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  • 1. Ahlberg, M.
    et al.
    Nordlund, E.
    Weichselbraun, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Good obstetric care requires interdisciplinary collaboration2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed)
  • 2. Ahlberg, M.
    et al.
    Nordlund, E.
    Weichselbraun, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Svenska barnmorskeförbundet: God förlossningsvård kräver tvärprofessionellt samarbete2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 20-21Article in journal (Refereed)
  • 3.
    Akhter, Nargis
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Akhter, Jasmine
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Component that make a midwife grow personally and professionally: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Midwifery care is an essential component of providing quality maternal and child health care. Mother and new born health outcomes depends on the quality of education, license to practice, the scope of practice, sufficient resources, referral mechanisms and effective teamwork. The aim of this meta-synthesis was to describe components building midwifery professionalism for delivery of quality care. Method: This study was a meta-synthesis focusing to describe the components needed for building midwifery professionalism for delivery of quality care in high, low and middle-income countries. After assessing for relevance and quality in peer-reviewed journals, 30 qualitative studies were included from 2009 to 2018, written in English. This involved an electronic search using the following databases: PubMed, CINAHL, web of Science, Google Scholar, Summon and manually search. Result: After analysis and synthesis, the major findings can be summarized in two components; Clinical experiences make the midwives’ grow personally and professionally and an enabling environment enhances the midwives’ personal and professional development. Subcategories were; Collaboration with other health professionals and with colleges/ colleagues at the workplace, Extensive hands on clinical experience, Professional management of the workplace, Quality pre-service education and quality of the midwifery educators, In-service training, Policies and guidelines regulate the midwifery workforce, Being a member of a midwifery association. Conclusion: To ensure mothers quality midwifery care; midwives play a critical role in strengthening the midwifery workforce in high and low-middle income countries. This study highlights the benefits of building capacity for strengthening midwives and the midwifery profession. Clinical implications: There is a need to improving the educational status, improving policy and practice of health care program and facilitate the necessary resources. There is need for further research to identify how much improvements the newly deployed midwifery cadre service will bring in the field of quality midwifery care personally and professionally especially in rural setting.

  • 4.
    Akhter, Shirina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Akter, Jesmin
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Midwife-led care: A concept analysis2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Midwife-led care is yet to be explored as a concept in the context of Bangladesh. Anunderstanding of what constitutes midwife-led care can be lectured at midwifery education and inturn clarify the content of the midwifery practice to the midwifery workforce. The aim is to definethe concept of “Midwife-led care” from a midwifery context, through the synthesis of text fromliterature and interview data with Bangladeshi health care providers, to clarify its meaning enablingcomprehension and use of the concept in clinical practice and education.Methods: A concept analysis consisting of written text from literature and individual interviewswith Bangladeshi health care providers. In total nine participants participated in this study. Theconcept analysis was undertaken according to a hybrid model which consists of theoretical,fieldwork and analytical phases. After a literature review, the concept was empirically elucidated inthe fieldwork phase. The final step was to describe criteria and attributes of the concept.Results: The tentative criteria and attributes of midwife-led care in the context of midwiferyservices in Bangladesh included development of a trustful, friendly relationship between the womanand midwife; promoting normal processes for the pregnant woman in antenatal care, during deliveryand after delivery in the post-partum period. It includes creating awareness about benefits of normalbirth assisted by a skilled birth attendant. Further, having collaboration and communication withother health care professionals when complications arise with the woman or the baby and provide asupportive environment for care which is easily accessed and close to the communities. Finally,professional knowledge and skills are necessary components for midwives working with midwifeledcare.Conclusion: This concept analysis provides a unique examination of midwife-led care. Midwife-ledcare can be establish in the Bangladeshi midwifery context and practice. However, all the aspects ofmidwife-led care need to be supported by a functional health system for the continuity of care.Clinical implications: In midwife-led care centers, the midwifery workforce can be supported intheir clinical practice based on findings in this thesis. As such, this thesis offers a contribution foreducation in the midwife-led care approach within midwife-led maternity services. This is highlyrecommended when introducing evidence-based interventions to improve midwifery servicedelivery in real-world settings.

  • 5.
    Akter, Rahana
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Barua, Shampa
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Bhuyan, Mosammat Parvin Akter
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Woman’s choice during labour and birth: A concept analysis2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: A woman has the right to give birth in the place of her choice, in privacy and with the company of a trusted supporter. The aim of this study was to define the concept "woman’s choice during labor and birthʺ in the Bangladesh context. Methods: The study design was concept analysis with data consisting of written text from literature and structured interviews. The concept analysis comprises three phases. Phase was 1) a theoretical phase, followed by 2) a field study phase, and finally 3) a synthesis phase with the field study phase in light of the theoretical phase. The setting was labor wards, nursing institutes and nursing college (post basic) at three different places in Bangladesh. Four midwifery students, one clinical midwife and four Midwifery teachers participated in this study. The interviews were recorded with the permission of the respondents. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review the concept was empirically elucidated in the fieldwork phase. Results: The tentative criteria attributes of woman’s choice during labour and birth in the Bangladeshi context are described: Woman choice during labour and birth means labour process, type of delivery, neonatal wellbeing, companionship at birth. Conclusion: Women’s choice in labour and birth is worldwide to make decisions within boundaries and particularly women’s choices are limited in Bangladesh. Professionally and personally the woman’s choices are limited by lack of options in the caring environment influenced by socio-cultural factors, socio-economic standards and education level. Clinical implications: Empirical findings from the theoretical concept analysis confirm the concept’s relevance in the midwifery context.

  • 6.
    Akter, Rina
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parvin, Masuda
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Supportive components of care during cesarean section birth: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

    : Caesarean section is the most common surgery worldwide today. The midwives support is therefore of uttermost important for women undergoing caesarean section. Aim: The aim of the meta-synthesis was to explore the experience related to planned and unplanned cesarean sections among primipara and multipara women in hospital settings worldwide. Method: This study is a meta-synthesis with meta-ethnographic analysis on women’s experiences of caesarean section birth. This is a qualitative research based on scientific literature. The inclusion criterion was peer-review qualitative articles from different original articles about women's experiences. Results: Five categories emerged: Caring attitude and behaviour, pre-existing imagination, relational influence, the need for caring and information. The findings suggest that nurse-midwife enhance their support and increase the women’s knowledge on caesarean section birth in order to improve the experience and also for women to make good choices. Women are influenced by people near to them when choosing to have a cesarean section or not. The mothers face challenges for postoperative recovery and quality of care. Midwives have a duty to assist these mothers. Conclusion: The findings emphasize the importance of person-centered communication skills and relationships in supporting a woman during caesarian section. Organizational systems and services that facilitate continuity of care giver for example, continuity of midwifery care or peer support models, are more likely to facilitate supportive care and a trust-building relationship. Clinical implication: The findings from this study can be used for educational purposes, and to create awareness about the role of midwifery care in relation to CS.

  • 7.
    Akther, Aklima
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Naher, Kalsarun
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parent’s perceptions experiences and attitudes about kangaroo mother care in neonatal wards: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    The knowledge of facility-based kangaroo mother care (KMC) in Bangladesh is comparatively recent; few facilities have been taking steps towards KMC service. Each year more than a million babies die due to the complication of prematurity. To eliminate the deaths due to prematurity, it is very important to share knowledge about the implementation, experiences, challenges and barriers for KMC practice to promote KMC intervention in the developing countries. Aim: To examine parents’ perceptions, experiences and attitude towards KMC in neonatal wards. Method: This study was a meta-synthesis focusing on parents’ perceptions and experiences of KMC. The included studies used several different qualitative methodologies compiled using Meta ethnography. Result: The results comprised of three categories were identified in this study. The First category was the Barriers towards KMC. This category comprised four preliminary patterns of parent’s perceptions of barriers to have KMC: Separating due to prematurity, Fear of harming, Pain prevented closeness, and Fear prevented closeness. The second category was facilitating factors for KMC, which covered parents’ experiences of the consult support expressed in four preliminary patterns: Own wish for closeness, Having positive experience and Support from the staff. The third category Benefits for KMC included three preliminary patterns of positive perceptions of KMC made by parents: Calming, warming and bonding, connecting with the premature baby and Being able to act as a parent. Conclusion: In this meta-synthesis, the main findings were realized into three categories of KMC- Barriers towards KMC, facilitating factors of KMC, Benefits of KMC. This is a low-cost and effectiveness method of reducing infant mortality. Clinical implications: Health care professionals have opportunities to implement Kangaroo Mother Care in low resource settings. First health care professionals have to be encouraged in all postnatal wards. Secondly, parents need to be aware about KMC so that they can promote their baby’s health and eventually save their baby’s life.

