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  • 1.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness: A method for systematic observation of fetal movements in late pregnancy2017Conference paper (Other academic)
  • 2.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Steineck, G
    Skokic, V
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness and pregnancy outcomes: a randomized controlled trial including 39,337 women2019Conference paper (Other academic)
  • 3.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, Helena
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness- a method for systematic observation of fetal movements in late pregnancy2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, no 1, article id 359Article in journal (Refereed)
    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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  • 4.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Linde, Anders
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Structured daily observation of fetal movements and transfer to neonatal clinic2017Conference paper (Other academic)
  • 5.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, H
    Georgsson, S
    Pettersson, K
    Steineck, G
    Skokic, V
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women2020In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, no 7, p. 829-837Article in journal (Refereed)
    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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  • 6.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, H
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, K
    Skokic, V
    Rådestad, Ingela
    Sophiahemmet University.
    Awareness of fetal movements and pregnancy outcomes among women born in Somalia and Sweden: A cluster-randomised controlled trialManuscript (preprint) (Other academic)
  • 7.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Increased labor induction and women presenting with decreased or altered fetal movements: A population-based survey2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 5, article id e0216216Article in journal (Refereed)
    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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  • 8.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness - a systematic method for observing fetal movements: A randomized controlled trial2019Conference paper (Other academic)
  • 9.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness: A useful tool when informing pregnant women about fetal movements2019Conference paper (Other academic)
  • 10.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness: En metod som kan stärka kvinnors uppmärksamhet av fosterrörelser2018Conference paper (Other academic)
  • 11.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Pettersson, Karin
    Skokic, Viktor
    Rådestad, Ingela
    Sophiahemmet University.
    Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area: a population-based study2020In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 13, no 1, article id 1794107Article in journal (Refereed)
    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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  • 12.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Georgsson, Susanne
    Sophiahemmet University.
    Warland, Jane
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 32-37, article id S1877-5756(18)30321-5Article in journal (Refereed)
    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.

  • 13.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Skokic, Viktor
    Rådestad, Ingela
    Sophiahemmet University.
    A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 577Article in journal (Refereed)
    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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  • 14.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Rossen, Jenny
    Sophiahemmet University.
    Storck-Lindholm, Elisabeth
    Rådestad, Ingela
    Sophiahemmet University.
    Prolonged pregnancy and stillbirth among women with overweight or obesity: A population-based study in Sweden including 64,632 women2023In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 23, article id 21Article in journal (Refereed)
    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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  • 15.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Fostrets rörelser2022In: Reproduktiv hälsa: Barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2022, 2, p. 374-380Chapter in book (Other academic)
  • 16.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Improving outcomes for women with decreased fetal movement: An interactive educational workshop2021Conference paper (Other academic)
  • 17.
    Andrén, Anna
    et al.
    Sophiahemmet University.
    Akselsson, Anna
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Ali, Salma Burhan
    Lindgren, Helena
    Sophiahemmet University.
    Osman, Hodan Mohamoud
    Erlandsson, Kerstin
    Miscommunication influences how women act when fetal movements decrease: An interview study with Swedish Somali migrant women2023In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 126, article id 103796Article in journal (Refereed)
    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.

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  • 18.
    Andrén, Anna
    et al.
    Sophiahemmet University.
    Akselsson, Anna
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Ali, Salma Burhan
    Lindgren, Helena
    Sophiahemmet University.
    Osman, Hodan Mohamoud
    Erlandsson, Kerstin
    Miscommunication influences how women act when fetal movements decrease an interview study with Swedish Somali migrant women2023Conference paper (Other academic)
  • 19.
    Andrén, Anna
    et al.
    Sophiahemmet University.
    Akselsson, Anna
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Ali, Salman Burhan
    Lindgren, Helena
    Sophiahemmet University.
    Osman, Hodan Mohamoud
    Erlandsson, Kerstin
    Brister i kommunikationen påverkar hur kvinnor agerar vid minskade fosterrörelser: En intervjustudie med svensksomaliska kvinnor2023Conference paper (Other academic)
  • 20.
    Andrén, Anna
    et al.
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Lindgren, Helena
    Sophiahemmet University.
    Erlandsson, Kerstin
    Akselsson, Anna
    Sophiahemmet University.
    Ökad uppmärksamhet av fosterrörelser och graviditetsutfall: Ett projekt riktat mot svensksomaliska kvinnor2023Conference paper (Other academic)
  • 21. Avelin, Pernilla
    et al.
    Erlandsson, Kerstin
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Sophiahemmet University.
    Swedish parents' experiences of parenthood and the need for support to siblings when a baby is stillborn2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 2, p. 150-8Article in journal (Refereed)
    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.

