Fathers’ emotional involvement with the neonate: impact of the umbilical cord cutting experience

Aims. This paper is a report on a study analysing the effect of the umbilical cord cutting experience on fathers’ emotional involvement with their infants. Background. Participation in childbirth offers an opportunity for father and mother to share the childbirth experience, so it is vital that midwives improve the fathers’ participation in this event. Design. A quasi-experimental study with a quantitative methodology was implemented. Methods. One hundred and five fathers were recruited as part of a convenience sample in a Maternity Public Hospital in a Metropolitan City in Portugal, between January and May of 2008. The Bonding Scale, the Portuguese version of the ‘Mother-to-Infant Bonding Scale’ was used to evaluate the fathers’ emotional involvement with the neonate at different moments: before childbirth, first day after childbirth and first month after childbirth. After childbirth, the fathers were divided into three separate groups depending on their umbilical cord cutting experience. Results. The results demonstrate that the emotional involvement between father and child tends to increase during the first days after childbirth and to decrease when evaluated 1 month after birth, for fathers who did not cut the umbilical cord. However, fathers who cut the umbilical cord demonstrate an improvement in emotional involvement 1 month later. Conclusion. Results suggest that the umbilical cord cutting experience benefits the father’s emotional involvement with the neonate, supporting the benefits of his participation and empowerment in childbirth

Exposure to domestic violence during pregnancy : impact on outcome, midwives' awareness, women's experience and prevalence in the south of Sweden

Objective: The overall aim of this thesis was to investigate pregnant women’shistory of violence and experiences of domestic violence during pregnancy andto explore the possible association between such violence and various outcomemeasures as well as background factors. A further aim was to elucidate midwives’awareness of domestic violence among pregnant women as well as women’sexperiences and management of domestic violence during pregnancy.Design/Setting/Population: Paper I utilised material derived from a populationbasedmulti-centre cohort study. A total of 2652 nulliparous women at nineobstetric departments in Denmark answered a self-administrated questionnaireat 37 weeks of gestation. Among the total sample, 37.1% (985) women met theprotocol criteria for labour dystocia. In Paper II an inductive qualitative methodwas used, based on focus group interviews with sixteen midwives working inantenatal care in southern Sweden who were divided into four focus groups. InPaper III a grounded theory approach was used to develop a theoretical modelof ten women’s experiences of intimate partner violence during pregnancy. PaperIV was a cross-sectional study including a cohort of 1939 pregnant women whoanswered a self-administered questionnaire at their first visit to seventeen ANCsin south-west Scania in Sweden.Results: In paper I, 35.4 % (n = 940) of the total cohort of women reportedhistory of violence, and among these, 2.5 % (n = 66) reported exposure toviolence during their first pregnancy. Further, 39.5% (n = 26) of those had neverbeen exposed to violence before. No associations were found between historyof violence or experienced violence during pregnancy and labour dystocia atterm. However, among those women consuming alcoholic beverages during latepregnancy, women exposed to violence had increased odds of labour dystocia(crude OR 1.49, CI: 1.07 – 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category ‘Failing both mother and theunborn baby’ highlighted the vulnerability of the unborn baby and the needto provide protection for the unborn baby by means of adequate care to thepregnant woman. Also, the analysis yielded five categories: 1) ‘Knowledge about‘the different faces’ of violence’ 2) ‘Identified and visible vulnerable groups’, 3)‘Barriers towards asking the right questions’, 4) ‘Handling the delicate situation’and 5) ‘The crucial role of the midwife’. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, ‘Struggling to survivefor the sake of the unborn baby’, constituted the main concerns of women whowere exposed to IPV during pregnancy. The core category also demonstratedhow the survivors handled their situation. Three sub-core categories wereidentified that were properties of the core category; these were: ‘Trapped inthe situation’, ‘Exposed to mastery’ and ‘Degradation processes’. In Paper IV,‘history of violence’ was reported by 39.5% (n = 761) of the women. Prevalenceof experience of domestic violence during pregnancy, regardless of type or levelof abuse, was 1.0 % (n = 18), and prevalence of history of physical abuse byactual intimate partner was 2.2 % (n = 42). The strongest factor associated withdomestic violence during pregnancy was history of violence (p < 0.001). Thepresence of several symptoms of depression was associated with a 7-fold risk ofdomestic violence during pregnancy (OR 7.0; 95% CI: 1.9-26.3).Conclusions: Our findings indicated that nulliparous women who have ahistory of violence or experienced violence during pregnancy do not appearto have a higher risk of labour dystocia at term, according to the definitionof labour dystocia used in this study. Additional research on this topic wouldbe beneficial, including further evaluation of the criteria for labour dystocia(Paper I). Avoidance of questions concerning the experience of violence duringpregnancy may be regarded as failing not only the pregnant woman but also theunprotected and unborn baby. Still, certain hindrances must be overcome beforethe implementation of routine enquiry concerning pregnant women’s experiencesof violence (Paper II). The theoretical model “Struggling to survive for the sakeof the unborn baby” highlights survival as the pregnant women’s main concernand explains their strategies for dealing with experiences of violence duringpregnancy. The findings may provide a deeper understanding of this complexmatter for midwives and other health care professionals (Paper III). The reportedprevalence of domestic violence during pregnancy in southwest Scania in Swedenis low. Both history of violence and the presence of several depressive symptomsdetected in early pregnancy may indicate that the woman also is exposed todomestic violence during pregnancy (Paper IV)