  • 8.
    Andersdotter, Nora
    et al.
    Dalarna University, School of Health and Welfare.
    Robbertse, Tanya
    Dalarna University, School of Health and Welfare.
    Combating Gender-Based Violence through Education: An interview study with educators in Gauteng, South Africa, about Gender-Based Violence in the Life Orientation curriculum2021Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    BackgroundGender-Based Violence (GBV) is a global problem rooted in gender inequality. South Africa has exceptionally high rates of GBV. Despite the fact that Comprehensive Sexuality Education (CSE) has been taught as part of the school subject Life Orientation to teach topics like gender equality, studies have demonstrated inconsistent implementation of this curriculum.AimTo investigate Life Orientation educators’ experiences of teaching the curriculum in relation to GBV and gender equality and manging the issue of GBV in public schools located in the Gauteng province, South Africa, and gain information about the challenges educators experience and what they think is needed to actively work towards preventing GBV in schools.Research DesignA qualitative research design was utilised.MethodTwelve participants were interviewed online using a semi-structured interview guide. The data was transcribed, coded, and analysed using inductive thematic analysis.ResultsThe results indicate that the participating educators experience various challenges and have diverse views on potential improvements. Limited educational and training resources, deep-rooted views of gender roles and cultural traditions, limited recognition of the subject’s importance by educational authorities, as well as uncertainty regarding existing school GBV policies are crucial findings on how the educators experience teaching GBV.ConclusionThis study identified challenges and the potential benefits of improved educator training to address the topic of GBV, more detailed coverage of GBV in the curriculum, increased awareness surrounding GBV and allocating more time to these concepts.

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  • 9.
    Aronzon, Hanna
    et al.
    Dalarna University, School of Health and Welfare.
    Persson, Stefanie
    Dalarna University, School of Health and Welfare.
    Underlivssmärta, urininkontinens och avföringsinkontinens åtta veckor och ett år efter barnafödande: En kvantitativ enkätstudie2023Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 10.
    Arvidsson, Sarah
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Lindahl, Janie
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Vårdpersonals erfarenheter av nollseparation mellan mamman och det nyfödda barnet: En fokusgruppsintervjustudie från ett mellanstort sjukhus i Sverige2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Despite the advantages of zero separation, there is still some separation during hospital stay between mother and child after childbirth. At present, variations are seen in the possibility of maintaining zero separation in different hospitals in Sweden. Aim: To examine the delivery-, maternity- and neonatal professionals’ experiences of zero separation between the mother and the newborn child at a medium-sized hospital in Sweden. Method: A qualitive focus group interview study with an inductive approach, with a total of 17 informants, that has been processed with qualitative content analysis. Results: After completing the content analysis 12 subcategories emerged that resulted in four categories; The meaning of zero separation, Enabling approach, Obstacles along the way and Need for improvement. A theme emerged as A mutual effort not to separate, which was regarded to the healthcare professionalls’ willingness and commitment to maintain zero separation between the mother, the child and the family. Conclusion: The healthcare professionalls’ at the concerned hospital had a strong commitment to keep the mother, newborn child and the family as a whole, but at the present there are not always conditions for achieving zero separation to the extent they wish. Clinical implications: The child’s right to their parent is strengthened by the healthcare professionalls’ application of zero separation in their work. The findings of the study could likely be taken into account by healthcare professionalls’ and could form the basis for development of routines and forms of education concerning zero separation.

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  • 11.
    Asaye, Mengstu Melkamu
    et al.
    University of Gondar, Gondar, Ethiopia.
    Gelaye, Kassahun Alemu
    University of Gondar, Gondar, Ethiopia.
    Matebe, Yohannes Hailu
    University of Gondar, Gondar, Ethiopia.
    Lindgren, Helena
    Karolinska Institutet, Solna.
    Erlandsson, Kerstin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis2023In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 5, article id e0285280Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.

    METHOD: A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.

    RESULTS: The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).

    CONCLUSIONS: The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

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  • 12. Askelsdottir, B.
    et al.
    Jonge, W. L. D.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Home care after early discharge: Impact on healthy mothers and newborns2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 8, p. 927-934Article in journal (Refereed)
    Abstract [en]

    Objective: to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth. Design: retrospective case-control study. Setting: a labour ward unit in Stockholm, Sweden handling both normal and complicated births. Participants: 96 women with single, uncomplicated pregnancies and births, and their healthy newborns. Intervention: early discharge at 12-24 hours post partum with 2-3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (. n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (. n=51). Instruments: mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded. Findings: women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (. p=0.021). Contact between the mother, newborn and partner did not differ between the groups. Conclusion: early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates. © 2012 Elsevier Ltd.

  • 13. Askelöf, U.
    et al.
    Andersson, O.
    Domellöf, M.
    Fasth, A.
    Hallberg, B.
    Hellström-Westas, L.
    Pettersson, K.
    Westgren, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Götherström, C.
    Wait a minute?: An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60- and 180-second umbilical cord clamping2017In: BMJ Open, E-ISSN 2044-6055, Vol. 7, no 12, article id e017215Article in journal (Refereed)
    Abstract [en]

    Background and objective: Umbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping. Design: Prospective observational study with two historical controls. Setting: A university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden. Methods: Iron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother's abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery. Results: After adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 μg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29). Conclusion: In this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency. © 2017 Article author(s).

  • 14.
    Assaysh-Öberg, Shereen
    et al.
    Dalarna University, School of Health and Welfare.
    Borneskog, Catrin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Ternström, Elin
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Women's experience of infertility & treatment - A silent grief and failed care and support.2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100879Article in journal (Refereed)
    Abstract [en]

    Infertility is one of the components of sexual and reproductive health and rights, but is not as widely addressed as pregnancy, birth, and contraception. Infertility is a global problem, and it is estimated that around 186 million individuals are affected worldwide. Infertility and infertility treatment impact on women's overall wellbeing including their mental, emotional, sexual and spiritual health. Anxiety and depression is prevalent in these women. This study sought to explore the experiences of women going through infertility and IVF in a global context. This study is a metasynthesis with a meta-ethnographic analysis design based on 19 qualitative research studies, including 503 women, focusing on women's experiences of infertility and IVF treatments. Three main themes were identified; the personal reproductive trauma, the impact of and on relationships, and being failed by the healthcare system and society. The personal trauma and experiences included stress, grief, inability to focus, chock, insomnia, anxiety, withdrawing from others, sense of hopelessness and guilt and shame. The infertility and IVF journey also either caused conflicts in relationships or helped the couples to grow stronger. At the same time, relationships with friends and family were strained due to isolation and feeling stigmatized, and not understood. Finally, the healthcare system and providers lacked adequate support, holistic and caring care, and the women felt dehumanized and failed by the healthcare system. It is therefore critical that the healthcare system provide the time, information and support needed to deal with infertility and IVF to maintain quality of life and wellbeing.

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  • 15.
    Bala, Hena Rani
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Chakma, Anti
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Khatun, Most. Zubayda Rokshanara
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Birth companion during labour and birth2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Having a birth companion during labour and birth to provide mental, emotional support as well as physical support is globally found to be essential for women. The process of giving birth is not only a biological event but also a process with social and emotional aspects. It is a right for every woman to receive evidence-based care during childbirth. There is also a global interest in improving the quality of maternal and newborn care. This includes a strong focus on respectful care as an essential component of quality of care. The aim of this study was to define the concept “Birth companion during labour and birth” through the synthesis of texts from literature and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning, enabling comprehension and use of the concept in clinical practice and education. Methods: The design of this study is a concept analysis that comprises three phases: 1) is a theoretical phase, followed by 2) a field study phase and 3) a synthesis phase. The participants were recruited purposively and invited to the interview with an invitation letter. The interviews were based on semi-structured and open-ended questions following an interview guide. A total of nine participants were enrolled in this study, five midwifery educators, two clinical midwives, and two midwifery students who worked at antenatal care, delivery, postpartum care, menstrual regulation, post abortion care and family planning care or involved in midwifery education. Results: A birth companion supports women during childbirth provide informational support, bridge communication gaps between clinical staff and women, provide practical support and emotional support, act as an advocate for the women, help women feel in control, provide continuous physical presence. Conclusion: The concept “Birth companion during labour and birth” was redefined in the following way: The birth companion can be any person chosen by the woman to provide her with support during labour and childbirth. This support is perceived to be associated with reduced maternal anxiety, it highlights the importance of a birth companion during labour and birth and on the emotional wellbeing of women in the Bangladeshi context. Clinical implications: This paper gives a deep insight to the concept of a birth companion during labour and birth and shows what is, and preferably should be, part of the clinical settings in Bangladesh. Ensuring a birth companion during labour and birth could improve health outcomes of women and give a positive childbirth experience.

  • 16.
    Banu, Afroza
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parvin, Shahanaj
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    "There Are Remaining Challenges in Bangladesh" A National Assessment Strategy Supports Reaching International Midwifery Standards Education: A focus group inquiry among midwifery faculty in Bangladesh2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Delivery by unskilled birth attendant is causing many maternal and neonatal deaths. Midwives can reduce maternal and neonatal deaths by providing skilled delivery care. To prepare skilled midwives a National Assessment Strategy for Midwifery Education Standards has been introduced.

    Aim: To describe midwifery faculty members’ perceptions of how to affirm quality midwifery education in Bangladesh using a national assessment strategy.

    Methods: A qualitative research design was chosen using a context-specific accreditation assessment tool, guided by the Global Standards for Midwifery Education. The participants were 33 midwifery teachers, and data were analyzed with content analysis.

    Results: The findings indicate that Bangladesh should be prepared to implement the Global Standards for Midwifery Education Accreditation Programmes. The assessment strategy has prepared the faculty for accreditation and paved the way through the development of standards in the tool, overcoming barriers, and using the possible facilitators.

