BACKGROUND: Midwifery continuity models of care have been associated with positive health outcomes and positive childbirth experiences. Such models may be beneficial for women with fear of birth but remain uncommon in Sweden.

AIM: To explore thoughts and perceptions of midwifery continuity of care among women with fear of birth and describe their experiences of fragmented maternity care.

METHOD: A qualitative research design in which semi-structured telephone interviews were conducted during pregnancy and postpartum with women scoring above 70 on the Fear of Birth Scale. Data was analyzed using reflexive thematic analysis.

RESULTS: . These illustrate women's desire to feel secure and their belief that a trusting relationship with a known midwife throughout pregnancy, childbirth and the postpartum period could reduce their fear. Fragmented standard care was perceived as stressful, and all women expressed interest in midwifery continuity of care.

CONCLUSION: Women with fear of birth believed that relational continuity with a known midwife could foster trust, guidance and reduce fear. The fragmented standard care was perceived as uncertain, contributing to emotional distress. These findings highlight the need for personalized and relational midwifery care.

INTRODUCTION: The midwifery continuity of care model is well-established internationally, but it is rarely offered in Sweden. Pregnant women's interest in midwifery continuity of care has not been investigated in recent years. This study aimed to investigate the interest of pregnant women and new mothers in Sweden regarding midwifery continuity of care and to identify factors associated with this interest.

METHODS: A national longitudinal digital questionnaire was conducted to collect background information, pregnancy-related variables, and childbirth-related variables, as well as to measure interest in midwifery continuity of care among women in Sweden. Odds ratios with 95% CIs and logistic regression analyses were used.

RESULTS: Of 1697 women who responded, 68.1% expressed a strong interest in midwifery continuity of care during pregnancy, and 74.2% during postpartum. Fear of childbirth was associated with a higher interest in midwifery continuity of care during pregnancy (adjusted odds ratio [aOR] 1.75; 95% CI, 1.34-2.27). Women who had mixed or negative experiences with the care they received were also more likely to be interested in the model (aOR, 2.33; 95% CI, 1.43-3.97).

DISCUSSION: Pregnant women and new mothers in Sweden show a high level of interest in midwifery continuity of care. However, current maternity services do not adequately meet these preferences, indicating a need to scale up continuity of care models, particularly for women who experience fear of childbirth and dissatisfaction with their care. Therefore, antenatal, intrapartum, and postpartum care in Sweden should be enhanced to better align with the needs and preferences of pregnant women and new mothers.

BACKGROUND: Midwifery continuity of care (MCoC) has been associated with reduced burnout and increased work satisfaction among midwives. Despite these benefits, MCoC is not common in Sweden.

AIM: This study aimed to explore midwives' profiles based on burnout levels and attitudes towards midwifery continuity of care, considering various background and work-related factors.

METHODS: A national cross-sectional digital survey was conducted among midwives in Sweden. The questionnaire covered the Copenhagen Burnout Inventory (CBI), attitudes towards MCoC and background variables. Cluster analysis identified a set of profiles, which were then compared by calculating odds ratios and 95 % confidence intervals for various background and work-related factors. Logistic regression examined the factors most associated with each profile.

FINDINGS: A three-cluster solution for the 1,983 midwives surveyed was suggested, labelled as Reserved, Visionary, and Sensitive. Midwives in the Reserved cluster exhibited negative attitudes towards MCoC, through negative scores on both components and negative scores on the CBI. Within the Visionary cluster, midwives showed positive scores on the Relational component of MCoC, but negative scores on the Practical and Organisational component and the CBI. In the Sensitive cluster, midwives exhibited the highest scores on the CBI and negative scores on the Practical and Organisational component of MCoC, with just slightly positive scores on the Relational component. Cluster membership was associated with length of work experience (p<0.001) and work domain (p<0.001).

CONCLUSION: Based on the CBI and attitudes towards MCoC, three distinct clusters of midwives were identified, with different factors contributing to membership in each cluster. Understanding how midwives relate to MCoC can facilitate the implementation of the model, potentially improving midwives' work-related health.

