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  • 1. Sjöblom, Ingela
    et al.
    Idvall, Ewa
    Rådestad, Ingela
    Sophiahemmet University.
    Lindgren, Helena
    A provoking choice: Swedish women's experiences of reactions to their plans to give birth at home2012In: Women and birth : journal of the Australian College of Midwives, ISSN 1878-1799, Vol. 25, no 3, p. e11-e18Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The home birth rate in Sweden is less than 1 in 1000, and home birth is not included within the health care system. This study describes women's experiences concerning reactions to their decision to give birth at home. DESIGN AND SETTING: A nationwide survey (SHE - Swedish Homebirth Experience) in Sweden was conducted between 1992 and 2005 whereas 735 women had given birth to 1038 children. Of 1038 questionnaires 1025 were returned. MEASUREMENTS: In the questionnaires an open-ended question asked women to report their experience of reactions to their decision to give birth at home The question was answered by 594 women, and data were analysed using content analysis. FINDINGS: The analysis yielded one overarching theme; "To be faced with fear for life and death" including being exposed to reactions about risks. This describes attitudes of professionals and family towards life and death and suggests perceptions of risk and fear of unexpected events. Four main categories were identified; Seen as an irresponsible person, Met with emotional arguments, Exposed to persuasion and Alienation. CONCLUSION: Women who plan for a home birth were confronted with negative attitudes and persuasion to make them change their mind. This made them feel alienated, and they searched for support among like-minded. Negative attitudes from health care professionals may erode their confidence in conventional health services and turn them towards other options. IMPLICATION FOR PRACTICE: Women who want to give birth at home should be given evidence-based information about risks and benefits. Enhanced knowledge among public and professionals about home births would improve the options for respectful encounters.

  • 2. Sjödin, Marie
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Zwedberg, Sofia
    A qualitative study showing women's participation and empowerment in instrumental vaginal births2018In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 31, no 3, p. e185-e189, article id S1871-5192(17)30525-5Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: An instrumental birth with a ventouse or forceps is a complicated birth, possibly resulting in fear of childbirth which could influence the entire birth experience negatively. Patients who are actively involved in their care have a stronger sense of satisfaction and a sense of participation can contribute to shorter hospital stays.

    AIM: To describe the experience of participation for women involved in an instrumental delivery with ventouse or forceps.

    METHOD: Qualitative semi-structured interviews with 16 women who gave birth aided by a ventouse or forceps. Their answers were analyzed through qualitative content analysis. In addition the women were asked to evaluate their experience during the delivery. Using a numerical scale (NRS) the birth experience was graded by choosing a number between 0 (worst possible experience) and 10 (best conceivable experience).

    FINDINGS: Two themes were extracted from the data: To be part of a team and To feel empowered. Five categories were identified from the women's descriptions of the experience of involvement during the instrumental delivery: to cooperate; to understand; to have contact; to participate, and to not be involved. Those women who rated their experience as low grade, described a lack of involvement in their childbirth compared to those women who rated their experience as high.

    CONCLUSION: This study shows how cooperation and empowerment of the woman are two key factors in order for the women to have a positive experience of their instrumental vaginal births. The study also shows that empowerment is created when the woman is actively engaged and participates in the birth process which gives her the feeling of being part of the team, creating an environment based on mutual understanding.

    The full text will be freely available from 2019-09-21 15:19
  • 3. 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.

  • 4. 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.

  • 5.
    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.

  • 6.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Pettersson, K
    Hagelberg, L
    Georgsson, Susanne
    Sophiahemmet University.
    Better safe than sorry: Reasons for consulting care due to decreased fetal movements2017Conference paper (Other academic)
  • 7.
    Linde, Anders
    et al.
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Pettersson, Karin
    Hagelberg, Linn
    Georgsson, Susanne
    Sophiahemmet University.
    "Better safe than sorry"-Reasons for consulting care due to decreased fetal movements2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 5, p. 376-381, article id S1871-5192(17)30074-4Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experience of reduced fetal movements is a common reason for consulting health care in late pregnancy. There is an association between reduced fetal movements and stillbirth.

    AIM: To explore why women decide to consult health care due to reduced fetal movements at a specific point in time and investigate reasons for delaying a consultation.

    METHODS: A questionnaire was distributed at all birth clinics in Stockholm during 2014, to women seeking care due to reduced fetal movements. In total, 3555 questionnaires were collected, 960 were included in this study. The open-ended question; "Why, specifically, do you come to the clinic today?" was analyzed using content analysis as well as the complementary question "Are there any reasons why you did not come to the clinic earlier?"

