Bakgrund: Under adolescensen genomgår tjejer puberteten och får den första menstruationen tillsammans med andra kroppsliga förändringar. Under denna känsliga fas i livet behöver tjejer information och utbildning i sex- och samlevnad för att tillgodogöras en god sexuell och reproduktiv hälsa. I Sverige har sex- och samlevnadsundervisning varit obligatorisk sedan 1950-talet. Trots det förekommer en stor okunskap i menstruationscykeln hos tjejer trots att information och utbildning om pubertet skall undervisas om redan i grundskolan.Syfte: Syftet med arbetet var att beskriva erfarenheter av menstruationscykeln hos tjejer i åldersgruppen 16–19 år.Metod: En kvalitativ intervjustudie tillämpades. Intervjufrågorna var semistrukturerade och en innehållsanalys med induktiv ansats användes. Totalt intervjuades 12 tjejer individuellt. Intervjuerna skedde digitalt på grund av COVID-19 pandemin.Resultat: Resultatet sammanfördes genom två kategorier: Betydelsen av information och utbildning samt Omställning och anpassning. Deltagarna beskrev att menstruationscykeln påverkade vardagen till det sämre. Deltagarna beskrev en brist på kunskap gällande menstruationscykeln och härledde det till brist på undervisning. Konklusion: Barnmorskor och lärare utgör en viktig roll i att informera och undervisa tjejer om menarke och menstruationscykeln. Att erhålla adekvat sex- och samlevnadsundervisning kan komma att påverka tjejers upplevelse av menarke och kommande menstruationer till det positiva.
OBJECTIVE: to describe women's experiences of participating in decision-making related to augmentation of labour. DESIGN: a qualitative approach using modified grounded theory technique. Open-ended interviews were conducted 1-3 days after childbirth. SETTING: the interviews were performed in the postnatal wards in five hospitals (tertiary level) in Stockholm, Sweden. PARTICIPANTS: 20 newly delivered women who had received oxytocin infusion for augmentation of labour during childbirth. FINDINGS AND KEY CONCLUSIONS: support and guidance from midwives in combination with knowledge and expectations about the intervention seemed to be important for women's satisfaction with decision-making concerning augmentation of labour. Four patterns of decision-making were found. One group of women participated in the decision-making regarding augmentation of labour while a second group was invited, but refrained from participation. These women were satisfied with the decisions made. A third group of women did not participate, but wanted to and they were dissatisfied with the decisions made. The fourth group did not participate in the decision-making-and did not want to. These women accepted the decisions made. The desire for information exceeded the desire for involvement in decision-making and the majority of women had confidence in the midwives' assessment.
Bakgrund: Portpartumblödningar (PPH) ger upphov till flest fall av mödradödlighet i världen, förekomsten och risken att dö är som högst i låginkomstländer men det har rapporterats om ökning även i västvärlden. I Sverige har cirka 7% en ICD-10 kod för PPH. Barnmorskor har en nyckelroll i att identifiera och initiera tidig diagnos av PPH för att kunna påbörja adekvata åtgärder, handlägga det akuta förloppet och samtidigt upprätthålla den värdighetsskyddande vårdrelationen. Syfte: Beskriva barnmorskors erfarenheter av postpartumblödningar >1000 ml i samband med förlossning. Metod: Kvalitativ metod med induktiv ansats. En webbenkät som besvarades av 24 barnmorskor. Enkätsvaren analyserades med innehållsanalys. Resultat: Fyra kategorier och tio subkategorier utgjorde resultatet. Barnmorskorna beskrev att handläggandet vid PPH begränsas av bristande samarbete, kunskap, hjälpmedel, oerfaren personal samt pressad arbetsmiljö och bidrog till känslor av otillräcklighet. Genom gott samarbete, teamträning, närvarande kollegor, förkroppsligad kunskap och goda förutsättningar kunde handläggningen bli framgångsrik, vilket bidrog till känslor av acceptans. Slutsats: Barnmorskor behöver ges förutsättningar för att handlägga PPH. Genom goda förutsättningar kan barnmorskor bistå PPH på ett patientsäkert sätt samtidigt som de själva känner trygghet och acceptans. Det är således en betydande del i att säkra vården vid PPH.
Background: Parental education classes are part of the national child health promotion programme of the Swedish Child Health Clinics (CHC). Aim: To investigate attendance at parental education classes during the infant's first year, and to identify factors associated with non-attendance in primiparous women. Methods: Swedish-speaking women were recruited from 97% of all antenatal clinics in Sweden during 3 wk, evenly spread over 1 y from 1999 to 2000. Questionnaires were mailed in early pregnancy, and at 2 mo and 1 y after the birth. Two thousand, four hundred and forty women answered the main outcome question about class attendance asked in the third questionnaire, and 1076 of these were first-time mothers. Results: Seventy-eight per cent of the primiparas attended classes and 31% of the multiparas. Factors associated with non-attendance in primiparas were: native language other than Swedish, a low level of education, smoking during pregnancy, inconvenient timing of pregnancy, maternal hospital admission, and infant health problems. Three per cent of the primiparas did not attend classes either during pregnancy or after the birth, and this group seemed to constitute an even less privileged group.
OBJECTIVE: to investigate the attendance rate at childbirth and parenthood education classes during pregnancy in a national Swedish sample and describe the characteristics of women who did not attend. DESIGN: a cohort study utilising a postal questionnaire in early pregnancy and at 2 months after birth. SETTING: women were recruited from 97% of all antenatal clinics in Sweden at their first 'booking' visit during three different weeks spread over 1 year in 1999-2000. PARTICIPANTS: 2546 women, who were 77% of those who consented to participate in the study and 55% of all women eligible for the study. MEASUREMENT AND FINDINGS: most primiparous women (93%) attended classes and the majority of the multiparae (81%) did not. Having a native language other than Swedish was associated with non-attendance in both primiparae and multiparae (OR 2.7, 95% CI 1.3-5.4; OR 2.1, 95% CI 1.4-3.1). In addition, the following factors were associated with non-attendance in the primiparae: unemployment (OR 2.0, 95% CI 1.1-3.8), smoking during pregnancy (OR 2.7, 95% CI 1.2-5.8), having considered abortion (OR 4.3, 95% CI 1.2-16.1), and having had few antenatal check-ups (OR 2.0, 95% CI 1.1-3.7). The following factors were associated with non-attendance in the multiparae: age older than 35 years (OR 1.6, 95% CI 1.1-2.3), low level of education (OR 3.6, 95% CI 2.3-5.7), and pregnancy unplanned but welcome (OR 1.5, 95% CI 1.1-2.0), having had counselling because of fear of childbirth (OR 1.6, 95% CI 1.1-2.4), and expressing a need of such counselling (OR 1.9, 95% CI 1.1-3.1). KEY CONCLUSIONS: the childbirth and parenthood education programme reached the majority of pregnant women, and that non-attendees were more disadvantaged in terms of socio-demographic background and feelings about the approaching birth. These women should be given special attention during the antenatal check-ups so that childbirth and parenthood education could be adapted to their specific needs.
OBJECTIVE: To investigate first-time mothers' views about antenatal childbirth and parenthood education and their contact with other class participants after birth, and to compare participants and non-participants with respect to the use of pain relief, experience of pain, mode of delivery, childbirth overall, duration of breastfeeding, and assessment of parental skills. METHODS: A national cohort of 1197 Swedish-speaking women completed three questionnaires: during early pregnancy, 2 months, and 1 year after giving birth. RESULTS: Seventy-four percent of first-time mothers stated that antenatal education helped prepare them for childbirth, and 40% for early parenthood. One year after giving birth, 58% of the mothers had met with other class participants. These outcomes were associated with the number of class sessions. When controlling for the selection of women into participants and non-participants, no statistical differences were found concerning memory of labor pain, mode of delivery, overall birth experience, duration of breastfeeding, and assessment of parental skills. However, participants had a higher rate of epidural analgesia. Mothers who were young, single, with low level of education, living in a small city, and smokers were less likely to find the classes helpful. CONCLUSION: Participation in childbirth and parenthood education classes did not seem to affect first-time mothers' experience of childbirth and assessment of parental skills, but expanded their social network of new parents. The higher epidural rate suggests that participation in classes made women more aware of pain relief techniques available, rather than improving their own coping with pain. More research should focus on current forms of antenatal education, with special focus on women of low socioeconomic status.
BackgroundToday, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.MethodsA qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.ResultsIn the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman's current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman's sense of security (an uncomplicated decision-making process).ConclusionsThe complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context. Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals' views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women's autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.
Syfte: Att undersöka kvinnors erfarenhet av könsstympning och vilken påverkan det har på deras hälsa med fokus på den perinatala och sexuella hälsan.
Metod: Kvalitativ intervjustudie med induktiv ansats. Tio kvinnor som genomgått könsstympning grad I-III deltog. Intervjuerna var semistrukturerade intervjuer och genomfördes på Zoom. Intervjuerna spelades in med mobiltelefoner och sedan transkriberades och analyserades med innehållsanalys på manifest nivå.
Resultat: Det utvecklades fyra kategorier och 10 subkategorier. Könsstympning påverkade perinatala och sexuella hälsan i flera avseende i form av flera olika komplikationer så som smärta vid själva ingreppet, men också vid samlag, problem med menstruation och problem under graviditet och förlossning. Kvinnorna blev ofta dåligt bemötta när de sökte vård och märkte att det fanns kunskapsluckor hos barnmorskor. Psykiska hälsan påverkades då kvinnorna hade en känsla av att vara annorlunda och att de blivit bestulna på en kroppsdel som de sörjde. Flera kvinnor hade genomgått rekonstruktion och rekommenderade andra att genomföra det.
Slutsats: Kvinnornas perinatala och sexuella hälsa påverkades negativt av könsstympningen i form av komplikationer. Smärta vid ingreppet, smärta vid samlag som påverkade samlivet och därmed sexuella hälsan negativt. Komplikationer under graviditet och förlossning med upprepade urinvägsinfektioner, stora bristningar och klipp i underlivet. Det dåliga bemötandet samt kunskapsluckan hos barnmorskorna upplevdes som jobbig.
Nyckelord: Förlossning, graviditet, kvalitativ metod, perinatal hälsa och sexuell hälsa
OBJECTIVE: To evaluate pain reduction after two injections of 50 units botulinum toxin A compared with placebo for provoked vestibulodynia. METHODS: We conducted a double-blinded, placebo-controlled randomized trial of 50 units botulinum toxin A or placebo injected in the bulbocavernosus muscles twice, 3 months apart, in women with provoked vestibulodynia. Primary outcome was self-reported dyspareunia or pain at tampon use on a visual analog scale (VAS, 0-100). Secondary outcomes were pain at weekly tampon insertion (VAS score), reduction of pelvic floor hypertonicity (measured with a vaginal manometer), adverse events, and sexual function and distress. A sample size of 38 participants for each group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (0-100) (mean score range 56-76 +/- 31 SD). RESULTS: Between May 2016 and June 2018, 124 women with provoked vestibulodynia were assessed, and 88 were randomized to botulinum toxin A (BTA group, n=44) or placebo (placebo group, n=44). Primary outcome showed a lower but statistically nonsignificant pain rating by 7 VAS units (95% CI -15.0 to 0.4) in the BTA group compared with the placebo group. Secondary results showed a significant decrease in pain at weekly tampon insertion by 11 VAS units (95% CI -16.6 to 6.0) with botulinum toxin A injection. The vaginal manometer measured lower maximum contraction strength by 7 mm Hg (95% CI -12.7 to -2.4) and lower 10-second endurance strength by 4 mm Hg (95% CI -7.72 to -1.16) in the BTA group compared with the placebo group. No changes were observed for sexual function and distress, but there was a significant increase in women attempting vaginal intercourse in the BTA group (0.27, 95% CI 0.06-0.48). No severe adverse events were reported. CONCLUSION: Twice-repeated injections of 50 units of botulinum toxin A in women with provoked vestibulodynia did not reduce dyspareunia or pain at tampon use, but secondary outcomes suggested positive effects of the treatment.
Background: Provoked vestibulodynia (PVD) is a common pain disorder afflicting primarily young women, and botulinum toxin A (BTA) has been to a limited extent tested as a treatment. Aim: Evaluate outcome 12 months after injection with BTA as a treatment for PVD. Methods: We conducted a double-blinded, placebo-controlled trial of twice repeated injections of 50 units of BTA or placebo in the bulbocavernosus muscles, 3 months apart, in women with PVD. Treatment outcome after six months’, failed to show any significant difference in pain reduction between the groups, as previously reported. Here, we report treatment outcomes 12 months after the first injections. In addition to injections, participants where instructed to perform pelvic floor exercises during month 6-12. 38 participants/group was calculated to achieve a statistical power of 80% based on an effect size of 20 VAS units (mean score range 56-76±31 SD). Outcomes: Primary outcome was self-reported dyspareunia or pain at tampon use, using a visual analogue scale (VAS) 0-100. Secondary outcomes were vaginal pressure measurements, psychological health, sexual function and distress. Results: From the initial 88 randomized women with PVD, 75 remained at 12 months; 38 in the BTA and 37 in the placebo group. There was no significant difference in primary outcome between the groups. Vaginal pressure in the BTA group had been restored to pre-treatment levels, with no differences between the groups at 12 months. There was an increase in sexual function in the BTA group, with a Female Sexual Function Index of 22.8 (±4.8) compared to the placebo group to 19.7 (±5.0), P=.048. No differences were observed in sexual distress, stress and anxiety. There was an increase in number of women attempting intercourse in the BTA group (74%) compared with placebo (43%), P=.005. Too few patients performed the pelvic floor exercises for this intervention to be analyzed. Clinical Implications: This study highlights BTA as a safe treatment option for patients with PVD. Strengths and limitations: The randomized, double-blinded design and repeated treatments are the major strengths of this study and it is the first study to objectively evaluate muscular effect after BTA injections. The major shortcoming is that few participants performed the pelvic floor exercises, preventing analyses. Conclusion: At 12 months’ follow up, no significant difference in reduction of dyspareunia or pain at tampon use was observed. Women receiving BTA attempted intercourse more often and improved their sexual function compared with women receiving placebo. Haraldson P, Mühlrad H, Heddini U, et al. Botulinum Toxin A for Provoked Vestibulodynia: 12 Months’ Follow-up of a Randomized Controlled Trial. J Sex Med 2022;19:1670–1679.
Abstract
Aim: To map first-time mothers experiences of breastfeeding support provided by maternal health care, birth center and BB.
Method: A quantitative survey with a cross-sectional design. The criterias to be included was first-time mothers who breastfed or wished to breastfeed and gave birth to a full-term child in the last two years. Data were collected through a web survey published on Facebook. A comfort selection was chosen and data were analyzed with descriptive statistics. Comparisons were made between two age groups
Results: A total of 197 first time mothers were answered in the survey. Group 1 consisted of first-time mothers aged 21-30 years and Group 2 consisted of first-time mothers aged 31-42 years. The breastfeeding support included written, verbal and practical guidance. Positive and negative factors in breastfeeding support were identified. Both differences but mainly similarities were identified among first-time mothers’ experiences of breastfeeding support. It was 70,3% of the entire population who wanted more information about breastfeeding. A difference was that Group 2 generally estimated lower breastfeeding support compared with Group 1.
Conclusion: The breastfeeding support was estimated quite low by both age groups. Almost half of the first-time mothers considered themselves to receive the best breastfeeding support from sources other than maternal health care, childbirth and BB. This indicates that the breastfeeding support that first-time mothers received was insufficient. First-time mothers requested more information about breastfeeding. High attendance of the midwife and individual guidance were positive factors.
Keywords: breastfeeding, experiences, midwives, mothers, support.
Objective: The objective of the study was to estimate the proportion of planned home births in Sweden and to identify maternal characteristics of women giving birth at home. Study design: This case-control study included register data of births from 1992 to 2001 in 352 women giving birth at home and 1760 women giving birth in a hospital. Results: Four hundred thirty-nine out-of-hospital births were found during the study period, and the proportion of planned home births was less than 0.5/1000. Women with home birth were more likely to have 4 children or more (odds ratio 3.7 [1.4 to 9.9]), be born in a European country outside Sweden (odds ratio 3.5 [1.8 to 6.8]), have a family income below the median (odds ratio 2.9 [2.0 to 4.1% not work outside the home (odds ratio 2.4 [1.7 to 3.5]), have a high level of education (odds ratio 2.1 [1.5 to 3.0]), and be older than 35 years (odds ratio 1.7 [1.1 to 2.5]). Conclusion: Women with planned home births appear to be a group having a different lifestyle, compared with Swedish women in general.