    Conclusion: There are remaining challenges in Bangladesh regarding "moving midwifery". Midwifery teachers demand for separate faculty from nursing. Promotion system for careers development can be initiated. Updating teachers knowledge, having adequate number of teachers with competencies, and maintained collaboration between teaching and clinical practice organizations are important for "moving midwifery" in Bangladesh.

    Clinical application: The present study results can be useful for midwifery education and clinical practice improvement.

  • 17.
    Begum, Momtaj
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Sultana, Nazma
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Women’s and health care provider perceptions and experiences of bottlenecks in midwifery care: A qualitative meta-synthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Women die from preventable causes during pregnancy and childbirth and often in relation to delays in midwifery care. Professional hierarchies might hamper the rights and desires of midwives in provision of normal birth in terms of the provision of quality care to all women and newborns. In health systems where decision making in normal births are influence by doctors this is particularly relevant, with women themselves subordinate to all health care professionals. Aim: The aim of this meta-synthesis was to examine women’s and health care provider’s perceptions and experiences of bottlenecks in midwifery care related to availability, accessibility, acceptability and quality of midwifery care. Method: This study was a qualitative meta-synthesis with a deductive approach, 15 article were selected for this qualitative meta-synthesis. A framework for the evaluation of quality of care and coverage of health services was used for the deductive approach. Results: Four categories emerged based on availability, accessibility, acceptability and quality of care. The delays were due to less awareness of danger signs of severe complications in the community, and delays in decision making by male family members and less empowerment of women, and lack of collaboration between health care professionals. We also identified how to overcome this situation. Conclusion: Midwifes may provide quality maternal care to all women and children and earn trust from community people to promote normal pregnancy and birth and prevent delays when complications arise. Clinical implications: Midwives can provide continuity care and through collaboration with other health care professionals advocate for women empowerment.

  • 18.
    Begum, Mst. Marium
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Nahar., Most. Nargis
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Parents’ and health care providers’ perceptions and experiences of supportive care in neonatal wards: A qualitative metasynthesis2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Four million infants die with in the first month of life and 27% of these deaths are directly related to low birth weight (LBW) or preterm birth. The main causes of infant death in premature and LBW infants is neonatal infections. It is thus crucial that the infant is taken care of in an appropriate way regarding caring and feeding and that care is provided to improve the child’s chances of survival and to lay the foundation for a healthy life. Aim: The aim of this meta-synthesiswas to examine parent`s and health care providers perceptions and experiences of supportive care in neonatal wards. Method: A qualitative meta-synthesis based on peer-reviewed scientific literature, and meta-ethnographic analysis method. In this meta-synthesis 16 articles were included. Result: The results comprised of two categories, Parents’ perspective of supportive strategies with eight corresponding preliminary patterns and Health care providers’ perspective of supportive strategies with six corresponding preliminary patterns. In the result section, each categories are presented with its corresponding preliminary patterns. The mothers experienced that the baby was unstable and therefore they wanted to be close to the baby at all times if something happened. Important was closeness to the infant is important, parental support according to needs, adequate communication and information with parents, genuine caring and continuous support to get close to the child. It also meant less light and less noise and privacy for the infant and the parent in the NICU ward.

    Conclusion

    Parents wanted to be able to be with his infant as rapidly after birth be reunited in case something happened. The importance of receiving information about their infant’s condition underpinned all communications that the parents undertook with NICU staff both in co-care when together with the child and part-care, when separated. Information for the parents was an important requirement of accepting their situation and immediately affected their anxiety. Clinical implications: The organizers of care must take in account that parents and infants will not be befitted by being cared for apart from each other. When planning for co-care enabling infants to be close to the parents, the mother-baby dyad should be prioritized. Context specific interview studies are suggested on co-care and part-care, parents and care providers perspectives.

  • 19. Begum, Nurjahan
    et al.
    Mitu, Jannatul Ferdoues
    Nandy, Purnima
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Respectful care during labour and birth: A concept analysis2019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Along with the Sustainable Development Goals (SDG) 3 and 5, the global effort is highly focused on evidence-based practice and respectful maternity care to reduce maternal and newborn mortality and morbidity. In Bangladesh disrespect and abuse against mothers during intrapartum period is common and the midwifery profession was introduced in 2013. The aim of this study is to define the concept “Respectful Care during labour and birth” through the synthesis of text from literature and interview with Bangladeshi health care providers. Methods: The study was done through a concept analysis from the literature and 10 semi-structured interviews with third-year midwifery students, clinical midwives and midwifery faculty. Results: The study found that in low-income countries women are more vulnerable to disrespectful care in various ways like physical and verbal abuse. Midwives provide only non-harmful care, due to poor salary, and lack of quality higher education. Private hospitals and midwife led-care centers provide better service than government hospitals. Conclusion: Midwives play a vital role to ensure respectful care for a mother during labour and childbirth. Clinical implications: The findings could be helpful to develop the profession for countries where the midwifery profession is new, like in Bangladesh

  • 20.
    Begun, Najma
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Upright position during labour and birth: A concept analysis2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The best birthing position for women to adopt during labour and birth is to vary the positions freely depending on the stages of labour. The aim of this study was to define the concept ‘upright position during labour and birth’ through the synthesis of texts from literature and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning, enabling comprehension and use of the concept in clinical practice and education.Methods: This study design was concept analysis. The setting was three different nursing institutes/colleges and nearby hospitals. Nine participants were invited to participate in an individual in-depth interview (IDI) with semi-structured open-ended questions. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically clarified in the fieldwork phase in the midwifery context of Bangladesh, described with the Quality Maternal and Newborn Care (QMNC) framework components.Results: The concept of upright position during labour and birth in the midwifery context was redefined. Altering between positions widening the pelvic relief labour pain for the woman, potentially resulting in a normal birth with a healthy mother and baby. Women do not expect upright positions in facility-based births but at homebirths.Conclusion: The women’s rights to spontaneously and freely move while in labour, altering between different vertical positions are associated with the midwives’ work “with women” supporting the women.Clinical implications: It is a simple intervention to apply in clinical setting and simple to teach to nurses, midwives and physicians and in graduate and postgraduate education.

  • 21.
    Birath, Camilla
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Edman, Sofia
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Förlossningsrädsla: En begreppsanalys ur barnmorskans perspektiv2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Fear of childbirth affects about one-fifth of all pregnant women and midwives face these in their work.

    Aim: The aim was to analys the concept fear of childbirth from a midwife perspective.

    Methods: A concept analysis with a hybrid model. First a theoretical phase with a search for literature, thereafter a fieldwork phase where five midwifes where interviewed followed by a final analytic phase.

    Results: Fear of childbirth is something that can affect women before, during or after pregnancy and childbirth. Fear of childbirth for primiparous women can be a lack of confidence in her ability to give birth, and for multiparous women have had a previous traumatic birth experience. The midwives described that fear of childbirth was a complex concept. Women did not usually use the word fear of childbirth, but the midwives interpreted what they noticed or saw in the woman as manifestations of fear of childbirth.

    Conclusion: Midwives use the concept in different ways and call for a clearer definition and way of working with fear of childbirth. The fear of childbirth is a great suffering for the pregnant woman and therefore the authors of this thesis consider that preventive work is important and that the midwife has a central and important role.

    Clinical Applicability: Midwives can use this study to develop their knowledge of fear of childbirth and see how other midwives view on the concept fear of childbirth.

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  • 22. Björvang, Richelle D.
    et al.
    Hallberg, Ida
    Pikki, Anne
    Berglund, Lars
    Dalarna University, School of Health and Welfare, Medical Science. Uppsala University.
    Pedrelli, Matteo
    Kiviranta, Hannu
    Rantakokko, Panu
    Ruokojärvi, Päivi
    Lindh, Christian H.
    Olovsson, Matts
    Persson, Sara
    Holte, Jan
    Sjunnesson, Ylva
    Damdimopoulou, Pauliina
    Follicular fluid and blood levels of persistent organic pollutants and reproductive outcomes among women undergoing assisted reproductive technologies2022In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 208, article id 112626Article in journal (Refereed)
    Abstract [en]

    Persistent organic pollutants (POPs) are industrial chemicals resistant to degradation and have been shown to have adverse effects on reproductive health in wildlife and humans. Although regulations have reduced their levels, they are still ubiquitously present and pose a global concern. Here, we studied a cohort of 185 women aged 21-43 years with a median of 2 years of infertility who were seeking assisted reproductive technology (ART) treatment at Carl von Linnékliniken in Uppsala, Sweden. We analyzed the levels of 9 organochlorine pesticides (OCPs), 10 polychlorinated biphenyls (PCBs), 3 polybrominated diphenyl ethers (PBDEs), and 8 perfluoroalkyl substances (PFASs) in the blood and follicular fluid (FF) samples collected during ovum pick-up. Impact of age on chemical transfer from blood to FF was analyzed. Associations of chemicals, both individually and as a mixture, to 10 ART endpoints were investigated using linear, logistic, and weighted quantile sum regression, adjusted for age, body mass index, parity, fatty fish intake and cause of infertility. Out of the 30 chemicals, 20 were detected in more than half of the blood samples and 15 in FF. Chemical transfer from blood to FF increased with age. Chemical groups in blood crossed the blood-follicle barrier at different rates: OCPs > PCBs > PFASs. Hexachlorobenzene, an OCP, was associated with lower anti-Müllerian hormone, clinical pregnancy, and live birth. PCBs and PFASs were associated with higher antral follicle count and ovarian response as measured by ovarian sensitivity index, but also with lower embryo quality. As a mixture, similar findings were seen for the sum of PCBs and PFASs. Our results suggest that age plays a role in the chemical transfer from blood to FF and that exposure to POPs significantly associates with ART outcomes. We strongly encourage further studies to elucidate the underlying mechanisms of reproductive effects of POPs in humans.