Exposure to domestic violence during pregnancy : impact on outcome, midwives' awareness, women's experience and prevalence in the south of Sweden

Objective: The overall aim of this thesis was to investigate pregnant women’shistory of violence and experiences of domestic violence during pregnancy andto explore the possible association between such violence and various outcomemeasures as well as background factors. A further aim was to elucidate midwives’awareness of domestic violence among pregnant women as well as women’sexperiences and management of domestic violence during pregnancy.Design/Setting/Population: Paper I utilised material derived from a populationbasedmulti-centre cohort study. A total of 2652 nulliparous women at nineobstetric departments in Denmark answered a self-administrated questionnaireat 37 weeks of gestation. Among the total sample, 37.1% (985) women met theprotocol criteria for labour dystocia. In Paper II an inductive qualitative methodwas used, based on focus group interviews with sixteen midwives working inantenatal care in southern Sweden who were divided into four focus groups. InPaper III a grounded theory approach was used to develop a theoretical modelof ten women’s experiences of intimate partner violence during pregnancy. PaperIV was a cross-sectional study including a cohort of 1939 pregnant women whoanswered a self-administered questionnaire at their first visit to seventeen ANCsin south-west Scania in Sweden.Results: In paper I, 35.4 % (n = 940) of the total cohort of women reportedhistory of violence, and among these, 2.5 % (n = 66) reported exposure toviolence during their first pregnancy. Further, 39.5% (n = 26) of those had neverbeen exposed to violence before. No associations were found between historyof violence or experienced violence during pregnancy and labour dystocia atterm. However, among those women consuming alcoholic beverages during latepregnancy, women exposed to violence had increased odds of labour dystocia(crude OR 1.49, CI: 1.07 – 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category ‘Failing both mother and theunborn baby’ highlighted the vulnerability of the unborn baby and the needto provide protection for the unborn baby by means of adequate care to thepregnant woman. Also, the analysis yielded five categories: 1) ‘Knowledge about‘the different faces’ of violence’ 2) ‘Identified and visible vulnerable groups’, 3)‘Barriers towards asking the right questions’, 4) ‘Handling the delicate situation’and 5) ‘The crucial role of the midwife’. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, ‘Struggling to survivefor the sake of the unborn baby’, constituted the main concerns of women whowere exposed to IPV during pregnancy. The core category also demonstratedhow the survivors handled their situation. Three sub-core categories wereidentified that were properties of the core category; these were: ‘Trapped inthe situation’, ‘Exposed to mastery’ and ‘Degradation processes’. In Paper IV,‘history of violence’ was reported by 39.5% (n = 761) of the women. Prevalenceof experience of domestic violence during pregnancy, regardless of type or levelof abuse, was 1.0 % (n = 18), and prevalence of history of physical abuse byactual intimate partner was 2.2 % (n = 42). The strongest factor associated withdomestic violence during pregnancy was history of violence (p < 0.001). Thepresence of several symptoms of depression was associated with a 7-fold risk ofdomestic violence during pregnancy (OR 7.0; 95% CI: 1.9-26.3).Conclusions: Our findings indicated that nulliparous women who have ahistory of violence or experienced violence during pregnancy do not appearto have a higher risk of labour dystocia at term, according to the definitionof labour dystocia used in this study. Additional research on this topic wouldbe beneficial, including further evaluation of the criteria for labour dystocia(Paper I). Avoidance of questions concerning the experience of violence duringpregnancy may be regarded as failing not only the pregnant woman but also theunprotected and unborn baby. Still, certain hindrances must be overcome beforethe implementation of routine enquiry concerning pregnant women’s experiencesof violence (Paper II). The theoretical model “Struggling to survive for the sakeof the unborn baby” highlights survival as the pregnant women’s main concernand explains their strategies for dealing with experiences of violence duringpregnancy. The findings may provide a deeper understanding of this complexmatter for midwives and other health care professionals (Paper III). The reportedprevalence of domestic violence during pregnancy in southwest Scania in Swedenis low. Both history of violence and the presence of several depressive symptomsdetected in early pregnancy may indicate that the woman also is exposed todomestic violence during pregnancy (Paper IV)