  • 22. Avelin, Pernilla
    et al.
    Gyllenswärd, Göran
    Erlandsson, Kerstin
    Rådestad, Ingela
    Sophiahemmet University.
    Adolescents' experiences of having a stillborn half-sibling2014In: Death Studies, ISSN 0748-1187, E-ISSN 1091-7683, Vol. 38, no 9, p. 557-562Article in journal (Refereed)
    Abstract [en]

    Although there is an increasing interest in siblings' experiences of loss and grief there is limited knowledge of adolescent's own perspectives, especially in a unique situation as after stillbirth in a reconstituted family. The authors interviewed 13 bereaved adolescents. They were sad that their family was not the same and expressed feelings of being inside family grief, yet outside, because they did not have full access in their reconstituted family. An implication of present findings is that it is important to include all the members of the family in the grieving process, even half-siblings of the deceased child.

  • 23. Avelin, Pernilla
    et al.
    Hildingsson, Ingegerd
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Make the stillborn baby and the loss real for the siblings: parents' advice on how the siblings of a stillborn baby can be supported2012In: Journal of Perinatal Education, ISSN 1058-1243, EISSN 1548-8519, Vol. 21, no 2, p. 90-98Article in journal (Refereed)
    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.

  • 24. 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.

  • 25. Bradford, Billie F
    et al.
    Cronin, Robin S
    Warland, Jane
    Akselsson, Anna
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Heazell, Alexander Ep
    McKinlay, Christopher J D
    Stacey, Tomasina
    Thompson, John M D
    McCowan, Lesley M E
    Fetal movements: A framework for antenatal conversations2023In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 36, no 3, p. 238-246, article id S1871-5192(22)00321-3Article in journal (Refereed)
    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.

  • 26. Bradford, Billie F
    et al.
    Hayes, Dexter J L
    Damhuis, Stefanie
    Shub, Alexis
    Akselsson, Anna
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Heazell, Alexander E P
    Flenady, Vicki
    Gordijn, Sanne J
    Decreased fetal movements: Report from the International Stillbirth Alliance conference workshop.2023In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, E-ISSN 1879-3479Article, review/survey (Refereed)
    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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  • 27. Cacciatore, Joanne
    et al.
    Erlandsson, Kerstin
    Rådestad, Ingela
    Sophiahemmet University.
    Fatherhood and suffering: A qualitative exploration of Swedish men's experiences of care after the death of a baby2013In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 50, no 5, p. 664-670Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This study was designed to evaluate fathers' experiences of stillbirth and psychosocial care. METHODS: Data were collected between 27 March 2008 and 1 April 2010 via a questionnaire posted on the homepage of the Swedish National Infant Foundation. The responses to the following open-ended questions were analyzed using content analysis: "Are you grateful today for anything that health care professionals did in connection with the birth of your child?" and "Are you sad, hurt or angry today about something personnel did in connection with the birth of your baby?". RESULTS: 113/131 (86%) fathers reported feelings of being grateful. Only 22/131 (16%) fathers reported feeling sad, hurt, or angry. Fathers expressed gratitude when health care professionals treated their newborn "with respect and without fear", "with extraordinary reverence", and when their fatherhood was validated by providers. They were also grateful when providers helped them to create memories of their baby. Fathers also reported feeling sad, hurt, or angry when providers were nonchalant and indifferent and when they perceived providers to be uncaring and disrespectful toward their baby. CONCLUSION: Bereaved fathers experience overall gratitude for person-centered psychosocial care in the aftermath of stillbirth, particularly when they feel validated as a grieving father and their child is acknowledged with reverence. CLINICAL IMPLICATIONS: Health care professionals should support fathers by treating the baby who died with respect and dignity and by validating and acknowledging both his grief experiences and his fatherhood just as they would for a grieving mother.

  • 28. Davidsson-Bremborg, Anna
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Memory triggers and anniversaries of stillborn children2013In: Nordic Journal of Religion and Society, ISSN 0809-7291, E-ISSN 1890-7008, Vol. 26, no 2, p. 157-174Article in journal (Refereed)
    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.

  • 29. Edqvist, Malin
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    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?2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 15, p. 18-22, article id S1877-5756(17)30103-9Article in journal (Refereed)
  • 30. Erlandsson, Kerstin
    et al.
    Lindgren, Helena
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 1, p. 28-33Article in journal (Refereed)
    Abstract [en]

    Objective. To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. Setting. One thousand and thirty-four women answered a web questionnaire. Sample. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. Main Outcome Measure. The premonition of an unwell unborn baby. Results. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. Conclusions. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

  • 31. Erlandsson, Kerstin
    et al.
    Lindgren, Helena
    Malm, Mari-Cristine
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Sophiahemmet University.
    Mothers' experiences of the time after the diagnosis of an intrauterine death until the induction of the delivery: a qualitative Internet-based study2011In: Journal of obstetrics and gynaecology research, ISSN 1341-8076, E-ISSN 1447-0756, Vol. 37, no 11, p. 1677-84Article in journal (Refereed)
    Abstract [en]

    AIM: This study aims to describe how mothers spend the period of time between being diagnosed with a dead baby in utero and the induction of the delivery.

    MATERIAL AND METHODS: Data were collected using a web questionnaire. Five hundred and fifteen women who had experienced a stillbirth after the 22nd week of gestation answered the open question: 'What did you do between the diagnosis of the child's death and the beginning of the delivery?' A qualitative content analysis method was used.

    RESULTS: The results show that some mothers received help to adapt to the situation, while for others, waiting for the induction meant further stress and additional psychological trauma in an already strained situation.

    CONCLUSION: There is no reason to wait with the induction unless the parents themselves express a wish to the contrary. Health care professionals, together with the parents, should try to determine the best time for the induction of the birth after the baby's death in utero. That time may vary, depending on the parents' preferences.

  • 32. Erlandsson, Kerstin
    et al.
    Säflund, Karin
    Wredling, Regina
    Rådestad, Ingela
    Sophiahemmet University.
    Support after stillbirth and its effect on parental grief over time2011In: Journal of social work in end-of-life & palliative care, ISSN 1552-4264, Vol. 7, no 2-3, p. 139-52Article in journal (Refereed)
    Abstract [en]

    In this study the authors describe parents' experiences of support over a 2-year period after a stillbirth and its effect on parental grief. Data was collected by questionnaire from 33 mothers and 22 fathers at 3 months, 1 year, and 2 years after a stillbirth. Midwives, physicians, counselors, and priests--at the hospital where the stillbirth occurred--are those on the front line providing professional support. The support from family and friends was seen to be important 2 years after the stillbirth. The need for professional support after stillbirth can differ, depending on the support provided by family, friends, and social networks. They may not fully realize the value of their support and how to be supportive. Printed educational materials given to individuals in the social network or family might therefore be helpful.

  • 33. 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.

  • 34. Flenady, Vicki
    et al.
    Ellwood, David
    Bradford, Billie
    Coory, Michael
    Middleton, Philippa
    Gardener, Glenn
    Rådestad, Ingela
    Sophiahemmet University.
    Homer, Caroline
    Davies-Tuck, Miranda
    Forster, Della
    Gordon, Adrienne
    Groom, Katie
    Crowther, Caroline
    Walker, Sue
    Foord, Claire
    Warland, Jane
    Murphy, Margaret
    Said, Joanne
    Boyle, Fran
    O'Donoghue, Keelin
    Cronin, Robin
    Sexton, Jessica
    Weller, Megan
    McCowan, Lesley
    Beyond the headlines: Fetal movement awareness is an important stillbirth prevention strategy2018In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, article id S1871-5192(18)31666-4Article in journal (Refereed)
  • 35. Flenady, Vicki
    et al.
    Wojcieszek, Aleena M
    Middleton, Philippa
    Ellwood, David
    Erwich, Jan Jaap
    Coory, Michael
    Khong, T Yee
    Silver, Robert M
    Smith, Gordon C S
    Boyle, Frances M
    Lawn, Joy E
    Blencowe, Hannah
    Leisher, Susannah Hopkins
    Gross, Mechthild M
    Horey, Dell
    Farrales, Lynn
    Bloomfield, Frank
    McCowan, Lesley
    Brown, Stephanie J
    Joseph, K S
    Zeitlin, Jennifer
    Reinebrant, Hanna E
    Ravaldi, Claudia
    Vannacci, Alfredo
    Cassidy, Jillian
    Cassidy, Paul
    Farquhar, Cindy
    Wallace, Euan
    Siassakos, Dimitrios
    Heazell, Alexander E P
    Storey, Claire
    Sadler, Lynn
    Petersen, Scott
    Frøen, J Frederik
    Goldenberg, Robert L
    Stillbirths: recall to action in high-income countries.2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10019, p. 691-702Article in journal (Refereed)
    Abstract [en]

    Variation in stillbirth rates across high-income countries and large equity gaps within high-income countries persist. If all high-income countries achieved stillbirth rates equal to the best performing countries, 19,439 late gestation (28 weeks or more) stillbirths could have been avoided in 2015. The proportion of unexplained stillbirths is high and can be addressed through improvements in data collection, investigation, and classification, and with a better understanding of causal pathways. Substandard care contributes to 20-30% of all stillbirths and the contribution is even higher for late gestation intrapartum stillbirths. National perinatal mortality audit programmes need to be implemented in all high-income countries. The need to reduce stigma and fatalism related to stillbirth and to improve bereavement care are also clear, persisting priorities for action. In high-income countries, a woman living under adverse socioeconomic circumstances has twice the risk of having a stillborn child when compared to her more advantaged counterparts. Programmes at community and country level need to improve health in disadvantaged families to address these inequities.

  • 36.
    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.

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  • 37. Gravensteen, Ida Kathrine
    et al.
    Helgadóttir, Linda Björk
    Jacobsen, Eva-Marie
    Rådestad, Ingela
    Sophiahemmet University.
    Sandset, Per Morten
    Ekeberg, Oivind
    Women's experiences in relation to stillbirth and risk factors for long-term post-traumatic stress symptoms: a retrospective study2013In: BMJ Open, E-ISSN 2044-6055, Vol. 3, no 10, p. e003323-Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: (1) To investigate the experiences of women with a previous stillbirth and their appraisal of the care they received at the hospital. (2) To assess the long-term level of post-traumatic stress symptoms (PTSS) in this group and identify risk factors for this outcome.

    DESIGN: A retrospective study.

    SETTING: Two university hospitals.

    PARTICIPANTS: The study population comprised 379 women with a verified diagnosis of stillbirth (≥23 gestational weeks or birth weight ≥500 g) in a singleton or twin pregnancy 5-18 years previously. 101 women completed a comprehensive questionnaire in two parts.

    PRIMARY AND SECONDARY OUTCOME MEASURES: The women's experiences and appraisal of the care provided by healthcare professionals before, during and after stillbirth. PTSS at follow-up was assessed using the Impact of Event Scale (IES).

    RESULTS: The great majority saw (98%) and held (82%) their baby. Most women felt that healthcare professionals were supportive during the delivery (85.6%) and showed respect towards their baby (94.9%). The majority (91.1%) had received some form of short-term follow-up. One-third showed clinically significant long-term PTSS (IES ≥ 20). Independent risk factors were younger age (OR 6.60, 95% CI 1.99 to 21.83), induced abortion prior to stillbirth (OR 5.78, 95% CI 1.56 to 21.38) and higher parity (OR 3.46, 95% CI 1.19 to 10.07) at the time of stillbirth. Having held the baby (OR 0.17, 95% CI 0.05 to 0.56) was associated with less PTSS.

    CONCLUSIONS: The great majority saw and held their baby and were satisfied with the support from healthcare professionals. One in three women presented with a clinically significant level of PTSS 5-18 years after stillbirth. Having held the baby was protective, whereas prior induced abortion was a risk factor for a high level of PTSS.

    TRIAL REGISTRATION: The study was registered at http://www.clinicaltrials.gov, with registration number NCT 00856076.

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  • 38. Gravensteen, Ida Kathrine
    et al.
    Jacobsen, Eva-Marie
    Sandset, Per Morten
    Helgadottir, Linda Björk
    Rådestad, Ingela
    Sophiahemmet University.
    Sandvik, Leiv
    Ekeberg, Øivind
    Healthcare utilisation, induced labour and caesarean section in the pregnancy after stillbirth: a prospective study2018In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 125, no 2, p. 202-210Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate healthcare utilisation, induced labour and caesarean section (CS) in the pregnancy after stillbirth and assess anxiety and dread of childbirth as mediators for these outcomes.

    DESIGN: Population-based pregnancy cohort study.

    SETTING: The Norwegian Mother and Child Cohort Study.

    SAMPLE: 901 pregnant women; 174 pregnant after stillbirth, 362 pregnant after live birth and 365 previously nulliparous.

    METHODS: Data from questionnaires answered in the second and third trimesters of pregnancy and information from the Medical Birth Registry of Norway.

    MAIN OUTCOME MEASURES: Self-reported assessment of antenatal care, register-based assessment of onset and mode of delivery.

    RESULTS: Women with a previous stillbirth had more frequent antenatal visits (mean 10.0; 95% confidence interval [CI] 9.4 - 10.7) compared with women with a previous live birth (6.0; 5.8 - 6.2) and previously nulliparous women (6.3; 6.1 - 6.6). Induced labour and CS, elective and emergency, were also more prevalent in the stillbirth group. The adjusted odds ratio for elective CS was 2.5 (95% CI 1.3 - 5.0) compared with women with previous live birth and 3.7 (1.8 - 7.6) compared with previously nulliparous women. Anxiety was a minor mediator for the association between stillbirth and frequency of antenatal visits, while dread of childbirth was not a significant mediator for elective CS.

    CONCLUSIONS: Women pregnant after stillbirth were more ample users of healthcare services and had more often induced labour and CS. The higher frequency of antenatal visits and elective CS could not be accounted for by anxiety or dread of childbirth. This article is protected by copyright. All rights reserved.

  • 39. Gravensteen, Ida Kathrine
    et al.
    Jacobsen, Eva-Marie
    Sandset, Per Morten
    Helgadottir, Linda Bjørk
    Rådestad, Ingela
    Sophiahemmet University.
    Sandvik, Leiv
    Ekeberg, Øivind
    Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 41Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women's relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth.

    METHODS: This study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors.

    RESULTS: Women pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90-10.32 and aOR 1.91, 95% CI 1.11-3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68-9.24 and aOR 1.91, 95% CI 1.08-3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval <  12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups.

    CONCLUSION: Women who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.

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  • 40. Heazell, Alexander E P
    et al.
    Siassakos, Dimitrios
    Blencowe, Hannah
    Burden, Christy
    Bhutta, Zulfiqar A
    Cacciatore, Joanne
    Dang, Nghia
    Das, Jai
    Flenady, Vicki
    Gold, Katherine J
    Mensah, Olivia K
    Millum, Joseph
    Nuzum, Daniel
    O'Donoghue, Keelin
    Redshaw, Maggie
    Rizvi, Arjumand
    Roberts, Tracy
    Toyin Saraki, H E
    Storey, Claire
    Wojcieszek, Aleena M
    Downe, Soo
    Stillbirths: economic and psychosocial consequences.2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10018, p. 604-16Article in journal (Refereed)
    Abstract [en]

    Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.

  • 41. Holste, Carola
    et al.
    Pilo, Christina
    Pettersson, Karin
    Rådestad, Ingela
    Sophiahemmet University.
    Papadogiannakis, Nikos
    Mothers' attitudes towards perinatal autopsy after stillbirth2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 11, p. 1287-90Article in journal (Refereed)
    Abstract [en]

    We investigated mothers' attitudes to autopsy of their stillborn baby and their experiences concerning information and treatment in relation to their loss in an observational study. Data were collected by postal questionnaires and telephone calls. Fifty-four of 72 mothers (76%) replied. Fifty-one (94%) received information from a physician about the possibility of having an autopsy; three (6%) did not get any information. The autopsy rate was 83% (n= 45). Thirty-six of 45 (80%) received adequate information about results. Twenty-five (56%) were pleased with how results were presented. Eleven (24%) were positive about individual contact with the pathologist who performed the autopsy. Fifty-one (94%) stated that their decision concerning autopsy was right. Mothers do not regret their decision concerning perinatal autopsy but they do not always receive thorough and timely information concerning autopsy and its results. Personal contact with the perinatal pathologist might help with specific questions both before and after autopsy.

  • 42. Höglund, Berit
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    Few women receive a specific explanation of a stillbirth: An online survey of women's perceptions and thoughts about the cause of their baby's death2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In Sweden, three to four out of every 1000 pregnancies end in stillbirth each year. The aim of this study was to investigate whether women who had experienced stillbirth perceived that they had received an explanation of the death and whether they believed that healthcare professionals were responsible for the death of the baby.

    METHODS: An online survey of 356 women in Sweden who had experienced a stillbirth from January 2010 to April 2014. A mixed-methods approach with qualitative content analysis was used to examine the women's responses.

    RESULTS: Nearly half of the women (48.6%) reported that they had not received any explanation as to why their babies had died. Of the women who reported that they had received an explanation, 84 (23.6%) had a specific explanation, and 99 (27.8%) had a vague explanation. In total, 73 (30.0%) of the 243 women who answered the question "Do you believe that healthcare personnel were responsible for the stillbirth?" stated Yes. The women reported that the healthcare staff had not acknowledged their intuition that the pregnancy was proceeding poorly. Furthermore, they perceived that the staff met them with nonchalance and arrogance. Additionally, the midwife had ignored or normalised the symptoms that could indicate that their pregnancy was proceeding poorly. Some women added that neglect and avoidance among the healthcare staff could have led to a lack of monitoring, which could have been crucial for the outcome of the pregnancy.

    CONCLUSIONS: Half of the women surveyed reported that they had not received an explanation of their baby's death, and more than one-fourth held healthcare professionals responsible for the death.

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  • 43. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    Childbirth: an emotionally demanding experience for fathers2012In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 3, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: While attending birth mostly has a positive impact on becoming a father, it has also been described as including feelings of discomfort and is more demanding than expected.

    OBJECTIVE: The objective was to explore Swedish fathers' birth experiences, and factors associated with a less-positive birth experience.

    METHODS: Mixed methods including quantitative and qualitative data were used. Two months after birth 827 fathers answered a questionnaire and 111 (13%) of these commented on the birth experience. Data were analysed with descriptive statistics, chi-square test for independence, risk ratios with a 95% confidence interval, logistic regression and content analysis.

    RESULTS: In total, 604 (74%) of the fathers had a positive or very positive birth experience. Used method identified a less-positive birth experience associated with emergency caesarean section (RR 7.5; 4.1-13.6), instrumental vaginal birth (RR 4.2; 2.3-8.0), and dissatisfaction with the partner's medical care (RR 4.6; 2.7-7.8). Healthcare professionals' competence and approach to the fathers were also related to the birth experience.

    CONCLUSIONS: As the fathers' birth experiences were associated with mode of birth and experiences of the intrapartum medical care fathers should be respectfully and empathically treated during labour and birth. It is essential to better engage fathers during the intrapartum period through involvement and support to improve the likelihood of a positive birth experience.

  • 44. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    Improvements of postnatal care are required by Swedish fathers2013In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 26, no 5, p. 465-480Article in journal (Refereed)
    Abstract [en]

    Purpose – This paper has two main aims: to explore fathers' postnatal care experiences with a specific focus on deficiencies and to investigate which service deficiencies remained important for fathers one year after childbirth.

    Design/methodology/approach – This is a prospective longitudinal study. Two months and one year after birth, the overall satisfaction with care were sought. A care quality index was created, based on perceived reality and subjective importance of the care given. The study excluded fathers not mastering Swedish. Total eligible fathers was consequently not known therefore pregnancies served as an estimate.

    Findings – In total, 827 fathers answered the questionnaire two months after birth and 655 returned the follow-up questionnaire after one year; 21 per cent were dissatisfied with overall postnatal-care. The most important dissatisfying factors were the way fathers were treated by staff and the women's check-up/medical care. Two months after the birth, information given about the baby's care and needs were most deficient when parents had been cared for in a hotel ward. Furthermore, information about the baby's needs and woman's check-up/medical care was most deficient when fathers had participated in emergency Caesarean section.

    Practical implications – Most fathers were satisfied with the overall postnatal care, but how fathers are treated by caregivers; the woman's check-up/medical care and information given about the baby's care and needs can be improved. Professionals should view early parenthood as a joint project and support both parents' needs.

    Originality/value – The paper provides knowledge about postnatal service quality including fathers' needs.

