Challenges in migrant women's maternity care in a high-income country: A population-based cohort study of maternal and perinatal outcomes

Introduction This study aims to explore maternal and perinatal outcomes of migrant women in Iceland.Material and methods This prospective population-based cohort study included women who gave birth to a singleton in Iceland between 1997 and 2018, comprising a total of 92 403 births. Migrant women were defined as women with citizenship other than Icelandic, including refugees and asylum seekers, and categorized into three groups, based on their country of citizenship Human Development Index score. The effect of country of citizenship was estimated. The main outcome measures were onset of labor, augmentation, epidural, perineum support, episiotomy, mode of birth, obstetric anal sphincter injury, postpartum hemorrhage, preterm birth, a 5-minute Apgar = 0.900) had similar or better outcomes compared with Icelandic women, whereas migrant women from countries with a lower Human Development Index score than that of Iceland (<0.900) had additionally increased odds of maternal and perinatal complications and interventions, such as emergency cesarean and postpartum hemorrhage.Conclusions Women's citizenship and country of citizenship Human Development Index scores are significantly associated with a range of maternal and perinatal complications and interventions, such as episiotomy and instrumental birth. The results indicate the need for further exploration of whether Icelandic perinatal healthcare services meet the care needs of migrant women

Michelle Windsor, ca. 1978 [picture] /

Title from inscriptions on verso.; Part of collection: Rennie Ellis: Aussies all.; Inscriptions: titled, "c. 1978/2006" and "Aussies All Exhibition"--In ink lower right on verso.; Item with accompanying exhibition note.; Condition: Good.; Also available in electronic version via the Internet at: http//nla.gov.au/nla.pic-vn4121524; Purchased from Rennie Ellis Photographic Archive through Josef Lebovic Gallery, 2007.; Exhibited: Rennie Ellis: Aussies all, National Portrait Gallery, Canberra, 2006. AuCNL

Home birth constructed as a safe choice in Iceland: A content analysis on Icelandic media

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageBackground: The rate of home birth in Iceland increased from 0.1% in the 90's, to 2.2% in 2012. As the media contributes to the development and public perceptions, engagement and use of health care, it is of interest to explore the media representation of planned home birth in Iceland. Objectives: The aim of this study was to explore the way in which the constructions of planned home birth are represented in the Icelandic media; the frequency with which planned home birth was discussed and by whom it was discussed; whether the discourse was congruent with practice development in the country; and if so, how such congruency was effected. Methods: Data from the main newspapers in Iceland published from the beginning of 1990 until the end of 2011 were explored using content analysis. Results: In total, 127 items were summarized and we identified five themes: approach to safety, having a choice, the medicalization of childbirth, the relationship between women and midwives, and the reaction of the pregnant woman's local community. Central in the analysis were the importance of being able to choose a safe place of birth and the need for woman-centred care. Conclusion: Overall planned home birth was not discussed with much intensity or frequency, but in general the discussion was shaped by a positive attitude. There was a distinction in the public media discourse among midwives and physicians or obstetricians who do not argue against planned home birth but who nevertheless speak with caution. The pregnant women who chose home birth found their own home to be safe and similar views were identified among women and midwives

Opting for natural birth: A survey of birth intentions among young Icelandic women.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageTo describe and analyse factors associated with natural birth intentions in a sample of pre-pregnant Icelandic women.An internationally validated tool was used to survey pre-pregnant women about their attitudes towards birth. The online survey was sent to all students at the University of Iceland in November 2014. Log binomial regression was used to calculate crude and adjusted relative risks (RRa), and corresponding 95% confidence intervals (CI), for intentions of natural birth (defined as vaginal birth without epidural analgesia) by high, moderate and low childbirth fear and by high, moderate and low confidence in birth knowledge. Models were adjusted for socio-demographic and psychological factors.410 eligible women completed the cross-sectional survey. Women with low fear of birth were more likely to have natural birth intentions when compared to women with moderate (RRa = 2.83; 95% CI; 1.48-5.41) and high (RRa = 4.86; 95% CI; 1.37-17.27) fear. Women with high confidence in their birth knowledge were more likely to have natural birth intentions compared to women with moderate (RRa = 2.81; 95% CI; 1.51-5.22) and low (RRa = 3.42; 95% CI; 1.43-8.18) confidence in their birth knowledge.Pre-pregnant women with low fear of birth and high confidence in their birth knowledge are more likely to have natural birth intentions. Addressing concerns about pain, safety, the perceived unpredictability of birth and worries about the physical impact of childbirth may strengthen natural birth intentions.University of Iceland Research Fund (Rannsoknarsjoour Haskola Islands

Content of antenatal care: Does it prepare women for birth?