    RESULTS: Five categories were revealed: Reaching dead line, Receiving advice from health care professionals, Undergoing unmanageable worry, Contributing external factors and Not wanting to jeopardize the health of the baby. Many women stated that they decided to consult care when some time with reduced fetal movements had passed. The most common reason for not consulting care earlier was that it was a new experience. Some women stated that they did not want to feel that they were annoying, or be perceived as excessively worried. Not wanting to burden health care unnecessarily was a reason for prehospital delay.

    CONCLUSION: Worry about the baby is the crucial reason for consulting care as well as the time which has passed since the women first experienced decreased fetal movements.

  • 8. 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)
  • 9. 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.

  • 10. Sjöblom, Ingela
    et al.
    Idvall, Ewa
    Lindgren, Helena
    Creating a safe haven-women's experiences of the midwife's professional skills during planned home birth in four Nordic countries2014In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 41, no 1, p. 100-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The midwife assisting a birth has a considerable influence on the woman's experience of the birth. The aim of this study was to investigate the experience of the midwife's professional skills among women in Norway, Denmark, Iceland, and Sweden who chose a planned home birth.

    DESIGN AND SETTING: All known home birth midwives were asked to inform the mothers about the project and invite them to complete a questionnaire about different aspects of their home birth experience.

    METHOD: The women were asked to assess 10 different aspects of the midwives' professional skills on a 4-graded scale below the main question: What was your experience of the midwife who assisted the labor? Furthermore, the mothers' experiences with the attending midwives were identified in the free text birth stories. The chosen method was a mixed method design.

    FINDINGS: The home birth midwives' professional skills were generally high scored. No statistically significant differences were found with respect to the assessment of the midwife. The content analyses yielded one overarching theme: The competence and presence of the midwife creates a safe haven, and three categories, midwife's safe hand, midwife's caring approach, and midwife's peaceful presence.

    CONCLUSION: Women choosing a home birth in the four Nordic countries experienced that their midwives were highly skilled and they found the presence of the midwives valuable in helping them to feel safe and confident during birth. Despite differences in organization and guidelines for home births, the women's experience of the midwife's professional skills did not differ between the four countries.

  • 11.
    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.

  • 12.
    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.

  • 13. Malm, Mari-Cristin
    et al.
    Lindgren, Helena
    Rubertsson, Christine
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Sophiahemmet University.
    Development of a tool to evaluate fetal movements in full-term pregnancy2014In: Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, ISSN 1877-5764, Vol. 5, no 1, p. 31-5Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study women's description of fetal movements in full-term pregnancy. Further to investigate if their descriptions could be sorted with regard to intensity and type of movements, using a matrix under development to be a tool for evaluating fetal movements in clinical praxis.

    METHODS: Data were collected by distributing questionnaires including an open question: "Please describe your perception of the baby's movements during this gestational week." A matrix listed seven categories of movements divided into powerful and non-powerful movements, was used for the content analysis.

    RESULTS: 393 (78%) women responded to the open question. The movements were split into two domains: Powerful movements and Non-powerful movements. Altogether, 383 (96%) women perceived fetal movements that were sorted as powerful movement: firm, slow stretching, large and side to side. Ten (4%) women described movements exclusively, i.e. movements that did not include any of the movements in the powerful domain. Most women perceived movements that corresponded to more than one type of category, and all movements described by the women could be referred to at least one of the categories in the matrix.

    CONCLUSION: The matrix was useful for identification of the women's perceptions of fetal movements in full-term pregnancy. Further studies are needed in order to develop the tool and its potential to evaluate the well-being of the fetus before it is to be used in clinical praxis.

  • 14.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Westerberg, Anna
    Ekholm, Ann
    Davidsson-Bremborg, Anna
    Erlandsson, Kerstin
    Evaluation of care after stillbirth in Sweden based on mothers' gratitude2011In: British journal of midwifery, ISSN 0969-4900, E-ISSN 2052-4307, Vol. 19, no 10, p. 646-652Article in journal (Refereed)
  • 15. 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.

  • 16.
    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.

  • 17.
    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.

     

  • 18.
    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)
  • 19.
    Rådestad, Ingela
    Sophiahemmet University.
    Fetal movements in the third trimester: important information about wellbeing of the fetus2010In: Sexual & Reproductive HealthCare: Official Journal of the Swedish Association of Midwives, ISSN 1877-5756, EISSN 1877-5764, Vol. 1, no 4, p. 119-121Article in journal (Other academic)
    Abstract [en]

    It can be quite natural for pregnant women to believe that a decrease in the frequency of fetal movements at the end of pregnancy is normal if they have been so informed. There is also probably scope for interpretation concerning what is to be regarded as a decrease in the number of movements. Non-evidence-based information that a decrease in fetal movements is normal during the third trimester poses a threat to the unborn baby's life. If the mother does not react to a decrease in frequency and if she waits too long before contacting healthcare professionals, the window of opportunity to save the baby's life may be closed.

