally. The International Stillbirth Alliance Virtual Conference in Sydney 2021 provided an opportunity for international experts in fetal movements to share reports on the findings of fetal movement awareness trials, consider evidence for biological mechanisms linking DFM and fetal death, appraise approaches to clinical assessment of DFM, and highlight research priorities in this area. Following this workshop summaries of the sessions prepared by the authors provide an overview of understandings of fetal movements in maternity care at the current time and highlights future directions in fetal movement research.

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  • 42.
    Carlsson, Tommy
    Sophiahemmet Högskola.
    Management of physical pain during induced second-trimester medical abortions: a cross-sectional study of methodological quality and recommendations in local clinical practice guidelines at Swedish hospitals2019Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, nr 1, s. 111-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim was to assess the methodological quality and describe recommendations for pain management in local clinical practice guidelines about induced second-trimester medical abortions at Swedish university and county hospitals.

    METHODS: In 2017, Swedish university and county hospitals that provided abortion care in the second trimester of pregnancy were contacted (n = 29), and guidelines from 25 were received (university: n = 6, county: n = 19). Guideline quality was assessed according to two systematic instruments. Recommendations were systematically assessed regarding frequency and tools for pain measurement, prophylactic pharmacologic treatment, as needed pharmacologic treatment and nonpharmacologic treatment.

    RESULTS: Overall methodological quality was poor across both instruments, as the majority of the guidelines did not fulfil the investigated quality criteria. For pain measurements, no guideline recommended measurement frequency and four recommended specific measurement tools. Prophylactic pharmacologic treatment, described in 23 (92%) guidelines, included paracetamol (n = 23, 92%), anti-inflammatory drugs (n = 23, 92%) and opioids (n = 18, 72%). As needed pharmacologic treatment, described in 23 (92%) guidelines, included anaesthetics (n = 21, 84%), opioids (n = 21, 84%) and paracetamol (n = 1, 4%). Recommendations for as needed anaesthetics included paracervical block (n = 21, 84%), epidural analgesia (n = 16, 64%) and inhalation of nitrous oxide (n = 5, 20%). Nonpharmacologic treatments were recommended in nine (36%) guidelines.

    CONCLUSIONS: The findings indicate that local clinical practice guidelines about induced second-trimester medical abortions are of inadequate methodological quality and that a large majority lack recommendations concerning systematic pain measurements. Although most recommend prophylactic and as needed pharmacologic management, national inconsistencies exist in Sweden with regard to recommendations of epidural analgesia, nitrous oxide and nonpharmacologic methods. In Sweden, there is room for improvement in the development of these guidelines.

  • 43.
    Carlsson, Tommy
    et al.
    Sophiahemmet Högskola.
    Balbas, Banaz
    Mattsson, Elisabet
    Written narratives from immigrants following a prenatal diagnosis: qualitative exploratory study2019Ingår i: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, nr 1, artikel-id 154Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Expectant parents often have optimistic expectations of the obstetric ultrasound examination and are unprepared for a diagnosis of foetal anomaly. Research that gives voice to the experiences of immigrants faced with a prenatal diagnosis is scarce, and there is a need for more exploratory research that provides insights into the experiences of these persons. The aim of this study was to explore narratives of experiences of immigrants with Arabic or Sorani interpreter needs when presented with a prenatal diagnosis of foetal anomaly.

    METHODS: A web-based tool with open-ended questions was distributed via Arabic and Kurdish non-profit associations and general women's associations in Sweden. Responses were received from six women and analysed with qualitative content analysis.

    RESULTS: The analysis resulted in three themes: (1) an unexpected hurricane of emotions, (2) trying to understand the situation though information in an unfamiliar language, and (3) being cared for in a country with accessible obstetric care and where induced abortion is legal.

    CONCLUSIONS: Immigrant women described an unexpected personal tragedy when faced with a prenatal diagnosis of foetal anomaly, and emphasised the importance of respectful and empathic psychological support. Their experiences of insufficient and incomprehensible information call attention to the importance of tailored approaches and the use of adequate medical interpreting services. There is a need for more descriptive studies that investigate decision-making and preparedness for induced abortion among immigrants faced with a prenatal diagnosis.