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageObjective: clinical guidelines for antenatal care recommend informing women about birth. The aim of this study was to explore the content of antenatal care from women's perspective and to establish whether they consider information on birth to be sufficient. Method: the data was gathered in a longitudinal, cross-sectional cohort study known as The Childbirth and Health Study in Iceland. The study group consisted of 765 women attending antenatal care at 26 urban and rural health care centres in Iceland, during the year 2009-2010. They participated by replying to two questionnaires, at 16 gestational weeks and six months after birth. The questions covered objective and subjective aspects of antenatal care, pregnancy, birth, and the postpartum period. Results: the majority (87%) of the women want to be informed about birth in the antenatal phase of care, and 41% reported 5-6 months post partum that too little time had been spent on this issue, by health care professionals. Post partum, mode of delivery affected women's estimated time spent on information in pregnancy, with women who had planned caesarean section being most satisfied with the time spent on antenatal information about birth. Women who experienced their birth as difficult or very difficult were more likely to report that insufficient time had been spent on information than women who had experienced their birth as easy or very easy. Conclusions: antenatal care can play an important role in preparing women for birth. This study shows that information about birth provided during pregnancy is insufficient from women's perspective, although some groups of women do report being more satisfied with this information. The way that this segment of antenatal care is provided leaves room for improvement.Research Fund of the Icelandic College of Family Physicians Primary Health Care of the Capital Area, Iceland Icelandic Midwifery Association Research Fund Landspitali (Icelandic National Hospital) University Hospital Research Fun

The predictive role of support in the birth experience: A longitudinal cohort study

To access publisher's full text version of this article click on the hyperlink belowBACKGROUND: Several risk factors for negative birth experience have been identified, but little is known regarding the influence of social and midwifery support on the birth experience over time. OBJECTIVE: The aim of this study was to describe women's birth experience up to two years after birth and to detect the predictive role of satisfaction with social and midwifery support in the birth experience. METHOD: A longitudinal cohort study was conducted with a convenience sample of pregnant women from 26 community health care centres. Data was gathered using questionnaires at 11-16 weeks of pregnancy (T1, n=1111), at five to six months (T2, n=765), and at 18-24 months after birth (T3, n=657). Data about sociodemographic factors, reproductive history, birth outcomes, social and midwifery support, depressive symptoms, and birth experience were collected. The predictive role of midwifery support in the birth experience was examined using binary logistic regression. RESULTS: The prevalence of negative birth experience was 5% at T2 and 5.7% at T3. Women who were not satisfied with midwifery support during pregnancy and birth were more likely to have negative birth experience at T2 than women who were satisfied with midwifery support. Operative birth, perception of prolonged birth and being a student predicted negative birth experience at both T2 and T3. CONCLUSIONS: Perception of negative birth experience was relatively consistent during the study period and the role of support from midwives during pregnancy and birth had a significant impact on women's perception of birth experience.Memorial Fund of Midwife Bjorg Magnusdottir and Farmer Magnus Jonasson Icelandic Midwives Association's Research Fund Landspitali University Hospital Research Fun

Effects of an intervention program for reducing severe perineal trauma during the second stage of labor.

To access publisher's full text version of this article click on the hyperlink belowBACKGROUND: Obstetric anal sphincter injuries lead frequently to short- and long-term consequences for the mother, including perineal pain, genital prolapse, and sexual problems. The aim of the study was to evaluate whether the implementation of an intervention program in the second stage of labor involving altered perineal support techniques reduced severe perineal trauma. METHODS: All women reaching the second stage of labor and giving birth vaginally to singleton babies at Landspítali University Hospital (comprising 76% of births in Iceland in 2013) were enrolled in a cohort study. Data were recorded retrospectively for 2008-2010 and prospectively in 2012-2014, for a total of 16 336 births. During 2011, an intervention program was implemented, involving all midwives and obstetricians working in the labor wards. Two professionals assessed and agreed on classification of every perineal tear. RESULTS: The prevalence of obstetric anal sphincter injuries decreased from 5.9% to 3.7% after the implementation (P < 0.001). Third-degree tears decreased by 40%, and fourth-degree tears decreased by 56% (P < 0.001). The prevalence of first-degree tears increased from 25.8% to 33.1%, whereas second-degree tears decreased from 44.7% to 36.6% between the before and after study periods. Severe perineal trauma was linked to birthweight, and this did not change despite the new intervention. CONCLUSIONS: Active intervention to reduce perineal trauma was associated with an overall significant decrease in obstetric anal sphincter injuries. Good perineal visualization, manual perineal support, and controlled delivery of the fetal head were essential components for reducing perineal trauma.Icelandic Ministry of Welfare Landspitali University Hospital Research Fund, Reykjavik, Icelan