Experiences of being exposed to intimate partner violence during pregnancy

In this study a phenomenological approach was used in order to enter deeply into the experience of living with violence during pregnancy. The aim of the study was to gain a deeper understanding of women's experiences of being exposed to intimate partner violence (IPV) during pregnancy. The data were collected through in-depth interviews with five Norwegian women; two during pregnancy and three after the birth. The women were between the age of 20 and 38 years. All women had received support from a professional research and treatment centre. The essential structure shows that IPV during pregnancy is characterized by difficult existential choices related to ambivalence. Existential choices mean questioning one's existence, the meaning of life as well as one's responsibility for oneself and others. Five constituents further explain the essential structure: Living in unpredictability, the violence is living in the body, losing oneself, feeling lonely and being pregnant leads to change. Future life with the child is experienced as a possibility for existential change. It is important for health professionals to recognize and support pregnant women who are exposed to violence as well as treating their bodies with care and respect

Att föda ett dött barn : Vården vid förlossningen och kvinnans situation tre år efter barnets död

ATT FÖDA ETT DÖTT BARN Vården vid förlossningen och kvinnans situation treår efter barnets död Ingela Rådestad Syftet med avhandlingen var att undersöka psykiska symtom och välbefinnandehos kvinnor tre år efter födelsen av ett dött barn och om omhändertagandeti samband med barnets födelse påverkar risken for symtom. Ytterligare syftenvar att beskriva kvinnans möte med sitt döda barn och hennes uppfattningav det känslomässiga stöd hon fått i samband med barnets födelse.Studierna är populationsbaserade och inkluderar kvinnor i Sverige. Informationeninhämtades via ett postat anonymt frågeformulär 1994 och analyseradesmed epidemiologisk metodik. I studie I ingår 17 kvinnor som fött ett döttbarn och 16 kvinnor (kontroller) som fött ett levande barn 1990, undersökningengav data för att formulera hypoteser. Studie II till V omfattar 380 kvinnorsom fött ett dött barn och 379 kvinnor (kontroller) som fött ett levandebarn 1991. Information erhölls från 636 (84%) kvinnor, 314 (83%) vars barnföddes dött och 322 (85%) som fött ett levande barn. Studie VI ären registerstudie med de 759 kvinnor som ingår i studie II-V och informationeninhämtades via Medicinska Födelseregistret och Patientregistret. Vården i samband med förlossningen har betydelse för kvinnans psykiskahälsa långt efter barnets födelse. Studien tyder på att det ärviktigt för kvinnans välbefinnande på sikt att hon får möjlighetatt knyta an till sitt döda barn. Kvinnor som fött ett dött barn ochfått ett adekvat omhändertagande före och efter förlossningenhade tre år senare likartade förutsattningar till fysiskt, psykiskt ochsocialt välbefinnande som kvinnor som fött ett levande barn. En lugn atmosfärdär mamman kan tillbringa så lång tid som hon själv behövermed sitt döda barn och bevarandet av minnen som ett kvalitativt bra och välarrangeratfotografi av barnet, en hårlock, hand- och fotavtryck från barnet och enultraljudsbild, är betydelsefullt för kvinnan. Över 90 procent avkvinnorna vars barn föddes dött tyckte att personalen visat deras dödabarn respekt och nästan 80 procent att personalen visat deras barn ömhet.Fler än 80 procent av kvinnorna tyckte att personalen hade förmedlat ettbra känslomässigt stöd under förlossningen och över hälftenav kvinnorna vars barn föddes dött tyckte att förlossningen var ettfint minne. För många kvinnor är det ändamålsenligt attinducera förlossningen efter konstaterandet av barnets död så snartkvinnan önskar. Troligtvis är det viktigt att minimera risken förytterligare psykiska belastningar under väntetiden fram till induktionen. Kvinnorvars barn dött var tre år efter förlossningen oftare tillfredsställdamed sin relation till barnets far och sin hem- och familjesituation jämfortmed kvinnorna som fött ett levande barn, men kvinnorna som mist sitt barn hadeoftare en lägre självkänsla, speciellt om de inte fått ett nyttbarn efter det döda barnets födelse. Förlusten av barnet ökarinte risken för skilsmässa men ensamstående kvinnor som mist sittbarn hade en betydligt sämre tillfredsställelse med sin situation jämfortmed ensamstående kvinnor vars barn föddes levande och ett psykosocialtstöd bör övervägas för dem. Smärtlindring under förlossningennär ett barn föds dött och om och hur produktionen av bröstmjolkinhiberas postpartum är områden som resultaten från studien visarett behov av att ytterligare studera. Keywords: Anxiety, emotional support, fetal death, marital satisfaction, psychicmorbidity, satisfaction with care, social satisfaction, stillbirth, well-being