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  • 23.
    Blüme, Sofia
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Quan, Marianne
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Kvinnors upplevelser av att genomgå en förlossningsdepression: En kvalitativ metasyntes2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Postpartum depression is a condition that affects up to 15 percent of women in               Sweden after childbirth. Untreated, this condition can have a negative effect on the health of both                the woman and the child. Midwives have an important role in identifying women who have               developed or are at risk of developing postpartum depression. ​Aim: ​To describe women's             experiences of postpartum depression. ​Method: ​Qualitative metasynthesis with metaethnographic         analysis method. Data was collected through three databases; PubMed, CINAHL and PsycInfo. A             total of 17 articles are included in the result of this metasynthesis, of which all of them passed a                   thorough quality critique.​Results: Four themes were identified;Achangingidentity,Anewroleas               a mother, A hindered bondingandAnemotionalstorm.​Conclusion:​Duringpostpartumdepression             women experience feelingsoflosingtheiridentity,difficultiesadaptingtomotherhood,problemsin             bonding with the child as well as a rollercoaster of emotions.Themidwifehasanimportantrolein                  prevention and early identification of postpartum depression. ​Clinical implications: This          metasynthesis can be used by midwives working in maternity care, as atooltoimprovethequality                 of care for women who have developed or are at risk of developing postpartum depression.

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  • 24.
    Bodinson, Siri
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Bygdeman, Ulrika
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Att föda hemma - Kvinnors upplevelser av planerad hemförlossning: En kvalitativ metasyntes2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: A planned home birth is defined as a birth that during the pregnancyis planned to take place at home or in a homelike environment outside the hospital,with the support from a midwife. The prevalence for planned home births variesglobally. In the Nordic countries the rate of planned home births is low, while in theNetherlands for example home birth is much more common. The reason why womenchoose a planned home birth is that they believe they will have more control overthe birth if they are at home, they want to avoid unnecessary interventions and theywant to give birth in a familiar setting. Aim: The purpose of the metasynthesis is todescribe women’s experiences of planned home birth. Method: A qualitative metasynthesis with meta-ethnography as tool for the analysis. The data collectionwas executed in the databases Cinahl and Pubmed. A quality check was made andin the end 17 studies were included in the result. Result: Three main themes wereidentified; To have the authority in one´s own hands, The habitat of the natural birthand To rest in the hands of the midwife. Conclusion: Women who had experienceda planned home birth felt that they had control over the birth, felt that they couldlisten to their bodies and follow their instincts and that they had a midwifesupporting and guiding them. Focus were on the natural birth without unnecessaryinterventions. Some women had negative experiences which were when they feltsome of these aspects were lacking and this led to a negative perception of the birth.Clinical implications: The result increases the understanding of the women´sexperiences of planned home birth and also the importance of getting to choose birthenvironment by yourself. The increased understanding could contribute to changein the clinical guidelines considering home birth in the different regions.

  • 25.
    Borneskog, Catrin
    et al.
    Uppsala University.
    Lampic, C
    Sydsjö, G
    Bladh, M
    Skoog Svanberg, A
    How do lesbian couples compare with heterosexual in vitro fertilization and spontaneously pregnant couples when it comes to parenting stress?2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 5, p. 537-45Article in journal (Refereed)
    Abstract [en]

    AIM: To study parenting stress in lesbian parents and to compare that stress with heterosexual parents following in vitro fertilisation (IVF) or spontaneous pregnancies.

    METHODS: This survey took place during 2005-2008 and was part of the Swedish multicentre study on gamete donation. It comprised 131 lesbian parents, 83 heterosexual IVF parents, who used their own gametes, and 118 spontaneous pregnancy parents. The participants responded to the questionnaire when the child was between 12 and 36-months-old and parenting stress was measured by the Swedish Parenting Stress Questionnaire (SPSQ).

    RESULTS: Lesbian parents experienced less parenting stress than heterosexual IVF parents when it came to the General Parenting Stress measure (p = 0.001) and the subareas of Incompetence (p < 0.001), Social Isolation (p = 0.033) and Role Restriction (p = 0.004). They also experienced less parenting stress than heterosexual spontaneous pregnancy couples, according to the Social Isolation subarea (p = 0.003). Birth mothers experienced higher stress than co-mothers and fathers, according to the Role Restriction measure (p = 0.041).

    CONCLUSION: These are reassuring findings, considering the known challenges that lesbian families face in establishing their parental roles and, in particular, the challenges related to the lack of recognition of the co-mother.

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  • 26.
    Borneskog, Catrin
    et al.
    Uppsala University.
    Lampic, Claudia
    Sydsjö, Gunilla
    Bladh, Marie
    Svanberg, Agneta Skoog
    Relationship satisfaction in lesbian and heterosexual couples before and after assisted reproduction: a longitudinal follow-up study.2014In: BMC Women's Health, E-ISSN 1472-6874, Vol. 14, article id 154Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: More and more lesbian couples are planning parenthood through donor insemination and IVF and the number of planned lesbian families is growing in Sweden and other western countries. Research has shown that lesbian couples report as much overall satisfaction in their relationships as do heterosexual couples. However, although parenthood is highly desired, many parents are unaware of the demands of parenthood and the strain on their relationship that the arrival of the baby might bring. The aim of this study was to compare lesbian and heterosexual couples' perceptions of relationship satisfaction at a three-year follow up after assisted reproduction.

    METHODS: The present study is a part of the Swedish study on gamete donation, a prospective longitudinal cohort study. The present study constitutes a three-year follow up assessment of lesbian and heterosexual couples after assisted reproduction. Participants requesting assisted reproduction at all fertility clinics performing gamete donation in Sweden, were recruited consecutively during 2005-2008. A total of 114 lesbian women (57 treated women and 57 partners) and 126 heterosexual women and men (63 women and 63 men) participated. Participants responded to the ENRICH inventory at two time points during 2005-2011; at the commencement of treatment (time point 1) and about three years after treatment termination (time point 3). To evaluate the bivariate relationships between the groups (heterosexual and lesbian) and socio-demographic factors Pearson's Chi- square test was used. Kolmogorov-Smirnov test was used for testing of normality, Mann-Whitney U- test to examine differences in ENRICH between the groups and paired samples t-test to examine scores over time.

    RESULTS: Lesbian couples reported higher relationship satisfaction than heterosexual couples, however the heterosexual couples satisfaction with relationship quality was not low. Both lesbian and heterosexual couples would be classified accordingly to ENRICH-typology as vitalized or harmonious couples.

    CONCLUSIONS: At a follow-up after assisted reproduction with donated sperm, lesbian couples reported stable relationships and a high satisfaction with their relationships, even when treatment was unsuccessful.

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  • 27.
    Borneskog, Catrin
    et al.
    Uppsala University.
    Skoog Svanberg, Agneta
    Lampic, Claudia
    Sydsjö, Gunilla
    Relationship quality in lesbian and heterosexual couples undergoing treatment with assisted reproduction.2012In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 27, no 3, p. 779-86Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: One of the major factors impacting on a couple's relationship is the desire to have children. To many couples having a child is a confirmation of their love and relationship and a means to deepen and develop their intimate relationship. At the same time parental stress can impact on relationship quality. Relationship quality in lesbian couples is, currently, sparsely studied. The aim of the present study was to compare lesbian and heterosexual couples' perceptions of their relationship quality at the commencement of assisted reproduction, and to relate this to background data such as educational level, having previous children and, for lesbian couples, the use of a known versus anonymous donor.

    METHODS: The present study is part of the prospective longitudinal 'Swedish study on gamete donation', including all fertility clinics performing donation treatment in Sweden. Of a consecutive cohort of 214 lesbian couples about to receive donor insemination and 212 heterosexual couples starting regular IVF treatment, 166 lesbian couples (78% response) and 151 heterosexual couples (71% response) accepted participation in the study. At commencement of assisted reproduction participants individually completed questionnaires including the instrument 'ENRICH', which is a standardized measure concerning relationship quality.

    RESULTS: In general, the couples rated their relationship quality as good, the lesbian couple better than the heterosexuals. In addition, the lesbian women with previous children assessed their relationship quality lower than did the lesbian woman without previous children. For heterosexual couples previous children did not influence their relationship quality. Higher educational levels reduced the satisfaction with the sexual relationship (P = 0.04) for treated lesbian women, and enhanced the rating of conflict resolution for treated lesbian women (P = 0.03) and their partners (P = 0.02). Heterosexual women with high levels of education expressed more satisfaction with communication in their relationship (P = 0.02) than did heterosexual women with lower educational levels.

    CONCLUSIONS: In this Swedish study sample of lesbian and heterosexual couples' relationships, we found that they were generally well adjusted and stable in their relationships when starting treatment with donated sperm or IVF, respectively. However, where lesbian women had children from a previous relationship, it decreased relationship quality. For the heterosexual couples previous children did not affect relationship quality.

