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BACKGROUND: Midwifery continuity models are highly recommended. Women with fear of birth living in rural areas might have difficulties accessing such care. Technology can play a role in enhancing contact with midwives during pregnancy and childbirth for these women.

OBJECTIVE: The aim of this study was to elucidate women's experiences of participating in a digital continuity of care model designed for pregnant women with fear of birth.

METHODS: A qualitative interview design, employing interviews with 15 women participating in a midwifery continuity project directed towards women with fear of birth. The participants used e-health tools for communication with midwives during their pregnancy and childbirth. Reflexive thematic analysis was used.

RESULTS: The analysis resulted in an overarching theme: 'A digital continuity model of midwifery care for women with fear of birth in a rural area is attractive'. The model created positive outcomes in terms of sustainability and use of resources. The women reported enhanced autonomy and reduced stress. Continuity of care fostered confidence and security throughout childbirth for the women, supported by a strong relationship with their midwives. The individualised care, which addressed mental health challenges and fears stemming from past childbirth experiences, led to positive outcomes.

CONCLUSION: A model with continuity using digital e-health could be a solution to meet women's needs in rural areas during childbirth, who suffer from fear of birth or have mental health problems. Care models need to be tailored to regional conditions, considering factors such as midwifery availability and geographical challenges.

Episiotomy and the medicalization make childbirth worse for women Our journal, Sexual and Reproductive Health Care (SRHC) received a letter to the editor from a group of healthcare professionals in Pakistan expressing concerns over the routine use of episiotomy during childbirth in their country. This issue is not isolated to Pakistan: many less industrialized countries in East Asia also report high rates of episiotomy. A 2018 systematic review highlighted the decline in the use of episiotomy in Europe and North America since the late 1980s, showing a decreasing trend in 26 countries. Notably, Sweden Iceland and Denmark reported episiotomy rates between 4–9 %, the lowest countries overall. Conversely, Asian countries in the same study data showed significantly higher rates with the following countries at the top of that list: India (68 % estimated in 2007/2008) China (85.50 % in 2003), Thailand (91.00 % in 2005), Vietnam (86.10 % in 1999) and notably Taiwan with an estimated rate of 100 % in 2002. Rates in other parts of the world generally range from 30 % to 50 % [1]. The routine performance of episiotomy is just one example among many of the trend towards medicalization of birth globally, in high and low-income countries around the world. a positive childbirth experience mentions 56 routines for intrapartum care, of which 21 are not recommended based on existing studies, including the routine or liberal use of episiotomy for women undergoing spontaneous vaginal birth. A positive postnatal experience should ensure that women, newborns, partners, parents, caregivers, and families receive consistent information, reassurance and support from motivated health workers withing a flexible, adequately resourced health system that recognizes their needs and respects their cultural contexts, and employs the best available evidence. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The transformation of normal birth through socio-cultural and ideological influences has led childbirths dominated by medicalization. Examples include the routine use of episiotomy, continuous fetal monitoring with CTG, liberal use of amniotomy, early cord clamping and cesarean section. Some studies indicate that women are simply placed in a passive, submissive or victimized position by the medical authority [2] without positively impacting mortality rates [5]. Furthermore, medicalization of birth could be correlated with obstetric violence, first recognized at state level in Venezuela in 2007 [3,4]. The World Health Organization (WHO) states that the concept of “normality” in childbirth is neither universal nor standardized. Over the last two decades, there has been a substantial increase in the application of a range of labour practices with the intention to initiate, accelerate, terminate, regulate, or monitor the physiological process of labour, with the aim of improving outcomes for women and babies. However, “this increasing medicalization of childbirth processes trends to undermine the woman’s own capability to give birth and negatively impacts her childbirth experience” [6]. The WHO guidelines for intrapartum care for

Background: the opportunity for women to give birth in water vary globally, and in Sweden waterbirth is offered in some of the maternityclinics in the country. An increased demand of water birth from pregnant women have been noticed. Research on waterbirth mainly focuses onwomen's experiences, but rarely on midwives' knowledge and perception.

Aim: the aim of this study was to describe midwives' experience of, and knowledge about waterbirth. With a qualitative method and inductiveapproach, 16 midwives with varying experience, working in a clinic that provides waterbirths, were interviewed. The interviews were analyzed withcontent analysis.

