Public health nurses’ encounters with undocumented migrant mothers and children

Objectives: Undocumented migrant children (UMC) are often affected by policies and practices that do not take their best interests into account. The aim of this study was to describe how public health nurses (PHNs) experienced challenges and dilemmas in ensuring the best interests of the undocumented migrant child. Design: This study had a qualitative descriptive design. Sample: Focus group interviews and semi-structured interviews were conducted with seven PHNs in four different child health centers (CHCs). Results: Qualitative content analysis was applied. Three main themes were identified: building trust, ensuring the best interests of the child, and dilemmas and challenges in ensuring the best interests of the child. The study revealed examples of immigration policy being prioritized over the best interests of the child. PHNs experienced frustration when the best interests of the child were not taken into account. Strategies for managing these conflicting demands were identified. Conclusion: Conflicting demands appeared when national immigration policies collided with fundamental human rights and ethical standards. Rules that exclude certain groups are incompatible with PHNs professional ethics.publishedVersio

Modifiable determinants of newborn macrosomia and birth complications

Globally the incidence of macrosomic newborns is increasing. In Norway the percentage of newborns weighing 4,000g or more has increased from 16 to 20% in less than three decades. Newborn macrosomia is associated with short-and long-term health risks for the infant, and increases the prevalence of birth complications. Parity, maternal age and gender of the child influence fetal growth. Maternal overweight is a risk factor for gestational diabetes (GDM) and newborn macrosomia. Some women with high body mass index (BMI) give birth to macrosomic newborns while others do not. Maternal lifestyle factors are potential predictors of pregnancy complications. Boys are heavier at birth than girls, but girls have higher fat mass at birth than boys. During the period of 2002 and 2005 the STORK-study followed a total of 553 pregnant women through pregnancy and childbirth at the Department of Obstetrics and Gynecology, Rikshospitalet. The aims of this thesis were to evaluate the contribution of modifiable factors that may influence the risk of fetal macrosomia. The first aim was to explore the roles of physical inactivity, BMI and fasting plasma glucose. A second aim was to study the impact of physical inactivity on delivery complications. The third aim was to examine whether maternal fasting plasma glucose levels influence birth weight in the two sexes differently. Pregestational physical inactivity, glucose and high BMI were independent determinants of fetal macrosomia. Pregestational physical inactivity increased the risk of perineal laceration degree three to four. Overweight women with an increase in fasting plasma glucose from early to late pregnancy had a 4.5-fold increase in risk of newborn macrosomia compared to the remaining group with a high BMI. The effect of maternal fasting plasma glucose on birth weight in girls was twice as high as in boys. Paternal birth weight was significantly associated with birthweight of boys, but no such association was seen for girls

Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway

Background: Prolonged labor might contribute to a negative birth experience and influence first-time mothers’ attitudes towards future pregnancies. Previous studies have not adjusted for possible confounding factors, such as operative delivery, induction and postpartum hemorrhage. We aimed to determine the impact of prolonged labor on birth experience and a wish for cesarean section in subsequent pregnancies. Methods: A survey including the validated “Childbirth Experience Questionnaire”. First-time mothers giving birth between 2012 and 2014 at a Norwegian university hospital participated. Data from deliveries were collected. Regression analysis and thematic content analysis were performed. Results: 459 (71%) women responded. Women with labor duration > 12 h had significantly lower scores on two out of four sub-items of the questionnaire: own capacity (p = 0.040) and perceived safety (p = 0.023). Other factors contributing to a negative experience were: Cesarean section vs vaginal birth: own capacity (p = 0.001) and perceived safety (p = 0.007). Operative vaginal vs spontaneous birth: own capacity (p = 0.001), perceived safety (p < 0.001) and participation (p = 0.047). Induced vs spontaneous start: own capacity (p = 0.039) and participation (p = 0.050). Postpartum hemorrhage ≥500 ml vs < 500 ml: perceived safety (p = 0.002) and participation (p = 0.031). In the unadjusted analysis, prolonged labor more than doubled the risk (odds ratio (OR) 2.66, 95%CI 1.42–4.99) of a subsequent wish for cesarean delivery. However, when adjustments were made for mode of delivery and induction, emergency cesarean section (OR 8.86,95%CI 3.85–20.41) and operative vaginal delivery (OR 3.05, 95%CI 1.46–6.38) remained the only factors significantly increasing the probability of wanting a cesarean section in subsequent pregnancies. The written comments on prolonged labor (n = 46) indicated four main themes: – Difficulties gaining access to the labor ward. – Being left alone during the unexpectedly long, painful early stage of labor. – Stressful operative deliveries and worse pain than imagined. – Lack of support and too little or contradictory information from the staff. Conclusions: Women with prolonged labors are at risk of a negative birth experience. Prolonged labor per se did not predict a wish for a cesarean section in a subsequent pregnancy. However, women with long labors more often experience operative delivery, which is a risk factor of a later wish for a cesarean section.publishedVersio