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  • 28.
    Borneskog, Catrin
    et al.
    Uppsala University.
    Sydsjö, G
    Lampic, C
    Bladh, M
    Svanberg, A S
    Symptoms of anxiety and depression in lesbian couples treated with donated sperm: a descriptive study.2013In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 120, no 7, p. 839-46Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate symptoms of anxiety and depression in lesbian couples undergoing assisted reproductive treatment (ART), and to study the relationship of demographic data, pregnancy outcome and future reproductive plans with symptoms of anxiety and depression.

    DESIGN: Descriptive, a part of the prospective longitudinal 'Swedish study on gamete donation'.

    SETTING: All university clinics in Sweden performing gamete donation.

    POPULATION: A consecutive sample of 214 lesbian couples requesting assisted reproduction, 165 of whom participated.

    METHODS: Participants individually completed three study-specific questionnaires and the Hospital Anxiety and Depression Scale (HADS): time point 1 (T1), at commencement of ART; time point 2 (T2), approximately 2 months after treatment; and time point 3 (T3), 2-5 years after first treatment.

    MAIN OUTCOME MEASURES: Anxiety and depression (HADS), pregnancy outcome and future reproductive plans.

    RESULTS: The vast majority of lesbian women undergoing assisted reproduction reported no symptoms of anxiety and depression at the three assessment points. A higher percentage of the treated women, compared with the partners, reported symptoms of anxiety at T2 (14% versus 5%, P = 0.011) and T3 (10% versus 4%, P = 0.018), as well as symptoms of depression at T2 (4% versus 0%, P = 0.03) and T3 (3% versus 0%, P = 0.035). The overall pregnancy outcome was high; almost three-quarters of lesbian couples gave birth 2-5 years after sperm donation treatments. Open-ended comments illustrated joy and satisfaction about family building.

    CONCLUSION: Lesbian women in Sweden reported good psychological health before and after treatment with donated sperm.

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  • 29.
    Boson, Maria
    et al.
    Dalarna University, School of Health and Welfare.
    Sundlöf, Sofia
    Dalarna University, School of Health and Welfare.
    Skiljer sig interventioner och förlossningsutfall mellan äldre och yngre förstföderskor med spontan värkstart?: en kvantitativ retrospektiv tvärsnittsstudie2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The age of first-time mothers increases in high-income countries and with increasing age, the risk of pregnancy related complications gets more common. The proportion of interventions that are needed to initiate, strengthen and monitor the psychological birth process is also increasing. Aim: The aim of this study was to investigate if interventions and delivery outcomes differ between older nulliparous women (≥35 years) and younger nulliparous women (20–24 years) with spontaneous onset of labor. Method: We conducted a quantitative retrospective cross-sectional study where data were collected from a hospital in Sweden. The material, which consisted of 232 nulliparous women, was processed with descriptive and comparative statistical analyzes. Results: In our study, we found that older nulliparous women more often received extended fetal monitoring and gave birth to babies weighing 4,500 grams or more compared to younger nulliparous women. Regardless of age, nulliparous gave birth vaginally and interventions such as administration of oxytocin and fetal scalp electrodes were used in around half of the births. Conclusion and clinical implications: There were few significant differences between the compared age groups. Our study didn’t show large differences between the age groups, however, research shows that age is a risk factor. As a midwife, you must consider that age is only one factor in assessing the woman giving birth.

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  • 30.
    Bouchiba Testouri, Sabrine
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Ögren, Emilia
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Kvinnors upplevelse av sexuell hälsa efter barnafödande: En kvalitativ metasyntes2019Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Sexuell hälsa definieras som ett tillstånd av fysiskt, psykiskt, emotionellt och socialt välbefinnande i relation till sexualitet. Att uppnå god sexuell hälsa är viktigt för kvinnors livskvalitet. Barnafödandet innebär en stor omställning i kvinnan och hennes parters liv. Det finns önskemål från kvinnor att samtala mer om den sexuella hälsan med sin barnmorska. Syfte: Syftet med denna studie var att beskriva kvinnors upplevelse av sexuell hälsa efter en förlossning, oavsett förlossningssätt. Metod: Kvalitativ metasyntes med metaetnografisk ansats. Datainsamling utfördes i databaserna CINAHL, PubMed och Web of Science. 15 artiklar kvalitetsgranskades och ingick i metasyntesens resultat. Resultat: Fyra huvudkategorier: Påverkad kroppsuppfattning, Sexuellt umgänge efter förlossning, Barnet i fokus samt Stöd och information. Till dessa följde sex underkategorier: Förändrad självbild, Bröstens tudelade syfte, Tidpunkt för återupptagande, Problem som uppstår, Från barnmorska och annan vårdpersonal och Från närstående. Slutsats: Kvinnors sexuella hälsa påverkas efter barnafödande. Kvinnors fysiska och psykiska mående påverkas, men även relationen till partnern. Kvinnor upplever brist på stöd och information från barnmorskor och annan vårdpersonal. Klinisk tillämpbarhet: Resultatet kan användas för att skapa en ökad förståelse och kunskap hos barnmorskor om vikten av kvinnors sexuella hälsa efter barnafödande.

  • 31.
    Busnardo, Solène Marie
    et al.
    Dalarna University, School of Health and Welfare.
    Giannakopoulou, Aikaterini
    Dalarna University, School of Health and Welfare.
    Alqarqani, Alhusayn Abdulhamid Hilal
    Dalarna University, School of Health and Welfare.
    Global policies on maternal mental health: A Scoping Review with a Policy Mapping2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Mental health (MH) has until recently been a neglected subject which is gradually being recognized from the governments worldwide. Although women are increasingly seeking for emotional support during the pregnancy period and the first year after birth, the main attention and studies remain focused on the medical aspects of those periods. leaving the various health policies and intervention plans addressing perinatal MH, insufficient and/or incomplete.

    Aim: This Scoping Review aims to present a worldwide Policy Mapping of the latest maternal mental health (MMH) policies from government agencies and major non-governmental organizations (NGOs), and a more in-depth view of recurrent influential factors across a few of the policies that acknowledge the MH of various vulnerable groups of women.

    Methodology: A Policy Mapping and a Scoping Review were chosen as the appropriate designs to present the percentage of countries that show awareness of MMH issues globally. A deductive Content Analysis identified recurrent categories in seven selected interrelated policies and provided a qualitative description of the findings.

    Results: The results of the quantitative research identified 103 countries that raise awareness on MMH in their latest policies, and 89 of them were from governmental sources. The study revealed 139 countries that had either no reachable data or did not address the issue in their policies. The Content Analysis of the seven selected policies identified a main category entitled ‘Influential socio-economic factors’ and two generic categories ‘Socio-cultural behaviors’ and ‘Socio-education inequalities’ with subcategories which highlight the family and individualism as both a strength and a burden for MMH. A holistic view of individuals in their specific context and the importance of speaking a common language is essential for appropriate mental healthcare. In low socio-economic groups more stigma and less identification of mental health issues is described.

    Conclusions: This study provides a global overview of the current awareness on MMH and supports world policy makers in strengthening the plans proposed on MMH issues. It sheds light on the need for contextualization and reflects the common needs and challenges for vulnerable groups of women.

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  • 32. Carlander, A. K. K.
    et al.
    Andolf, E.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Health-related quality of life five years after birth of the first child2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 2, p. 101-107Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to describe the overall health-related quality of life (HRQoL) in women five years after the birth of their first child as well as the HRQoL in relation to mode of delivery. Methods: 545 first-time pregnant women, drawn from a hospital situated in Sweden, consented to be included in a cohort. Five years after the birth of the first child, 372 (68%) women agreed to participate in a follow-up study. HRQoL was measured using the Swedish Health-Related Quality of Life Survey (SWED-QUAL) questionnaire. Socio-demographic background and variables related to pregnancy and childbirth were collected using a self-report questionnaire. Results: Overall, the HRQoL was perceived to be good. Suboptimal scores were obtained for the three variables: Sleeping problems, Emotional well-being - negative affect and Family functioning - sexual functioning. Women having a vaginal birth, an instrumental vaginal birth or women who underwent caesarean section on maternal request were more likely to report better perceived HRQoL than women who had undergone an emergency caesarean section or caesarean section due to medical indication. Conclusion: This study demonstrates that the overall HRQoL of the women in the cohort was reported as good. Mode of delivery was associated with differences in HRQoL five years after birth of the first child. Our result suggests that some differences in perceived HRQoL persist in the long term. © 2015 Elsevier B.V.

  • 33. Carlander, A. -KK.
    et al.
    Edman, G.
    Christensson, K.
    Andolf, E.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Contact between mother, child and partner and attitudes towards breastfeeding in relation to mode of delivery2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate contact between mothers and their newborn child and study if there are differences between those who requested an elective caesarean section compared to women who had a vaginal birth and those who underwent an elective caesarean section due to obstetrical indication. The psychometric properties of a scale that measure the contact between mother and child were also investigated. Design: A prospective cohort study. Setting: Danderyd Hospital, Stockholm, Sweden. Sample: 510 primiparas from three groups: women undergoing caesarean section on maternal request (n = 96), women undergoing caesarean section on obstetrical indication (n = 116) and women planning a vaginal delivery (n = 198). The later were further divided into subgroups; women who underwent assisted vaginal delivery (n = 35) and women who had an emergency caesarean section (n = 65). Methods: The instrument used was the Alliance Scale. Main outcome measure: The contact between mother and child in relation to mode of delivery. Results: The contact with the child was rated as positive on all occasions: there were no significant differences between the groups. The relation to the partner was rated as positive at all occasions. Mothers with a vaginal delivery experienced breastfeeding less stressful than the mothers with a caesarean delivery. Three and nine months after delivery the mothers with a caesarean delivery on request reported more breastfeeding problems than mothers in the other groups. Mothers with a vaginal delivery rated less sadness at every occasion. Conclusion: Mode of delivery does not seem to affect how mothers experience their contact towards the newborn child. © 2009 Elsevier B.V. All rights reserved.