  • 20. 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.

  • 21.
    Rådestad, Ingela
    Sophiahemmet University.
    Fostrets rörelser2016In: Reproduktiv hälsa: barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2016, 1, p. 284-288Chapter in book (Other academic)
  • 22. Åhlund, Susanne
    et al.
    Rådestad, Ingela
    Sophiahemmet University.
    Zwedberg, Sofia
    Sophiahemmet University.
    Edqvist, Malin
    Lindgren, Helena
    Haemorrhoids - A neglected problem faced by women after birth2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 18, p. 30-36, article id S1877-5756(18)30042-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the prevalence and severity of haemorrhoids after birth among first-time mothers in relation to management during the second stage of labour and to describe the women's experiences with haemorrhoids.

    METHOD: A mixed method explanatory sequential design was used. Nulliparous women were allocated to an intervention group for whom the second-stage of labour practice followed the MIMA model (Midwives management during second stage of labour) or to a control group for whom standard-care practice was followed. Data were collected three weeks and 1.5 years after birth.

    RESULT: A total of 496 (82.1%) women responded to the questionnaire three weeks after birth, 120 (70%) responded to the questionnaire 1.5 years after the birth. The women in the intervention group had fewer symptoms from haemorrhoids three weeks after birth compared to the women in the control group (adj. OR 0.6 95% CI 0.4-0.9). Half of the women in the intervention and control group (50.8%) who reported problems with haemorrhoids three weeks after birth still experienced problems after 1.5 years. The majority of all women did not seek medical care due to their symptoms. The women who described that they experienced haemorrhoids as a problem after birth felt neglected by the healthcare system.

    CONCLUSION: A substantial percentage of women had symptoms from haemorrhoids after birth. Many of these women felt that their problems were neglected. Women who experienced a slow birth of the baby's head and spontaneous pushing suffered less from haemorrhoids 3 weeks after birth.

  • 23. 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.

  • 24. 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.

  • 25.
    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, ISSN 1932-6203, 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.

  • 26.
    Rådestad, Ingela
    Sophiahemmet University.
    Intrauterin fosterdöd2016In: Reproduktiv hälsa: barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2016, 1, p. 417-425Chapter in book (Other academic)
  • 27. Malm, M-C
    et al.
    Lindgren, H
    Rådestad, Ingela
    Sophiahemmet University.
    Losing contact with one's unborn baby: mothers' experiences prior to receiving news that their baby has died in utero2011In: Omega, ISSN 0030-2228, E-ISSN 1541-3764, Vol. 62, no 4, p. 353-367Article in journal (Refereed)
    Abstract [en]

    Background: A change in the pattern of movement of her unborn baby could be indicative that the baby might die. Aim: To study mothers' experiences during the time prior to receiving news that their baby has died. Method: Interviews with 26 mothers. Results: Premonition that something had happened to their baby, a sense based on a lack of movements were experienced. Six categories describe the mother's insight that the baby's life was threatened: not feeling in touch with their baby; worry' feeling something is wrong; not understanding the unbelievable; wanting information; and being certain that their baby had died. The overarching theme "There is something wrong" was formulated. Conclusion: The mother could not understand the unbelievable: that the baby had died in utero. Implications: Mother's should be cautioned to trust their insights and seek medical advice if they are concerned over the lack of movement from the unborn baby

  • 28. 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.

  • 29. 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.

  • 30.
    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)
  • 31.
    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)
  • 32.
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness: det bästa för ditt ofödda barn2013Book (Other (popular science, discussion, etc.))
  • 33.
    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)
  • 34.
    Rådestad, Ingela
    Sophiahemmet University.
    Mindfetalness: Structured observation of fetal movements2017Conference paper (Other academic)
  • 35.
    Rådestad, Ingela (Contributor)
    Sophiahemmet University.
    Linde, Anders (Contributor)
    Sophiahemmet University.
    Minskade fosterrörelser - rekommendationer om information, råd och en inledande bedömning: kunskapsstöd med nationella rekommendationer2016Report (Refereed)
  • 36. 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.

  • 37. 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.