A provoking choice : Swedish women's experiences of reactions to their plans to give birth at home

Objective The home birth rate in Sweden is less than 1 in 1000, and home birth is not included within the health care system. This study describes women's experiences concerning reactions to their decision to give birth at home. Design and setting A nationwide survey (SHE – Swedish Homebirth Experience) in Sweden was conducted between 1992 and 2005 whereas 735 women had given birth to 1038 children. Of 1038 questionnaires 1025 were returned. Measurements In the questionnaires an open-ended question asked women to report their experience of reactions to their decision to give birth at home The question was answered by 594 women, and data were analysed using content analysis. Findings The analysis yielded one overarching theme; “To be faced with fear for life and death” including being exposed to reactions about risks. This describes attitudes of professionals and family towards life and death and suggests perceptions of risk and fear of unexpected events. Four main categories were identified; Seen as an irresponsible person, Met with emotional arguments, Exposed to persuasion and Alienation. Conclusion Women who plan for a home birth were confronted with negative attitudes and persuasion to make them change their mind. This made them feel alienated, and they searched for support among like-minded. Negative attitudes from health care professionals may erode their confidence in conventional health services and turn them towards other options. Implication for practice Women who want to give birth at home should be given evidence-based information about risks and benefits. Enhanced knowledge among public and professionals about home births would improve the options for respectful encounters

Few women receive a specific explanation of a stillbirth - an online survey of women's perceptions and thoughts about the cause of their baby's death

Background In Sweden, three to four out of every 1000 pregnancies end in stillbirth each year. The aim of this study was to investigate whether women who had experienced stillbirth perceived that they had received an explanation of the death and whether they believed that healthcare professionals were responsible for the death of the baby. Methods An online survey of 356 women in Sweden who had experienced a stillbirth from January 2010 to April 2014. A mixed-methods approach with qualitative content analysis was used to examine the women's responses. Results Nearly half of the women (48.6%) reported that they had not received any explanation as to why their babies had died. Of the women who reported that they had received an explanation, 84 (23.6%) had a specific explanation, and 99 (27.8%) had a vague explanation. In total, 73 (30.0%) of the 243 women who answered the question Do you believe that healthcare personnel were responsible for the stillbirth? stated Yes. The women reported that the healthcare staff had not acknowledged their intuition that the pregnancy was proceeding poorly. Furthermore, they perceived that the staff met them with nonchalance and arrogance. Additionally, the midwife had ignored or normalised the symptoms that could indicate that their pregnancy was proceeding poorly. Some women added that neglect and avoidance among the healthcare staff could have led to a lack of monitoring, which could have been crucial for the outcome of the pregnancy. Conclusions Half of the women surveyed reported that they had not received an explanation of their baby's death, and more than one-fourth held healthcare professionals responsible for the death

Women's Experiences of Fetal Movements before the Confirmation of Fetal Death-Contractions Misinterpreted as Fetal Movement

BACKGROUND: Decreased fetal movement often precedes a stillbirth. The objective of this study was to describe women's experiences of fetal movement before the confirmation of fetal death. METHODS: Data were collected through a Web-based questionnaire. Women with stillbirths after 28 gestational weeks were self-recruited. Content analysis was used to analyze the answers to one open question. The statements from mothers of a stillborn, born during gestational weeks 28 to 36 were compared with those of a stillborn at term. RESULTS: The women's 215 answers were divided into three categories: decreased, weak, and no fetal movement at all; 154 (72%) of the descriptions were divided into three subcategories: decreased and weak movement (106; 49%), no movement at all (35; 16%), and contraction interpreted as movement (13; 6%). The category fetal movement as normal includes 39 (18%) of the descriptions. The third category, extremely vigorous fetal activity followed by no movement at all, includes 22 (10%) of the descriptions. Eight (15%) of the women with stillbirths in gestational weeks 28 to 36 interpreted contractions as fetal movement as compared to 5 (5%) of the women with stillbirths at term. DISCUSSION: Uterine contractions can be interpreted as fetal movement. A single episode of extremely vigorous fetal activity can precede fetal death. The majority of the women experienced decreased, weaker, or no fetal movement at all 2 days before fetal death was diagnosed. Mothers should be educated to promptly report changes in fetal movement to their health care providers. Using fetal movement information to evaluate possible fetal distress may lead to reductions in stillbirths

