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  • 1.
    Avelin, Pernilla
    et al.
    Karolinska institutet.
    Erlandsson, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare.
    Hildingsson, Ingegerd
    Mittuniversitetet.
    Rådestad, Inegla
    Sophiahemmet högskola.
    Swedish parents' experiences of parenthood and the need for support to siblings when a baby is stillborn2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 2, p. 150-158Article in journal (Refereed)
    Abstract [en]

    Background:

    It has been argued that having a stillborn baby in the family affects older siblings more than parents realize. The aim of this study was to describe parenthood and the needs of siblings after stillbirth from the parents' perspective.

    Methods:

    Six focus groups were held with 27 parents who had experienced a stillbirth and who had had children before the loss. The discussion concerned parents' support to the siblings, and the sibling's meeting, farewell, and memories of their little sister or brother. Data were analyzed using qualitative content analysis.

    Results:

    The overall theme of the findings was parenthood in a balance between grief and everyday life. In the analysis, three categories emerged that described the construction of the theme: support in an acute situation, sharing the experiences within the family, and adjusting to the situation.

    Conclusions:

    The siblings' situation is characterized by having a parent who tries to maintain a balance between grief and everyday life. Parents are present and engaged in joint activities around the stillbirth together with the siblings of the stillborn baby. Although parents are aware of the sibling's situation, they feel that they are left somewhat alone in their parenthood after stillbirth and therefore need support and guidance from others.

  • 2.
    Cacciatore, Joanne
    et al.
    Arizona State University, United States .
    Rådestad, Ingela
    Mälardalen University, School of Health, Care and Social Welfare.
    Frederik Frøen, J
    Norwegian Institute of Public Health.
    Effects of contact with stillborn babies on maternal anxiety and depression2008In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 35, no 4, p. 313-320Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Some guidelines encourage mothers to see and hold their babies after stillbirth, which might be traumatizing. The study objective was to investigate the effects of women seeing and holding their stillborn baby on the risk of anxiety and depression in a subsequent pregnancy and in the long term. METHODS: Thirty-seven organizations recruited women who had experienced stillbirth (N = 2,292 of whom 286 reported being pregnant). Anxiety and depressive symptoms were assessed by using the 25-item Hopkins Symptom Check List. RESULTS: Among nonpregnant women, seeing and holding their stillborn baby were associated with lower anxiety symptoms (OR 0.68, 95% CI 0.49-0.95) and a tendency toward fewer symptoms of depression (OR 0.72, 95% CI 0.51-1.02), compared with pregnant women. Participants who were pregnant also had less depressive symptomatology (OR 0.57, 95% CI 0.43-0.75), but more symptoms of anxiety if they had seen and held their baby (OR 3.79, 95% CI 1.42-10.1). CONCLUSIONS: Seeing and holding the baby are associated with fewer anxiety and depressive symptoms among mothers of stillborn babies than not doing so, although this beneficial effect may be temporarily reversed during a subsequent pregnancy.

  • 3.
    Erlandsson, Kerstin
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Dsilna, Ann
    Fagerberg, Ingegerd
    Mälardalen University, School of Health, Care and Social Welfare.
    Christensson, Kyllike
    Mälardalen University, School of Health, Care and Social Welfare.
    Skin-to-skin care with the father after cesarean birth and its effect on newborn crying and prefeeding behavior.2007In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 34, no 2, p. 105-14Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous reports have shown that skin-to-skin care immediately after vaginal birth is the optimal form of care for full-term, healthy infants. Even in cases when the mother is awake and using spinal analgesia, early skin-to-skin contact between her and her newborn directly after cesarean birth might be limited for practical and medical safety reasons. The aim of the present study was to compare the effects of skin-to-skin contact on crying and prefeeding behavior in healthy, full-term infants born by elective cesarean birth and cared for skin-to-skin with their fathers versus conventional care in a cot during the first 2 hours after birth. METHODS: Twenty-nine father-infant pairs participated in a randomized controlled trial, in which infants were randomized to be either skin-to-skin with their father or next to the father in a cot. Data were collected both by tape-recording crying time for the infants and by naturalistic observations of the infants' behavioral response, scored every 15 minutes based on the scoring criteria described in the Neonatal Behavioral Assessment Scale (NBAS). RESULTS: The primary finding was the positive impact the fathers' skin-to-skin contact had on the infants' crying behavior. The analysis of the tape recordings of infant crying demonstrated that infants in the skin-to-skin group cried less than the infants in the cot group (p<0.001). The crying of infants in the skin-to-skin group decreased within 15 minutes of being placed skin-to-skin with the father. Analysis of the NBAS-based observation data showed that being cared for on the father's chest skin-to-skin also had an impact on infant wakefulness. These infants became drowsy within 60 minutes after birth, whereas infants cared for in a cot reached the same stage after 110 minutes. Rooting activity was more frequent in the cot group than in the skin-to-skin group (p<0.01), as were sucking activities (p<=0.001) and overall duration of wakefulness (p<0.01). CONCLUSIONS: The infants in the skin-to-skin group were comforted, that is, they stopped crying, became calmer, and reached a drowsy state earlier than the infants in the cot group. The father can facilitate the development of the infant's prefeeding behavior in this important period of the newborn infant's life and should thus be regarded as the primary caregiver for the infant during the separation of mother and baby.