BACKGROUND: In Sweden, women often meet with different midwives during antenatal, intrapartum, and postpartum care, due to the structure of maternity care, with few alternatives which provide continuity. This study aims to explore women's interest in having a midwife they know present during labor and birth and to identify the characteristics of women who prefer this option.

METHODS: A comparative study was conducted involving two Swedish nationwide cohorts of Swedish-speaking pregnant women. The first cohort included 3,061 women, and the second 1,812 women. Descriptive statistics and odds ratios were calculated.

RESULTS: In total, 4,873 pregnant women completed the survey. Most participants were aged 25-35 years, living with a partner, and born in Sweden. Interest in having a midwife they know increased from 53% in 1999 to 76% in 2024. Key factors associated with this preference included primiparity (OR 3.80; 95% CI 3.27-4.40), being pregnant in 2024 (OR 3.21; 2.70-3.86), being born outside Sweden (OR 2.73; 2.11-3.54), and fear of birth (OR 2.03; 1.56-2.63).

CONCLUSIONS: Interest in having a known midwife during childbirth has grown significantly in Sweden, highlighting the need for policy changes that promote awareness and expand this option for women.

PROBLEM: Midwives' levels of burnout seem to be increasing worldwide.

BACKGROUND: Previous research show a high prevalence of burnout in midwives.

AIM: To compare levels of burnout in two national Swedish samples of midwives completing a similar survey.

METHODS: A comparative study of two cross-sectional national surveys directed at midwives in 2012 and 2022. To measure burnout in midwives, the Copenhagen Burnout Inventory with 19 items was used.

FINDINGS: The sample consisted of 2209 midwives: 466 from 2012 and 1743 from 2022. Personal burnout showed an increase from 39.5 % to 53.6 % over the years; work burnout increased from 15.5 % to 49.2 % and client burnout increased from 15 % to 20.9 %. Personal burnout was associated with working shift. Work burnout was associated with length of work experience and working rotating shifts; and client burnout was associated with shorter work experience.

DISCUSSION: The highest increase in burnout was found in the work domain in 2022 compared to 2012. Notable in the present study is the increase in client burnout, which could be a sign of midwives becoming less caring and more cynical.

CONCLUSION: This study showed that self-reported levels of burnout among Swedish midwives increased over the ten-year period studied. The largest increase was found in the subscale work burnout. Midwives with shorter work experience and those with shift work were the most vulnerable to burnout. Improved organisation of midwifery services needs to be designed to ensure healthy working conditions for midwives.

BACKGROUND: Midwifery continuity models are growing worldwide, but few such alternatives are available in Sweden. There is sparse knowledge about Swedish midwives' attitudes about midwifery continuity models.

AIM: The aim of this study was to explore Swedish midwives' attitudes toward continuity models. An additional aim was to evaluate the psychometric properties of a previously developed instrument measuring attitudes to continuity models.

METHODS: A cross-sectional survey of a national sample of 2537 midwives in Sweden. The participants completed a questionnaire online. A Principal component Analysis was performed to identify components in the instrument.

RESULTS: A fairly similar proportion of midwives worked in antenatal care (30.7%), intrapartum care (30.7%) and in other areas (31.1%). Many midwives (59%) agreed that continuity models should be available to women, but were not certain about if such models should be offered to all women or low risk women only. Two domains of the attitude scale were identified; Relationship-based Midwifery Continuity Models, and Practical and Organisational Aspects of Midwifery Continuity Models. Age, having children, marital status, length of work experience and place of work were associated with high agreement non the two components.

CONCLUSION: Many midwives in general held positive attitudes about continuity models. The relationship aspects were highly valued but midwives were also hesitant about the practical and organisational aspect of continuity models. Unbiased information to midwives about the pros and cons with continuity models should be offered, in order to limit misunderstandings about the model.

BACKGROUND: Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated.

