21 research outputs found
A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term
<p>Abstract</p> <p>Background</p> <p>Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The <b>aim </b>of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term.</p> <p>Methods</p> <p>A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia.</p> <p>Results</p> <p>Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96).</p> <p>Conclusions</p> <p>Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.</p
Domestic violence and pregnancy : impact on outcome and midwives' awareness of the topic
Objective: The overall aim of this thesis was to investigate whether selfreported
history of violence is associated with increased risk of labour dystocia
in nulliparous women at term and to elucidate midwivesâ awareness of domestic
violence during pregnancy in southern Sweden.
Design/Method/Setting/Population: Paper I utilised a population-based
multi-centre cohort study design. A self-administrated questionnaire was administered
at four points in time with start at 37 weeks of gestation, at nine
obstetric departments in Denmark. The total cohort comprised 2652 nulliparous
women, among whom 985 (37.1%) met the protocol criteria for labour
dystocia. In paper II an inductive qualitative design was utilised, based on focus
group interviews. Participants were midwives with experience of working
in antenatal care units connected to two university hospitals in southern Sweden.
Sixteen midwives were recruited by network sampling complemented by
purposive sampling, and were divided into four focus groups of 3 to 5 individuals.
Results: In paper I cohort of the total, 940 (35.4 %) women reported experience
of violence and of these 66 (2.5 %) women reported exposure of violence
during their first pregnancy. Further, 39.5% (n = 26) of those had never been
exposed to violence before. Univariate logistic regression analysis showed no
association between history of violence or experienced violence during pregnancy
and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR
0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women
consuming alcoholic beverages during late pregnancy had increased odds of
labour dystocia (crude OR 1.49, CI: 1.07 â 2.07) compared to unexposed to
violence women who were alcohol consumers (crude OR 0.89, 95 % CI: 0.69-
1.14). In paper II five categories emerged: 1) âKnowledge about âthe different
facesâ of violenceâ, perpetrator and survivor behaviour, and violence-related consequences. 2) âIdentified and visible vulnerable groupsâ, âat riskâ groups for
exposure to domestic violence during pregnancy, e.g. immigrants and substance
users. 3) âBarriers towards asking the right questionsâ, the midwife herself
as an obstacle, lack of knowledge among midwives as to how to handle
disclosure of violence, and presence of the father-to-be at visits to the midwife.
4) âHandling the delicate situationâ, e.g. the potential conflict between the
midwifeâs professional obligation to protect the abused woman and the unborn
baby and the survivorâs wish to avoid interference. 5) âThe crucial role of
the midwifeâ, insufficient or non-existent support, 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 âFailing
both mother and the unborn babyâ 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.
Conclusions: Our findings indicate that nulliparous women who have a history
of violence or experienced violence during pregnancy do not appear to
have a higher risk of labour dystocia at term, according to the definition of labour
dystocia used in this study. Additional research on this topic would be
beneficial, including further evaluation of the criteria for labour dystocia (Paper
I). 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
pregnant womenâs experiences of violence. It is of importance to develop
guidelines and a plan of action for all health care personnel at antenatal clinics
as well as continuous education and professional support for midwives in
southern Sweden (Paper II)
Exposure to domestic violence during pregnancy : impact on outcome, midwivesâ awareness, womenÂŽsexperience and prevalence in the south of Sweden
Objective: The overall aim of this thesis was to investigate pregnant womenâshistory 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 midwivesâawareness of domestic violence among pregnant women as well as womenâsexperiences 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 womenâs 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 â 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category âFailing both mother and theunborn babyâ 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) âKnowledge aboutâthe different facesâ of violenceâ 2) âIdentified and visible vulnerable groupsâ, 3)âBarriers towards asking the right questionsâ, 4) âHandling the delicate situationâand 5) âThe crucial role of the midwifeâ. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, âStruggling to survivefor the sake of the unborn babyâ, 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: âTrapped inthe situationâ, âExposed to masteryâ and âDegradation processesâ. In Paper IV,âhistory of violenceâ 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 womenâs experiencesof violence (Paper II). The theoretical model âStruggling to survive for the sakeof the unborn babyâ highlights survival as the pregnant womenâs 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, midwivesâ awareness, womenÂŽsexperience and prevalence in the south of Sweden
Objective: The overall aim of this thesis was to investigate pregnant womenâshistory 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 midwivesâawareness of domestic violence among pregnant women as well as womenâsexperiences 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 womenâs 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 â 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category âFailing both mother and theunborn babyâ 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) âKnowledge aboutâthe different facesâ of violenceâ 2) âIdentified and visible vulnerable groupsâ, 3)âBarriers towards asking the right questionsâ, 4) âHandling the delicate situationâand 5) âThe crucial role of the midwifeâ. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, âStruggling to survivefor the sake of the unborn babyâ, 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: âTrapped inthe situationâ, âExposed to masteryâ and âDegradation processesâ. In Paper IV,âhistory of violenceâ 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 womenâs experiencesof violence (Paper II). The theoretical model âStruggling to survive for the sakeof the unborn babyâ highlights survival as the pregnant womenâs 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, midwivesâ awareness, womenÂŽsexperience and prevalence in the south of Sweden
Objective: The overall aim of this thesis was to investigate pregnant womenâshistory 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 midwivesâawareness of domestic violence among pregnant women as well as womenâsexperiences 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 womenâs 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 â 2.07) compared to women who were unexposedto violence. In Paper II, an overarching category âFailing both mother and theunborn babyâ 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) âKnowledge aboutâthe different facesâ of violenceâ 2) âIdentified and visible vulnerable groupsâ, 3)âBarriers towards asking the right questionsâ, 4) âHandling the delicate situationâand 5) âThe crucial role of the midwifeâ. In Paper III, the analysis of the empiricaldata formed a theoretical model, and the core category, âStruggling to survivefor the sake of the unborn babyâ, 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: âTrapped inthe situationâ, âExposed to masteryâ and âDegradation processesâ. In Paper IV,âhistory of violenceâ 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 womenâs experiencesof violence (Paper II). The theoretical model âStruggling to survive for the sakeof the unborn babyâ highlights survival as the pregnant womenâs 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)
Lifestyle factors, self-reported health and sense of coherence among fathers/partners in relation to risk for depression and anxiety in early pregnancy
Background
Father's health is important for mothers and unborn/newborn children and knowledge about expectant fathersâ health in relation to lifestyle and psychosocial aspects is essential.