OBJECTIVE: To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish. DESIGN: National survey. SETTING: Swedish antenatal clinics. POPULATION: 3,283 Swedish-speaking women booked for antenatal care, at approximately 600 Swedish antenatal clinics, during three weeks spread over one year (1999-2000). METHODS: A questionnaire was mailed shortly after the first antenatal visit. MAIN OUTCOME MEASURES: Women's preferences for mode of delivery. RESULTS: 3,061 women completed the first questionnaire, corresponding to 94% of those who consented to participate after exclusion of reported miscarriages. The background characteristics of the study sample were very similar to a one-year cohort of women giving birth in Sweden during 1999. The result showed that 8.2% of the women would prefer to have a caesarean section. A wish for caesarean section was associated with parity, age, civil status, residential area and obstetric history. Women preferring caesarean section were more depressed and worried, not only about giving birth, but also about other things in life. A multivariate logistic regression model showed three factors being statistically associated with a wish for caesarean section: a previous caesarean section, fear of giving birth and a previous negative birth experience. CONCLUSIONS: Relatively few women wish to have a caesarean section when asked in early pregnancy, and these women seem to be a vulnerable group.
BACKGROUND: The national recommendation in Sweden regarding number of antenatal care visits was reduced in 1996. The aim of this study was to explore the factors associated with number of visits made and with women's own opinions about these visits. Another aim was to study associations between the number of visits and satisfaction with antenatal care overall. METHODS: All Swedish-speaking women who came for their first visit to the midwife in 593 participating clinics during 3 weeks evenly spread over 1 year in 1999-2000 were invited to participate in the study. Information was collected by postal questionnaires after the booking visit and 2 months after childbirth. Cases of preterm delivery and intrauterine death were excluded. RESULTS: After excluding miscarriages, non-Swedish-speaking women, and women booked at non-participating clinics, about 69% of all women booked in antenatal care were recruited. Of these, 2421 (83%) completed the two questionnaires. About 25% followed the standard visiting schedule for a normal pregnancy, 57% made more visits, and 17% fewer visits. The number of visits made was associated with parity, medical diagnosis, depressive symptoms, level of education, and women's preferences in early pregnancy. Women's own opinion that they made too few visits was associated with a preference for more visits in early pregnancy and actually receiving fewer visits than the standard schedule. The view that they made too many visits was associated with a previous negative birth experience, a wish for fewer visits, having a medical diagnosis, many children, and major worries. The vast majority of women (87.6%) were satisfied with antenatal care overall but less with emotional (76.9%) than with medical (82.3%) aspects. No association was found between number of visits made and satisfaction, but women's own opinion that they had too few visits was associated with dissatisfaction with medical as well as emotional aspects of care and the opinion that they made too many visits with the emotional aspects of care. CONCLUSION: Two-thirds of the women did not follow the standard visiting schedule, the majority of women made more visits. The number of antenatal visits seemed to be fairly well adapted to women's individual needs and, to some extent, to their own wishes. Very few women were dissatisfied with the number of visits made as well as the antenatal care overall.
Syfte: Att kartlägga barnmorskors erfarenheter vid akut omhändertagande av barn i samband med förlossning.
Metod: Kvantitativ tvärsnittsstudie. Datainsamling genom webbenkäter som analyserades med deskriptiv statistik.
Resultat: Totalt besvarades 100 enkäter av barnmorskor verksamma på förlossningsavdelning. Av barnmorskorna uppgav 64 % att de med säkerhet kunde identifiera barn med asfyxi, 49 % kunde utföra neonatal HLR med säkerhet. Både barnmorskor med kortare och längre erfarenhet behövde mer teoretisk och praktisk kunskap i akut omhändertagande av barn vid födelsen, mest kunskap behövde de med kortast erfarenhet. Barnmorskor med kortare erfarenhet var även mindre säkra i att stödja och informera föräldrar när barnet behövde akut omhändertagande.
Slutsats: Det är barnmorskors ansvar att handlägga barn som är i behov av akut omhändertagande vid förlossning. Det är möjligt att det behövs mer förberedelser och längre introduktion i ämnet för nyutexaminerade barnmorskor.
AIM: This paper reports a study evaluating the sensitivity of a semi-structured interview schedule and card sort methods in assessing postpartum concerns of women. BACKGROUND: Several methods have been used to assess postpartum maternal concerns and the process of becoming a mother, but few studies have evaluated the methods with respect to their sensitivity for obtaining information. METHOD: A cohort of mothers was followed-up at one (n = 110) and 6 weeks (n = 83) after childbirth in Dar es Salaam, Tanzania. Women with a minimum of 7 years of primary education were interviewed and they also sorted cards. Those with less fewer than 7 years of primary education were interviewed only. The methods were used in alternate order to assess method interaction. RESULTS: In the interviews at 1 week, mothers more often expressed worry and interest related to the baby or themselves when they had sorted cards first. The extent to which women expressed worry and interest about specific baby- and mother-related topics was generally higher for women who had sorted cards before the interview at both 1 and 6 weeks. Independent of whether they were interviewed only, interviewed after sorting cards or before, mothers more often expressed a higher degree of interest than of worry about the baby and self at both 1 and 6 weeks. The order of the data collection methods did not influence the way women sorted cards as being worries and interests. CONCLUSION: Compared to interview using a semi-structured interview schedule, our findings suggest that the card sort is more sensitive in obtaining information about women's concerns. Although the interview method has the advantage of reaching less educated people, the card sort is a technique that is associated with fewer barriers and is a more participatory method for those who can use it.