  • 4.
    Hildingsson, Ingegerd
    et al.
    Mid Sweden Univ.
    Rådestad, Ingela
    Mälardalen University, School of Health, Care and Social Welfare.
    Lindgren, Helena
    Dalarna Univ.
    Birth Preferences that Deviate from the Norm in Sweden: Planned Home Birth versus Planned Cesarean Section2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 4, p. 288-295Article in journal (Refereed)
    Abstract [en]

    Background: Opting for a home birth or requesting a cesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study was to compare background characteristics of women who chose these very different birth methods and to see how these choices affected factors of care and the birth experience. Methods: This descriptive study employed a secondary data analysis of a sample of women who gave birth from 1997 to 2008, including 671 women who had a planned home birth and 126 women who had a planned cesarean section based on maternal request. Data were collected by means of questionnaires. Logistic regression with crude and adjusted odds ratios (OR) with a 95 percent confidence interval (95% CI) was calculated. Results: Women with a planned home birth had a higher level of education (OR: 2.3; 95% CI: 1.5-3.6), were less likely to have a high body mass index (OR: 0.1; 95% CI: 0.01-0.6), and were less likely to be smokers (OR: 0.2; 95% CI: 0.1-0.4) when compared with women who had planned cesarean sections. When adjusted for background variables, women with a planned home birth felt less threat to the baby's life during birth (OR: 0.1; 95% CI: 0.03-0.4), and were more satisfied with their participation in decision making (OR: 6.0; 95% CI: 3.3-10.7) and the support from their midwife (OR 3.9; 95% CI: 2.2-7.0). They also felt more in control (OR: 3.3; 95% CI: 1.6-6.6), had a more positive birth experience (OR: 2.9; 95% CI: 1.7-5.0), and were more satisfied with intrapartum care (OR: 2.3; 95% CI: 1.3-4.1) compared with women who had a planned cesarean section on maternal request. Conclusions: Women who planned a home birth and women who had a cesarean section based on maternal request are significantly different groups of mothers in terms of sociodemographic background. In a birth context that promotes neither home birth nor cesarean section without medical reasons, we found that those women who had a planned home birth felt more involvement in decision making and had a more positive birth experience than those who had a requested, planned cesarean section.

  • 5.
    Karlström, Annika
    et al.
    Mid Sweden Univ.
    Rådestad, Ingela
    Mälardalen University, School of Health, Care and Social Welfare.
    Ericsson, Carola
    Umea Univ.
    Rubertsson, Christine
    Mälardalen University, School of Health, Care and Social Welfare.
    Nystedt, Astrid
    Mid Sweden Univ.
    Hildingsson, Ingegerd
    Mid Sweden Univ.
    Cesarean Section without Medical Reason, 1997 to 2006: A Swedish Register Study2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

     Background: Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code. Methods: Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data. Results: The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p < 0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables. Conclusions: The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common.

  • 6.
    Lindgren, Helena E
    et al.
    Mälardalen University, School of Health, Care and Social Welfare.
    Hildingsson, Ingegerd M
    Christensson, Kyllike
    Mälardalen University, School of Health, Care and Social Welfare.
    Rådestad, Ingela J
    Mälardalen University, School of Health, Care and Social Welfare.
    Transfers in planned home births related to midwife availability and continuity: a nationwide population-based study.2008In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 35, no 1, p. 9-15Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. METHODS: A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. RESULTS: Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8-3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1-9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1-9.4) and multiparas (RR 3.4; 95% CI 1.3-9.0). CONCLUSIONS: The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife's unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred.

  • 7. Lindgren, Helena
    et al.
    Erlandsson, Kerstin
    Mälardalen University, School of Health, Care and Social Welfare.
    Women's experiences of empowerment in a planned home birth: a Swedish population-based study.2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 4, p. 309-17Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Childbirth can be an empowering event in a woman's life. However, little is known about women's own perceptions of power and empowering sources during childbirth. This study aimed to describe the factors experienced as empowering during a planned home birth.

    METHODS: The inclusion criteria were women in Sweden who had a planned home birth between 1992 and 2005. All the women (n = 735) who agreed to participate received one questionnaire for each planned home birth. A total of 1,038 questionnaires were sent to the women. The written birth stories were analyzed using content analysis and descriptive statistics.

    RESULTS: In the analysis of the participants' birth experience four categories and one overall theme emerged from the stories. The categories identified were sensations, guidance, tacit support, and identification of needs. Greater emphasis was put on guidance among first-time mothers than among multiparas, for whom tacit support was identified as the most empowering factor. The overall theme was identified as "resting in acceptance of the process." The empowerment women expressed by achieving and maintaining a sense of control allowed them to rest in acceptance of the efforts that are part of a normal birth.

    CONCLUSION: Women who choose to give birth at home find empowering sources within themselves from their environment and from the active and passive support of persons they have chosen to be present at the birth.

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