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  • 1. Ahmed, Caisha Arai
    et al.
    Khokhar, Amrish Tayyibah
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Bogren, Malin
    Defibulated immigrant women's sexual and reproductive health from the perspective of midwives and gynaecologists as primary care providers in Sweden - A phenomenographic study.2021Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 29, artikkel-id 100644Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To capture care providers' perceptions of defibulated immigrant women's sexual and reproductive health, illuminated by their experiences as care providers for these women.

    METHODS: Individual interview study with 13 care providers at Swedish healthcare facilities: six gynaecologists and seven midwives caring for defibulated immigrant women, analysed with a phenomenographic method.

    FINDINGS: One of the care providers' perceptions of women who had been defibulated was that they had an altered genital function, meaning a wider introitus, improved vaginal intercourse, and more ease urinating and menstruating. The care providers also perceived that women who were defibulated had to balance their wellbeing, struggling between a positive self-image and handling their emotions. Existing in-between cultural values led to a fear of being excluded while at the same time having a desire to be included in the new culture.

    CONCLUSION: Defibulation affects women's sexual and reproductive health and calls for a holistic perspective when providing services, individualized according to the woman's care needs. Support and counselling, should include information about defibulation already during the adolescent years to promote sexual and reproductive health and well-being.

  • 2.
    Armuand, Gabriela
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Grandahl, Maria
    Uppsala University.
    Volgsten, Helena
    Uppsala University.
    Stern, Jenny
    Uppsala University; Sophiahemmet University, Stockholm.
    Characteristics of good contraceptive counselling - An interview study2024Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 39, artikkel-id 100948Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: One key component in preventing unplanned pregnancies is to provide effective contraceptive counselling. This study aimed to investigate what characterises good contraceptive counselling from the woman's perspective.

    METHODS: A qualitative study with a phenomenological approach. Twenty-four women aged 15-45 participated in semi-structured, individual, face-to-face interviews that lasted, on average, one hour. Data were analysed by latent content analysis.

    RESULTS: One overall theme emerged, person-centred contraceptive counselling - an interactive process, with three main categories: (i) a trustworthy healthcare provider, (ii) creating a liaison and (iii) the right time and place.

    CONCLUSIONS: The healthcare provider's attributes as well as what happened between the healthcare provider and the woman, and the surrounding context, had a bearing on the women's descriptions of good contraceptive counselling. The process of the counselling was described as more important than the actual outcome; thus, healthcare providers need to be aware that this seemingly straightforward consultation is rather multi-layered and has great health promoting potential.

    Fulltekst (pdf)
    fulltext
  • 3.
    Assaysh-Öberg, Shereen
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Borneskog, Catrin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Ternström, Elin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Women's experience of infertility & treatment - A silent grief and failed care and support.2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, artikkel-id 100879Artikkel i tidsskrift (Fagfellevurdert)
    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.

    Fulltekst (pdf)
    fulltext
  • 4. Ayala, Ana
    et al.
    Christensson, Kyllike
    Velandia, Marianne
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Fathers’ care of the newborn infant after caesarean section in Chile: a qualitative study2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, s. 75-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In Chilean hospitals the current model of care after caesarean section is to separate newborn infants from both parents. The care of newborn infants and the parents' experience immediately after caesarean section requires further exploration.

    Aim: To describe fathers' experiences and perceptions of being the primary caregiver to their newborn infant during the first 90 minutes after caesarean section in a public general maternity hospital setting in Santiago de Chile.

    Method: The questionnaire was one part of a larger research programme named: “Caregiving Models after Elective Caesarean Section – Parents' perceptions and effects on infants' wellbeing”. Four open ended questions were used to gather written text on the experiences and perceptions of 95 fathers who were the primary caregiver to their newborn infant. Ethical approval was obtained from the Ethics Committee, Scientific Assessment Metropolitan Health Service South East. Systematic text condensation according to Malterud's description was used for analysis of the written text.

    Findings: Two themes were identified: “understanding the first moment of life” and “shared responsibility for future family life” with each theme divided into six categories.

    Conclusion: This study concludes by arguing that in situations where the mother is unavailable or unable to provide basic care, the father should be supported to care for the newborn infant.

    Clinical implications: Parents should be made aware of the benefits of this caring model especially when mother and baby have been separated after birth.

  • 5.
    Bogren, Malin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Opportunities, challenges and strategies when building a midwifery profession. Findings from a qualitative study in Bangladesh and Nepal2018Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, s. 45-49Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of this paper was to identify opportunities and challenges when building a midwifery profession in Bangladesh and Nepal.

    Methods

    Data were collected through 33 semi-structured interviews with government officials, policy-makers, donors, and individuals from academia and non-government organizations with an influence in building a midwifery profession in their respective countries. Data were analyzed using content analysis.

    Findings

    The opportunities and challenges found in Bangladesh and Nepal when building a midwifery profession emerged the theme “A comprehensive collaborative approach, with a political desire, can build a midwifery profession while competing views, interest, priorities and unawareness hamper the process”. Several factors were found to facilitate the establishment of a midwifery profession in both countries. For example, global and national standards brought together midwifery professionals and stakeholders, and helped in the establishment of midwifery associations. The challenges for both countries were national commitments without a full set of supporting policy documents, lack of professional recognition, and competing views, interests and priorities.

    Conclusion and clinical application

    This study demonstrated that building a midwifery profession requires a political comprehensive collaborative approach supported by a political commitment. Through bringing professionals together in a professional association will bring a professional status. Global standards and guidelines need to be contextualized into national policies and plans where midwives are included as part of the national health workforce. This is a key for creating recognized midwives with a protected title to autonomously practice midwifery, to upholding the sexual and reproductive health and rights for women and girls.

  • 6.
    Borneskog, Catrin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Engström, Gabriella
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Islam, Noor
    Dalarna University, Falun.
    Byrskog, Ulrika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Pedersen, Christina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Strömsöe, Anneli
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Medicinsk vetenskap.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    MSc student group,
    Public nursing institute in Bangladesh.
    Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, artikkel-id 100861Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    INTRODUCTION: Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions.

    METHOD: Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data.

    RESULTS: The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement.

    CONCLUSION: There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.

    Fulltekst (pdf)
    fulltext
  • 7.
    Byrskog, Ulrika
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Hussein, I. H.
    Yusuf, F. M.
    Egal, J. A.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    The situation for female survivors of non-partner sexual violence: A focused enquiry of Somali young women's views, knowledge and opinions2018Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 16, s. 39-44Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    The aim of the study is to elucidate young women’s perceptions of the situation for female survivors of non-partner sexual violence in Somaliland.

    Methods

    Young Somali women with diverse backgrounds (n = 25) shared views, knowledge and opinions about non partner sexual violence in focus group discussions held in urban settings. Data was analysed using content analysis.

    Results

    A main category “Bound by culture and community perceptions” with four subcategories comprises the informants’ perceptions of non-partner sexual violence among young women in Somaliland. Illuminated is the importance of protecting oneself and the family dignity, a fear of being rejected and mistrusted, how the juridical system exists in the shadow of tradition and potential keys to healthcare support.

    Conclusion

    The study raises awareness of the dilemmas which may be faced by young women subjected to non-partner sexual violence and healthcare providers in the intersection between state and traditional norms. Education is a key when it comes to a young woman considering the use of the services available in a society where traditional problem-solving is relied on parallel to state-based support. State-based functions, communities and families need to work together to provide comprehensive support to young female survivors of non-partner sexual violence in Somaliland.

  • 8.
    Bürger, Isabel
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Borneskog, Catrin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Perceived associations between the menstrual cycle and Attention Deficit Hyperactivity Disorder (ADHD): A qualitative interview study exploring lived experiences2024Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 40, artikkel-id 100975Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The research gap regarding Attention Deficit Hyperactivity Disorder (ADHD) in people who were assigned female at birth has led to a lack of knowledge and adequate approaches in clinical practice, as well as diagnosis processes. Recent studies report potential associations between reproductive hormones and ADHD, but existing research remains scarce.

    AIM: This study aims to explore the experiences of people who perceive an association between their menstrual cycle and their ADHD symptoms.

    METHODOLOGY: Design and Method. A qualitative research design with an inductive approach was used. Ten participants were interviewed, using semi-structured, in-depth interviews. The data was transcribed, coded, and analyzed using reflexive thematic analysis according to Braun and Clarke.

    RESULTS: Findings show participant's perceived associations between their ADHD and their menstrual cycle: participants reported experiencing ADHD symptom mor severe during the mid-luteal phase of the menstrual cycle. Other results showed uncertainty around ADHD medication in relation to the cycle and varied experiences with health care encounters as well as heightened challenged around menstrual health management.

    CONCLUSIONS: This study provides insights to how perceived associations between ADHD and the menstrual cycle might be experienced. This report highlights the need for further research and theory about the potential associations between ADHD and reproductive hormones. The researchers strongly suggested that forthcoming ADHD studies consider times of key hormonal changes, such as puberty and menarche, menopause, hormonal birth control, pregnancy, hormone treatment, and more.

    Fulltekst (pdf)
    fulltext
  • 9. 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 child2015Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, nr 2, s. 101-107Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 10. 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 delivery2010Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, nr 1, s. 27-34Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 11.
    Dahir, Gallad
    et al.
    Somali National University, Mogadishu, Somalia.
    Kulane, Asli
    Karolinska Institutet.
    Omar, Bakar
    Somali National University, Mogadishu, Somalia.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Somali National University, Mogadishu, Somalia.
    We have almost accepted child spacing. Let's wait on family planning and limiting children': Focus group discussions among young people with tertiary education in Somalia2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 35, artikkel-id 100828Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Somalia has high rates of maternal mortality, fertility and pregnancy among young women. Factors contributing to this situation are a lack of knowledge regarding sexual and reproductive health, early marriages, cultural norms and the unmet need for or use of contraceptives. This study aimed to explore the perceptions of family planning among young men and women with tertiary education in Mogadishu.

    METHODS: A purposeful and convenience strategy using snowballing was used to recruit participants. Four focus group discussions were held online with 26 young women and men aged 19-25 years old. All participants were studying at five different universities in Mogadishu, and only one participant was married. The data were analysed using thematic analysis.

    FINDINGS: The findings showed that participants objected to the concept of family planning but supported the concept of child spacing. They highlighted that people of their generation with tertiary education practise child spacing to combine careers with family life. Although all the participants knew of the benefits of child spacing, they had different opinions on whether modern contraceptive methods were an option for them. They were more comfortable with traditional contraceptive methods and believed that the quality of the modern contraceptive medicine available in the country was unreliable.

    CONCLUSION: Our findings suggest that it is crucial not only to include young people in family planning awareness initiatives and implementation but also to give them a voice to advocate family planning and start dialogues within their own communities.

  • 12.
    Egal, Jama Ali
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Essa, Amina
    University of Hargeisa, Somaliland.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet, Stockholm.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Facility-based maternal deaths: Their prevalence, causes and underlying circumstances. A mixed method study from the national referral hospital of Somaliland2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, artikkel-id 100862Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Somaliland has one of the highest rates of maternal deaths in the world. An estimated 732 women die for every 100,000 live births. This study aims to identify the prevalence of facility-based maternal deaths, the causes and their underlying circumstances by interviewing relatives and health care providers at the main referral hospital.

    METHOD: A hospital-based mixed method study. The prospective cross-sectional design of the WHO Maternal Near Miss tool was combined with narrative interviews with 28 relatives and 28 health care providers in direct contact with maternal deaths. The quantitative data was analysed with descriptive statistics using SPSS and the qualitative part of the study was analysed with content analysis using NVivo.

    RESULTS: From the 6658 women included 28 women died. The highest direct cause of maternal death was severe obstetric haemorrhage (46.4%), followed by hypertensive disorders (25%) and severe sepsis (10.7%). An indirect obstetric cause of death was medical complications (17.9%). Twenty-five per cent of these cases were admitted to ICU and 89% had referred themselves to the hospital for treatment. The qualitative data identifies two categories of missed opportunities that could have prevented these maternal mortalities: poor risk awareness in the community and inadequate interprofessional collaboration at the hospital.

    CONCLUSION: The referral system needs to be strengthened utilizing Traditional Birth Attendants as community resource supporting the community facilities. The communication skills and interprofessional collaboration of the health care providers at the hospital needs to be addressed and a national maternal death surveillance system needs to be commenced.

    Fulltekst (pdf)
    fulltext
  • 13. Egeh, Abdi-Aziz
    et al.
    Dugsieh, Osman
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    The views of Somali religious leaders on birth spacing: A qualitative study2019Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, s. 27-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Birth spacing is an important health intervention for women to attain good physical and mental health. In Somalia, religious leaders play a decisive role in approving or rejecting the use of family planning.

    Objective

    The study aimed to investigate Somali Islamic religious leaders’ views on birth spacing.

    Method

    Qualitative individual interviews were conducted with 17 Somali Islamic religious leaders aged 28–59 years and analysed through content analysis.

    Results

    The main category that emerged from the analysis was that the concept “birth spacing should be used and nor family planning to be in accordance with the Islamic religion. Two perspectives of views of birth spacing were identified: accepted ways and unaccepted ways. The accepted ways include breastfeeding, use of contraceptives causing no harm to the women’s health, and coitus interruptus. The preferred method should be determined by a joint agreement between the husband and wife, and that Muslim doctors should play a key role while the couples investigate their preferred method. Using contraceptives with the intention to limit the number of children was against Islamic values and practice. In addition, it was believed that using condoms promoted the temptation to engage in sex outside the marriage and was therefore prohibited.

    Conclusion

    According to the religious Islamic leaders, selected practice recommendations for contraceptive use is permitted in relation to birth spacing to promote the health of the mother and child. When providing professional contraceptive counselling to Muslim women, the word “birth spacing” is recommended to be used instead of “family planning”.