Syfte: Att beskriva barnmorskors erfarenheter av att vårda kvinnor som genomgått könsstympning. Metod: Kvalitativ intervjustudie med induktiv ansats. Tio barnmorskor med erfarenhet av att vårda könsstympade kvinnor intervjuades med semistrukturerade intervjuer via Zoom. Intervjuerna spelades in på mobiltelefon, transkriberades och analyserades med kvalitativ innehållsanalys. Resultat: I resultatet utvecklades fem kategorier och 12 subkategorier. Kunskapsnivån varierade efter antal år i yrket samt hur ofta barnmorskorna vårdade kvinnor som genomgått könsstympning. Det framkom avsaknad av kunskap om sociokulturell kontext och svårigheter att förstå kvinnor som valt att könsstympas. Användandet av tolk ansågs utmanande då samtal skedde via trepartskommunikation. Beroende på var barnmorskorna arbetade i Sverige uppmärksammades skillnader i hur strukturerat omhändertagandet av kvinnor var samt vilken typ av vård som kunde erbjudas. Slutsats: Barnmorskornas erfarenheter av att vårda kvinnor som genomgått könsstympning var god. Det framkom att kunskapsnivån varierade utifrån antalet år i yrket. Samtidigt uttrycktes att det fanns kunskapsluckor och att det alltid gick att lära mer. Barnmorskeutbildningens undervisning om ämnet ansågs vara bristfällig. Patientgruppen ansågs som utmanande då det oftast fanns en språkbarriär. Det saknades tydliga riktlinjer på barnmorskornas arbetsplatser kring hur kvinnor som genomgått könsstympning skulle vårdas.
Sammanfattning
Bakgrund: Senaste tjugo åren har en succesiv minskning av andelen helammade barn i Sverige skett. Kvinnor kan uppleva ett outtalat krav från samhället att amma sitt barn, att hon är en sämre mamma om hon inte lyckas med amningen. Amning kan beskrivas som naturlig och lätt men många kvinnor upplever problem under amningsperioden. Amningsvägledningen tycks inte i tillräckligt stor utsträckning betona de komplikationer som kan uppstå och hur dessa kan hanteras.
Syfte: Att kartlägga kvinnors erfarenheter av bristande amningsvägledning i relation till utebliven eller tidigt avslutad amning.
Metod: Kvantitativ metod genom webbaserad enkätundersökning. Dataanalys med deskriptiv statistik.
Resultat: Totalt inkluderades 116 kvinnor. Majoriteten (75%) rapporterade en positiv inställning till att amma. Tidigare amningserfarenhet har betydelse för amningen av nästkommande barn. Amningsvägledningen från barnmorskan upplevs som bristfällig genom hela vårdkedjan. Över hälften av kvinnorna (55%) ammade inte sitt barn alls eller upp till en månad.
Slutsatser: Amningsvägledningen saknade information om eventuella problem som kan uppstå och hur dessa kan hanteras, konkreta tips för att få till en fungerande amning samt stöd och närvaro av barnmorskan vid amningssituationerna. Resultatet kan ge ökad kunskap och förståelse kring kvinnors erfarenheter av amning vilket kan stärka barnmorskor i deras arbete och bemötande av kvinnor.
Nyckelord: amningsvägledning, avslutad amning, barnmorska, kvantitativ metod
Background: Globally, studies illustrate different approaches among health care professionals to decision making about caesarean section (CS) and that attitudes regarding the extent to which a CS on maternal request (CSMR) can be granted vary significantly, both between professionals and countries. Absence of proper regulatory frameworks is one potential explanation for high CSMR rates in some countries, but overall, it is unclear how recommendations and guidelines on CSMR relate to CSMR rates. In Sweden, CSMR rates are low by international comparison, but statistics show that the extent to which maternity clinics perform CSMR vary among Sweden’s 21 self-governing regions. These regions are responsible for funding and delivery of healthcare, while national guidelines provide guidance for the professions throughout the country; however, they are not mandatory. To further understand considerations for CSMR requests and existing practice variations, the aim was to analyse guideline documents on CSMR at all local maternity clinics in Sweden. Methods: All 43 maternity clinics in Sweden were contacted and asked for any guideline documents regarding CSMR. All clinics replied, enabling a total investigation. We used a combined deductive and inductive design, using the framework method for the analysis of qualitative data in multi-disciplinary health research. Results: Overall, 32 maternity clinics reported guideline documents and 11 denied having any. Among those reporting no guideline documents, one referred to using national guideline document. Based on the Framework method, four theme categories were identified: CSMR is treated as a matter of fear of birth (FOB); How important factors are weighted in the decision-making is unclear; Birth contracts are offered in some regions; and The post-partum care is related to FOB rather than CSMR. Conclusion: In order to offer women who request CS equal and just care, there is a pressing need to either implement current national guideline document at all maternity clinics or rewrite the guideline documents to enable clinics to adopt a structured approach. The emphasis must be placed on exploring the reasons behind the request and providing unbiased information and support. Our results contribute to the ongoing discussion about CSMR and lay a foundation for further research in which professionals, as well as stakeholders and both women planning pregnancy and pregnant women, can give their views on this issue.
