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  • 1.
    Asplin, Nina
    et al.
    Sophiahemmet University.
    Wessel, Hans
    Marions, Lena
    Georgsson Öhman, Susanne
    Sophiahemmet University.
    Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 6, p. 620-627Article in journal (Refereed)
    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.

  • 2. Avelin, Pernilla
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Säflund, Karin
    Wredling, Regina
    Erlandsson, Kerstin
    Parental grief and relationships after the loss of a stillborn baby2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 6, p. 668-673Article in journal (Refereed)
    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.

  • 3. Barimani, M
    et al.
    Jonas, W
    Zwedberg, Sofia
    Sophiahemmet University.
    Parents' experiences when students are present during labour and childbirth: A cross-sectional survey of parents in Sweden2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 77, p. 130-136, article id S0266-6138(19)30188-3Article in journal (Refereed)
    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.

  • 4. Erlandsson, Kerstin
    et al.
    Warland, Jane
    Cacciatore, Joanne
    Rådestad, Ingela
    Sophiahemmet University.
    Seeing and holding a stillborn baby: mothers' feelings in relation to how their babies were presented to them after birth-findings from an online questionnaire2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 3, p. 246-250Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to determine if the way caregivers offer opportunities to see and hold a stillborn baby impacts a mother's feelings about the experience of seeing and holding her newborn. DESIGN AND SETTING: a web questionnaire hosted by the Swedish National Infant Foundation from March 2008 to April 2010. PARTICIPANTS: 840 eligible participants who had experienced a stillbirth after the 22nd gestational week from 1955 to 2010 and completed an online questionnaire about their experiences. METHODS: descriptive and inferential statistics. FINDINGS: when mothers were presented the baby as a normal part of birth without being asked if they wanted to see, they more often reported that the experience was comfortable compared to mothers who were asked if they wanted to see the baby 86% vs. 76% (p=<0.01). The incitation of fear in mothers was 70% vs. 80% (p=0.02) in favour of mothers who were not asked. Furthermore the mothers who were not asked more often stated that it felt natural and good when compared to those who said staff asked if the mother wanted to see, 73% vs. 61% (p=0.07) and (78%) vs. (69%) p=0.19, respectively. A trend was seen toward more mothers feeling natural, good, comfortable, and less frightened if the provider engaged in 'assumptive bonding', that is the baby is simply and naturally presented to the mother without asking her to choose. KEY CONCLUSIONS: mothers of stillborn babies felt more natural, good, comfortable and less frightened if the staff supported assumptive bonding by simply offering the baby to the mother. IMPLICATIONS FOR PRACTICE: care providers should approach caring for grieving mothers with tenderness and humility, assuming that they will wish to see and hold their stillborn baby.

  • 5. Fooladi, Ensieh
    et al.
    Weller, Carolina
    Salehi, Maryam
    Abhari, Farideh Rezaee
    Stern, Jenny
    Sophiahemmet University.
    Using reproductive life plan-based information in a primary health care center increased Iranian women's knowledge of fertility, but not their future fertility plan: A randomized, controlled trial2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 77-86, article id S0266-6138(18)30286-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Reproductive Life Plan (RLP)-based information in counseling has been reported in the USA and Sweden to increase women's knowledge of fertility and informed decision making about future fertility plans. This study examined if utilizing the RLP tool would have the same impact on Iranian women.

    DESIGN: A randomized, three-armed, controlled trial. 181 women were randomly allocated to the intervention group (IG, n = 61), control group 1 (CG1, n = 60) or control group 2 (CG2, n = 60).

    SETTING: A primary health care center in the Sari city, the Provincial capital of Mazandaran, Iran.

    PARTICIPANTS: Women of reproductive age who were able to conceive.

    INTERVENTIONS: The intervention group received oral and written information about fertility based on the RLP tool. Participants were contacted 2 months after the intervention. The primary outcome measure was the change in women's knowledge of fertility, particularly folic acid intake prior to pregnancy, over a 2 month period. The change in women's family planning intentions were also assessed. The participants in the IG shared their experiences at follow-up.

    FINDINGS: At baseline, there was no difference between the groups regarding the mean knowledge of fertility score. At 2 months, after adjustment for age, history of pregnancy and baseline values, the between group difference in change from baseline was 5.8 (p < 0.001). While there was no significant difference between the IG and CG1 for folic acid intake prior to pregnancy at baseline, the group difference for folic acid intake prior to pregnancy post intervention was statistically significant (85% vs 25%, p < 0.001). At follow-up, women's desire to have more children, preferred age to conceive the last child and the desired age gap between children in the IG and CG1 did not significantly change over time. Women reported the RLP counseling tool used by midwives as useful.

    KEY CONCLUSIONS: Provision of RLP-based information for Iranian women with a clear pregnancy intention in the context of a stable relationship, increased knowledge of fertility without changing their future fertility plan. The RPL counseling tool was appreciated by study participants. The lack of improvement in women's fertility intentions over time may reflect the involvement of other factors influencing decision making about childbearing in Iran. Whether the RLP can change women's behavior is yet to be established.

    IMPLICATIONS FOR PRACTICE: The RLP can be used by health care professionals, especially midwives, as a tool to increase women's fertility knowledge, which may result in fertility behavior change.