    Fulltekst (pdf)
    fulltext
  • 14.
    Erlandsson, Kerstin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet, Solna, Sweden.
    Lindgren, Helena
    Karolinska Institutet, Solna, Sweden.
    Kopp Kallner, Helena
    Karolinska Institutet, Solna, Sweden.
    Ådén, Ulrika
    Karolinska Institutet, Solna, Sweden.
    Osika Friberg, Ingrid
    The Swedish Gender Equality Agency, Gothenburg, Sweden.
    Schäfer Elinder, Liselotte
    Karolinska Institutet, Solna, Sweden.
    Hajeebhoy, Nemat
    Nutrition, Global Development, Gates Foundation, United States.
    Gemzell-Danielsson, Kristina
    Karolinska Institutet, Solna, Sweden.
    ambassador group for tool development, MIDWIZE framework implementation,
    Leaders at policy and institution level in Uganda, Ethiopia, Tanzania, Malawi, Kenya, Burkina Faso, Ghana and The Gambia.
    Development of a tool to analyse what resources are needed to implement a midwife-led care framework: the MIDWIZE conceptual framework2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 33, artikkel-id 100763Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A midwife led care project targeting to decide what to do to achieve the SDG 2030 in maternal and child health, made a project team develop a tool to analyse what health care systems need, to adopt the MIDWIZE Conceptual Framework. The MIDWIZE Conceptual Framework wish to introduce the comprehensive midwifery-managed care provided women in Sweden to other countries, regions, and units where the framework is not fully applied.

    METHODS: In order to determine what resource needs would have to be met to improve midwife led care, a tool was developed using Delphi study technique.

    RESULTS: Using Delphi study technique together with on-site visits to two Sub-Saharan African countries, members of a project team went to Ethiopia and Uganda, where they visited governments, clinical or educational institutions and together with African leaders developed availability and efficiency of a tool to determine resource needs.

    CONCLUSION: If at some future time, a single country, region or unit, might want to use the tool for quality improvement purpose of midwife led care, then the tool might aid in taking the first step to determine what resources might be required and what changes might be recommended as concerns policy at the clinical or educational institution level that are part of already existing health care structures.

    Fulltekst (pdf)
    fulltext
  • 15.
    Erlandsson, Kerstin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Lustig, Helena
    Lindgren, Helena
    Women's experience of unplanned out-of-hospital birth in Sweden: a phenomenological description2015Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, nr 4, s. 226-229Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Between 0.5 and 2 percent of women planning to give birth in a hospital environment in Sweden will have an unplanned out-of-hospital birth. Few studies have described mothers' experiences of out-of-hospital births and none on a Swedish population. In an attempt to fill this gap, we have made this pilot study designed to capture mothers' experiences of unplanned out-of-hospital births in Sweden.

    Method: Qualitative interviews with eight Swedish women, one to three years after they experienced an unplanned out-of-hospital birth. Data were analysed using the method of phenomenological description.

    Results: The meaning of giving unplanned birth outside a hospital environment was “The lived experience of a pendular movement between the good fortune and pride in managing the situation and the fear of what could have happened when giving unplanned birth outside a hospital environment.” In the analysis two clusters emerged that supported the essence: Balancing Emotions and Handling Unfamiliar Actions.

    Conclusions: This study contributes to an understanding of the natural processes when giving birth. The findings can be useful when communicating the experience of unplanned out-of-hospital birth to parents in antenatal classes. The women could be encouraged to listen and trust their own body signs as a preparation for giving birth in any type of setting. Guidelines for taking care of women with out-of-hospital birth experiences are suggested.

  • 16.
    Erlandsson, Kerstin
    et al.
    Karolinska Institutet.
    Wells, M. B.
    Wagoro, M. C.
    Kadango, A.
    Blomgren, J.
    Osika Friberg, I.
    Klingberg-Allvin, Marie
    Karolinska Institutet.
    Lelei, A.
    Lindgren, H.
    Coordinators, Country participants and
    Implementing an internet-based capacity building program for interdisciplinary midwifery-lead teams in Ethiopia, Kenya Malawi and Somalia2021Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 30, artikkel-id 100670Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020–21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute. Objective: To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period. Methods: The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected. Results: Participants believed the internet-based programme was appropriate for their countries’ contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health. Conclusion: The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health. © 2021

    Fulltekst (pdf)
    fulltext
  • 17. Finlayson, Kenneth
    et al.
    Dixon, Annie
    Smith, Chris
    Dykes, Fiona
    Flacking, Renée
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, UK.
    Mothers’ perceptions of family centred care in neonatal intensive care units2014Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 3, s. 119-124Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore mothers' perceptions of family centred care (FCC) in neonatal intensive care units (NICUs) in England. 

    Design: The qualitative experiences of 12 mothers from three NICUs in the UK were elicited using individual interviews. A thematic network analysis was conducted on the transcribed interviews. 

    Main outcome measures: A central global theme supported by a number of organizing themes were developed reflecting the views of the mothers and their experiences of FCC. 

    Results: A global theme of "Finding My Place" was identified, supported by six organizing themes: Mothering in Limbo; Deference to the Experts; Anxious Surveillance; Muted Relations, Power Struggles and Consistently Inconsistent. Mothers experienced a state of liminality and were acutely sensitive to power struggles, awkward relationships and inconsistencies in care. To try to maintain their equilibrium and protect their baby they formed deferential relationships with health professionals and remained in a state of anxious surveillance. 

    Conclusions: This study illustrates that despite the rhetoric around the practice of FCC in NICUs, there was little in the mother's narratives to support this. It is of the utmost importance to minimize the consequences of the liminal experience, to improve staff-mother interactions and to facilitate mothers' opportunities to be primary caregivers. 

  • 18.
    Flacking, Renée
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK ; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Thomson, Gill
    University of Central Lancashire.
    Ekenberg, Linda
    Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK.
    Löwegren, Linda
    Maternal and Infant Nutrition and Nurture Unit (MAINN), School of Health, University of Central Lancashire, Preston, Lancashire, UK.
    Wallin, Lars
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Influence of NICU co-care facilities and skin-to-skin contact on maternal stress in mothers of preterm infants2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 3, s. 107-112Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the influence of co-care facilities and amount of skin-to-skin contact during Neonatal Intensive Care Unit (NICU) stay on maternal stress in mothers of preterm infants at two months corrected age.

    Methods:  A prospective cohort study that involved 300 mothers of pre-term infants was conducted in four NICUs (two with co-care facilities and two with non co-care) in Sweden. Data on duration of skin-to-skin contact per day for all days admitted to the NICU were collected using self-reports. Maternal stress was measured by the Swedish Parental Stress Questionnaire (SPSQ) at two months of infant’s corrected age.

    Results: Mothers whose infants were cared for in a NICU with co-care facilities reported significantly lower levels of stress in the dimension of ‘incompetence’ compared to mothers whose infants had been cared for in non co-care NICUs.  The amount of skin-to- skin experienced during the neonatal stay was not significantly associated with levels of maternal stress at two months corrected age.