Å føde hjemme: om stedlig sanselig erfaring i rommet

Kapitlet belyser hva hjemmefødende kvinner og jordmødre forteller om fødsels­opplevelsen og om samspillet mellom mor, far og jordmor. Kapitlet bygger på en ny empirisk studie av sju fødekvinners narrativer og sju jordmødres hjemmefødselserfaringer. Forfatterne undersøker hvordan de, basert på fødekvinners subjektive erfaringer, kan forstå fenomenet hjemmefødsel i lys av estetikk og et stedsfilosofisk forankret folkehelseperspektiv. Studien viser at hjemmefødselen fremtrer som en stedlig estetisk erfaring preget av kropp, natur og kultur. Informantene formidler at det å leve og å føde handler om å risikere. Forfatterne finner at det å føde hjemme innebærer en bred forståelse av risiko, ansvar og medbestemmelse, men også av feiring, fellesskap og ontologisk trygghet

Fetal Growth versus Birthweight: The Role of Placenta versus Other Determinants

in utero. We aimed to study the effects of maternal characteristics on both birthweight and fetal growth in third trimester and introduce placental weight as a possible determinant of both birthweight and fetal growth in third trimester.The STORK study is a prospective cohort study including 1031 healthy pregnant women of Scandinavian heritage with singleton pregnancies. Maternal determinants (age, parity, body mass index (BMI), gestational weight gain and fasting plasma glucose) of birthweight and fetal growth estimated by biometric ultrasound measures were explored by linear regression models. Two models were fitted, one with only maternal characteristics and one which included placental weight.Placental weight was a significant determinant of birthweight. Parity, BMI, weight gain and fasting glucose remained significant when adjusted for placental weight. Introducing placental weight as a covariate reduced the effect estimate of the other variables in the model by 62% for BMI, 40% for weight gain, 33% for glucose and 22% for parity. Determinants of fetal growth were parity, BMI and weight gain, but not fasting glucose. Placental weight was significant as an independent variable. Parity, BMI and weight gain remained significant when adjusted for placental weight. Introducing placental weight reduced the effect of BMI on fetal growth by 23%, weight gain by 14% and parity by 17%.In conclusion, we find that placental weight is an important determinant of both birthweight and fetal growth. Our findings indicate that placental weight markedly modifies the effect of maternal determinants of both birthweight and fetal growth. The differential effect of third trimester glucose on birthweight and growth parameters illustrates that birthweight and fetal growth are not identical entities

Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this afects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. Methods: In this historic cohort study we included pregnant women aged 18–49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. Results: We identifed 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1–3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion: Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.publishedVersio

Styrket og tidligere tilbud til småbarnsforeldre. Systematisk samarbeid mellom helsestasjon og familievernkontor. Evaluering av Tiltak 26 i «En god barndom varer livet ut». Tiltaksplan for å bekjempe vold og seksuelle overgrep mot barn og ungdom (2014-2017)

Myndighetene ønsker å bedre barns oppvekstvilkår gjennom å bidra til gode og lett tilgjengelige tjenester for å styrke kvaliteten i samliv, samt forebygge samlivskonflikter og samlivsbrudd. Helsestasjonene og familieverntjenesten står sammen i en særstilling når det gjelder mulighet til å bidra til gode parforhold for å fremme barnas beste. Barne-, ungdoms- og familiedirektoratet (Bufdir) har i samarbeid med Helsedirektoratet (Hdir) hatt ansvar for å gjennomføre et treårig prøveprosjekt med systematisk samarbeid mellom disse tjenestene. Oppdraget er formulert i tiltak 26 i «En god barndom varer livet ut. Tiltaksplan for å bekjempe vold og seksuelle overgrep mot barn og ungdom (2014-2017)». Prosjektet har vart i perioden 2015-2017. VID vitenskapelige høgskole har evaluert prøveprosjektetpublishedVersio

Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study

Objective The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. Methods This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l. Results OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact. Conclusion GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweigh