81 research outputs found
No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>The WHO advises against recumbent or supine position for longer periods during labour and birth and states that caregivers should encourage and support the woman to take the position in which she feels most comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births and may thus counterbalance any increase in perineal trauma and blood loss.</p> <p>Methods</p> <p>A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by intention to treat.</p> <p>Results</p> <p>The main findings of this study were that birth on the birth seat did not reduce the number of instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal edema.</p> <p>Conclusions</p> <p>The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a birth seat caused no adverse consequences for perineal outcomes and may even be protective against episiotomies.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov.ID: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01182038">NCT01182038</a></p
No reduction in instrumental vaginal births and no increased risk for adverse perineal outcome in nulliparous women giving birth on a birth seat: results of a Swedish randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>The WHO advises against recumbent or supine position for longer periods during labour and birth and states that caregivers should encourage and support the woman to take the position in which she feels most comfortable. It has been suggested that upright positions may improve childbirth outcomes and reduce the risk for instrumental delivery; however RCTs of interventions to encourage upright positions are scarce. The aim of this study was to test, by means of a randomized controlled trial, the hypothesis that the use of a birthing seat during the second stage of labor, for healthy nulliparous women, decreases the number of instrumentally assisted births and may thus counterbalance any increase in perineal trauma and blood loss.</p> <p>Methods</p> <p>A randomized controlled trial in Sweden where 1002 women were randomized to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The primary outcome measurement was the number of instrumental deliveries. Secondary outcome measurements included perineal lacerations, perineal edema, maternal blood loss and hemoglobin. Analysis was by intention to treat.</p> <p>Results</p> <p>The main findings of this study were that birth on the birth seat did not reduce the number of instrumental vaginal births, there was an increase in blood loss between 500 ml and 1000 ml in women who gave birth on the seat but no increase in bleeding over 1000 ml and no increase in perineal lacerations or perineal edema.</p> <p>Conclusions</p> <p>The birth seat did not reduce the number of instrumental vaginal births. The study confirmed an increased blood loss 500 ml - 1000 ml but not over 1000 ml for women giving birth on the seat. Giving birth on a birth seat caused no adverse consequences for perineal outcomes and may even be protective against episiotomies.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov.ID: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01182038">NCT01182038</a></p
Labour augmentation and fetal outcomes in relation to birth positions: A secondary analysis of an RCT evaluating birth seat births
The trajectory of fear of birth during and after pregnancy in women living in a rural area far from the hospital and its labour ward
Introduction: Â There is a growing interest in fear of childbirth. The prevalence, reasons and treatment have been investigated, but the development of fear of birth during and after pregnancy in a sample of women from a rural area is less studied. The aim of this study was to explore the trajectories of fear of birth and associated factors in a sample of women living in a rural area of Sweden. Methods: Â A longitudinal cohort study of women were recruited to a continuity-of-care project in mid-pregnancy and followed up 2 months after birth. Data were collected by two questionnaires. Fear of birth was assessed using the Fear of Birth Scale (FOBS) in mid-pregnancy, in retrospect after birth and looking forward to a possible future birth. Results: Â The questionnaire was completed by 280 women in mid-pregnancy and by 236 women after giving birth. The mean FOBS fluctuated over time: it was highest in pregnancy, lower after birth and then increased once more when women were thinking about a future birth. Factors associated with developing fear after birth were mainly related to having had an emergency caesarean section, epidural, augmentation, or neonatal care that resulted in a less positive birth experience. Reduction of fear was associated with antenatal support. For some women, the levels of fear did not change, and these women were characterised with worse self-rated health but also more negative experiences of having given birth. Conclusion: Â Fear of birth seemed to change over time and was associated with womenâs emotional wellbeing, circumstances accompanying the actual birth and the whole birth experience. Support during pregnancy could change the trajectory of fear of birth. Women whose levels of fear were high rated their health lower and had a more negative birth experience. More research is needed into how best to help women overcome their fear of birth
Pregnant womenâs emotional well-being and attitudes: cluster analysis of two cohorts in Sweden