Results: The difficulty of estimating bleeding in water was perceived as a challenge. Also, the surveillance of the baby when CTG was usedwas another challenge. The working environment for the midwife working in positions where they had to lean into the pool was also mentionedas a challenge. The state of education and knowledge was varying, but trusting one's skills in assisting a waterbirth was based both in the level ofexperience as a midwife and in the number and frequency of assisting waterbirths. The clinic's policies and guidelines on waterbirth also played apart in the perceived safety.

Conclusion: midwifes experienced of waterbirths was that waterbirth is positive both for the woman and the midwife herself. Knowledge wasobtained mainly through practical experience, other midwives, and clear guidelines.

Objective: Correctly assessing the amount of blood loss is crucial in order to adequately treat postpartum haemorrhage (PPH) at an early stage and diminish any related symptoms and/or complications. The aim of our study is to analyse correctness in visually estimated blood loss during labour and to measure the differences between subjectively measured and weighted blood losses (ml). Design: Cross-sectional study Setting: A Swedish maternity unit with 6000 annual births Participants: Midwives employed at a big maternity unit at a hospital in northern Stockholm, Sweden. Intervention: Midwives assisting 192 vaginal births were asked to visually estimate the blood loss from the assisted delivery. Coasters and sanitary pads were weighed following the birth. We analysed if there were any differences between subjective measured blood loss (ml) and weighted blood loss. These two methods were also compared to quantify concordance between estimated blood volume and the actual volume. Findings: The number of overestimates of blood loss was 45.3 % (n=87) with an average of 72.9 ml; the number of underestimates was 49.4 % (n=95) with an average of 73.8 ml. Exact correct estimations of blood loss were done in 5.2 % of the cases (n=10). The largest overestimation of a postpartum bleeding was by 520 ml; the largest underestimation was by 745 ml. Conclusion: There was both underestimation and overestimation of blood loss. We found small but significant overestimates in PPH < 300 ml (16 ml). In PPH > 300 ml, there was a small but not significant underestimates (34 ml). Based upon our findings, we conclude that it is reasonable to start weighing blood loss when it exceeds 300 ml. © 2022 The Authors

Background: Giving birth is a transformative event. Memories of the birth often remain in a woman's mind for the rest of her life. Key aspects of a mother's overall birth experience include concerns about the safety and health of the baby, and the first contact the mother has with her child. To the best of our knowledge, research has not yet been published relating to the ways in which women undergoing caesarean sections in the 1970s and 1980s experienced the birth of their baby and whether or not their mode of delivery has affected their reproductive health and their relationship to their child. Objective: To describe women's experience of undergoing a caesarean section in the 1970s and 1980s in Sweden. Design: A qualitative method using semi-structured questions and content analysis. Participants: Twenty-two women were interviewed who underwent caesarean section during the 1970s and 1980s in Sweden. Results: The overarching theme surrounding women's experience of having undergone a caesarean section 30–40 years ago is that it is described as “undesired life event”. Four categories were established: vaginal birth as the norm; a total loss of control; acceptance and contact with the child. Conclusion: Undergoing a caesarean section during the 1970s and 1980s was considered to be an undesired life events. The interlocuters who participated in this study had little knowledge about operative childbirth and were poorly prepared for a complicated birth and postpartum care. The women did not suffer any long-term physiological harm yet were harmed psychologically until they came to terms with their negative experience and reached acceptance of it. © 2020 Elsevier B.V.

Background: It has been described that bedside reporting can contribute to patient safety and increase patient involvement in healthcare. To our knowledge, however, there is no existing research on bedside handover during labour. Aim: The aim of this study was to examine the patient's experiences of bedside handover during labour. Method: A qualitative design was used. Nineteen couples were interviewed after childbirth regarding their experiences of bedside handover during delivery. Twelve of those had experienced bedside handover and were, thereby, included in the study. The interviews were performed in a delivery ward in Stockholm during January 2018. The material was analysed according to content analysis. Results: Four main categories emerged from the data: non-verbal communication, verbal communication, concerns, and birth experience. In general, bedside handover was perceived to be positive, the participants felt they were treated professionally, and that they had been involved during the handover. One advantage with the handover was the possibility for parents to confirm the sharing of information during the handover, which made them feel secure. Moreover, most of the parents reported they received good treatment and had a good labour experience. Parents’ experiences of bedside handover and midwives’ support were summarised as follows: midwives used common words and avoided using medical terminology, and they kept eye contact with the woman and her partner. Conclusion: Bedside handover was experienced by both parents as a way of being positively included in the care of their newborn. The caregivers were described as being attentive, respectful, and were good listeners. © 2020 Elsevier B.V.