Bakgrund: Intrauterin fosterdöd är en sällsynt händelse, av 1000 förlossningar är det cirka tre till fyra förlossningar där det inträffar i Sverige. Som förälder kan det vara svårt att hantera sorgen vid intrauterin fosterdöd och därmed finns det behov av stöd. Föräldrarna uppger att de inte får den rätta vård och stöd som de är i behov av. Det finns bristfällig kommunikation mellan barnmorskor och föräldrar. Stöd till barnmorskor är lika viktigt, vilket är en förutsättning för att kunna hantera svåra situationer. Syftet: Att beskriva barnmorskors erfarenhet av att stödja föräldrar efter förlossning vid intrauterin fosterdöd. Metod: Kvalitativ metod med induktiv ansats. En webbenkät som besvarades av 25 barnmorskor. Resultat: Fyra kategorier och nio subkategorier utformades. Barnmorskorna ansåg att grunden till god vård för föräldrarna vid intrauterin fosterdöd var att vara närvarande och stödja föräldrarna genom hela vårdtiden. Det kan vara en utmaning att hantera egna känslor samtidigt som det är en hög arbetsbelastning på arbetsplatsen. Behovet av fördjupad kunskap kring stödjandet av föräldrarna föreligger. Slutsats: Barnmorskorna ansåg behovet av vidareutbildning inom ämnet för att kunna hantera svåra situationer. Stödet till barnmorskorna var en viktig faktor för att klara av att bemöta föräldrarna vid intrauterin fosterdöd.
Syfte: Att kartlägga mammors erfarenheter av amningsstöd på BB.Metod och Material: Webbaserad tvärsnittsstudie med kvantitativ ansats. Inklusionskriterier; mammor som fått barn och vårdats på en specifik BB-avdelning i Mellansverige under åren 2019–2021 samt valt att amma. Enkäten bestod av 60 slutna frågor och 5 fritextfrågor. Redovisas med deskriptiv statistik samt kvantifiering av fritextsvaren. Resultat: Baserades på n=146 mammor. Både positiva och negativa erfarenheter beskrevs av mammorna. En majoritet av deltagarna önskade högre närvaro av barnmorskan och mer stöd i samband med amning. Det rapporterades erfarenheter av att ha blivit lämnade ensamma med barnet större delen av vårdtiden och fann det bästa stödet i partnern. Få beskrev dock att partnern involverades i amningsstödet. Olika råd gavs av personalen vilket skapade en känsla av otrygghet och tvivel till personalens kompetens. Många beskrev att hands-on metod användes i samband med amningsstöd. Upprättande av amningsplan saknades för majoriteten och bristfällig information om amningssignaler gavs. Slutsatser: Många mammor var missnöjda med amningsstödet och kände en otrygghetmed amningen vid hemgång. Det önskades mer stöd och bekräftelse i samband med amning. Möjligtvis kan det initiala bristande stödet ha påverkat mammornas fortsatta amning och lett till ett tidigare amningsavslut.
Bakgrund: Svenska förstföderskor blir allt äldre. Åldern då fertiliteten hos kvinnor är som högst sammanfaller för många med en tid i livet som innefattar olika krav och måsten. Ett stort antal kvinnor i fertil ålder har bristfällig kunskap om hur ålder och olika livsstilsfaktorer påverkar fertiliteten. Genom att undersöka kvinnors önskemål gällande information om fertilitet samt hur kvinnor önskar få denna information kan vården bättre anpassas efter dessa önskemål. Syfte: Att undersöka om svenska kvinnor i 18–45 års ålder önskar information om fertilitet samt på vilket sätt de önskar få denna information. Metod: Kvantitativ tvärsnittsstudie. Datainsamling genom webbenkät, sammanställd med deskriptiv statistik. Resultat: Totalt besvarade 267 kvinnor webbenkäten, en majoritet, 67%, var i åldrarna 24–35 år. Hälften av kvinnorna, 52%, önskade i nuläget information om fertilitet och nästan hälften, 48%, hade önskat information tidigare i livet. En majoritet ansåg att information om fertilitet är lämpligt att ges vid preventivmedelsrådgivning av en barnmorska, samt att skolklasser ska bli kallade till informationsträffar om fertilitet. Sveriges regioner ansågs ha störst ansvar att informera om fertilitet. Slutsatser: Kvinnor i fertil ålder önskar i hög utsträckning information om fertilitet. Genom regionernas ansvar är barnmorskor som yrkesgrupp viktiga informatörer och folkbildare, främst genom preventivmedelsrådgivning.
Objective: To compare two upright delivery positions at the second stage of labour in healthy primiparous women with regard to duration of the second stage of labour and maternal experience. Design: A randomised controlled trial. Setting: A county hospital delivery ward. Sample: Primiparous subjects (n = 271) were randomly allocated to a kneeling (n = 138) or a sitting (n = 133) position during the second stage of labour. A postpartum questionnaire was answered by 264/271 women (97%) participating in the trial. Methods: Primiparous subjects were randomised to a kneeling or sitting delivery position during second stage of labour. Analysis was performed on an intention-to-treat basis. Main outcome measure: Duration of the second stage of labour. Results: A comparison of the duration of the second stage of labour (kneeling 48.5 minutes +/- 27.6 SD, sitting 41 minutes +/- 23.4 SD) revealed no significant difference between the groups. A sitting position during the second stage of labour was associated with a higher level of delivery pain (P < 0.01), a more frequent perception of the second stage as being long (P = 0.002), less comfort for giving birth (P = 0.03) and more frequent feelings of vulnerability (P = 0.05) and exposure (P = 0.02). There were no significant differences in the frequency of sphincter ruptures although a sitting position was associated with a higher degree of postpartum perineal pain (P < 0.001) (Table 3). Conclusion: Kneeling and sitting upright during the second stage of labour do not significantly differ from one another in duration of the second stage of labour. In healthy primiparous women, a kneeling position was associated with a more favourable maternal experience and less pain compared with a sitting position.