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  • 44.
    Carlsson, Tommy
    et al.
    Sophiahemmet Högskola.
    Ulfsdottir, Hanna
    Sophiahemmet Högskola.
    Waterbirth in low-risk pregnancy: An exploration of women's experiences2020Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 76, nr 5, s. 1221-1231Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To explore retrospective descriptions about benefits, negative experiences and preparatory information related to waterbirths.

    DESIGN: A qualitative study.

    METHODS: Women who gave birth in water with healthy pregnancies and low-risk births were consecutively recruited between December 2015 - October 2018 from two birthing units in Sweden. All who gave birth in water during the recruitment period were included (N=155) and 111 responded to the survey. Women were emailed a web-based survey six weeks postpartum. Open-ended questions were analyzed with qualitative content analysis.

    RESULTS: Two themes were identified related to benefits: (1) physical benefits: the water eases labor progression while offering buoyancy and pain relief; and (2) psychological benefits: improved relaxation and control in a demedicalized and safe setting. Two themes were identified related to negative experiences: (1) equipment-related issues due to the construction of the tub and issues related to being immersed in water; and (2) fears and worries related to waterbirth. In regard to preparatory information, respondents reported a lack of general and specific information related to waterbirths, even after they contacted birthing units to ask questions. Supplemental web-based information was sought, but the trustworthiness of these sources was questioned and a need for trustworthy web-based information was articulated.

    CONCLUSION: Women who give birth in water experience physical and psychological benefits, but need better equipment and sufficient information. There is room for improvement with regard to prenatal and intrapartum care of women who give birth in water.

    IMPACT: Judging from women's recounts, midwives and nurses should continue advocating waterbirth in low-risk pregnancies. The lack of adequate equipment in Swedish birthing units articulated by women challenge current routines and resources. The findings illustrate unfulfilled needs for preparatory information about waterbirth, further strengthening that midwives should discuss the possibility of waterbirth when meeting expectant parents in the antenatal setting.

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  • 45. Davidsson-Bremborg, Anna
    et al.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Memory triggers and anniversaries of stillborn children2013Ingår i: Nordic Journal of Religion and Society, ISSN 0809-7291, E-ISSN 1890-7008, Vol. 26, nr 2, s. 157-174Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Care after stillbirths has changed radically within the last twenty years, not least because of research. However, less attention has been given to memorialization in the longer perspective. This is a qualitative study based on a web questionnaire with the aim to uncover memorialization practices on anniversary days. 596 bereaved mothers of stillborn children provided an answer to an open question on how they observed the anniversary. The inductive analysis resulted in six categories of memorialization: (1) internal memorialization; (2) home-based memorialization; (3) traditional grave visits; (4) extended memorialization rituals; (5) alternative activities; and (6) coincidental activities. Different memory triggers – gifts, objects, food, and places – were used to evoke memories, honour the child, and strengthen the bonds with the child and within the family.

  • 46. Delbaere, Ilse
    et al.
    Stern, Jenny
    Sophiahemmet Högskola.
    Fertility2020Ingår i: Preconception health and care: A life course approach / [ed] Jill Shawe, Eric A.P. Steegers & Sarah Verbiest, Springer , 2020, 1, s. 53-79Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 47. Drevin, Jennifer
    et al.
    Kristiansson, Per
    Stern, Jenny
    Sophiahemmet Högskola.
    Rosenblad, Andreas
    Measuring pregnancy planning: A psychometric evaluation and comparison of two scales2017Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, nr 11, s. 2765-2775Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To psychometrically test the London Measure of Unplanned Pregnancy and compare it with the Swedish Pregnancy Planning Scale.

    BACKGROUND: The incidence of unplanned pregnancies is an important indicator of reproductive health. The London Measure of Unplanned Pregnancy measures pregnancy planning by taking contraceptive use, timing, intention to become pregnant, desire for pregnancy, partner agreement, and pre-conceptual preparations into account. It has, however, previously not been psychometrically evaluated using confirmatory factor analysis. The Likert-scored single-item Swedish Pregnancy Planning Scale has been developed to measure the woman's own view of pregnancy planning level.

    DESIGN: Cross-sectional design.