  • 38.
    Rådestad, Ingela
    Sophiahemmet University.
    När ett nyfött barn dör2016In: Reproduktiv hälsa: barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2016, 1, p. 740-742Chapter in book (Other academic)
  • 39. 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.

  • 40.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Henley, K
    Sormunen, Taina
    Sophiahemmet University.
    Perinatal palliative care after a stillbirth: Midwives experiences of using Cubitus baby2017Conference paper (Other academic)
  • 41. Listermar, Karin Henley
    et al.
    Sormunen, Taina
    Sophiahemmet University.
    Rådestad, Ingela
    Sophiahemmet University.
    Perinatal palliative care after a stillbirth: Midwives' experiences of using Cubitus baby2019In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, article id S1871-5192(19)30081-2Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Usually, parents remain at the hospital for two or three days after a stillbirth in Sweden, and the routine until recently has been to place the baby in a refrigerator during the night. A device, the Cubitus Baby, a specially designed cot with cooling blocks, was implemented in all 47 delivery wards during 2013 and 2014.

    AIM: To investigate the midwives' experiences of using the device when supporting parents after the stillbirth.

    METHOD: Questionnaires were completed by midwives, and a single open-ended question was analysed using content analysis.

    FINDINGS: 154 midwives responded. Four categories were identified, with two subgroups in each category: Feelings of dignity (Satisfactory feelings in working with grief; Design and function), Caring cooling (The cooling function; A cold baby), Time for farewell (Time together; Time to make your own choice) and Satisfying feelings for the parents (The parents and Cubitus Baby; The possibility for bonding).

    CONCLUSIONS: The midwives found that this practice provided a more dignified and worthwhile form of care. There is no need to separate the stillborn baby from the parents during their stay at the hospital. In modern perinatal palliative care, it is not justifiable to place a stillborn baby in a refrigerator.

  • 42. 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.

  • 43.
    Rådestad, Ingela (Contributor)
    Sophiahemmet University.
    Plötslig oväntad död hos spädbarn: Kunskapsstöd med nationella rekommendationer till hälso- och sjukvården2016Report (Other academic)
  • 44. 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)
  • 45. Malm, Mari-Cristin
    et al.
    Hildingsson, Ingegerd
    Rubertsson, Christine
    Rådestad, Ingela
    Sophiahemmet University.
    Lindgren, Helena
    Prenatal attachment and its association with foetal movement during pregnancy - A population based survey2016In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 29, no 6, p. 482-486Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the association between the magnitude of foetal movements and level of prenatal attachment within a 24h period among women in the third trimester of pregnancy.

    DESIGN: a prospective population-based survey.

    SETTING: A county in central Sweden.

    PARTICIPANTS: Low risk pregnant women from 34 to 42 weeks gestation, N=456, 299 multiparous and 157 primiparous women.

    MEASUREMENTS: The revised version of the Prenatal Attachment Inventory (PAI-R) and assessment of the perception of foetal movements per 24h in the current gestational week.

    FINDINGS: A total of 81 per cent of the eligible women completed the questionnaire. The overall sample of women found that the majority (96%) felt their baby move mostly in the evening. More than half of the respondents (55%) stated that they perceived frequent foetal movement on two occasions during a 24h period, while almost a fifth (18%) never or only once reported frequent foetal movement in a 24h period. Just over a quarter (26%) of respondents perceived frequent movement at least three times during a 24h period. Perceiving frequent foetal movements on three or more occasions during a 24h period, was associated with higher scores of prenatal attachment in all the three subscales.

    KEY CONCLUSION: Perceiving frequent foetal movements at least during three occasions per 24h periods in late pregnancy was associated with prenatal attachment.

    IMPLICATIONS FOR PRACTICE: encouraging women to focus on foetal movements may positively affect prenatal attachment, especially among multiparous women >35 years.

  • 46. Omerov, Pernilla
    et al.
    Steineck, Gunnar
    Runeson, Bo
    Christensson, Anna
    Kreicbergs, Ulrika
    Sophiahemmet University.
    Pettersén, Rossana
    Rubenson, Birgitta
    Skoogh, Johanna
    Rådestad, Ingela
    Sophiahemmet University.
    Nyberg, Ullakarin
    Preparatory studies to a population-based survey of suicide-bereaved parents in Sweden2013In: Crisis, ISSN 0227-5910, E-ISSN 2151-2396, Vol. 34, no 3, p. 200-10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is a need for evidence-based guidelines on how professionals should act following a suicide. In an effort to provide empiric knowledge, we designed a nationwide population-based study including suicide-bereaved parents.

    AIM: To describe the process from creating hypotheses through interviews to the development of a population-based questionnaire.

