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

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:  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:  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:  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:  Fear of birth seemed to change over time and was associated with women’s 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 women’s emotional well-being and attitudes: cluster analysis of two cohorts in Sweden

Background: The focus on women’s 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 women’s background characteristics and attitudes towards pregnancy and childbirth. Cluster analysis was performed with four validated instruments. Results: Despite no differences in the women’s backgrounds, emotional well-being differed between the cohorts. Separate cluster analyses revealed similar profiles. The ‘emotionally healthy’ cluster represented low scores for depressive symptoms, worries and fear of birth and high scores for sense of coherence. By contrast, the ‘emotionally unhealthy’ 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 ‘emotionally unhealthy’ 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. Women’s 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 women’s 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, Cronbach’s 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 women’s experiences of postnatal care are warranted

Pregnant women’s emotional well-being and attitudes: cluster analysis of two cohorts in Sweden

Background: The focus on women’s 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 women’s background characteristics and attitudes towards pregnancy and childbirth. Cluster analysis was performed with four validated instruments. Results: Despite no differences in the women’s backgrounds, emotional well-being differed between the cohorts. Separate cluster analyses revealed similar profiles. The ‘emotionally healthy’ cluster represented low scores for depressive symptoms, worries and fear of birth and high scores for sense of coherence. By contrast, the ‘emotionally unhealthy’ 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 ‘emotionally unhealthy’ 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. Women’s 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 förväntningar på och upplevelser av vården under graviditet och förlossning