  • 34.
    Chakma, Ripana
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Khatun, Minara
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Soddoqio, Noor-E-Alam
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Continuous Labour Support: A concept analysis2019Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The concept of ‘continuous labour support’ is a non-medical support, one-toone support and continuous presence. Aim: The aim of this study is to define the concept ‘continuous labour support’ through the synthesis of texts from literatures and interview data with Bangladeshi health care providers, in an attempt to clarify its meaning enabling comprehension and use of the concept in clinical practice and education. Design: The study design is concept analysis with data consisting of written texts from literature and nine semi structured interviews in nursing institutes, nursing colleges and maternity wards in Bangladesh. Measurements and finding: The result of the fieldwork phase of this study regarding continuous labour support has been categorized according to the midwifery and quality care model developed. The main challenges are staff shortages, heavy workload, and low level of autonomy in medical hierarchy and insufficient and interrupted supplies. Conclusion: Continuous support during childbirth is an important and essential component of midwifery practices, but it is not widely and universally practiced in the Bangladeshi hospitals due to different policy levels and contextual causes. Clinical implications: Practical findings from the concept analysis confirms the relevance of the concept in the midwifery context.

  • 35.
    Chowdhury, Pinky
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Hossain, Quazi Mamun
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Family Planning advice during Postpartum Care: A concept analysis2019Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Midwifery education has been provided in Bangladesh since 2013. Midwiferycare includes family planning, normal physiological process of pregnancy, birth, and thepostpartum period up to six weeks including newborn care. The aim is to define the concept“Family planning advice during postpartum care” through the synthesis of text from literatureand interview with Bangladeshi health care providers.Methods: This study design is a concept analysis from the literature and nine semi-structuredinterviews with third-year midwifery students, clinical midwives and midwifery faculty.Results: The results of the concept analysis are the description of the concept "familyplanning advice during postpartum care” through the lens of the Quality Maternal andNewborn Care Framework (QMNCF), as well as barriers and possibilities of the concept inthe Bangladeshi context.Conclusion: The study provided descriptions useful for the teaching of midwifery students,different family planning methods and they could be more clearly described in curriculum andsyllabuses. There has not been other similar studies done in the new midwifery context ofBangladesh.Clinical implications: The findings of this concept analysis is of relevance to the midwiferycontext.

  • 36. Curtis, C.
    et al.
    Faundes, A.
    Yates, A.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Bokosi, M.
    Lacoste, M.
    Postabortion family planning progress: The role of donors and health professional associations2019In: Global Health Science and Practice, ISSN 2169-575X, Vol. 7, p. S222-S230Article in journal (Refereed)
  • 37.
    Dogland, Andréa
    Dalarna University, School of Health and Welfare.
    Experiences of women that have been exposed to female genital mutilation2021Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Female genital mutilations (FGM) is against human rights. Not only does FGM creates different complications during a person’s sexual and reproductive life but it can also affect a person’s psychological emotion. FGM comes in four different varietyAim: To examine the experience of women that has been subjected to female genital mutilations.Methodology: A literature review including 14 studies, with a qualitative approach. The studies have been analyzed with Evans analyzing model.Results: Result show three different themes and five different sub-themes. FGM is seen as part of a tradition and is seen as a cultural devotion. Many believe that the act of FGM is something that should stop while some believe that it is a good way to be part of a community. FGM is seen as something that help women to control their sexual desire and away to keep girls from have sex before marriage. When moving to other countries were FGM was not a custom some women started to question FGM and some felt more excluded from the new society.Conclusion: FGM is very complex. Looking at FGM we need to look at more than just the act of cutting, we need to look at the deeply rooted tradition and how it holds societies in a firm grip. More efforts needs to be put in place to change the mind of generations of people so that FGM finally will end.

  • 38.
    Eggeh, Hamda Abdisamad
    Dalarna University, School of Health and Welfare.
    Somali Mothers’ Knowledge and Parenting Practices on Child Development: A Qualitative Study with Mothers Living in Borama, Somaliland2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: The long history of research on the parent-child relationship has focused almost exclusively on how parents influence the development of their offspring. Parenting knowledge has been associated with the improvement of the child and its life expectancy through direct and indirect effects, mediated by other factors, including socioeconomic status and living conditions.

    Aim/ research questions: The study investigated Somali mothers’ knowledge and parenting practices on child development in Borama District, Somaliland.

    Methodology: This study employed an inductive qualitative design, using in-depth interviews. Ten mothers were recruited from three maternal and child health centers in Somaliland. A qualitative thematic analysis was used to analyze the interview transcripts.

    Results: The study found that mothers have knowledge about factors that contribute to child development, such as adequate nutrition. The participants demonstrated that they have knowledge about what is expected from their children when it comes to social and behavioral skills. They expected their children to be obedient and to follow the social values and norms. There were some traditional child-rearing practices that mothers did not want to continue, such as physical punishment and female genital mutilation.

    Conclusion: Our study found that mothers have knowledge about the nutritional requirements of their children in the first years and the expected social and behavioral skills at the age of six to eight years. However, mothers did not have much understanding of factors contributing to cognitive development. The findings from this study stress the need for developing and tailoring parenting education programs to increase Somali mothers’ knowledge of child development.

  • 39.
    Ehrling, Malin
    Dalarna University, School of Education, Health and Social Studies, Caring Science.
    Kvinnans individuella upplevelse av förlossningssmärta: En begreppsanalys2017Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background:

    Labor pain is a term used in education and healthcare, where women are cared for during pregnancy and in maternity wards. How the concept is defined is described in literature and how and what is covered by the concept is wide. Labor pain has great location within maternity care but as a concept it is relatively undefined. Aim: The aim was to describe the concept of labor pain through a concept analysis. Methods: A concept analysis with qualitative design. Five midwives were selected trough a convenience sampling and were interviewed; earlier a literature review was conducted. The result from the field study phase was brought together with the result from the theoretical phase. Results: After the analysis of the concept of labor pain the main results is that it is truly one unique experience of labour pain. Defined three dimensions sensory, affective and cognitive. The sensory dimension stands for physiology, the affective dimension for earlier experiences and the cognitive dimension for how a person thinks about pain and the experience of it. Pain in labour is a unique experience. Only the woman in labour knows how it feels like. Pain during labour is an individual experience and just like all other experience it has its unique and individual interpretation for the person involved. Conclusion: Labor pain can be identified as a complex concept adapted to each pregnancy based on the defined dimensions. Clinical applicability: Clarification of the concept is important in education of midwifery students.

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  • 40.
    Ekström, Annika
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Beskrivning av en kulturellt anpassad kurs för blivande mödrar med familjer i Nepal: En kvalitativ intervjustudie med sjukvårdspersonal2018Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Since poverty and lack of transportation make it hard for people to have access to hospital care, it is common that a pregnant woman deal with her pregnancy, childbirth and postpartum time on her own or with help of family members. This is the most vulnerable period of a woman life and knowledge about danger signs and signs of complications could be life-saving to women who are affected. Antenatal education is therefore suggested in various studies and relevant topics for such courses are expected to be reviled through the results of this study. Aim: The aim of this study was to describe topics and outline of a culturally tailored antenatal education to families in Nepal, illuminated by healthcare providers experiences. Methods: A qualitative design with semi-structured interviews was chosen. An interview guide was prepared beforehand with topics inspired by the Swedish antenatal education guide. A total of 26 interviews with healthcare providers including midwives, skilled birth attendants (SBA’s), medical doctors, village nurses or nurses, were conducted in both urban and rural areas in Nepal form province 3, 4 and 5. Findings: This study identified health care providers’ perceptions of what to include in a country contextual adjusted antenatal education/family support program to Nepali parents and potentially to other family members of the extended family. The descriptions of what to include in the parental education/family support program, provide a wide range of areas, this in a context where parental education does not exist. Five main themes were found; Course format and content, Pregnancy, Birth preparedness, Childbirth and postpartum. Conclusion: Increased knowledge and more involvement of fathers in pregnancy, childbirth and in the care of the child will promote equality between men and women in Nepal. Furthermore, it may empower women with self-confidence and their decision-making power regarding their own and their children’s health and wellbeing. Clinical application: This study may be used as an underlying document in the design of antenatal education for expectant parents and possibly extended family members in Nepal.

  • 41. Ekström, Å.
    et al.
    Altman, D.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Larsson, C.
    Andolf, E.
    Planned cesarean section versus planned vaginal delivery: Comparison of lower urinary tract symptoms2008In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 19, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

    We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p < 0.001) and 9 months (p = 0.001) follow-up. In a multivariable risk model, vaginal delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9 - 42] and for urinary urgency (RR 7.3 95% CI 1.7 - 32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5 - 19) and at 3 months follow-up (OR 3.9, 95% CI 1.7 - 8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section. © International Urogynecology Journal 2007.