  • 6.
    Georgsson, Susanne
    et al.
    Sophiahemmet University.
    Linde, Anders
    Sophiahemmet University.
    Pettersson, Karin
    Nilsson, Rebecca
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    To be taken seriously and receive rapid and adequate care: womens' requests when they consult health care for reduced fetal movements.2016In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, p. 102-108Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: decreased fetal movement is a reason for women to seek health care in late pregnancy.

    OBJECTIVE: to examine what pregnant women who present with decreased fetal movements want to communicate to health care professionals and to other women in the same situation.

    DESIGN: a qualitative descriptive study.

    SETTING AND PARTICIPANTS: questionnaires were distributed in all seven labour wards in Stockholm from 1 January to 31 December 2014 to women who consulted care due to decreased fetal movements. In total, 3555 questionnaires were completed of which 1 000 were included in this study. The women's responses to the open ended question: "Is there something you want to communicate to health care professionals who take care of women with decreased fetal movement or to women who experience decreased fetal movements?", were analysed with manifest content analysis.

    FINDING: three categories were revealed about requests to health care professionals: Pay attention to the woman and take her seriously, Rapid and adequate care and Improved information on fetal movements. Regarding what the women want to communicate to other pregnant women, four categories were revealed: Contact health care for check-up, Pay attention to fetal movement, Recommended source of information and Practical advice.

    CONCLUSION: pregnant women who consult health care due to decreased fetal movements want to be taken seriously and receive rapid and adequate care with the health of the infant as the primary priority. The women requested uniform information about decreased fetal movements. They wished to convey to others in the same situation the importance of consulting care once too often rather than one time too few.

  • 7.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Malm, Mari-Cristin
    Lindgren, Helena
    Pettersson, Karin
    Franklin Larsson, Lise-Lotte
    Sophiahemmet University.
    Being alone in silence - Mothers' experiences upon confirmation of their baby's death in utero2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 3, p. e91-e95Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore mothers' experiences of the confirmation of ultrasound examination results and how they were told that their baby had died in-utero.

    DESIGN: in-depth interviews.

    SETTING: Sweden.

    PARTICIPANTS: 26 mothers of stillborn babies.

    MEASUREMENT: narratives were analysed using a qualitative content analysis with an inductive approach.

    FINDINGS: the mothers experienced that silence prevailed during the entire process of confirming the ultrasound results. Typically all present in the ultrasound room were concentrating and focusing on what they observed on the screen, no one spoke to the mother. The mothers had an instinctive feeling that their baby might be dead based on what they observed on the ultrasound screen and on their interpretation of the body language of the clinicians and midwives. Some mothers reported a time delay in receiving information about their baby's death. Experiencing uncertainty about the information received was also noticed.

    CONCLUSION: mothers emphasised an awareness of silence and feelings of being completely alone while being told of the baby's death.

    IMPLICATION FOR PRACTICE: the prevalence of silence during an ultrasound examination may in certain cases cause further psychological trauma for the mother of a stillborn baby. One way to move forward given these results may be to provide obstetric personnel sufficient training on how difficult information might be more effectively and sensitively provided in the face of an adverse pregnancy outcome.

  • 8.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Ekborn, Marie
    Georgsson, Susanne
    Sophiahemmet University.
    Like an empowering micro-home: A qualitative study of women's experience of giving birth in water2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 26-31, article id S0266-6138(18)30277-8Article in journal (Refereed)
    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.

  • 9.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet University.
    Saltvedt, Sissel
    Georgsson, Susanne
    Sophiahemmet University.
    Women's experiences of waterbirth compared with conventional uncomplicated births2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 79, article id 102547Article in journal (Refereed)
    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.

  • 10. Åhlund, Susanne
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Zwedberg, Sofia
    Sophiahemmet University.
    Lindgren, Helena
    Perineal pain the first year after childbirth and uptake of post-partum check-up: A Swedish cohort study2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 78, p. 85-90, article id S0266-6138(19)30208-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this prospective cohort study was to investigate the prevalence of perineal pain related to the perineal injury within the first year after childbirth. The study further explored the rates of postpartum check-up attendance, and whether they had undergone a vaginal examination, pelvic floor assessment and exercise advice.

    RESEARCH DESIGN: The primary outcome was women's self-perceived and selfreported occurrence of pain related to perineal injuries (within three, six and 12 months) after birth. Secondary outcomes were uptake of postpartum check-up six to 12 weeks after birth and care received at the check-up. A postal questionnaire was completed one year after birth. Descriptive data was used to present data.

    FINDINGS: A total of 461 Swedish women (77%) were included in the study. The majority of women with severe perineal injuries (75.0%), and 61.8% of those with moderate injuries II suffered from perineal pain three months postpartum, while 60% with severe injuries and 38.7 with moderate injuries II still had perineal pain six months after birth. The postpartum check-up was attended by 90.6%. However, one out of four had not been given a pelvic examination or advised about pelvic floor exercises.

    KEY CONCLUSION: Many primiparas suffer from pain related to perineal injuries during the first year after birth. One out of ten women has problems with perineal pain one year postpartum. It is essential to investigate and recognize the impact of perineal pain on women's daily life and psychological and emotional wellbeing at the postpartum checkup.

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