https://www.mdu.se/

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.

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.

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.

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.

The overall aim of the thesis was to describe care of the newborn infant immediately after birth, during maternal-infant separation; the father as primary caregiver and the mother’s experiences of separation and later reunion with the infant, in order to enhance development of care for the newborn infant during maternal-infant separation. In study I, II and III a phenomenological approach was used to gain access to mothers’ and fathers’ lived experiences (I, III) and lifeworld (II). Six interviews with mothers with experiences of separation and later reunion with their infants (study I) and interviews with 15 fathers taking care of their infants as primary caregivers during maternal-infant separation (study III) were included in the analyses. Study II was an observation study through videotape recording of 15 fathers taking care of their infants during the first two hours after birth. For the purpose of study IV and V, a quantitative design with naturalistic observations, audiotape recordings and respiratory monitoring was used. The infants in study IV and V were randomly assigned two groups: being cared for skin-to-skin with their father who was seated comfortably in an armchair or being placed in a cot, with their father seated beside them. Data was collected from 29 (study IV) and 13 infants (study V) respectively.

The essence of the mothers’ experiences (study I) was their strong desire to be close to their babies during maternal-infant separation. Mothers wanted to be close to their babies whatever the circumstances, and to be kept fully informed at all times. It was the mothers’ experience that the organization, staff and other circumstances prolonged the separation. The essence of fathers lived experiences while taking care of their infant while mother and child were apart (study III) yielded a meaning of alterability towards togetherness between father and child. This movement meant immediate and gradual alterability within the father himself that made him gradually undertake the responsibility, as he got to know his child. The essence of the father’s observed lifeworld in study II yields the very first experience of the father coming increasingly closer to the newborn infant and revealing an ebb and flow variation in the father’s involvement with the child. There was an ebb and flow between becoming a father and a physical withdrawal, rather than immediately taking the practical approach of becoming a resource for the infant. In study IV the infants in the skin-to-skin group cried less than the infants in the cot group (p<0.001). 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). The pattern for wakefulness showed a lower level for the skin-to-skin group when compared with the cot group (p<0.01). The infants in the skin-to-skin group of study V showed higher inspiratory and expiratory air flows, larger breath volume (all (p<0.001) and minute ventilation when compared with the cot group. A caregiving model, where fathers hold their infants skin-to-skin in an upright position on their chest, seemed to have a positive impact on the infant’s wellbeing. At the same time, the father took the child to himself. The mothers, separated from their child, had a strong desire to be close to the baby.

This study aims to capture parental descriptions of how siblings take leave of and mourn a stillborn brother or sister and how their parents support them. Data were collected by questionnaires from 16 parents of siblings to a stillborn child one year after the stillbirth. Data were analysed numerically for the multiple-choice questions and content analysis was used for parental comments and descriptions. The results describe siblings’ farewell to a stillborn brother or sister and how their parents in the midst of their own grief were involved in supporting siblings’ wellbeing, and observed their mourning reactions. Although the findings need to be interpreted with caution, they may provide insight that enables staff to become more sensitive to the whole family experience in the practice of their profession. Further research into siblings’ grief and parental support after stillbirth is crucial so that further light may be shed on their situation.

Cesarean birth is a mode of delivery that often minimizes the mothers’ possibility to handle her term baby skin-to-skin while the father takes care of the baby for part, or all, of the first hours. No attention has, as far as we know, been given to different caregiving models and their eventual effects on the adaptation of breathing for the term infant born by elective cesarean. Previous publications on breathing patterns in newborn infants have mostly been conducted on premature infants in kangaroo care. The aim of this pilot study was to compare the effects of two caregiving models on the adaptation of breathing and infant crying after elective cesarean section, in term infants during the first hours after birth. Term infants born by elective cesarean were held skin-to-skin on their father’s chest or cared-for in a cot during the mother’s post operative observation stay. Thirteen father-infant pairs participated in a pilot sub-study with a randomized control trial design. Data were collected both by respiratory inductance plethysmography (RIP) and by tape-recorded crying time. The data raises important questions about the effects on breathing adaptation in relation to caregiving models. The infants in the skin-to-skin group showed significantly higher inspiratory and expiratory air flows, larger breath volume (all p < 0.001) and minute ventilation as compared with the cot group. The infants in the skin-to-skin group cried less than the infants in the cot group (p < 0.001). A caregiving model where fathers hold their infants skin-to-skin in an upright position on their chest has a positive impact on the infants’ respiratory adaptation and reduced infant crying. Larger studies of caregiving models after elective cesarean birth on the adaptation of breathing need to be conducted.

