Manual and Electroacupuncture for Labour Pain: Study Design of a Longitudinal Randomized Controlled Trial

Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women's experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov: NCT01197950

Risk of Subsequent Preeclampsia by Maternal Country of Birth: A Norwegian Population-Based Study

In this nationwide population-based study, we investigated the associations of preeclampsia in the first pregnancy with the risk of preeclampsia in the second pregnancy, by maternal country of birth using data from the Medical Birth Registry of Norway and Statistics Norway (1990–2016). The study population included 101,066 immigrant and 544,071 non-immigrant women. Maternal country of birth was categorized according to the seven super-regions of the Global Burden of Disease study (GBD). The associations between preeclampsia in the first pregnancy with preeclampsia in the second pregnancy were estimated using log-binomial regression models, using no preeclampsia in the first pregnancy as the reference. The associations were reported as adjusted risk ratios (RR) with 95% confidence intervals (CI), adjusted for chronic hypertension, year of first childbirth, and maternal age at first birth. Compared to those without preeclampsia in the first pregnancy, women with preeclampsia in the first pregnancy were associated with a considerably increased risk of preeclampsia in the second pregnancy in both immigrant (n = 250; 13.4% vs. 1.0%; adjusted RR 12.9 [95% CI: 11.2, 14.9]) and non-immigrant women (n = 2876; 14.6% vs. 1.5%; adjusted RR 9.5 [95% CI: 9.1, 10.0]). Immigrant women from Latin America and the Caribbean appeared to have the highest adjusted RR, followed by immigrant women from North Africa and the Middle East. A likelihood ratio test showed that the variation in adjusted RR across all immigrant and non-immigrant groups was statistically significant (p = 0.006). Our results suggest that the association between preeclampsia in the first pregnancy and preeclampsia in the second pregnancy might be increased in some groups of immigrant women compared with non-immigrant women in Norway.publishedVersio

Women's health after childbirth

The overall aim of this thesis is to describe women's health after childbirth in a national Swedish sample by investigating the prevalence of a number of physical symptoms and self-rated health (SRH). The prevalence of stress incontinence at one year after delivery, and possible predictors, was investigated specifically. Risk factors for poor SRH at two months and one year after childbirth were identified. To further understand what the question of SRH captures in the context of childbirth and early parenthood, the reasoning of new mothers when answering the question 'How would you summarize your state of health at present' at one year after the birth, was explored. For the purpose of Papers I-III, we used selected data from a national Swedish survey (the KUB project.. Women's experiences of childbirth), investigating women's physical and psychological assessment of childbirth This study was designed as a cohort study in which women were followed by means of three questionnaires from early pregnancy to one year after the birth. Swedish-speaking women were recruited at their first antenatal booking visit, from 593 (97%) antenatal clinics in Sweden. About 4600 women were eligible. Of the 3455 (75%) who consented to participate, 3061 answered the first questionnaire, 2762 the second and 2563 the third; 2450 (53%) filled in all three questionnaires. The representativity of the sample was assessed by comparison with all births taking place in Sweden in 1999, according to the Swedish Medical Birth Register. For the purpose of Paper IV, a qualitative design using the method of combined concurrent and retrospective thinkaloud interviews, followed by a semi-structured interview, was used, The 26 respondents, recruited from Child Health Clinics one year after delivery, were asked to say out loud everything that came into their minds, from the moment they first saw the question until they finally gave their answer. The analysis was guided by a theoretical framework describing four cognitive tasks, usually performed when a respondent answers a survey question: interpretation of the question, retrieval of information, forming a judgment and giving a response. Tiredness, headache, neck, shoulder and low back pain were common problems at two months, as well as one year after childbirth. At two months, pain from cesarean section, dyspareunia, and hemorrhoids were frequent problems, whereas stress incontinence was often reported at one year. Nevertheless, SRH was reported to be 'very good' or 'good' by 91 % of the women at two months after birth, and by 86% at one year (Paper I). One year after the birth, 22% of the women had symptoms of stress incontinence but only 2% said it caused them major problems. The strongest predictor was urinary incontinence (overall leakage) 4-8 weeks after a vaginal delivery as well as after a cesarean section. Other predictors in women with a vaginal delivery were: multiparity, obesity and constipation 4-8 weeks postpartum (Paper II). Physical problems, such as tiredness, musculoskeletal symptoms and abdominal pain, and emotional problems such as depressive symptoms, increased the risk of poor SRH in both primiparas and multiparas at one or both time points. Negative experience of breastfeeding (2 months) and infant sleeping problems (1 year) were infant-related risk factors in both groups, and prematurity was a risk factor in primiparas at two months. Insufficient social support increased the risk in multiparas. In primiparas, outcome of labor, such as negative birth experience after operative delivery was associated with poor SRH at one year, and perineal pain at two months (Paper III). The qualitative study showed that the question on SRE was a measure of women's general health and wellbeing in their present life situation, but it did not seem to measure recovery after childbirth specifically. The question on SRH seemed to capture a woman's total life situation, such as family functioning and wellbeing, relationship with partner, the issue of combining motherhood and professional work, level of energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise, and feelings of happiness and joy. Neither childbirth-related events nor some childbirth-related symptoms (urogenital and anal symptoms) were included in women's reasoning (Paper IV). In conclusion, this thesis shows that physical problems were common in early motherhood, but in spite of this, few women assessed their health as poor. Self-rated health mainly captures a woman's total life situation as well as ongoing physical and emotional health problems affecting daily life. The quantitative study suggests that mode of delivery and childbirth experience have long-term effects on SRH, but the qualitative study did not support this finding, showing that more research is needed on long-term effects of childbirth on mothers' experiences of their health