  • 45. Johansson, Margareta
    et al.
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Hildingsson, Ingegerd
    The Internet: one important source for pregnancy and child information among prospective fathers2010In: Journal of Men's Health, ISSN 1875-6867, E-ISSN 1875-6859, Vol. 7, no 3, p. 249-258Article in journal (Refereed)
  • 46.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, K
    Holmström, S
    Norberg, E
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movement in late pregnancy: a content analysis of women´s experiences of how their unborn baby moved less or differently2016Conference paper (Other academic)
    Abstract [en]

    Background: Pregnant women sometimes worry about their unborn baby’s health, often due to decreased fetal movements. Objectives: To examine how women, who consulted health care due to decreased fetal movements, describe how the baby had moved less or differently. Methods: Women were recruited from all seven delivery wards in Stockholm, Sweden, during 1/1 – 31/12 2014.The women completed a questionnaire after it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women’s responses to, “Try to describe how your baby has moved less or had changes in movement”. Results: Four categories and six subcategories were identified: “Frequency” (decreased frequency, absence of kicks and movement), “Intensity” (weaker fetal movements, indistinct fetal movements), “Character” (changed pattern of movements, slower movements) and “Duration”. In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements. Conclusion: Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital delay if the fetus is at risk of fetal compromise.

    Funding: The Little Child´s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation funded this study.

     

  • 47.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Holmström, Sofia
    Norberg, Emma
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movement in late pregnancy - a content analysis of women's experiences of how their unborn baby moved less or differently2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pregnant women sometimes worry about their unborn baby's health, often due to decreased fetal movements. The aim of this study was to examine how women, who consulted health care due to decreased fetal movements, describe how the baby had moved less or differently.

    METHODS: Women were recruited from all seven delivery wards in Stockholm, Sweden, during 1/1 - 31/12 2014. The women completed a questionnaire after it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women's responses to, "Try to describe how your baby has moved less or had changes in movement".

    RESULTS: Four categories and six subcategories were identified: "Frequency" (decreased frequency, absence of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (changed pattern of movements, slower movements) and "Duration". In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements.

    CONCLUSION: Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital delay if the fetus is at risk of fetal compromise.

    TRIAL REGISTRATION: Not applicable.

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  • 48.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Pettersson, Karin
    Holmström, Sofia
    Norberg, Emma
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movement in late pregnancy: A content analysis of women's experiences of how their unborn baby moved less or differently2016Conference paper (Other academic)
  • 49.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Decreased fetal movements and perinatal outcome2016Conference paper (Other academic)
    Abstract [en]

    Background: Decreased fetal movement is associated with adverse perinatal outcome, including stillbirth. Objectives: To investigate perinatal outcome for women who seek consultation due to reduced fetal movements in late pregnancy. Methods: All women (gestational week 28+), who came to one of the seven obstetric clinics in the Stockholm region, Sweden, in 2014 due to concerns for decreased fetal movements, were asked to fill in a questionnaire and to give informed consent to follow-up of their child in the medical birth register. Preliminary results: In total 2584 women completed the questionnaire, 75 % of the women were born in Sweden and 72% were primiparas. The women were aged <19-24 (10%), 25-34 (66%) 35->40 (24%) and two-thirds had a university education. Almost one third (28%) of the women sought health care more than once due to decreased fetal movement during their pregnancy. Sixty eight percent of the women experienced decreased fetal movement for 24 hours or more before the came to the hospital for an examination of the fetus.  Data from the medical birth registry says that 90% of the women gave birth to a child after a full-term pregnancy and 72 per cent had a vaginal birth. Conclusion: The analysis is in progress, we will have more data to present in September. Funding: The Little Child´s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation funded this study.

  • 50.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Pettersson, K
    Rådestad, Ingela
    Sophiahemmet University.
    Women´s experiences of fetal movements before the confirmation of fetal death: contractions misinterpreted as fetal movement2016Conference paper (Other academic)
    Abstract [en]

    Background: Decreased fetal movement often precedes a stillbirth. Objectives: The objective of this study was to describe women´s experiences of fetal movement before the confirmation of fetal death. Methods: Data were collected through a Web-based questionnaire in 2009 to 2013 and women who had answered the questionnaire before September 1, 2013. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question: “How do you remember the fetal movement during the 48 hours that preceded the diagnosis of intrauterine death?” The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term. Results: The women’s 215 answers were divided into three categories: Decreased, weak, and no fetal movement at all 154 (72%); Fetal movement as normal 39 (18%) and Extremely vigorous fetal activity followed by no movement at all 22 (10%). Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to five (5%) of the women with stillbirths at term. Conclusion: Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all two days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths. Funding:The Little Child´s Foundation, Sophiahemmet Foundation, The Swedish National Infant Foundation and Capo’s Research Foundation.

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