    METHOD: We used interviews, qualitative analysis and various means of validation to create a study-specific questionnaire to be used in a nonselected nationwide population of suicide-bereaved parents and a control population of nonbereaved (N = 2:1). The Swedish Register of Causes of Death and the Multigeneration Register were used to identify eligible individuals. All presumptive participants received a letter of invitation followed by a personal contact.

    RESULTS: We developed a questionnaire covering the participants' perception of participation, their daily living, psychological morbidity, professional actions, and other experiences in immediate connection to the time before and after the suicide. Almost three out of four parents (bereaved = 666, nonbereaved = 377) responded to the questionnaire.

    CONCLUSIONS: By involving parents early in the research process we were able to create a questionnaire that generated a high participation rate in a nationwide population-based study that might help us to answer our hypotheses about bereavement after suicide.

  • 47.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Akselsson, Anna
    Sophiahemmet University.
    Georgsson, Susanne
    Sophiahemmet University.
    Lindgren, H
    Pettersson, K
    Steineck, G
    Rationale, study protocol and the cluster randomization process in a controlled trial including 40,000 women investigating the effects of mindfetalness.2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, p. 56-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Shortening pre-hospital delay may decrease stillbirth rates and rates of babies born with a compromised health. Stillbirth may be preceded by a decrease in fetal movements. Mindfetalness has been developed as a response to the shortcomings of kick-counting for the monitoring of fetal movements by the pregnant woman. We do not know if practicing Mindfetalness may diminish pre-hospital delay. Nor do we know if practicing Mindfetalness may increase or decrease the percentage of women seeking health care for unfounded, from a medical perspective, worry for her fetus' well-being.

    METHODS:

    This article describes the rationale, study protocol and the randomization process for a planned study randomly allocating 40,000 pregnant women to receive, or not receive, proactive information about practicing Mindfetalness. The unit of randomization is 63 antenatal clinics in the Stockholm area. Midwives in the antenatal clinics randomized to Mindfetalness will verbally inform about practicing Mindfetalness, hand out brochures (printed in seven languages) and inform about a website giving information about Mindfetalness. Routine care will continue in the control clinics. All information for the analyses, including the main endpoint of an Apgar score below 7 (e.g., 0-6 with stillbirth giving a score of 0), measured five minutes after birth, will be retrieved from population-based registers.

    RESULTS:

    We have randomized 33 antenatal clinics to Mindfetalness and 30 to routine care. In two clinics a pilot study has been performed. One of the clinics randomly allocated to inform about Mindfetalness will not do so (but will be included in the intention-to-treat analysis). In October 2016 we started to recruit women for the main study.

    CONCLUSION:

    The work up to now follows the outlined time schedule. We expect to present the first results concerning the effects of Mindfetalness during 2018.

  • 48.
    Rådestad, Ingela
    Sophiahemmet University.
    Rätt information om fosterrörelser räddar liv2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 42, p. 2102-Article in journal (Other (popular science, discussion, etc.))
  • 49. 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.

  • 50.
    Rådestad, Ingela
    et al.
    Sophiahemmet University.
    Sormunen, Taina
    Sophiahemmet University.
    Rudenhed, Lisa
    Sophiahemmet University.
    Pettersson, Karin
    Sleeping patterns of Swedish women experiencing a stillbirth between 2000-2014: an observational study2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1, p. 193-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: External (to the fetus) stressors may act together with maternal factors as well as fetal and placental factors to increase the risk of stillbirth. Data published in 2011 indicate non-left side sleeping positions, particularly the supine one, is such a stressor; we do not know, however, if this new knowledge has influenced the choice of sleeping position among pregnant women.

    METHODS: Using a web-based questionnaire made available at the home page of the Swedish national infant foundation we collected information on sleeping positions among women who gave birth to a stillborn baby between 2000 and 2014.

    RESULTS: The questionnaire was completed by 583 women. About one third of the women reporting their sleeping position stated that they lay down on their the left side when going to bed, and another third reported lying down as often on the left as on the right side. Figures for typically going to bed on the left side the 4 weeks preceding the stillbirth was as follows: 72 (30 %) of 242 between 2011 and 2014 and 86 (27 %) of 313 between 2000 and 2010. Among the 240 women who remembered their position when waking up on the day the stillbirth was diagnosed, 63 (26 %) reported a supine position.

    CONCLUSION: Our data indicate that one third of the women went to bed on the left side the month before the stillbirth. The data are consistent with the notion that efforts in Sweden to advise women to lie on their left side when going to bed may decrease the rate of stillbirth.

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