  • 42. Elgemark, Karin
    et al.
    Graner, Sofie
    McTaggart, Julia
    Ramirez Löfström, Jennie
    Sörensen, Daniela
    Envall, Niklas
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Danderyd Hospital; Karolinska Institute, Stockholm.
    Kopp Kallner, Helena
    The 13.5-mg, 19.5-mg, and 52-mg Levonorgestrel-Releasing Intrauterine Systems and Risk of Ectopic Pregnancy2022In: Obstetrics and Gynecology, ISSN 0029-7844, E-ISSN 1873-233X, Vol. 140, no 2, p. 227-233Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the Pearl Index for risk of ectopic pregnancy in women using levonorgestrel-releasing intrauterine systems (LNG-IUS) with hormonal reservoirs of 13.5 mg, 19.5 mg, or 52 mg. METHODS: This was a retrospective cohort study. Women diagnosed with an ectopic pregnancy in Stockholm County, Sweden, between January 1, 2014, and December 31, 2019, were identified through the electronic medical record system. The final analysis included 2,252 cases of ectopic pregnancy. Information on age, reproductive and medical history, as well as current use of contraception was retrieved. The time of intrauterine device (IUD) insertion before ectopic pregnancy and the numbers of sold LNG-IUS during the study period were used to calculate the incidence rate for ectopic pregnancy during use per 100 woman-years (Pearl Index). RESULTS: Among women with an ectopic pregnancy diagnosis, 105 presented with a known type of hormonal IUD in situ, of whom 94 were included in the calculations of the Pearl Index. The estimated Pearl Index for ectopic pregnancy was 0.136 (95% CI 0.106-0.176) for the LNG-IUS 13.5-mg, 0.037 (95% CI 0.021-0.067) for the LNG-IUS 19.5-mg, and 0.009 (95% CI 0.006-0.014) for the LNG-IUS 52-mg. With the 52-mg LNG-IUS as referent, the relative risk (RR) for ectopic pregnancy was higher during the first year for LNG 13.5-mg (RR 20.59, 95% CI 12.04-35.21), and for both 13.5-mg (RR 14.49, 95% CI 9.01-23.3) and 19.5-mg (RR 4.44, 95% CI 1.64-12.00) during the total study period. CONCLUSION: The absolute risk of ectopic pregnancy during the use of LNG-IUS at any doses was low. The results show that the lower the dose of the IUD, the higher the risk of an ectopic pregnancy. Higher-dose LNG-IUS should be considered when providing contraceptive counseling to a woman with known risk factors for ectopic pregnancy who are considering a hormonal IUD. Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

  • 43. Emtell Iwarsson, Karin
    et al.
    Envall, Niklas
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Karolinska Institutet, Stockholm.
    Bizjak, Isabella
    Bring, Johan
    Kopp Kallner, Helena
    Gemzell Danielsson, Kristina
    Increasing uptake of long-acting reversible contraception with structured contraceptive counselling: cluster randomised controlled trial (the LOWE trial).2021In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 128, no 9, p. 1546-1554Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the effect of structured contraceptive counselling on uptake of long-acting reversible contraceptives (LARCs), and pregnancy rates.

    DESIGN: Cluster randomised trial SETTING: Abortion, youth, and maternal health clinics in Stockholm, Sweden.

    POPULATION: Sexually active women ≥18 years without a wish for pregnancy seeking abortion and/or contraceptive counselling.

    METHODS: For participants in clinics randomised to intervention, trained health care providers implemented a study-specific intervention package designed for structured contraceptive counselling. Participants in the control clinics received routine counselling.

    MAIN OUTCOME MEASURES: Primary outcome was choice of LARCs at first visit. Secondary outcomes were LARC initiation at three months and pregnancy rates at three and 12 months. We used logistic mixed-effects models with random intercept for clinic to account for clustering.

    RESULTS: From September 2017 to May 2019, 28 randomised clinics enrolled 1364 participants. Analyses including 1338 subjects showed that more participants in the intervention compared to control group chose LARCs (267/658 (40.6%) versus 206/680 (30.3%), odds ratio (OR) 2.77, 95% CI 1.99 to 3.86). LARC initiation was higher in the intervention compared to the control group (213/528 (40.3%) versus 153/531 (28.8%), OR 1.74, 95% CI 1.22 to 2.49). At abortion clinics, pregnancy rate was significantly lower at 12 months in the intervention versus the control group (13/101 (12.9%) versus 28/103 (27.2%), OR 0.39, 95% CI 0.18 to 0.88).

    CONCLUSIONS: Structured contraceptive counselling increased LARC uptake in all clinics and significantly reduced unintended pregnancy rates in abortion clinics at 12 months follow-up.

  • 44.
    Emtell Iwarsson, Karin
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Larsson, Elin C
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
    Bizjak, Isabella
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Envall, Niklas
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Kopp Kallner, Helena
    Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Obstetrics and Gynaecology, Danderyd Hospital, Stockholm, Sweden.
    Gemzell-Danielsson, Kristina
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Division of Gynaecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Long-acting reversible contraception and satisfaction with structured contraceptive counselling among non-migrant, foreign-born migrant and second-generation migrant women: evidence from a cluster randomised controlled trial (the LOWE trial) in Sweden.2022In: BMJ sexual & reproductive health, ISSN 2515-1991, Vol. 48, no 2, p. 128-136Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This trial aimed to evaluate effects of structured contraceptive counselling among non-migrants, foreign-born migrants and second-generation migrants.

    METHODS: A cluster randomised controlled trial was conducted in 2017-2019 at abortion, youth and maternal health clinics in Stockholm, Sweden (the LOWE trial). Patients were eligible if they were 18 years or older, could understand Swedish or English (or if assisted by an interpreter), were sexually active or planning to be, and were seeking contraception for pregnancy prevention. We randomised clinics at a 1:1 allocation ratio to give either structured contraceptive counselling (intervention) or to maintain standard contraceptive counselling (control). Blinding was not deemed feasibile. A study-specific package for structured contraceptive counselling was used and comprised an educational video, an effectiveness chart, four key questions and a box with contraceptive models. Outcomes were effects of the intervention on long-acting reversible contraception (LARC) choice, initiation and use, and satisfaction with the intervention material among the participants.

    RESULTS: We involved 14 clinics in each of the intervention and control groups, respectively. A total of 1295 participants were included: 1010 non-migrants, 169 foreign-born migrants and 116 second-generation migrants. Participants in the intervention group chose LARC to a higher extent than the control group (adjusted OR (aOR) 2.85, 95% CI 2.04-3.99), had higher LARC initiation rates (aOR 2.90, 95% CI 1.97 to 4.27) and higher LARC use within the 12-month follow-up period (aOR 2.09, 95% CI 1.47 to 2.96). The majority of the participants who received the intervention package found all the different parts to be supportive in contraceptive choice. The effectiveness chart was the only part of the package that a higher proportion of foreign-born migrants (58/84, 69%) and second-generation migrants (40/54, 74.1%) found supportive in contraceptive choice compared to non-migrants (259/434, 59.7%) (p = 0.048).

    CONCLUSIONS: Structured contraceptive counselling increased LARC choice, initiation and use, controlled for participants' migration background. The effectiveness chart was found to be significantly more supportive among foreign-born migrants and second-generation migrants compared to non-migrants when choosing contraceptive methods.

    TRIAL REGISTRATION NUMBER: NCT03269357.

  • 45.
    Englund, Linda
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    KASAM, känslor och hälsa i samband med barnafödande: En deskriptiv tvärsnittsstudie2020Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: A positive childbirth experience that meets the woman's expectations is more than giving birth to a healthy baby. The research often focuses on the medical outcome of childbirth. If one instead focuses on what maintains health as in the salutogenic model, one can gain increased knowledge about women's birth experience. Purpose: The aim of this study was to investigate sense of coherence in relation to women's feelings and health in connection with childbirth.   Methods: The method was a descriptive cross-sectional study. A questionnaire was answered 2–3 months after giving birth. 1193 women agreed to participate in the study and 738 women answered, giving a response rate of 62%.  Results: Women with a high SOC did to a higher extent describe their feelings of security, control, pride higher and estimated also their physical health and mental well-being higher. Women with low SOC rated to a higher extent that the staff contributed to a feeling of being ignored and failed during labour and birth. The result showed no significant differences between SOC and demographic data, parity or birth outcomes.  Conclusion: Women's experience of feelings and emotions during childbirth is connected to their sense of coherence. A higher focus is required to women with low SOC in order to improve their positive feelings during childbirth, and thereby contributing to increased physical and mental health.  Clinical applicability: SOC can be used as a screening tool during pregnancy to identify those women who need increased support during childbirth.