Objectives: The aim was to explore adolescents' beliefs and awareness regarding fertility and preconception health, as well as their views and experiences of information about fertility and preconception health directed at their age group. Methods: We performed seven semi-structured focus group interviews among upper secondary school students (n = 47) aged 16-18 years in two Swedish counties. Data were analysed by qualitative content analysis. Results: One theme ('important but far away') and five categories ('starting a family far down on the list'; 'high awareness but patchy knowledge of fertility and preconception health'; 'gender roles influence beliefs about fertility and preconception health'; 'wish to preserve fertility and preconception health in order to keep the door to procreation open'; 'no panacea - early and continuous education about fertility and preconception health') emerged from the interviews. Participants recognised the importance of preconception health and were highly aware of the overall importance of a healthy lifestyle. Their knowledge, however, was patchy and they had difficulties relating to fertility and preconception health on a personal and behavioural level. Participants wanted more information but had heterogeneous beliefs about when, where and how this information should be given. Conclusion: The adolescents wanted information on fertility and preconception health to be delivered repeatedly as well as through different sources.
BACKGROUND: Depression and other psychiatric disorders during pregnancy and postpartum is an important health problem, especially if the symptoms are recurrent or sustained. METHODS: All Swedish speaking women attending their first antenatal care visit during three predestined weeks were invited to participate. Depressive symptoms were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) in early pregnancy, two months and one year postpartum. RESULTS: In all, 2430 women completed three questionnaires. A dose-effect relation was found between the numbers of stressful life events experienced in the year prior to pregnancy and mean EPDS score in pregnancy. The prevalence of recurrent or sustained depressive symptoms (EPDS> or =12 on all three evaluations) was 3% (79/2430). Three factors were associated with depressive symptoms, two or more stressful life events in the year prior to pregnancy, native language other than Swedish and unemployment. CONCLUSIONS: Apart from questions about psychiatric history, a psychosocial history in early pregnancy including stressful life events, native language and employment status could help the health professionals to identify women at risk for recurrent or sustained depression during pregnancy and the year after giving birth.
BACKGROUND: To be hit by one's intimate partner during the first year after childbirth may affect a woman's health and ability to take care of her newborn. The purpose of this study was to document the prevalence and indicators in early pregnancy of a woman being hit by her partner during the year after childbirth. METHOD: Information was collected by a postal questionnaire in early pregnancy and 12 months after childbirth from the approximately 5,550 women in Sweden who visited an antenatal care clinic for the first time during one of three chosen weeks in 1999 and 2000. RESULTS: Of the 3,266 recruited women, 2,563 returned the follow-up questionnaire. Being hit during the first year after childbirth was reported by 52 of the 2,563 (2%) women: 32 (61%) had been hit by their partner once, 12 (23%) twice, and 8 (15%) three or more times. Risk increased in women who were age 24 years or younger (3.9% had been hit), unmarried (7.1%), born in countries outside Europe (6.8%), with a partner born outside Europe (5.4%), had a low level of education (8.9%), and were unemployed (5.0%). In early pregnancy, women with back pain (4.0%), a chronic illness (4.1%), coital pain (6.1%), frequent depression-related symptoms (8.1%), stomach pain (3.8%), or a urinary tract problem (6.3%) were hit more often than others after childbirth. CONCLUSIONS: At least 2 percent of Swedish women giving birth in 2000 were hit by their partner during the year after childbirth. Using identified predictors during antenatal care may increase the likelihood of finding women at risk, thereby enhancing the possibility of interventions to prevent this crime and health hazard.
Syfte: Att beskriva kvinnors erfarenheter av barnmorskans stöd vid hyperemesis gravidarum.
Metod: En kvalitativ manifest innehållsanalys med ett induktivt förhållningssätt. Semistrukturerade intervjuer genomfördes med sex kvinnor.
Resultat: Under analysprocessen framkom åtta subkategorier och tre kategorier. Kvinnorna beskrev att de inte blev tagna på allvar, HG normaliserades och barnmorskorna saknade förståelse för tillståndet. Samtalsstöd framställdes som betydande, för såväl kvinnorna som partners. Att erhålla bekräftelse på att fostret mådde bra ingav trygghet. Att ha en relation till barnmorskorna samt ligga steget före avseende behandling framkom som betydelsefullt. Information och barnmorskans kompetens förefall vara omständigheter som påverkade erfarenheten av stöd.
Konklusion: Tidigare forskning visar att HG har inflytande på fysiskt och psykiskt mående hos drabbade kvinnor. Trots det, framkom i resultatet att kvinnorna erfar övervägande bristfälligt och otillräckligt stöd, såväl emotionellt som handgripligt, från barnmorskorna. Mest framträdande i resultatet var kvinnornas erfarenheter av dåligt bemötande och att kvinnorna saknade relation till barnmorskan under tiden de varit som mest sjuka. Ämnet har kunskapsluckor vad gäller stöd, behandling och förståelse från barnmorskor. Ökad kunskap och förståelse för kvinnor med HG bör eftersträvas för att förbättra situationen. Ytterligare forskning är därför av intresse.
BACKGROUND: In this study of women who had undergone an emergency caesarean section (EmCS), the aim was to examine the associations between, on the one hand, the new mother's sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and on the other hand, post-traumatic stress symptoms 3 months' postpartum. METHODS: In a prospective study, 122 Swedish- or English-speaking new mothers completed 2 self-assessment questionnaires, at 2 days and 3 months after an EmCS. To measure SOC, we used the Sense of Coherence Scale (SOC-13), and to measure reactions to traumatic events, the Impact of Event Scale (IES-15). RESULTS: Independent risk factors associated with post-traumatic stress symptoms were: imminent fetal asphyxia as an indication for the operation, and low SOC in the woman. The group of women with low SOC were those with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women. CONCLUSIONS: Symptoms of post-traumatic stress following EmCS are associated both with the new mother's personal coping style and with the circumstances of the event. We recommend that women who belong to groups who more often report a low SOC or who had imminent asphyxia as an indication for the operation should be offered support and follow-up.