A qualitative study showing women's participation and empowerment in instrumental vaginal births

BACKGROUND: An instrumental birth with a ventouse or forceps is a complicated birth, possibly resulting in fear of childbirth which could influence the entire birth experience negatively. Patients who are actively involved in their care have a stronger sense of satisfaction and a sense of participation can contribute to shorter hospital stays. AIM: To describe the experience of participation for women involved in an instrumental delivery with ventouse or forceps. METHOD: Qualitative semi-structured interviews with 16 women who gave birth aided by a ventouse or forceps. Their answers were analyzed through qualitative content analysis. In addition the women were asked to evaluate their experience during the delivery. Using a numerical scale (NRS) the birth experience was graded by choosing a number between 0 (worst possible experience) and 10 (best conceivable experience). FINDINGS: Two themes were extracted from the data: To be part of a team and To feel empowered. Five categories were identified from the women's descriptions of the experience of involvement during the instrumental delivery: to cooperate; to understand; to have contact; to participate, and to not be involved. Those women who rated their experience as low grade, described a lack of involvement in their childbirth compared to those women who rated their experience as high. CONCLUSION: This study shows how cooperation and empowerment of the woman are two key factors in order for the women to have a positive experience of their instrumental vaginal births. The study also shows that empowerment is created when the woman is actively engaged and participates in the birth process which gives her the feeling of being part of the team, creating an environment based on mutual understanding

A decrease in cesarean sections and labor inductions among Swedish women by awareness of fetal movements with the Mindfetalness method

BACKGROUND: Maternal perception of decreased fetal movements is commonly used to assess fetal well-being. However, there are different opinions on whether healthcare professionals should encourage maternal observation of fetal movements, as researchers claim that raising awareness increases unnecessary interventions, without improving perinatal health. We aimed to investigate whether cesarean sections and labor induction increase by raising women's awareness of fetal movements through Mindfetalness. Further, we aimed to study perinatal health after implementing Mindfetalness in maternity care. METHODS: In a cluster randomized controlled trial, 67 maternity clinics were allocated to Mindfetalness or routine care. In the Mindfetalness group, midwives distributed a leaflet telling the women to focus on the character, strength and frequency of the fetal movements without counting each movement. The instruction was to do so for 15 min daily when the fetus was awake, from gestational week 28 until birth. In this sub-group analysis, we targeted women born in Sweden giving birth from 32 weeks' gestation. We applied the intention-to-treat principle. RESULTS: The Mindfetalness group included 13,029 women and the Routine-care group 13,456 women. Women randomized to Mindfetalness had less cesarean sections (18.4% vs. 20.0%, RR 0.92, CI 0.87-0.97) and labor inductions (19.2% vs. 20.3%, RR 0.95, CI 0.90-0.99) compared to the women in the Routine-care group. Less babies were born small for gestational age (8.5% vs. 9.3%, RR 0.91, CI 0.85-0.99) in the Mindfetalness group. Women in the Mindfetalness group contacted healthcare due to decreased fetal movements to a higher extent than women in the Routine care group (7.8% vs. 4.3%, RR 1.79, CI 1.62-1.97). The differences remain after adjustment for potential confounders. CONCLUSIONS: Raising awareness about fetal movements through Mindfetalness decreased the rate of cesarean sections, labor inductions and small-for-gestational age babies. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02865759 ). Registered 12 August 2016, www.clinicaltrials.gov

Women with non-Swedish speaking background and their children: a longitudinal study of uptake of care and maternal and child health

Aim: To study uptake of care at the antenatal and child health clinic (CHC), and maternal and child health up to 5 years after the birth, as reported by mothers with a non-Swedish speaking background (NSB). Methods: A sample of 300 women with a NSB, 175 originated from a poor country and 125 originated from a rich country, were compared with a reference group of 2761 women with a Swedish speaking background. Four postal questionnaires were completed: during pregnancy, and 2 months, 1 year and 5 years after the birth. Results: Mothers with a NSB from a poor country of origin did not differ from the reference group of mothers with a Swedish speaking background regarding number of clinic visits, but they had a lower attendance rate at antenatal and postnatal education classes. Depressive symptoms, parental stress and poor self-rated health were more common in these women, and they reported more psychological and behavioral problems in their 5-year olds. Women with a rich country origin did not differ from the reference group regarding maternal and child health, but had a lower uptake of all out-patient care, except parental classes after the birth. Conclusion: Women originating from a poor country seem to be under great stress during pregnancy and the child's first years