Background: The focus on womenâs emotional well-being during pregnancy has intensified in the past 20 years. Objective: To identify profiles of pregnant women based on their emotional well-being and assess changes in those profiles over time. Methods: In a cross-sectional study, 280 women in Sweden were recruited to a continuity project for comparison with a historical cohort of 3061 women recruited two decades ago. Data were collected with a pregnancy-focused questionnaire measuring womenâs background characteristics and attitudes towards pregnancy and childbirth. Cluster analysis was performed with four validated instruments. Results: Despite no differences in the womenâs backgrounds, emotional well-being differed between the cohorts. Separate cluster analyses revealed similar profiles. The âemotionally healthyâ cluster represented low scores for depressive symptoms, worries and fear of birth and high scores for sense of coherence. By contrast, the âemotionally unhealthyâ cluster, comprising 35% of each cohort, represented high scores for depressive symptoms, worries and fear of birth and low scores for coherence. Women belonging to the âemotionally unhealthyâ cluster were more likely to be single, to be born outside Sweden and to have negative attitudes towards childbirth. Conclusion: Pregnant women in Sweden now and 20 years ago showed similar profiles in terms of emotional well-being, in two clusters differing in background characteristics and attitudes towards childbirth regardless of period. Womenâs emotional well-being needs to be recognised during pregnancy, because poor emotional health can adversely affect not only pregnant women but also their infants and families
Psychometric evaluation of the early postnatal questionnaire for Swedish population
Background: Previously developed instruments measuring the quality of postnatal care, based on womenâs experiences and views, are mainly country-specific which makes it important to have studies for specific populations. The aim of this study was to explore validity and reliability evidence of a previously developed postnatal questionnaire for women living in Sweden. Method: A cross-sectional study based on self-report questionnaire. The questionnaire included the Early Postnatal Questionnaire (EPQ), and was administered to 1061 women who gave birth in two regional hospitals in Swedish during 2017. Validity evidence of the EPQ was undertaken using principal component analysis. Regarding reliability, Cronbachâs alpha was used. Results: The questionnaire was returned by 483 postnatal women. The analysis resulted in three components: Information, Postnatal Environment and Caring Relationship. The Cronbach alpha values of the components ranged from 0.762 to 0.879. Foreign-born women scored higher (more positively) in all three components, compared to women born in Sweden. Conclusions: The results of this study suggest that the instrument EPQ is a psychometrically useful tool, suitable for both research and clinical settings. The three-component structure provides researchers with the opportunity to conduct a more detailed exploration of various aspects of postnatal care to develop postnatal care. Further studies focusing on foreign-born womenâs experiences of postnatal care are warranted
Pregnant womenâs emotional well-being and attitudes: cluster analysis of two cohorts in Sweden
Background: The focus on womenâs emotional well-being during pregnancy has intensified in the past 20 years. Objective: To identify profiles of pregnant women based on their emotional well-being and assess changes in those profiles over time. Methods: In a cross-sectional study, 280 women in Sweden were recruited to a continuity project for comparison with a historical cohort of 3061 women recruited two decades ago. Data were collected with a pregnancy-focused questionnaire measuring womenâs background characteristics and attitudes towards pregnancy and childbirth. Cluster analysis was performed with four validated instruments. Results: Despite no differences in the womenâs backgrounds, emotional well-being differed between the cohorts. Separate cluster analyses revealed similar profiles. The âemotionally healthyâ cluster represented low scores for depressive symptoms, worries and fear of birth and high scores for sense of coherence. By contrast, the âemotionally unhealthyâ cluster, comprising 35% of each cohort, represented high scores for depressive symptoms, worries and fear of birth and low scores for coherence. Women belonging to the âemotionally unhealthyâ cluster were more likely to be single, to be born outside Sweden and to have negative attitudes towards childbirth. Conclusion: Pregnant women in Sweden now and 20 years ago showed similar profiles in terms of emotional well-being, in two clusters differing in background characteristics and attitudes towards childbirth regardless of period. Womenâs emotional well-being needs to be recognised during pregnancy, because poor emotional health can adversely affect not only pregnant women but also their infants and families
Kvinnors förvÀntningar pÄ och upplevelser av vÄrden under graviditet och förlossning
Det finns ingen samlad kunskap om hur kvinnor i Sverige upplever vÄrden
som ges under graviditet, förlossning och nyblivet förÀldraskap. Det Àr
tidigare kÀnt att delaktighet (1-4) och stöd av barnmorska (2,4,5,6,7)
pÄverkar bÄde förlossningsupplevelsen och upplevelsen av vÄrden i sig.
Kvinnornas upplevelse av vÄrden pÄverkas Àven av information och
kommunikation med barnmorskan (8), vÄrdens individualisering (9),
vÄrdarkontinuiteten (7) samt utformningen av vÄrdmiljön (7,9) .
Syftet med avhandlingen Àr att beskriva kvinnors förvÀntningar och
upplevelser av vÄrden under graviditet och förlossning.