BACKGROUND: The quality of care received by a woman who gives birth to a dead baby is crucial for her long-term well-being, and limiting the period between diagnosis of intrauterine death and induction of delivery decreases her anxiety risk. The primary objective of this study was to explore why induction of delivery for most women should not be delayed more than 24 hours from the diagnosis of intrauterine death. A secondary objective was to determine how the time between diagnosis and delivery should be spent. METHODS: Twelve women were interviewed about their experience before and during the diagnosis of their baby's death and the event of birth. Interviews took place 6 to 18 months after the delivery and were analyzed using a phenomenological methodology. RESULTS: Women experienced premonition, difficulty communicating their worry, cessation of verbal communication with staff, unreality and numbing, desire to get rid of the dead child immediately, going through childbirth, and total silence. Many women believed that they were not respected as a human being during the process of diagnosing the intrauterine death. Themes emerged indicating caregivers should not reduce to zero the time between diagnosis of intrauterine death and induction of delivery. Time may be needed to obtain medical information about the delivery and to prepare the woman for meeting with and saying goodbye to her long-awaited but now silent baby. CONCLUSION: The period between diagnosis of intrauterine death and induction of delivery may give health professionals a major opportunity to improve a woman's ability to cope with the event of stillbirth and prepare her to meet with her loved but now silent baby. Further clinical research can identify supportive mechanisms for parents, and sources of iatrogenic psychological trauma that should be eliminated.
Despite the fact that emergency contraceptive pills (ECP) have become easily available across the country during recent years, abortion numbers continue to rise in Sweden, especially in the young age groups (< 25). In a series of studies, we have investigated knowledge, attitudes and experience of ECP among young women. Our results show that, whereas most women are aware of the method, many lack knowledge about the mechanism of action and time frames for best use, which could explain why ECPs are not used by more than a fraction of women who might have had benefit from their use. Since half of the women requesting a termination of pregnancy stated that they would have used ECP if they had had them available at home at the time of the unprotected intercourse which led to an unintended pregnancy, it seems reasonable to encourage women to keep ECPs at home, in case the need should arise. It is important that ECPs are available without prescription, but beyond that, much more information about ECP is necessary in order for the method to be widely accepted and used as a back-up after failure with other contraceptives.
BACKGROUND: A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the prevalence and risk factors of a negative birth experience in a national sample. METHODS: A longitudinal cohort study of 2541 women recruited from all antenatal clinics in Sweden during 3 weeks spread over 1 year was conducted. Data were collected by three questionnaires, which measured women's global experience of labor and birth 1 year after the birth, and obtained information on possible risk factors during pregnancy and 2 months after the birth. RESULTS: Seven percent of the women had a negative birth experience. The following risk factors were found: (1) factors related to unexpected medical problems, such as emergency operative delivery, induction, augmentation of labor, and infant transfer to neonatal care; (2) factors related to the woman's social life, such as unwanted pregnancy and lack of support from partner; (3) factors related to the woman's feelings during labor, such as pain and lack of control; and (4) factors that may be easier to influence by the caregivers, such as insufficient time allocated to the woman's own questions at antenatal checkups, lack of support during labor, and administration of obstetric analgesia. CONCLUSIONS: Many risk factors were related to unexpected medical problems and participants' social background. Of the established methods to improve women's birth experience, childbirth education and obstetric analgesia seemed to be less effective, whereas support in labor and listening to the woman's own issues may be underestimated
Several factors can affect the childbirth experience among parents. Previous research showed that parental education was insufficient. Parents who participated in both regular parental classes and psychoprophylaxis education were more satisfied with the psychoprophylaxis education compared to those who participated in only traditional parental classes. Psychoprophylaxis should be more considered as it could help the woman to handle her pain and contribute to increased self-esteem. The aim was to describe and illustrate the parents' childbirth experiences when psychoprophylaxis was used as childbirth preparation. The material for the study was collected through seven semi-structured interviews analyzed by qualitative content analysis. Three self-rated scales were used to illustrate the experiences of childbirth, pain in childbirth and psychoprophylaxis. The results showed that childbirth experience with psychoprophylaxis was individual. The psychoprophylaxis was a help when coping with labor pains for the mothers but also for the fathers to manage the mothers labor pain. Parental cooperation and midwifery support was important when using the psychoprophylaxis. Complicated deliveries with interventions and separation between child and parents contributed to a negative birth experience, despite using psychoprophylaxis and support from the midwife. The parents meant that there was a need for psychoprophylaxis and several mothers could not imagine giving birth without the use of psychoprophylaxis.
Background: In Sweden, approximately 440 children die in intrauterine fetal death annually. Losing a child before birth causes great sadness and despair to the parents. Midwives' have a significant role in supporting and nurturing parents in those situations, which is often experienced as a difficult and emotional task. Aim: To describe midwives' experiences associated to intrauterine fetal death. Method: Focus group interviews made with midwives working at a delivery ward in central Sweden, data were analyzed with qualitative content analysis. Result: The data analysis resulted in ten subcategories,four categories and an overall theme. The categories were Presence, A meaningful task, Being both professional and a human being, and Support at work. The overall theme was To make meaning of the seemingly meaningless. The midwives needed time to be able to be fully present with the parents. According to the midwives it was a meaningful experience to be supportive and make a difference for the parents. To be professional while at the same time dealing with their own feelings appeared as a difficult task. They received the best support from their colleagues. Conclusion: Supporting the parents and creating a memorable moment with their stillborn baby was experienced as the most eager in these situations, and made the task meaningful for the midwives.