This paper describes the meaning of a father’s presence with a full-term healthy child delivered by caesarean section, as observed during the routine post-operative separation of mother and child. Videotaped observations recorded at a maternity clinic located in the metropolitan area of Stockholm, Sweden formed the basis for the study, in which fifteen fathers with their infants participated within two hours of elective caesarean delivery in the 37th - 40th week of pregnancy. A phenomenological analysis based on Giorgi’s method was conducted on the data. The description of the new father’s experiences that emerged pointed to a process of being and becoming in taking the child to himself. Fatherhood developed gradually as a result of recurrent experiences of the child’s expressions. There was an ebb and flow between taking on the role of being a father and physical withdrawal from the role. The findings of this study not only confirm previous accounts of new fathers’ experiences, but go further in revealing an ebb and flow variation in the fathers’ involvement. What this indicates is that the process of transition to fatherhood requires not only presence but time. The period required for this process thus must not be disturbed, but supported, trusting in the father’s ability to assume his role as a father. It is suggested that, in addition to their relevance in guiding the attitudes and expectations of those professionally involved in postnatal care and community health, these findings could be useful in antenatal courses for parents, and especially in instances when caesarean birth is planned, to highlight the meaning of the role of fathers as caregivers.

The aim was to describe the meaning of the father’s lived experiences when taking care of his infant as the primary caregiver during the first hours after birth, when the infant was apart from the mother due to the mother’s postoperative care. Fifteen fathers were interviewed between 8 days to 6 weeks after birth. The results describe a movement towards father-child togetherness characterized by an immediate and gradual change within the father as he undertakes increasing responsibility while getting to know his child. The results can be reflected upon in antenatal classes in order to integrate the father’s important role in the care of his infant, in a situation where the mother-infant dyad has been interrupted.

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.

OBJECTIVE: To describe how mothers of premature or sick mature babies, experienced the care and their own state of health after birth in postnatal care in a neonatal co-care ward. DESIGN: A Husserlian phenomenology method inspired by Giorgi was used. Six mothers were interviewed using a semi-structured, open-ended interview guide. SETTING: A neonatal ward using a concept of co-care for premature or sick mature babies and their mothers. FINDINGS: In essence, mothers felt that, whatever the circumstances, they wanted to be close to their babies. It was the mother's experience that the organisation, staff or other circumstances prolonged the separation from her baby. The mother experienced the separation from the baby intensely during the first days after birth (even for a short period of time); after returning home, they had still not come to terms with it. The mothers regarded the entire stay in hospital as one event; they did not differentiate between wards or ward staff in the delivery, maternity or neonatal wards. All mothers in the study had, therefore, also experienced part-care for shorter or longer periods when separated from their baby, being then later reunited in co-care. CONCLUSION: This study can be used as a basis for discussion on more individualised care through co-operation and organisation between delivery, maternity and neonatal wards, in order to reduce the amount of time mother and baby are separated.

The aim of this phenomenographic study was to capture fathers' conceptons of parental educatio topics illuminated by their experiences as primary caregiver of their child immediately following bith. Fifteen fathers were interviewed between 8 days and 6 weeks after the birth of their child. For further information go to abstract in the article.

Objective: To describe the thoughts, reflections, and experiences of friends-with-benefits relationships among a group of Swedish adolescents. Design and Sample: A qualitative study with an explorative and descriptive design. Eight adolescents, aged 16-18, were interviewed. Measures: Individual in-depth interviews were undertaken. Data were analyzed using latent content analysis. Results: The informants involved themselves in Friends-with-benefits (FWB) relationships to find physical and psychological intimacy without any expectations or demands. FWB relationships were perceived to have more advantages when the partner was a close friend with whom an informant felt comfortable. There was ambivalence about the legitimacy of romantic feelings in an FWB relationship, although it was quite common. Sexual concurrency was common and often accepted. Sexual risk-taking behavior involving the use of alcohol and a lack of contraception was considered common in FWB relationships. Informants requested more education and support as regards their sexual behavior. Conclusions: FWB relationships were often initiated to find physical and psychological intimacy with no expectations or demands. Advantages such as sexual concurrency and no demands were central. A deeper understanding of how adolescents think and reason about sexuality and relationships can make a difference when working to improve young people's sexual and reproductive health.

Growing numbers of openly gay women choose to have children, but there have been few studies on the topic. The aim of this study was to describe the co-mother's experiences of care provided during their partner's pregnancy, childbirth and the postnatal period. Six co-mothers were interviewed between six weeks and three years after the birth of their child. The open interviews were analysed using content analysis. The overall theme of the findings was 'like everyone else, but not quite'. The following main categories were identified: need for acknowledgement, need for care designed to suit same-sex couples, and in the hands of nursing staff. Co-mothers felt themselves to be 'like everyone else but not quite'. In order to support the relationship of same-sex parents in parenthood it is important for midwifery staff to recognize co-mothers as an equal parent of the child