    Conclusion:  The finding that mothers who do not experience co-care facilities experience greater levels of stress in relation to feelings of incompetence is of concern. Improvements to NICU environments are needed to ensure that mother-infant dyads are not separated.

  • 19. Hildingsson, I.
    et al.
    Westlund, K.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Burnout in Swedish midwives2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 3, s. 87-91Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: In many countries midwives tend to leave their profession. Factors associated with workforce attrition include high workload, stress, poor management and a lack of promotional opportunities. The aim of the study was to investigate Swedish midwives' levels of burnout and their attitudes towards leaving the profession. Method: A random sample of 1000 midwives who are members of the Swedish Midwifery Association were sent a questionnaire. Burnout was measured using the Copenhagen Burnout Inventory. In addition the midwives were asked if they had experienced any situation that made them consider leaving their work and to give a comment about the reason. Results: 475 of 978 Eligible midwives (48.6%) returned the questionnaire. The Cronbach alpha values ranged from 0.81 to 0.93 for the burnout subscales. One hundred and eighty four (39.5%) scored high in the subscale Personal burnout, while Work burnout and Client burnout was around 15%. The strongest associations between Burnout and midwives' characteristics were age <40, work and work experience <10. years. One in three midwives had considered leaving the profession. Lack of staff and resources and a stressful work environment was associated with all three subscales of midwives' burnout. Other important explanatory variables were conflict with work mates and/or mangers and worries about the future and own health. Conclusion: More than one third of the midwives included in this survey reported some kind of burnout. Paying attention to midwives work is important in order to maintain a healthy, motivated midwifery workforce that will continue serving women and their families. © 2013 Elsevier B.V.

  • 20. Hildingsson, I.
    et al.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Editorial2010Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, nr 1Artikkel i tidsskrift (Fagfellevurdert)
  • 21. Khatun, M
    et al.
    Akter, P
    Yunus, S
    Pedersen, C
    Byrskog, Ulrika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Experiences of implementing evidence-based midwifery care in delivery wards to improve the transition of midwifery students to clinical practice in Bangladesh: A qualitative interview study with mentors2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764Artikkel i tidsskrift (Fagfellevurdert)
  • 22. Khatun, Monira
    et al.
    Akter, Parvin
    Yunus, Samiha
    Alam, Khairul
    Pedersen, Christina
    Byrskog, Ulrika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Challenges to implement evidence-based midwifery care in Bangladesh. An interview study with medical doctors mentoring health care providers.2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 31, artikkel-id 100692Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: In 2013 the first midwives in Bangladesh to be educated according to international standards completed their course and were awarded a diploma. Sixty percent of their training took place in clinical placement sites. In order to achieve appropriate mentor support while in clinical practice, a mentorship programme was initiated whereby local doctors were appointed by Save the Children. The aim of this study is to describe the mentors' purpose and the actions they took to improve midwifery care at clinical placement sites. Their appointment was intended to support local Health Care Providers (HCPs) at clinical placement sites meant for educating midwifery students in evidence-based midwifery care.

    METHODS: An open-ended interview study with 14 mentors. The data was analysed using content analysis.

    RESULTS: The main category, the theme that emerged from the analysis was "Creating commitment". "Creating commitment" describe how the mentors; the medical doctors employed by Save the Children, "Motivate", "Educate", "Mentor", "Advocate" and "Communicate" (subcategories) to creating commitment for quality midwifery care "In the organization of care" and "In clinical care practices" (categories). As intended, they enabled HCPs, midwifery students, and newly graduated midwives to provide quality midwifery care.

    CONCLUSIONS: Using medical doctors' status and power to support the development of a newly emerging midwifery cadre in a country where midwifery is just emerging as a profession is because midwives integrated in the health system will improve the birthing process, improve life chances for newborns, and reduce morbidity and mortality in Bangladesh. It is recommended for implementation in other similar national contexts.

    Fulltekst (pdf)
    fulltext
  • 23. Kiragu, J. M.
    et al.
    Osika Friberg, I.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet.
    Wells, M. B.
    Wagoro, M. C. A.
    Blomgren, J.
    Lindgren, H.
    Costs and intermediate outcomes for the implementation of evidence-based practices of midwifery under a MIDWIZE framework in an urban health facility in Nairobi, Kenya2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, artikkel-id 100893Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability. Methods: We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD). Results: At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD. Conclusion: Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings. © 2023

  • 24. Kiruja, J.
    et al.
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Egal, J. A.
    Essén, B.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Maternal near-miss and death incidences – Frequencies, causes and the referral chain in Somaliland: A pilot study using the WHO near-miss approach2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 12, s. 30-36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Somaliland is a self-declared country with a population of 3.5 million. Most of its population reside in rural areas. The objective of this pilot near-miss study was to monitor the frequency and causes of maternal near-miss and deaths and the referral chain for women to access Skilled Birth Attendants (SBA). Method: A facility-based study of all maternal near-miss and mortality cases over 5 months using the WHO near-miss tool in a main referral hospital. Reasons for bypassing the Antenatal Care facility (ANC) and late arrival to the referral hospital were investigated through verbal autopsy. Results: One hundred and thirty-eight (138) women with severe maternal complications were identified: 120 maternal near-miss, 18 maternal deaths. There were more near-miss cases on arrival (74.2%) compared with events that developed inside the hospital (25.8%). Likewise, there were more maternal deaths (77.8%) on arrival than was the case during hospitalization (22.2%). The most common mode of referral among maternal near-miss events was family referrals (66.7%). Of 18 maternal deaths, 15 were family referrals. Reasons for bypassing ANC were as follows: lack of confidence in the service provided; lack of financial resources; and lack of time to visit ANC. Reasons for late arrival to the referral hospital were as follows: lack of knowledge and transportation; and poor communication. Conclusion and clinical implication: To increase the utilization of ANC might indirectly lower the number of near-miss and death events. Collaboration between ANC staff and referral hospital staff and a more comprehensive near-miss project are proposed. © 2017 Elsevier B.V.

  • 25.
    Kiruja, Jonah
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Vårdvetenskap. Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Essén, Birgitta
    Uppsala University, Uppsala, Sweden.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Healthcare providers' experiences of comprehensive emergency obstetric care in Somaliland: An explorative study with focus on cesarean deliveries2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 34, artikkel-id 100768Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study aimed to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care (EmOC) with a focus on cesarean deliveries in a referral hospital and maternal and child health centers in Somaliland.

    METHODS: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight HCPs were divided into groups of 6-8 for discussions lasting 1 to 2 h. All HCPs included in the study had experiences with the provision of EmOC. Data were analyzed using thematic analysis.

    RESULTS: Collective family decision making was identified by HCPs as a barrier to the provision of EmOC. This tradition of decision making at a group level was perceived as time-consuming and delayed HCPs from obtaining informed consent for EmOC. Low socioeconomic status and poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal EmOC at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure.

    CONCLUSIONS: HCPs encountered difficulties with the provision of EmOC. A broad array of strategies targeting the community and healthcare system is needed, including training of HCPs on intracultural communication competence, interprofessional collaboration and use of alternative birth methods other than CS. Antenatal care can be used to prepare families for potential obstetric emergencies and as an opportunity to obtain written informed consent.

    Fulltekst (pdf)
    fulltext
  • 26.
    Klingberg-Allvin, Marie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Graner, Sophie
    Phuc, Ho Dang
    Höjer, Bengt
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Johansson, Annika
    Pregnancies and births among adolescents: a population based prospective study in rural Vietnam2010Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, nr 1, s. 15-19Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To describe birth rates and pregnancy outcomes, specifically stillbirth, preterm delivery and low birth weight (LBW) in relation to socio-demographic characteristics, among adolescent women in a rural district in northern Vietnam.

    Material and method. Within an epidemiological field laboratory, quarterly surveillance of 7767 adolescent women in the ages 15–19 during the period January 1999 to December 2005 was conducted. Birth rates were calculated and pregnancy outcomes were described in relation to background factors.

    Result. A total of 1021 pregnancies were reported by 926 adolescent women during the period of whom 17% were below 18years. The estimated adolescent birth rate during 1999–2005 was 27/1000 women-years. The incidence of stillbirth among all births was 19/1000 births. These were more likely to be delivered preterm. The incidence of preterm deliveries and LBW infants was 193 and 75 per 1000 live births, respectively. There were no differences in socio-demographic background for stillbirth, preterm delivery or LBW.

    Conclusion. Adolescent birth rates were similar to those found in the recent Vietnamese DHS and considerably lower than the average for South-East Asia. Higher rates of stillbirth and preterm delivery were found than those previously reported for Vietnam, indicating the need for careful monitoring of adolescent pregnancies and their infants. Further research is needed to explore if and how much socio-demographic variables influence pregnancy outcome, comparing more differentiated groups, as a basis for interventions to assure access to adequate reproductive health care services for all women.

  • 27. Larsson, C.
    et al.
    Saltvedt, S.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Andolf, E.
    Factors independently related to a negative birth experience in first-time mothers2011Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, nr 2, s. 83-89Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate the impact of personality, socio-demographic and obstetric factors on birth experience in a cohort of healthy first-time mothers. A second aim was to compare a visual analogue scale and Wijma Delivery Experience Questionnaire B as instruments evaluating birth experience. Material and methods: In total, 541 women were prospectively followed from the end of pregnancy until 9 months postpartum. Socio-demographic, psychological and somatic data as well as personality characteristics were collected. Experience of delivery was measured with a visual analogue scale and with Wijma Delivery Experience Questionnaire B. Sixty-three variables were considered to be associated with the experience of delivery. Nineteen of these, found to be significantly associated with birth experience, were entered in a logistic regression analysis. Results: The logistic regression analysis showed that a memory of pain during birth, high usage of analgesics postpartum, long hospital stay, worry in late pregnancy and high self-rated irritation were related to a more negative birth experience, while high confidence in the midwife was related to a more positive experience. The correlation between experiences of delivery rated by Wijma Delivery Experience Questionnaire B and the visual analogue scale was 0.52 (p<0.001). Conclusion: To help women to cope with pain during and after birth could be an important factor to improve birth experience. Even though the correlation between the visual analogue scale and Wijma Delivery Experience Questionnaire B was moderate, the visual analogue scale could be used as a simple method for screening of birth experience. © 2010 Elsevier B.V.

  • 28. Larsson, Erin C
    et al.
    Fried, Sarah
    Essén, Birgitta
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Equitable abortion care: A challenge for health care providers. Experiences from abortion care encounters with immigrant women in Stockholm, Sweden2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, s. 14-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    To explore health care providers' experiences of providing care to immigrant women seeking abortion care.

    Methods

    A qualitative study including interviews with ten midwives and three medical doctors at four abortion clinics in the Stockholm area. Interviews were analysed using thematic analysis.

    Results

    Initially, health care providers were reluctant to make statements concerning the specific needs among immigrant women. Yet, the health care providers sometimes found it challenging to deal with the specific needs among immigrant, mostly non-European, women. Three themes were identified: (1) Reluctance to acknowledge specific needs among immigrant women; (2) Striving to provide contraceptive counselling to immigrant women; (3) Organizational barriers hindering patient-centred abortion care to immigrant women

    Conclusions

    Health care providers' experiences of the specific needs among non-European, immigrant women are not openly discussed, although they are acknowledged. To achieve equitable access to sexual and reproductive health (SRH), health care providers need to be better equipped when encountering immigrant women in abortion care, especially regarding contraceptive counselling. The potential impact of patients' knowledge, norms and values is not adequately dealt with in the clinical encounter. Moreover, to provide patient-centred care, it is crucial to understand how to develop and implement SRH care that ensures equal access to high-quality care.

  • 29.
    Lindgren, Helena
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    She leads, he follows - fathers' experiences of a planned home birth: a Swedish interview study2011Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, nr 2, s. 65-70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To gain an understanding of fathers' experiences of a planned home birth.

    Study design: In-depth interviews were conducted with eight Swedish fathers who had the experience of a total of 23 births, of which 17 were planned home births. The fathers were recruited by the midwives who had assisted with the planned home births. Content analysis was used.

    Results: Analysis revealed the main theme "she leads - he follows". The fathers were compliant to the woman's decision; they also described it as a deliberate choice and struggled with feelings of being different in comparison with the established way of becoming a father.

    Conclusion: The experience of a planned home birth for the father was a process in which he had to put his own ideas on giving birth aside and carefully follow his woman. Sharing fears and happiness during the process by being compliant to the woman may strengthen the new fatherhood. The fathers' role in the process of making an unconventional choice is an example that could probably be applied to similar situations in pregnancy and childbirth.

  • 30.
    Malm, Mari-Cristin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Department of Women’s and Children’s Health, Uppsala University, Sweden.
    Lindgren, Helena
    Sahlgrenska Akademin, Göteborgs Universitet.
    Rubertsson, Christine
    Kvinnor och Barns Hälsa, Uppsala Universitet.
    Hildingsson, Ingegerd
    Kvinnor och Barns Hälsa, Uppsala Universitet.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Development of a tool to evaluate fetal movements in full-term pregnancy2014Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 1, s. 31-35Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To study women’s description of fetal movements in full-term pregnancy. Further to investigate if their descriptions could be sorted with regard to intensity and type of movements, using a matrix under development to be a tool for evaluating fetal movements in clinical praxis.

    Methods: Data were collected by distributing questionnaires including an open question: “Please describe your perception of the baby’s movements during this gestational week.” A matrix listed seven categories of movements divided into powerful and non-powerful movements, was used for the content analysis.

    Results: 393 (78%) women responded to the open question. The movements were split into two domains: Powerful movements and Non-powerful movements. Altogether, 383 (96%) women perceived fetal movements that were sorted as powerful movement: firm, slow stretchinglarge and side to side. Ten (4%) women described movements exclusively, i.e. movements that did not include any of the movements in the powerful domain. Most women perceived movements that corresponded to more than one type of category, and all movements described by the women could be referred to at least one of the categories in the matrix.