Det finns ingen samlad kunskap om hur kvinnor i Sverige upplever vården som ges under graviditet, förlossning och nyblivet föräldraskap. Det är tidigare känt att delaktighet (1-4) och stöd av barnmorska (2,4,5,6,7) påverkar både förlossningsupplevelsen och upplevelsen av vården i sig. Kvinnornas upplevelse av vården påverkas även av information och kommunikation med barnmorskan (8), vårdens individualisering (9), vårdarkontinuiteten (7) samt utformningen av vårdmiljön (7,9) . Syftet med avhandlingen är att beskriva kvinnors förväntningar och upplevelser av vården under graviditet och förlossning. Av alla svensktalande kvinnor som skrevs in i mödrahälsovården i Sverige under tre rekryteringsveckor (vecka 18 och 38, 1999, samt vecka 2, 2000) och bedömdes behärska svenska språket, accepterade 3293 (drygt 71 %) medverkan i KUB- projektet (Kvinnor Upplevelser av Barnafödande). Data insamlades med hjälp av frågeformulär i tidig graviditet, två månader och ett år efter förlossningen. Det första frågeformuläret besvarades av 3061 kvinnor (91 %). Två månader efter förlossningen besvarade 2762 (84 %) nästa frågeformulär och ett år efter förlossningen besvarade 2563 (88 %) det tredje frågeformuläret. Deskriptiv statistik, epidemiologisk metodik med skattning av relativa risker samt regressionsanalys har används i analysarbetet Delarbete I Hildingsson I, Waldenström U, Rådestad 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 förväntningar på mödrahälsovården, avseende vårdens innehåll, önskemål om antalet besök samt betydelsen att träffa samma barnmorska under graviditeten. Kontroll av det ofödda barnets hälsa var högst prioriterat avseende mödrahälsovårdens innehåll följt av kontroll av den blivande mammans hälsa och ett bemötande som gör att även partnern känner sig delaktig. Lägst skattat var föräldrautbildning. 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 %) ansåg det viktigt att få träffa samma barnmorska under graviditeten. Studiens slutsatser kan sammanfattas i att dagens mödrahälsovård är väl accepterad av kvinnorna, både vad gäller kontinuitet och innehåll, trots att det kan finnas en möjlig konflikt mellan kvinnornas höga förväntningar och vad som faktiskt är medicinskt möjligt rörande förebyggande åtgärder för att förbättra barnets hälsa innan det är fött. Ett mer individualiserat besöksprogram är önskvärt och det är viktigt att uppmärksamma kvinnor med tidigare obstetriska problem och negativa förlossningsupplevelser. Delarbete II Hildingsson I, Rådestad 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 mödrahälsovårdsbesök och kvinnornas åsikter om huruvida de upplevde besöken för få, lagom eller för många, hos 2421 kvinnor med fullgångna graviditeter och levande födda barn. Ett ytterligare syfte var att studera om antalet besök påverkat tillfredsställelse med mödrahälsovården. Resultatet visade att endast 25 procent av kvinnorna följde det rekommenderade basprogrammet, 57 procent erhöll fler besök och 17 procent färre. Fler besök var vanligare bland förstföderskor, kvinnor yngre än 25 år, hos de som fick en medicinsk diagnos eller visat tecken på depression tidigt i graviditeten. Färre besök förekom hos äldre, omföderskor och bland kvinnor med högre utbildning. Kvinnor som ansåg antalet besök vara för få var mer oroliga, hade önskemål om fler besök men erhöll färre. Att anse besöken som för många visade samband med låg utbildningsnivå, tidigare negativ förlossningsupplevelse och önskemål om färre besök. Majoriteten av kvinnorna (87.9%) var nöjda när de gjorde en övergripande skattning av mödravården, men kvinnorna var mer nöjda med de medicinska aspekterna av vården än de känslomässiga. Inga samband fanns mellan tillfredsställelse med vården och antalet besök kvinnorna fick. Kvinnornas uppfattning om antalet besök hade däremot samband med hur de skattade tillfredsställelse med vården. Delarbete III Hildingsson I, Rådestad I, Rubertsson C, Waldenström U. Few women wish to be delivered by caesarean section. British Journal of Obstetrics and Gynaecology, 2002; 109: 618-623. På senare år har antalet kejsarsnitt ökat dramatiskt och idag föds cirka 15 procent av alla barn i Sverige med hjälp av kejsarsnitt. Anledningar till ökningen av kejsarsnitt förklaras ofta som krav från välutbildade 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 sägs också vara förlossningsrädda. Syftet med detta delarbete var att undersöka hur många kvinnor i Sverige som skulle vilja förlösas med kejsarsnitt vid tiden för förlossning, när de tillfrågas tidigt i graviditeten, samt vad som utmärker 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 än kvinnor som önskade vaginal förlossning. Hos förstföderskor tyder data på att en viktig orsak till att önska kejsarsnitt är rädsla inför förlossningen. Hos omföderskor var tidigare planerat kejsarsnitt, tidigare akut kejsarsnitt, förlossningsrädsla samt en tidigare negativ förlossningsupplevelse prediktorer. Slutsatserna av delarbetet är att få kvinnor önskar kejsarsnitt i tidig graviditet - ungefär hälften så många som senare faktiskt förlöses med kejsarsnitt. Den bild som framställs i media att kravfulla kvinnor med kontrollbehov står bakom den ökade andelen kejsarsnitt kunde inte bekräftas av studien. Delarbete IV Hildingsson I, Rådestad I, Waldenström U. Swedish Women s Interest in Homebirth and In-Hospital Birth Center Care. Birth, 2003; 30: 11-22. Alternativ till sjukhusförlossning är sällsynt idag i Sverige. När det gäller planerade hemförlossningar uppgår dessa till mindre än en promille av alla födslar i Sverige. ABC-vård (Alternative Birth Center) finns endast på ett sjukhus i Sverige. Syftet med delarbetet var att undersöka hur många kvinnor som är intresserade av hemförlossning och ABC-vård i Sverige och vilka kvinnor som har det intresset. Resultatet visade att i tidig graviditet var 5 procent av kvinnorna intresserade av hemförlossning, två månader efter förlossning var siffran 2 procent och efter ett år 3procent. För vidare analyser valdes de 24 kvinnor som vid samtliga tre tillfällen uttryckt intresse för hemförlossning. Efter att enstaka möjliga förklaringsvariabler studerats, visade regressionsanalys att följande faktorer hade starkast samband med önskemål om hemförlossning: att ha barnets syskon eller väninna med vid förlossningen, inte vilja ha farmakologisk smärtlindring, låg utbildning, samt missnöje med det medicinska omhändertagandet vid aktuell förlossning. Prevalensen för kvinnors intresse för ABC-vård var i tidig graviditet 23 procent två månader efter förlossningen var 26 procent intresserade och efter ett år 27 procent. Förklarande faktorer hos de 217 kvinnor som vid alla tre mätti

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 &lt; 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