The aim of this study was to describe fathers' experiences of being present on a postnatal ward and during the first days at home following a complicated birth. Fifteen fathers were interviewed, and content analysis was used for the analysis. The theme illustrated that fathers were a resource for both mother and child through practical and emotional engagement. The categories describe how the father empowers the mother and illustrates adapting to new family roles. Following complicated birth, fathers should be invited to stay around-the-clock on postnatal wards because it gives them the opportunity to place their resources at the disposal of mother and child. In antenatal courses, fathers should be prepared for their empowering role after a complicated birth

Background: Over the years the involvement of the partner in the childbirth process has resulted in an increasing interest in the partner's role. Research into the partner's experiences is still limited. This study aimed to describe the experiences of fathers at the birth of their child from the father's perspective. Method: Sixteen fathers were interviewed about their experiences at the birth of their child between 8 days and 6 weeks after the birth. The interviews were analysed using a phenomenological approach. Results: The findings not only recount that the moment of birth was a life changing and overwhelming moment characterised by feelings of love and belonging, but go further in revealing the birth of a child as a movement from belonging to belonging through a blessed moment of love for a child. Conclusion: What this finding indicates is that the birth of a child is an important experience in the quality of life of men, calling for their participation at the birth of the child and for a strategy of leaving the family alone right after this outstanding life moment of a new birth.

OBJECTIVE: To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. 

SETTING: One thousand and thirty-four women answered a web questionnaire. 

SAMPLE:  Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. 

METHODS: Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. 

MAIN OUTCOME MEASURE: The premonition of an unwell unborn baby. 

RESULTS: In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. 

CONCLUSIONS: Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

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.

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

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. © 2012 Elsevier Ltd.

OBJECTIVE: To gain an understanding of fathers' experiences of a planned home birth.

STUDY DESIGN: In-depth interviews were conducted with eight Swedish fathers who had the experience of a total of 23 births, of which 17 were planned home births. The fathers were recruited by the midwives who had assisted with the planned home births. Content analysis was used.

RESULTS: Analysis revealed the main theme "she leads - he follows". The fathers were compliant to the woman's decision; they also described it as a deliberate choice and struggled with feelings of being different in comparison with the established way of becoming a father.

CONCLUSION: The experience of a planned home birth for the father was a process in which he had to put his own ideas on giving birth aside and carefully follow his woman. Sharing fears and happiness during the process by being compliant to the woman may strengthen the new fatherhood. The fathers' role in the process of making an unconventional choice is an example that could probably be applied to similar situations in pregnancy and childbirth.

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.

OBJECTIVE: Carrying death instead of life is beyond understanding and a huge psychological challenge for a pregnant mother. The aim of this study was to investigate the mothers' experiences of the time from the diagnosis of the death of their unborn baby until induction of labour.

METHOD: In this qualitative study, in-depth interviews were conducted with 21 mothers whose babies had died prior to birth. The interviews were then analysed using content analysis.

RESULTS: The overall theme that emerged from the mothers' experiences is understood as "waiting in no-man's-land", describing the feeling of being set aside from normality and put into an area which is unrecognized. Four categories were established: 'involuntary waiting' describes the sense of being left without information about what is to come; 'handling the unimaginable' concerns the confusing state of finding oneself in the worst-case scenario and yet having to deal with the birth; 'broken expectations' is about the loss not only of the baby but also of future family life; and 'courage to face life' describes the determination to go on and face reality.

CONCLUSIONS: The mother's experiences during the time after the information of their baby's death in utero until the induction of labour can be understood as a sense of being in no-man's-land, waiting without knowing for what or for how long.

Caring routines in many countries for parents following the death of a baby have shifted over the last 40 years, from initial recommendations that parents should not see their baby, to the opposite in present day. This study aims to describe mothers' gratitude for the actions taken by health professionals in connection with the birth of their child. The study also examines whether the aspects of care for which they were grateful differed between mothers whose children died before and after 1990. Data was collected from 799 women via a questionnaire posted on the homepage of the Swedish National Infant Foundation. Women who gave birth to a stillborn child after 1990 expressed gratefulness more often than women who gave birth to a stillborn child before 1990, for several reasons including the help received in creating memories of their baby. The motherswere thankful for being supported in their motherhood, and that the staff encouraged them to see, hold and be with their baby.

Kangaroo mother care (KMC) was first introduced in Mozambiquein 1984. The aim of this study was to describe Mozambicanmothers’ experiences of going through admission, passing froman intensive care ward to a nursery ward with their prematurebaby, undergoing KMC training before early discharge. A clinicalcase study was conducted, involving naturalistic observationsand a face-to-face interview with 41 mothers participating tocomplete a questionnaire. Descriptive statistics and manifestcontent analysis were used in this study. The results show thatthe mothers were of low socio-economic standing and felt thatthey did not have enough information on KMC. The hierarchicalorganization within the hospital setting as well as communalisticbehaviours influenced the mothers’ support of KMC, includinginformation, communication, relationships and actions. Theconclusion is that there is an important challenge for trainedneonatal nurses to improve the guidelines for KMC and toempower mothers and their families to adopt KMC.