First-time mothers' satisfaction with their birth experience : a cross-sectional study

Objective: To explore first-time mothers' satisfaction with their birth experience using Visual Analog Scale and to identify possible risk factors for a negative birth experience. Design: A cross-sectional design using retrospective data collection from electronic medical files. Setting: A birthing center in southern Sweden, which has approximately 1400 births annually. Participants: Primiparous women (N = 584) who gave birth during 2017. The cut-off point for a negative birth experience was set as <= 4 on the Visual Analog Scale. Measurements and findings: The mean age of the women was 29 years (SD 5.1; range 16-47 years). Prevalence of a negative birth experience was 9.6%. The strongest risk factors for a negative birth experience were having obstetric anal sphincter injuries (AOR 2.8 CI 95% 1.1-7.2) and oxytocin augmentation started in the first stage of labor (AOR 2.2 CI 95% 1.1-4.4). Key conclusions: Women who had their labours augmented with oxytocin or sustained an anal sphincter injury were statistically significantly more likely to have a negative birth experience. However, it is uncertain whether the women scored pain experience or birth experience when they reported their satisfaction on the Visual Analog Scale; further investigation is required. Implications for practice: It is important to use a reliable and validated instrument to measure birth experience in order to promote respectful and supportive care for new mothers. (C) 2019 Elsevier Ltd. All rights reserved

Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden

Objective: to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden. Design: an inductive qualitative design, using focus groups interviews. Setting: midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals. Findings: five categories emerged: 'Knowledge about the different faces' of violence', perpetrator and survivor behaviour, and violence-related consequences. 'Identified and visible vulnerable groups', at risk' groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. 'Barriers towards asking the right questions', the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. 'Handling the delicate situation', e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. The crucial role of the midwife', insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category 'Failing both mother and the unborn baby' which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman. Key conclusions and implication for practice: avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden. (C) 2010 Elsevier Ltd. All rights reserved

Entrepreneurship and growth : A study of the impact external factors have on growth