    Conclusion: The matrix was useful for identification of the women’s perceptions of fetal movements in full-term pregnancy. Further studies are needed in order to develop the tool and its potential to evaluate the well-being of the fetus before it is to be used in clinical praxis.

  • 31.
    Malm, Mari-Cristin
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Rådestad, Ingela
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. School of Health, Care and Social Welfare, Mälardalen University, Västerås.
    Lindgren, Helena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Waiting in no-man's-land: mothers´experiences before the induction of labor after their baby has died in utero2011Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, nr 2, s. 51-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Carrying death instead of life is beyond understanding and a huge psychological challenge for apregnant mother. The aim of this study was to investigate the mothers’ experiences of the time from thediagnosis of the death of their unborn baby until induction of labour.

    Method: In this qualitative study, in-depth interviews were conducted with 21 mothers whose babieshad died prior to birth. The interviews were then analysed using content analysis.

    Results: The overall theme that emerged from the mothers’ experiences is understood as ‘‘waiting in noman’s-land’’, describing the feeling of being set aside from normality and put into an area which is unrecognized. Four categories were established: ‘involuntary waiting’ describes the sense of being left withoutinformation about what is to come; ‘handling the unimaginable’ concerns the confusing state of findingoneself in the worst-case scenario and yet having to deal with the birth; ‘broken expectations’ is aboutthe loss not only of the baby but also of future family life; and ‘courage to face life’ describes the determinationto go on and face reality.

    Conclusions: The mother’s experiences during the time after the information of their baby’s death in uterountil the induction of labour can be understood as a sense of being in no-man’s-land, waiting withoutknowing for what or for how long.

  • 32. Mattebo, M.
    et al.
    Bogren, M.
    Brunner, N.
    Dolk, A.
    Pedersen, Christina
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Sexuell, reproduktiv och perinatal hälsa.
    Perspectives on adolescent girls’ health-seeking behaviour in relation to sexual and reproductive health in Nepal2019Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, s. 7-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim

    To explore health care providers’ perspectives on adolescent girls’ health-seeking behaviour in Nepal in relation to their sexual and reproductive health and rights. Twenty health-care providers were included in this interview study. Ethical approval was obtained from the Nepal Health Research Council.

    Findings

    The main category ‘Barriers affect adolescent girls’ health-seeking behaviour in relation to their sexual and reproductive health’ was divided into five categories: a conservative society with social stigma; lack of information, education and knowledge; lack of facilities and respectful care; insufficient confidentiality and privacy; and unmet needs of adolescent-friendly facilities.

    Conclusions

    Lack of knowledge among adolescent girls and unmet needs of adolescent-friendly facilities affect their access to sexual and reproductive health care in Nepal. Lack of knowledge could be seen as a barrier, and as a reason why adolescent girls do not seek sexual and reproductive health care.

  • 33. Millde-Luthander, C.
    et al.
    Högberg, U.
    Nyström, M. E.
    Pettersson, H.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Grunewald, C.
    The impact of a computer assisted learning programme on the ability to interpret cardiotochography. A before and after study2012Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, nr 1, s. 37-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate if a computer assisted learning programme could bring about a higher degree of individuals who correctly classified cardiotochography (CTG) recordings in a non-selected population of midwives and physicians. Study design: A before and after study. Setting: Södersjukhuset, Stockholm, Sweden. Subjects: One hundred and thirty midwives and 49 physicians at the maternity unit, September 2009-April 2010. A computer assisted learning programme for interpreting CTG patterns has been created. All 179 individuals included made the first interpretation and the 135 individuals also completing the education made the second interpretation. A third randomly selected interpretation was performed immediately following the second; permitting two participants to classify a CTG together. Comparison between the before and after-test was based on the Fisher exact test. Main Outcome measure: The proportion of individuals who correctly classified CTGs before and after the training. Results: Sixty four percentage of the individuals classified the CTGs correctly before and 66% after the training (P=0.76). There was no difference between the two professional groups. Normal CTGs were correctly identified by 36% of the individuals before and in 80% after the training (P=0.065). Corresponding figures for pathological CTGs were 83% and 85% (P=1.00), respectively. Conclusion: We found no improvement in the proportion of individuals who classified CTGs correctly after the completion of a computer assisted learning programme in fetal monitoring. The baseline level of competence was higher than expected. © 2011 Elsevier B.V..

  • 34. Mohamoud Osman, Hodan
    et al.
    Ali Egal, Jama
    Kiruja, Jonah
    Osman, Fatumo
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Erlandsson, Kerstin
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Women’s experiences of stillbirth in Somaliland: A phenomenological description2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, nr 1, s. 107-111Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Low- and middle-income countries in Africa have the highest rates of stillbirths in the world today: as such, the stories of the grief of these women who have had a stillbirth in these settings need to be told and the silence on stillbirth needs to be broken. In an attempt to fill this gap, the aim of this study was to describe the experiences of Muslim Somali mothers who have lost their babies at birth.

    Method: Qualitative interviews with ten Somali women one to six months after they experienced a stillbirth. Data were analyzed using Giorgi's method of phenomenological description.

    Results: In the analysis, four descriptive structures emerged: “a feeling of alienation”; “altered stability in life”; “immediate pain when the sight of the dead baby turns into a precious memory”; and “a wave of despair eases”. Together, these supported the essence: “Balancing feelings of anxiety, fear and worries for one's own health and life by accepting Allah's will and putting one's trust in him”.

    Conclusions: This study makes an important contribution to our knowledge about how stillbirth is experienced by women in Somaliland. This information can be useful when health care providers communicate the experiences of stillbirth to women of Muslim faith who have experienced an intrauterine fatal death (IUFD) resulting in a stillbirth. 

  • 35.
    Norris, Megan
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd.
    Borneskog, Catrin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    The Cisnormative Blindspot Explained: Healthcare Experiences of Trans Men and Non-Binary Persons and the accessibility to inclusive sexual & reproductive Healthcare, an integrative review.2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 32, artikkel-id 100733Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Trans men and non-binary persons assigned female at birth (AFAB) often encounter resistance and reluctance pertaining to their healthcare needs. As a result of patriarchal-based decision-making and cis-heteronormative ideologies, the trans and gender diverse (TGD) population is routinely left out of representation in research, education, and healthcare. The aim of this integrative literature review is to describe the experiences of trans men and non-binary persons AFAB in healthcare interactions and their sexual and reproductive healthcare needs. A total of 32 articles were analyzed, synthesized, and reconceptualized through joint inductive and deductive analysis with a transfeminist and intersectional lens. From these papers, two broader concepts emerged with five sub-concepts that portrayed underlying barriers to care (primed with fear, onus of self-advocacy, and call for competence) and internalized ideologies (pregnancy incompatibility and presumptive care). A multidisciplinary approach is essential to employ in implementation efforts involving improved standards of care and in achieving desired family planning. As this is not as linear as addressing a knowledge gap, but one of deeper set intrinsic ideologies, instruction on the necessary impact of continued education and peer learning within the context of in-group dynamics can help the efficiency of designated change agents within the healthcare systems themselves.

    Fulltekst (pdf)
    fulltext
  • 36.
    Omar, Bakar
    et al.
    Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Italy; School of Public Health and Research, Somali National University, Mogadishu, Somalia.
    Larsson, Elin C
    Department of Global Public Health and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Calza, Stefano
    Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy.
    Osman, Fatumo
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Perceptions of family planning among some Somali men living in Sweden: A phenomenographic study2022Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 32, artikkel-id 100732Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: A growing body of research in Sweden has focused on migration and reproductive health, particularly on women's perspectives, including family planning and contraception. However, knowledge is limited on how immigrant men perceive family planning. The topic is important because women's use of family planning has been shown to be influenced by their partners and community. Therefore, this study aims to explore perceptions of family planning among Somali men living in Sweden.

    METHODS: A qualitative phenomenographic approach was used. Four focus group discussions were conducted with 41 men aged 28-59 years. Data were analysed using phenomenographic analysis.

    FINDINGS: The following four categories were identified in the analysis: 1) a happier and more sustainable family; 2) ideal family size versus cultural commitment; 3) fears of using modern family planning methods; and 4) a need to be included in family planning. The findings illuminated the complexities of perceptions of family planning. Although Somali men understood the benefits of family planning, they seemed to prefer a large family. However, due to their new social context in Sweden, they had also changed their views on having as large a family as in their home country.

    CONCLUSION: Our findings suggest that Somali men living in Sweden want to be involved in family planning counselling, which may increase women's use of contraception. However, healthcare providers must ensure that the woman desires her partner's involvement and be culturally sensitive about couples' needs.

    Fulltekst (pdf)
    fulltext
  • 37. Rehnström Loi, Ulrika
    et al.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet.
    Gemzell-Danielsson, Kristina
    Faxelid, Elisabeth
    Oguttu, Monica
    Makenzius, Marlene
    Contraceptive uptake among post-abortion care-seeking women with unplanned or planned pregnancy in western Kenya.2020Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 23, artikkel-id 100486Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To investigate contraceptive uptake among PAC-seeking women reporting either planned pregnancies (PP) or unplanned pregnancies (UP) and to identify factors associated with UP.

    STUDY DESIGN: This was a sub-study nested in randomised controlled trial (RCT) on women who sought PAC in a low-resource setting in western Kenya. The analysis was based on 807 women who were followed up at 7-10 days and by 472 women at 3 months.

    MAIN OUTCOME MEASURES: Descriptive statistics and a binary logistic regression model with odds ratios (OR) and 95% confidence intervals (CI) were used.

    RESULTS: Of the 807 women, 375 (46.3%) reported UP, and 432 (53.3%) PP. Most women, regardless of reported pregnancy intention, agreed to start using contraceptive methods: UP 273 (72.8%) and PP 338 (78.2%), respectively, P = 0.072. Independent factors associated with UP were young age (14-20 years; OR 1.177; 95% CI, 1.045-2.818; P = 0.033), unmarried status (OR 9.149; 95% CI, 5.719-14.638; P < 0.001), nulliparity (OR 1.968; 95% CI, 1.287-3.008; P = 0.002), concealed pregnancy (OR 7.708; 95% CI, 3.299-18.012; P < 0.001) and absence of a partner at the clinic visit (OR 3.174; 95% CI, 2.214-4.552; P < 0.001). At 3-month follow-up, there was no difference in contraceptive use between the UP group (161; 77.4%) and the PP group (193; 73.7%), P = 0.350.

    CONCLUSION: Contraceptive counselling should be systematically offered to all PAC-seeking women, regardless of their stated pregnancy intention. Adolescents, unmarried women, nulliparous, women with concealed pregnancy and attending the PAC clinic without a partner should be given extra attention by PAC providers offering contraceptive counselling.

  • 38. Rådestad, Ingela
    et al.
    Lindgren, Helena
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Women’s perceptions of fetal movements in full-term pregnancy2012Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, nr 3, s. 113-116Artikkel i tidsskrift (Fagfellevurdert)
  • 39.
    Råssjö, Eva-Britta
    et al.
    Falun Cent Hosp, Dept Obstet & Gynaecol, Falun, Sweden; Clin Res Ctr, Dalarna, Sweden.
    Byrskog, Ulrika
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Falun Cent Hosp, Dept Obstet & Gynaecol, Falun, Sweden; Dalarna Univ, Sch Hlth & Social Sci, Falun, Sweden.
    Samir, Raghad
    Falun Cent Hosp, Dept Obstet & Gynaecol, Falun, Sweden ; Clin Res Ctr, Dalarna, Sweden.
    Klingberg-Allvin, Marie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Inst, Dept Womens & Childrens Hlth, S-10401 Stockholm, Sweden.
    Somali women’s use of maternity health services and the outcome of their pregnancies: a descriptive study comparing Somali migrants with inborn Swedish Women2013Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, nr 3, s. 99-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To describe how Somali immigrant women in a Swedish county access and use the antenatal care and health services, their reported and observed health problems and the outcome of their pregnancies.

    Study design: Retrospective, descriptive study, comparing data obtained from the records of antenatal and obstetric care for Somali born women with the same data for parity matched women born in Sweden giving birth between 2001 and 2009.

    Main outcome measures: Utilisation of antenatal health care (timing and number of visits), pregnancy complications (severe hyperemesis, anaemia, preeclampsia, urinary tract infections), mode of birth (normal vaginal, operative vaginal, caesarean), and infant outcomes (preterm birth, birth weight, and perinatal mortality)

    Results: Compared to the 523 Swedish-born women the 262 Somali women booked later and made less visits for antenatal care. They were more likely to have anaemia, severe hyperemesis and recurrent urinary tract infection. Emergency caesarean section (OR 9.90, CI 1.16-3.10), especially before start of labour (OR 4.96, CI 1.73-14.22), high perinatal mortality  with seven versus one perinatal deaths and small for date infants (OR 2.95, CI 1.49-5.82) was also more prevalent.

    Conclusion: Pregnant Somali immigrant women constitutes a vulnerable group that needs targeted attention. There is an increased risk for intrauterine foetal death, small for date and low birth weight infants as well as serious maternal morbidity.

     

     

     

  • 40. Sahlin, M.
    et al.
    Andolf, E.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Mode of delivery among Swedish midwives and obstetricians and their attitudes towards caesarean section2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, s. 112-116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background A knowledge gap exists around midwives' and obstetricians' mode of delivery in comparison to the general population, and if their personal experience influences their attitudes towards different modes of delivery. Objectives The aim of the present study was to investigate midwives' and obstetricians' mode of delivery compared to the population at large. The second aim was to see if their mode of delivery had been influenced by the expanded indications for caesarean section as described in medical literature. Thirdly, the differences between obstetricians' and midwifes' attitudes to caesarean section on maternal request was investigated. Material and method Textbooks from midwifery education and medical schools were reviewed using a structured protocol. A questionnaire for midwives and obstetricians containing questions on mode of delivery, attitudes towards patients' autonomy and performing caesarean sections on maternal request was sent to 380 midwives and 97 obstetricians born in 1935, 1955 or 1975 with an invitation to participate in the study. Two hundred and sixty three midwives and 55 obstetricians provided completed responses. Results The review of textbooks identified that the number of indications for caesarean section has increased. Indications for caesarean section increased in medical textbooks from seven in the oldest books, from year 1955, to 11 in the textbook from 1993. The focus has shifted in more recently published textbooks to prevention of fatal deliveries. In earlier obstetric care they tend to learn to solve the catastrophe when it had occurred. No significant relationship between midwives' and obstetricians; own mode of delivery and their attitudes towards performing a caesarean section on maternal request (p = 0.191) was found. Thirty percent of the obstetricians reported that they would perform a caesarean section if the pregnant woman requested one. The study found a significant difference between the professions in the statement “the proportion of caesarean section is too high” where midwives to a greater extent agreed with the statement (p = 0.033). There were no significant differences between caesarean section as the mode of delivery for midwives and obstetricians as compared to the general population. Midwives born in 1975 had significantly lower rate of instrumental births compared to the population at large (p < 0.05). Conclusions Over the years, the indications for caesarean section have increased. The increase is shown in both the textbooks read during the different time periods as well as among the Swedish midwives and obstetricians born in 1955 and 1975. © 2016 Elsevier B.V.

  • 41. Sahlin, M.
    et al.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Andolf, E.
    Löfgren, M.
    Klint Carlander, A. -K
    “An Undesired Life Event”: A retrospective interview study of Swedish women's experiences of Caesarean Section in the 1970s and 1980s.”2021Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 27, artikkel-id 100581Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 42.
    Sattar, Saifullah Muhammed Rafid Us
    et al.
    Högskolan Dalarna.
    Akeredolu, Oluwaseyi
    Högskolan Dalarna.
    Bogren, Malin
    Institute of Health and Care Sciences, Gothenburg.
    Erlandsson, Kerstin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Borneskog, Catrin
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Facilitators influencing midwives to leadership positions in policy, education and practice: A systematic integrative literature review.2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 38, artikkel-id 100917Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The development of midwives as leaders is a crucial step towards achieving equality in sexual, reproductive, maternal, and neonatal health, Universal Health Coverage (UHC) and Sustainable Development Goals (SDG). However, many midwives work only to implement policies made by others rather than being drivers of policy changes. Little is known and researched about why midwives are not involved in decision and policymaking related to sexual, reproductive, maternal, and neonatal health. Hence, with a focus on midwifery leadership within the global community and the limited opportunities for women to hold leadership positions, this research explores the facilitators influencing midwives' opportunities to become leaders in policy development, education and practice. Inspired by Whittemore and Knafl, this integrative literature review was conducted after twenty-two relevant articles were identified through a search of the following databases: PubMed, CINAHL, and Scopus. Inductive content analysis was applied to analyze data. The result indicates that for midwives to become influential leaders, they must be active in strategic planning at the highest level. This inevitably effects how far midwives can act as agents for change, even if they possess the knowledge and skills for a leadership position. Policies and regulations influence how midwives' status in society is acknowledged and recognized. A clearly articulated educational pathway will enable their professional growth and expertise, making them knowledgeable and skillful as leaders. Enabling midwives to step into leadership positions at government level requires reforms which include midwives in decision-making. Excluding midwives from decision-making processes is detrimental to the goal of achieving universal health coverage. The first step is to provide midwives with a protected title, enabling them to work autonomously in an enabling environment with normal pregnancy and birth to achieve the SDG 2030 goals.

    Fulltekst (pdf)
    fulltext
  • 43.
    Ternström, Elin
    et al.
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Hildingsson, Ingegerd
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Haines, Helen
    Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia..
    Karlström, Annika
    Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
    Sundin, Örjan
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Ekdahl, Johanna
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Segebladh, Birgitta
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Larsson, Birgitta
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Rondung, Elisabet
    Mid Sweden Univ, Dept Psychol, Ostersund, Sweden..
    Rubertsson, Christine
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth: A study protocol2017Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, s. 75-82Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

  • 44.
    Ternström, Elin
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa. Karolinska Institutet, Stockholm.
    Small, Rhonda
    Karolinska Institutet, Stockholm; La Trobe University, Melbourne, Victoria, Australia.
    Lindgren, Helena
    Karolinska Institutet, Stockholm; Sophiahemmet University, Stockholm.
    Migrant women's experiences of an individual language-assisted information and support visit to the labor ward before giving birth - A qualitative study from Sweden2023Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 38, artikkel-id 100915Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Migrant women are less likely to receive an individualized maternal care where they feel safe, informed and supported but few measures have been undertaken to meet their needs. In Södertälje municipality in Sweden, community-based antenatal care midwives identify migrant women and offer them and their partners language-assisted information and support through an individual two-hour-visit to the labor ward. The aim of the present study was to explore migrant women's experiences of antenatal care including receiving language-assisted information and support during pregnancy through a two-hour INFOR-visit to the labor ward.

    METHODS: Semi-structured interviews were conducted with 10 non-Swedish speaking migrant women, using an interpreter. Interview analysis was conducted using reflexive thematic analysis.

    RESULTS: The individualized support, including thorough information given with language support available, sufficient time for questions and discussion, and a caring approach - did appear to inform and reassure the women. Overall, they felt that they were seen and treated as individuals during both pregnancy and birth and that their specific needs were listened to and met by the health care providers. Having professional interpreters was seen as essential for receiving the right information, something achieved at the individual visit.

    CONCLUSIONS: The findings from this study provide evidence that a two-hour-visit to the labor ward during pregnancy has potential to empower migrant women during pregnancy and birth and to improve their experiences of maternity care. The two-hour-visit is a relatively simple intervention with the potential of not only improving migrant women's experiences of pregnancy and birth, but also their medical outcomes.

    Fulltekst (pdf)
    fulltext
  • 45.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Disrespect and abuse during birth and postnatal care2019Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21Artikkel i tidsskrift (Fagfellevurdert)
  • 46.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Editorial2014Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, nr 2Artikkel i tidsskrift (Fagfellevurdert)
  • 47.
    Wiklund, Ingela
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Sexuell, reproduktiv och perinatal hälsa.
    Episiotomy and the medicalization make childbirth worse for women2024Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 40, artikkel-id 100977Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

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

  • 48.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Female Genital Mutilation and challenges in disseminating high quality healthcare guidelines2016Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, s. 1-2Artikkel i tidsskrift (Fagfellevurdert)
  • 49.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Leadership at all levels is needed to make a change in maternal, neonatal, and child health2010Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, nr 3Artikkel i tidsskrift (Fagfellevurdert)
  • 50.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    New guidelines for cesarean section on maternal request2012Inngår i: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, nr 3Artikkel i tidsskrift (Fagfellevurdert)
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