Av alla svensktalande kvinnor som skrevs in i mödrahÀlsovÄrden i Sverige
under tre rekryteringsveckor (vecka 18 och 38, 1999, samt vecka 2, 2000)
och bedömdes behÀrska svenska sprÄket, accepterade 3293 (drygt 71 %)
medverkan i KUB- projektet (Kvinnor Upplevelser av Barnafödande). Data
insamlades med hjÀlp av frÄgeformulÀr i tidig graviditet, tvÄ mÄnader och
ett Är efter förlossningen. Det första frÄgeformulÀret besvarades av 3061
kvinnor (91 %). TvÄ mÄnader efter förlossningen besvarade 2762 (84 %)
nÀsta frÄgeformulÀr och ett Är efter förlossningen besvarade 2563 (88 %)
det tredje frÄgeformulÀret. Deskriptiv statistik, epidemiologisk metodik
med skattning av relativa risker samt regressionsanalys har anvÀnds i
analysarbetet
Delarbete I
Hildingsson I, Waldenström U, RÄdestad I. Women's expectations on
antenatal care as assessed in early pregnancy: number of visits,
continuity of caregiver and general content. Acta Obstetricia et
Gynecologica Scandinavica, 2002; 81: 118-125.
Det specifika syftet med delarbetet var att beskriva kvinnors
förvÀntningar pÄ mödrahÀlsovÄrden, avseende vÄrdens innehÄll, önskemÄl om
antalet besök samt betydelsen att trÀffa samma barnmorska under
graviditeten. Kontroll av det ofödda barnets hÀlsa var högst prioriterat
avseende mödrahÀlsovÄrdens innehÄll följt av kontroll av den blivande
mammans hÀlsa och ett bemötande som gör att Àven partnern kÀnner sig
delaktig. LÀgst skattat var förÀldrautbildning. Majoriteten av kvinnorna
(70 %) önskade följa basprogrammet, men kvinnor med dödfött barn och
missfall i anamnesen, infertilitetsproblematik och tidigare negativ
förlossningsupplevelse önskade fler besök. De allra flesta (97 %) ansÄg
det viktigt att fÄ trÀffa samma barnmorska under graviditeten. Studiens
slutsatser kan sammanfattas i att dagens mödrahÀlsovÄrd Àr vÀl accepterad
av kvinnorna, bÄde vad gÀller kontinuitet och innehÄll, trots att det kan
finnas en möjlig konflikt mellan kvinnornas höga förvÀntningar och vad
som faktiskt Àr medicinskt möjligt rörande förebyggande ÄtgÀrder för att
förbÀttra barnets hÀlsa innan det Àr fött. Ett mer individualiserat
besöksprogram Àr önskvÀrt och det Àr viktigt att uppmÀrksamma kvinnor med
tidigare obstetriska problem och negativa förlossningsupplevelser.
Delarbete II
Hildingsson I, RÄdestad I, Waldenström U. Number of antenatal visits and
women s opinions. A national survey (inskickat till tidskrift).
Syftet med detta delarbete var att göra en uppföljning av antalet
mödrahÀlsovÄrdsbesök och kvinnornas Äsikter om huruvida de upplevde
besöken för fÄ, lagom eller för mÄnga, hos 2421 kvinnor med fullgÄngna
graviditeter och levande födda barn. Ett ytterligare syfte var att
studera om antalet besök pÄverkat tillfredsstÀllelse med
mödrahÀlsovÄrden. Resultatet visade att endast 25 procent av kvinnorna
följde det rekommenderade basprogrammet, 57 procent erhöll fler besök och
17 procent fÀrre. Fler besök var vanligare bland förstföderskor, kvinnor
yngre Àn 25 Är, hos de som fick en medicinsk diagnos eller visat tecken
pÄ depression tidigt i graviditeten. FÀrre besök förekom hos Àldre,
omföderskor och bland kvinnor med högre utbildning. Kvinnor som ansÄg
antalet besök vara för fÄ var mer oroliga, hade önskemÄl om fler besök
men erhöll fÀrre. Att anse besöken som för mÄnga visade samband med lÄg
utbildningsnivÄ, tidigare negativ förlossningsupplevelse och önskemÄl om
fÀrre besök. Majoriteten av kvinnorna (87.9%) var nöjda nÀr de gjorde en
övergripande skattning av mödravÄrden, men kvinnorna var mer nöjda med de
medicinska aspekterna av vÄrden Àn de kÀnslomÀssiga. Inga samband fanns
mellan tillfredsstÀllelse med vÄrden och antalet besök kvinnorna fick.
Kvinnornas uppfattning om antalet besök hade dÀremot samband med hur de
skattade tillfredsstÀllelse med vÄrden.
Delarbete III
Hildingsson I, RÄdestad I, Rubertsson C, Waldenström U. Few women wish to
be delivered by caesarean section. British Journal of Obstetrics and
Gynaecology, 2002; 109: 618-623.
PÄ senare Är har antalet kejsarsnitt ökat dramatiskt och idag föds cirka
15 procent av alla barn i Sverige med hjÀlp av kejsarsnitt. Anledningar
till ökningen av kejsarsnitt förklaras ofta som krav frÄn vÀlutbildade
yrkeskvinnor som lever i en storstad och som vill planera in sin födsel i
en fulltecknade almanacka. En betydande andel av de kvinnor som önskar
kejsarsnitt sÀgs ocksÄ vara förlossningsrÀdda.