Aims
To determine sociodemographic and lifestyle factors, selfâreported health and sense of coherence among fathers and partners in relation to their risk for depression and anxiety in early pregnancy.
Methods
A crossâsectional design, descriptive statistics, chiâsquared analysis, Tâtest, binary logistic regression, multiple logistic regression with OR and 95% CI were used.
Results
A total of 532 prospective fathers/partners constituted the cohort (mean age 31.55, SD 5.47 years). Nearly, one in ten (9.8%) had a statistically high risk for depression; mainly those who were unemployed (p = 0.043), had financial distress (0.001), reported âvery or fairly badâ health (p = 0.002), had a âvery or fairly badâ sexual satisfaction (p = 0.006) and scored low on the SOC scale (p < 0.001). They smoked more often (p = 0.003) were hazardous users of alcohol (p = 0.001) and slept with difficulties (p = 0.001). Those with sleeping difficulties were 5.7 times more likely to have several symptoms of depression (p = 0.001). Hazardous users of alcohol and smokers had 3.1 respectively 3.0 times higher risk for depression (p = 0.001 respectively 0.003). The single strongest risk factor was a low score on the SOCâscale which gave 10.6 (AOR 10.6; 95% CI 5.4â20.6) higher risk for depression. Highâanxiety âjust nowâ was reported by 8.9% and âin generalâ by 7.9%, and those who had sleeping difficulties reported âvery or fairly badâ health (p < 0.001).
Conclusions
Allocating more resources and introducing more familyâfocused care with depression and anxiety screening in early pregnancy for both expecting parents at antenatal care should be strongly considered by actors and policymakers, as this is a step in maintaining a family's wellâbeing
The degree of suffering among pregnant women with a history of violence, help-seeking, and police reporting
Objectives: To explore the degree of self-reported suffering following violent incidents and the prevalence of police reporting as well as other help-seeking behaviour among women in early pregnancy with history of violence. Study design: A cross-sectional design. 1939 pregnant women 18 years were recruited prospectively between March 2012 and September 2013 in south-west Sweden. Of those, 761 (39.5%) reported having a history of violence, and they comprised the cohort investigated in the present study. Descriptive statistics, Chi-square analysis, and T-test were used for the statistical calculations. Results: More than four of five women (80.5%) having a history of emotional abuse (n = 374), more than half (52.4%) having history of physical abuse (n = 561), and almost three of four (70.6%) who experienced sexual abuse (n = 302) reported in the early second trimester of their pregnancy that they still suffered from their experience. Of those women who had experienced emotional, physical, and sexual abuse, 10.5%, 25.1%, and 18.0%, respectively, had never disclosed their experiences to anyone. At most, a quarter of the abused women had reported a violent incident to the police. Conclusions: All midwives and other actors who meet women with experience of abuse need to have increased knowledge about the long-term consequences of all types of abuse. Increased routine questioning of pregnant women about history of violence would help to prevent experiences of violence from affecting pregnancy and childbirth negatively and facilitate the provision of help and support
Obstetric violence a qualitative interview study.
OBJECTIVE: To investigate the meaning of the concept of 'obstetric violence' to women in Sweden, who reported a negative birth experience. DESIGN: An inductive qualitative approach with individual narratives. A thematic qualitative content analysis was used. SETTING: Three midwifery clinics in southwest Scania. PARTICIPANTS: Twelve women who had given birth less than three years previously and reported a negative/traumatic birth experience. FINDINGS: The key findings showed that the women had experienced psychological and physical abuse during childbirth which may be interpreted as 'obstetric violence'. Four categories emerged from the analyses describing the women's experiences: Lack of information and consent including poor information and no right to participate in decisions concerning the process of labour, Insufficient pain relief, which encompassed unbearable pain without pain relief, Lack of trust and security where the women experienced staff with bad attitudes and jargon, and The experience of abuse including threats of violence from midwives and where the birth experience was compared to rape. KEY CONCLUSIONS: The study shows that physical and psychological abuse during childbirth exists in Sweden and that women experience this as being subjected to 'obstetric violence' during childbirth. The phenomenon of obstetric violence is very complex. The abuse of women during childbirth might be a significant problem and quality assurance is required to secure the rights of women giving birth. IMPLICATIONS FOR PRACTICE: In order to secure the rights of birthing women and to promote respectful and supportive care for new mothers, quality development programs are required