OBJECTIVE: to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models.

METHODS: A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis.

RESULTS: A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest.

CONCLUSION: A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.

OBJECTIVE: The aim of this paper was to compare current perceptions of empowerment in their work with results from a sample of midwives recruited 2012.

DESIGN: A comparative cross-sectional cohort study of national samples of midwives in Sweden from 2012 to 2022.

PARTICIPANTS: 475 midwives recruited from the Swedish midwifery association in 2012 and 1782 through two midwifery unions in 2022.

METHODS: Data were collected using a questionnaire with background information and the revised version of the Perception of Empowerment Scale (PEMS). Mean scores and domains of the PEMS were compared between the years.

FINDINGS: Midwives' perceptions of empowerment changed over time, in both directions. Their perception of their skills and education, advocating for and empowering women as well as support from the team and manager increased over the years. Midwives in 2022 were less likely to perceive that they were involved in a midwifery-led practice, and the communication with managers was rated lower. Midwives sensed a lack of professional recognition from the medical profession and their contribution to the care of birthing women. Access to resources for birthing women was perceived lower in 2022 compared to 2012. Younger age, shorter work experience and working in labour wards or postnatal wards were associated with lower perceptions of empowerment.

CONCLUSIONS: Midwives need to have the authority and reality to practice midwife-led care, to receive control over their work. Good communication and recognition from the medical profession is essential to be empowered. This is important in order to maintain a healthy workforce.

BACKGROUND: Negative encounters in healthcare might affect women's health. During their reproductive life span, women are exposed to various health examinations, and have reported disrespectful care and obstetric violence. Such experiences might be a basis for fear of birth.

AIM: to explore and describe the prevalence, associated factors and experiences of previous negative healthcare encounters in women with fear of birth.

METHODS: A cross-sectional mixed-method study of 335 pregnant women with fear of birth. Data were collected by a questionnaire in mid-pregnancy, which included socio-demographic and obstetric background data as well as a question about the occurrence of previous negative experiences in healthcare.

RESULT: A previous negative experience of healthcare was found in 189 women (56.6%). The analysis of the women's comments regarding what caused their negative experiences generated three themes: disrespectful treatment and no one listened; painful, inadequate, or improper care; and impact of other people's stories.

CONCLUSION: This study showed that previous negative experiences in healthcare were common in women with fear of birth and the content of the encounters could be summarised as disrespectful care and obstetric violence. Women's previous encounters in healthcare might be an underlying reason for fear of birth and should be investigated. It is, therefore, of utmost importance to listen to women and their narratives in order to establish a trustful relationship and promote evidence-based, women-centred, respectful care, which is urgently needed.

BACKGROUND: There is evidence that continuity models of midwifery care benefit women and babies in terms of less birth interventions and higher maternal satisfaction. Studies about continuity models in a Swedish context are lacking.

OBJECTIVE: The aim of this study was to describe how women experience continuity of midwifery care in a Swedish rural area, and thereby provide a deeper understanding of what this care entails for women.

METHODS: A qualitative interview study using thematic analysis was carried out. Telephone interviews were conducted with 33 women who participated in a continuity of midwifery care project in a rural area of Sweden.

RESULTS: The overarching theme 'a longing for a sense of security', pervaded the three main themes: 'The importance of professional midwifery care', 'Continuity of midwifery - fulfilled expectations or full of disappointments' and 'New prerequisites - acceptable to some, but not a substitute for everyone', which explains different aspects affecting the feeling of security. The endeavour to feel secure during pregnancy, birth and postpartum was a continually recurring subject that cannot be overstated.

CONCLUSION: Continuity of midwifery care strengthened women's feelings of security during pregnancy, birth and postpartum. The deepened relationship developed over time was a central part of the positive aspects of the experience of continuity in midwifery care. Expectations and prerequisite circumstances are important to consider when developing and introducing new care models. Service providers and decision makers should pay attention to and prioritise this relational aspect when planning care for women during the childbearing period.