Syftet med detta delarbete var att undersöka hur mÄnga kvinnor i Sverige
som skulle vilja förlösas med kejsarsnitt vid tiden för förlossning, nÀr
de tillfrÄgas tidigt i graviditeten, samt vad som utmÀrker dessa kvinnor.
Resultatet visade att 8.2 procent av kvinnorna önskade kejsarsnitt. Dessa
kvinnor var i högre grad generellt oroliga, mer ofta deprimerade och
upplevde graviditeten mer negativt Àn kvinnor som önskade vaginal
förlossning. Hos förstföderskor tyder data pÄ att en viktig orsak till
att önska kejsarsnitt Àr rÀdsla inför förlossningen. Hos omföderskor var
tidigare planerat kejsarsnitt, tidigare akut kejsarsnitt,
förlossningsrÀdsla samt en tidigare negativ förlossningsupplevelse
prediktorer. Slutsatserna av delarbetet Àr att fÄ kvinnor önskar
kejsarsnitt i tidig graviditet - ungefÀr hÀlften sÄ mÄnga som senare
faktiskt förlöses med kejsarsnitt. Den bild som framstÀlls i media att
kravfulla kvinnor med kontrollbehov stÄr bakom den ökade andelen
kejsarsnitt kunde inte bekrÀftas av studien.
Delarbete IV
Hildingsson I, RÄdestad I, Waldenström U. Swedish Women s Interest in
Homebirth and In-Hospital Birth Center Care. Birth, 2003; 30: 11-22.
Alternativ till sjukhusförlossning Àr sÀllsynt idag i Sverige. NÀr det
gÀller planerade hemförlossningar uppgÄr dessa till mindre Àn en promille
av alla födslar i Sverige. ABC-vÄrd (Alternative Birth Center) finns
endast pÄ ett sjukhus i Sverige.
Syftet med delarbetet var att undersöka hur mÄnga kvinnor som Àr
intresserade av hemförlossning och ABC-vÄrd i Sverige och vilka kvinnor
som har det intresset. Resultatet visade att i tidig graviditet var 5
procent av kvinnorna intresserade av hemförlossning, tvÄ mÄnader efter
förlossning var siffran 2 procent och efter ett Är 3procent. För vidare
analyser valdes de 24 kvinnor som vid samtliga tre tillfÀllen uttryckt
intresse för hemförlossning. Efter att enstaka möjliga
förklaringsvariabler studerats, visade regressionsanalys att följande
faktorer hade starkast samband med önskemÄl om hemförlossning: att ha
barnets syskon eller vÀninna med vid förlossningen, inte vilja ha
farmakologisk smÀrtlindring, lÄg utbildning, samt missnöje med det
medicinska omhÀndertagandet vid aktuell förlossning.
Prevalensen för kvinnors intresse för ABC-vÄrd var i tidig graviditet 23
procent tvÄ mÄnader efter förlossningen var 26 procent intresserade och
efter ett Är 27 procent. Förklarande faktorer hos de 217 kvinnor som vid
alla tre mÀtti
Perceptions and imagined performances of pregnancy, birth and parenting among voluntarily child-free individuals in Sweden
Objective: Reasons to avoid pregnancy, birth and parenting among voluntarily child-free individuals remain largely unknown. The aim of this qualitative study is to better understand the perceptions and worries about pregnancy, birth and parenting among child-free individuals in Sweden. Methods: A total of 23 individual interviews were conducted in 2020- 2021, and data were evaluated in thematic network analysis. Results: The organizing themes captured significant consequences and complications of pregnancy and birth perceived by child-free individuals and their various thoughts about their unsuitability for parenthood. Reproductive health was associated with fears of pregnancy, birth, chronic disease and mental illness and long-acting reproductive contraceptives, sterilisation and abortion were regarded as appropriate, sustainable ways to remain child-free. Conclusion: Child-free individuals avoid exposure to pregnancy, birth and parenting due to fears, perceived risks, potential complications and their perceived unsuitability for parenthood. They greatly value and protect their healthy, unharmed bodies and emphasise sound family planning
Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment
Background: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. Method: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women's feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. Results: Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours. Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P < 0.00). The factors that contributed most strongly to a negative birth experience in women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement 'My birth experience made me decide not to have any more children' (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement 'It was exiting to give birth' (OR 0.13, 95% CI 0.34-0.5). Conclusions: There is need for increased clinical skill in identification and classification of prolonged labour, in order to improve care for all women and their experiences of birthing processes regardless whether they experience a prolonged labour or not
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