    METHODS: In 2012-2013, 5493 pregnant women living in Sweden were invited to participate in the Swedish Pregnancy Planning study, of whom 3327 (61%) agreed to participate and answered a questionnaire. A test-retest pilot study was conducted in 2011-2012. Thirty-two participants responded to the questionnaire on two occasions 14 days apart. Data were analysed using confirmatory factor analysis, Cohen's weighted kappa and Spearman's correlation.

    RESULTS: All items of the London Measure of Unplanned Pregnancy contributed to measuring pregnancy planning, but four items had low item-reliability. The London Measure of Unplanned Pregnancy and Swedish Pregnancy Planning Scale corresponded reasonably well with each other and both showed good test-retest reliability.

    CONCLUSION: The London Measure of Unplanned Pregnancy may benefit from item reduction and its usefulness may be questioned. The Swedish Pregnancy Planning Scale is time-efficient and shows acceptable reliability and construct validity, which makes it more useful for measuring pregnancy planning.

  • 48. Edqvist, Malin
    et al.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Lundgren, Ingela
    Mollberg, Margareta
    Lindgren, Helena
    Practices used by midwives during the second stage of labor to facilitate birth - Are they related to perineal trauma?2018Ingår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, s. 18-22, artikel-id S1877-5756(17)30103-9Artikel i tidskrift (Refereegranskat)
  • 49. Ekstrand Ragnar, Maria
    et al.
    Grandahl, Maria
    Stern, Jenny
    Sophiahemmet Högskola.
    Mattebo, Magdalena
    Important but far away: adolescents' beliefs, awareness and experiences of fertility and preconception health2018Ingår i: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 23, nr 4, s. 265-273Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group.

    METHODS: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis.

    RESULTS: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given.

    CONCLUSION: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.

  • 50. Eriksson, Catrin
    et al.
    Skinstad, Matilda
    Georgsson, Susanne
    Carlsson, Tommy
    Sophiahemmet Högskola.
    Quality of websites about long-acting reversible contraception: a descriptive cross-sectional study2019Ingår i: Reproductive Health, ISSN 1742-4755, E-ISSN 1742-4755, Vol. 16, nr 1, artikel-id 172Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Today, there are various short- and long-acting contraceptive alternatives available for those who wish to prevent unintended pregnancy. Long-acting reversible contraception are considered effective methods with a high user satisfaction. High-quality information about contraception is essential in order to empower individuals to reach informed decisions based on sufficient knowledge. Use of the Web for information about contraception is widespread, and there is a risk that those who use it for this purpose could come in contact with sources of low quality.

    OBJECTIVE: The overarching aim was to investigate the quality of websites about long-acting reversible contraception.

    METHODS: Swedish client-oriented websites were identified through searches in Google (n = 46 included websites). Reliability and information about long-acting reversible contraceptive choices were assessed by two assessors with the DISCERN instrument, transparency was analyzed with the Journal of the American Medical Association benchmarks, completeness was assessed with inductive content analysis and readability was analyzed with Readability Index.

    RESULTS: The mean DISCERN was 44.1/80 (SD 7.7) for total score, 19.7/40 (SD 3.7) for reliability, 22.1/35 (SD 4.1) for information about long-acting reversible contraceptive choices, and 2.3/5 (SD 1.1) for overall quality. A majority of the included websites had low quality with regard to what sources were used to compile the information (n = 41/46, 89%), when the information was produced (n = 40/46, 87%), and if it provided additional sources of support and information (n = 30/46, 65%). Less than half of the websites adhered to any of the JAMA benchmarks. We identified 23 categories of comprehensiveness. The most frequent was contraceptive mechanism (n = 39/46, 85%) and the least frequent was when contraception may be initiated following an abortion (n = 3/46, 7%). The mean Readability Index was 42.5 (SD 6.3, Range 29-55) indicating moderate to difficult readability levels, corresponding to a grade level of 9.

    CONCLUSIONS: The quality of client-oriented websites about long-acting reversible contraception is poor. There is an undeniable need to support and guide laypersons that intend to use web-based sources about contraceptive alternatives, so that they may reach informed decisions based on sufficient knowledge.

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