In today’s Sweden there is great belief in entrepreneurship and the benefits it can bring to the country. The Swedish government has taken note of this growing enthusiasm and realized the contribution it can make to facilitate national growth. Successful efforts have been made in Sweden to support entrepreneurship and innovation, which has resulted in a relative ease for individuals to start their own businesses. The number of companies started today is higher than ever and there are signs of a common faith in growth among new entrepreneurs. Unfortunately only a small fraction of these new businesses succeed in growing big. The harsh truth is that these companies will not contribute to national growth if they do not grow themselves. But what is preventing them from growing? A number of studies have shown that both the environment and the entrepreneur himself are important factors when examining companies’ growth. That is because the environment affects the entrepreneur’s strategic decisions and forces him/her to act in certain ways. These decisions, in turn, affect the company, that can then demonstrategrowth (or not). By examining five different factors that can influence the entrepreneur’s opportunity for growth, this study concludes that a number of political decisions and conditions can constitute as barriers for growth while a strong entrepreneurial orientation can help the entrepreneur to deal with negative factors in the environment

Depressive symptoms during pregnancy and postpartum in women and use of antidepressant treatment : a longitudinal cohort study

Objective; The aim of this study was to investigate whether women, who reported “symptoms of depression” during pregnancy and up to 1.5 years postpartum, who reported domestic violence or not, were treated with antidepressant medication. Material and Methods; A prospective longitudinal cohort study recruited primi- and multiparous women (n=1939). The Edinburgh Postnatal Depression Scale (EPDS), the NorVold Abuse Questionnaire, and a questionnaire about medication during pregnancy were distributed and administered three times, during early, late pregnancy and during the postpartum period. Antidepressant medication was compared between women with EPDS scores &lt; 13 and scores EPDS ≥ 13 as the optimal cut-off for lower and higher symptoms of depression. Results; EPDS scores &gt; 13 were detected in 10.1 % of the women during the whole pregnancy, of those 6.2 % had depressive symptoms already in early pregnancy and 10.0 % during the postpartum period. Women with EPDS scores ≥ 13 and non-exposure to domestic violence were more often non-medicated (p &lt; 0.001). None of the women with EPDS scores ≥ 13 exposed to domestic violence had received any antidepressant medication, albeit the relationship was statistically non-significant. Conclusion; Pregnant women who experienced themselves as having several depressive symptoms, social vulnerability and even a history of domestic violence, did not receive any antidepressant treatment during pregnancy nor postpartum. This study shows the importance of detecting depressive symptoms already during early pregnancy and a need for standardized screening methods

Struggling to survive for the sake of the unborn baby : a grounded theory model of exposure to intimate partner violence during pregnancy

BACKGROUND: Intimate partner violence (IPV) during pregnancy is a serious matter which threatens maternal and fetal health. The aim of this study was to develop a grounded theoretical model of women's experience of IPV during pregnancy and how they handle their situation. METHOD: Ten interviews with women who had experience of being exposed to IPV during pregnancy were analyzed using the grounded theory approach. RESULTS: The core category 'Struggling to survive for the sake of the unborn baby' emerged as the main concern of women who are exposed to IPV during pregnancy. The core category also demonstrates how the survivors handle their situation. Also, three sub-core categories emerged, 'Trapped in the situation' demonstrates how the pregnant women feel when trapped in the relationship and cannot find their way out. 'Exposed to mastery' demonstrates the destructive togetherness whereby the perpetrator's behavior jeopardizes the safety of the woman and the unborn child. 'Degradation process' demonstrates the survivor's experience of gradual degradation as a result of the relationship with the perpetrator. All are properties of the core category and part of the theoretical model. CONCLUSION: The theoretical model "Struggling to survive for the sake of the unborn baby" highlights survival as the pregnant women's main concern and explains their strategies for dealing with experiences of violence during pregnancy. The findings may provide a deeper understanding of this complex matter for midwives and other health care providers. Further, the theoretical model can provide a basis for the development and implementation of prevention and intervention programs that meet the individual woman's needs