  • 46.
    Envall, Niklas
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Karolinska Institutet.
    Emtell Iwarsson, K.
    Bizjak, I.
    Gemzell Danielsson, K.
    Kopp Kallner, H.
    Evaluation of satisfaction with a model of structured contraceptive counseling: Results from the LOWE trial2021In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 100, no 11, p. 2044-2052Article in journal (Refereed)
    Abstract [en]

    Introduction: Intervention trials of structured contraceptive counseling have proved to increase use of long-acting reversible contraceptives (LARCs) and decrease numbers of unintended pregnancies. However, these interventions have not been evaluated from a user perspective. This study aimed to evaluate both healthcare providers’ and participants’ satisfaction with an intervention used in a large trial in Sweden. Material and methods: A cross-sectional study on the intervention group from a cluster randomized trial conducted at 28 clinics in Stockholm, Sweden. Clinics were randomized (1:1 allocation ratio) to provide either structured contraceptive counseling (intervention) or standard contraceptive counseling (control). The intervention consisted of four parts; an educational video to be seen by the participant prior to contraceptive counseling, key questions to be asked by the healthcare provider, an effectiveness chart, and a box of contraceptive models. Eligible participants were 18 years or older, sexually active without a wish to conceive, and with the main purpose of contraceptive use being pregnancy prevention. Healthcare providers completed an electronic semi-structured survey to evaluate the intervention. This study analyses provider and participant satisfaction with the counseling material used in the intervention and if the intervention was found to be supportive in contraceptive counseling and contraceptive choice. Trial registration: ClinicalTrials.gov (NCT03269357). Results: Fourteen intervention clinics enrolled 658 participants from September 2017 to May 2019. Response rate among providers was 88.0% (55/62) and among participants 97.1% (639/658). Providers found the intervention to be supportive in their counseling. Each separate part of the intervention package received high ratings from both providers and participants. Participants found the educational video and the effectiveness chart to be more helpful than the box of contraceptive models in their contraceptive choice. Providers reported the time taken to complete the intervention outside the study to be time-neutral to standard counseling, and most providers wished to continue to use all parts of the intervention package. Conclusions: The intervention of structured contraceptive counseling had high provider and participant satisfaction. The structured counseling package could be used in several clinical settings to improve quality in contraceptive counseling and to enhance informed decision making about use of contraceptive methods. © 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG)

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  • 47.
    Envall, Niklas
    et al.
    Karolinska institutet.
    Graflund Lagercrantz, Helena
    Sunesson, Jessica
    Kopp Kallner, Helena
    Intrauterine mepivacaine instillation for pain relief during intrauterine device insertion in nulliparous women: a double-blind, randomized, controlled trial2019In: Contraception, ISSN 0010-7824, E-ISSN 1879-0518, Vol. 99, no 6, p. 335-39Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: 

    To evaluate whether intrauterine mepivacaine instillation before intrauterine device (IUD) insertion decreases pain compared to placebo.

    STUDY DESIGN: 

    We performed a double-blind, randomized, controlled trial comparing mepivacaine 1% 10 mL versus 0.9% NaCl intrauterine instillation using a hydrosonography catheter 5 min before IUD insertion in women 18 years of age or older. Participants completed a series of 10-cm visual analogue scales (VAS) to report pain during the procedure. The primary outcome was the difference in VAS scores with IUD insertion between intervention group and placebo. Secondary outcomes included VAS before and after insertion and analgesia method acceptability.

    RESULTS: 

    We randomized 86 women in a 1:1 ratio; both groups had similar baseline characteristics. In the intention-to-treat analysis, the primary outcome, median VAS with IUD insertion, was 4.8 cm in the intervention group [n=41, interquartile range (IQR) =3.1-5.8] and 5.9 cm in the placebo group (n=40, IQR=3.3-7.5, p=.062). In the per-protocol analysis, the median VAS with IUD insertion was 4.8 cm (IQR=3.1-5.5) and 6.0 cm (IQR=3.4-7.6) for the intervention and placebo groups, respectively (p=.033). More women in the intervention group reported the procedure as easier than expected (n=26, 63.4% vs. n=15, 37.5%), and fewer reported it as worse than expected (n=3, 7.3% vs. n=14, 35%, p=.006).

    CONCLUSION: 

    Intrauterine mepivacaine instillation before IUD insertion modestly reduces pain, but the effect size may be clinically significant.

    IMPLICATIONS STATEMENT: 

    While the reduction in VAS pain scores did not meet our a priori difference of 1.3 points for clinical significance, participants' favorable subjective reaction suggests that this approach merits further study.

    Copyright © 2019 Elsevier Inc. All rights reserved.

    KEYWORDS: 

    Contraception; Intrauterine devices; Mepivacaine; Pain; VAS

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  • 48. Envall, Niklas
    et al.
    Kopp Kallner, Helena
    Groes Kofoed, Nina
    Use of effective contraception 6 months after emergency contraception with a copper intrauterine device or ulipristal acetate - a prospective observational cohort study2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 8, p. 887-95Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Emergency contraception must be followed by the use of an effective method of contraception in order to reduce future risk of unintended pregnancies. Provision of long-acting reversible contraception (LARC) is highly effective in this regard. The aim of our study was to compare use of an effective method of contraception 6 months following insertion of a copper intrauterine device (Cu-IUD) or intake of ulipristal acetate (UPA) for emergency contraception (EC).

    MATERIAL AND METHODS:

    Women (n = 79) presenting with need for EC at an outpatient midwifery clinic chose either Cu-IUD or UPA according to preference. Follow up was 3 and 6 months later through telephone interviews. Primary outcome was use of an effective contraceptive method at the 6-month follow up. Secondary outcomes included use of an effective contraceptive method at 3 months follow up and acceptability of Cu-IUD.

    RESULTS:

    A total of 30/36 (83.3%) women who opted for Cu-IUD for EC used an effective contraceptive method 6 months after their first visit compared with 18/31 (58.1%) women who opted for UPA (p = 0.03). In the Cu-IUD group 28/36 (77.8%) were still using Cu-IUD at 6 months and 31/36 (86%) stated that they would recommend the Cu-IUD to others as an EC method.

    CONCLUSION:

    Significantly more women who chose Cu-IUD for EC used an effective method for contraception at the 6-month follow up. The results of this study support increased use of Cu-IUDs for EC.

  • 49.
    Envall, Niklas
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm; Department of Women's and Children's Health, Karolinska Institutet, Stockholm.
    Wallström, Tove
    Department of Clinical Science and Education, South General Hospital Stockholm, Stockholm; Department of Obstetrics and Gynecology, South General Hospital Stockholm, Stockholm.
    Gemzell Danielsson, Kristina
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm; WHO Collaborating Centre, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm.
    Kopp Kallner, Helena
    Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet, Stockholm; Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm.
    Use of contraception and attitudes towards contraceptive use in Swedish women: an internet-based nationwide survey2022In: European journal of contraception & reproductive health care, ISSN 1362-5187, E-ISSN 1473-0782, Vol. 27, no 5, p. 409-417Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Explore contraceptive use, unmet need of and attitudes towards contraceptive use in Sweden. Secondly, to investigate knowledge of contraceptives, prevalence and outcomes of unintended pregnancies.

    MATERIALS AND METHODS: Internet based e-survey of Swedish women aged 16-49. The e-survey contained 49 questions with both spontaneous and multi-choice character on demographics, contraceptive use, knowledge of and attitudes towards contraception, importance of monthly bleeding, and experience of unintended pregnancy. The e-survey was closed when reaching the estimated sample size of 1000 respondents.

    RESULTS: A total of 1016 women participated, whereof 62.4% used contraception, 31.8% did not and 5.8% had stopped in the last 12 months. Unmet need for contraception was estimated at 17.2%. At least one unintended pregnancy was experienced by 19.9%. All women rated effectiveness as the most important characteristic of a contraceptive method.

    CONCLUSIONS: Use of contraception in Swedish women remains low, 62.4%, and the unmet need for contraception has increased to 17.2%. Method effectiveness and health benefits of hormonal contraception should be emphasised during contraceptive counselling, and actions are needed to target groups with low use of effective contraception as well as to reach those who never seek contraception.

    KEY MESSAGE Close to one third of Swedish women do not use contraception and one fifth have experienced at least one unintended pregnancy. Unmet need for contraception is high despite easy access and subsidies for young women.

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  • 50.
    Eriksson, Magdalena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Zetterlund, Jolie
    Dalarna University, School of Education, Health and Social Studies, Sexual Reproductive Perinatal Health.
    Midwives’ experiences of becoming and being a midwife in the post-conflict setting of Somaliland.: An interview study2018Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Working as a midwife means being an important key to health and counsellor for women, their families and the community. Post conflict refer to the fragile situation occurring after a conflict. The effects of the war in Somalia led to a collapse of the health care system, with consequences for midwives catering for women before, during and after childbirth.

    Purpose: To describe midwives’ experiences of becoming and being a midwife in the post-conflict setting of Somaliland.

    Method: A qualitative and empirical interview study with inductive approach was chosen for this study to gain broader a view of midwives' experiences. Eleven individual interviews with midwives were analysed by thematic analysis.

    Findings: Time as refugees and current social situation were factors that had shaped the midwives, as well as challenges in professional life related to lack of equipment and training, encountering women with low health status, and women in need of additional health education and awareness in general and in reproductive health. Improvement of women's health and rights was also described as a key part of the midwives' jobs.

    Conclusion: Previous life experiences combined with challenges in working life and the desire to change and improve were of great importance for the midwives working in the post conflict setting of Somaliland and gave the them roles as changemakers for Somali women.

    Clinical Applicability: This study can be used to increase the understanding of women’s health and the prerequisites for midwives and women living in, or originating from, a conflict or post conflict setting with experiences of war and displacement.

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