Satisfaction with life during pregnancy and early motherhood in first-time mothers of advanced age: A population-based longitudinal study

Background: The trend to delay motherhood to the age of 30 and beyond is established in most high-income countries but relatively little is known about potential effects on maternal emotional well-being. This study investigates satisfaction with life during pregnancy and the first three years of motherhood in women expecting their first baby at an advanced and very advanced age. Methods: The study was based on the National Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Data on 18 565 nulliparous women recruited in the second trimester 1999–2008 were used. Four questionnaires were completed: at around gestational weeks 17 and 30, and at six months and three years after the birth. Medical data were retrieved from the national Medical Birth Register. Advanced age was defined as 32–37 years, very advanced age as ≥38 years and the reference group as 25–31 years. The distribution of satisfaction with life from age 25 to ≥40 years was investigated, and the mean satisfaction with life at the four time points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced and very advanced age and satisfaction with life when controlling for socio-demographic factors. Results: Satisfaction with life decreased from around age 28 to age 40 and beyond, when measured in gestational weeks 17 and 30, and at six months and three years after the birth. When comparing women of advanced and very advanced age with the reference group, satisfaction with life was slightly reduced in the two older age groups and most of all in women of very advanced age. Women of very advanced age had the lowest scores at all time points and this was most pronounced at three years after the birth. Conclusion: First-time mothers of advanced and very advanced age reported a slightly lower degree of satisfaction with life compared with the reference group of younger women, and the age-related effect was greatest when the child was three years of age

Community-based bilingual doulas for migrant women in labour and birth – findings from a Swedish register-based cohort study

Background Community-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals. Methods Register study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education. Results Migrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64). Conclusions CBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed

Characteristics of first-time fathers of advanced age: a Norwegian population-based study

Background: The modern phenomenon of delayed parenthood applies not only to women but also to men, but less is known about what characterises men who are expecting their first child at an advanced age. This study investigates the sociodemographic characteristics, health behaviour, health problems, social relationships and timing of pregnancy in older first-time fathers. Methods: A cross-sectional study was conducted of 14 832 men who were expecting their first child, based on data from the Norwegian Mother and Child Cohort Study (MoBa) carried out by the Norwegian Institute of Public Health. Data were collected in 2005–2008 by means of a questionnaire in gestational week 17–18 of their partner’ s pregnancy, and from the Norwegian Medical Birth Register. The distribution of background variables was investigated across the age span of 25 years and above. Men of advanced age (35–39 years) and very advanced age (40 years or more) were compared with men aged 25–34 years by means of bivariate and multivariate logistic regression analyses. Results: The following factors were found to be associated with having the first child at an advanced or very advanced age: being unmarried or non-cohabitant, negative health behaviour (overweight, obesity, smoking, frequent alcohol intake), physical and mental health problems (lower back pain, cardiovascular diseases, high blood pressure, sleeping problems, previous depressive symptoms), few social contacts and dissatisfaction with partner relationship. There were mixed associations for socioeconomic status: several proxy measures of high socioeconomic status (e.g. income >65 000 €, self-employment) were associated with having the first child at an advanced or very advanced age, as were several other proxy measures of low socioeconomic status (e.g. unemployment, low level of education, immigrant background).The odds of the child being conceived after in vitro fertilisation were threefold in men aged 34–39 and fourfold from 40 years and above. Conclusions: Men who expect their first baby at an advanced or very advanced age constitute a socioeconomically heterogeneous group with more health problems and more risky health behaviour than younger men. Since older men often have their first child with a woman of advanced age, in whom similar characteristics have been reported, their combined risk of adverse perinatal outcomes needs further attention by clinicians and researchers