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Background:

It has been argued that having a stillborn baby in the family affects older siblings more than parents realize. The aim of this study was to describe parenthood and the needs of siblings after stillbirth from the parents' perspective.

Methods:

Six focus groups were held with 27 parents who had experienced a stillbirth and who had had children before the loss. The discussion concerned parents' support to the siblings, and the sibling's meeting, farewell, and memories of their little sister or brother. Data were analyzed using qualitative content analysis.

Results:

The overall theme of the findings was parenthood in a balance between grief and everyday life. In the analysis, three categories emerged that described the construction of the theme: support in an acute situation, sharing the experiences within the family, and adjusting to the situation.

Conclusions:

The siblings' situation is characterized by having a parent who tries to maintain a balance between grief and everyday life. Parents are present and engaged in joint activities around the stillbirth together with the siblings of the stillborn baby. Although parents are aware of the sibling's situation, they feel that they are left somewhat alone in their parenthood after stillbirth and therefore need support and guidance from others.

BACKGROUND: Breastfeeding support is important for breastfeeding mothers; however, it is less clear how mothers of preterm infants (< 37 gestational weeks) experience breastfeeding support during the first year. Thus, the aim of this study was to describe how mothers of preterm infants in Sweden experience breastfeeding support during the first 12 months after birth.

METHODS: This qualitative study used data from 151 mothers from questionnaires with open-ended questions and telephone interviews. The data were analyzed using an inductive thematic network analysis with a hermeneutical approach.

RESULTS: The results exposed two organizing themes and one global theme. In the organizing theme "genuine support strengthens," the mothers described how they were strengthened by being listened to and met with respect, understanding, and knowledge. The support was individually adapted and included both practical and emotional support. In the organizing theme "inadequate support diminishes," the mothers described how health professionals who were controlling and intrusive diminished them and how the support they needed was not provided or was inappropriate. Thus, the global theme "being thrown into a lottery-dependent on the health professional who provided breastfeeding support" emerged, meaning that the support received was random in terms of knowledge and support style, depending on the individual health professionals who were available.

CONCLUSION: Breastfeeding support to mothers of preterm infants was highly variable, either constructive or destructive depending on who provided support. This finding clearly shows major challenges for health care, which should make breastfeeding support more person-centered, equal, and supportive in accordance with individual needs.

Background: Opting for a home birth or requesting a cesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study was to compare background characteristics of women who chose these very different birth methods and to see how these choices affected factors of care and the birth experience.

Methods: This descriptive study employed a secondary data analysis of a sample of women who gave birth from 1997 to 2008, including 671 women who had a planned home birth and 126 women who had a planned cesarean section based on maternal request. Data were collected by means of questionnaires. Logistic regression with crude and adjusted odds ratios (OR) with a 95 percent confidence interval (95% CI) was calculated.

Results: Women with a planned home birth had a higher level of education (OR: 2.3; 95% CI: 1.5-3.6), were less likely to have a high body mass index (OR: 0.1; 95% CI: 0.01-0.6), and were less likely to be smokers (OR: 0.2; 95% CI: 0.1-0.4) when compared with women who had planned cesarean sections. When adjusted for background variables, women with a planned home birth felt less threat to the baby's life during birth (OR: 0.1; 95% CI: 0.03-0.4), and were more satisfied with their participation in decision making (OR: 6.0; 95% CI: 3.3-10.7) and the support from their midwife (OR 3.9; 95% CI: 2.2-7.0). They also felt more in control (OR: 3.3; 95% CI: 1.6-6.6), had a more positive birth experience (OR: 2.9; 95% CI: 1.7-5.0), and were more satisfied with intrapartum care (OR: 2.3; 95% CI: 1.3-4.1) compared with women who had a planned cesarean section on maternal request.

Conclusions: Women who planned a home birth and women who had a cesarean section based on maternal request are significantly different groups of mothers in terms of sociodemographic background. In a birth context that promotes neither home birth nor cesarean section without medical reasons, we found that those women who had a planned home birth felt more involvement in decision making and had a more positive birth experience than those who had a requested, planned cesarean section. (BIRTH 37:4 December 2010).

Background: Childbirth can be an empowering event in a woman’s life. However, we know little about women’s own perceptions of power and empowering sources during childbirth. This study aims to describe the factors experienced as empowering during a planned home birth.

Method and material: The inclusion criteria were women in Sweden who had a planned home birth between 1992 and 2005. All the women (n=735) who agreed to participate received one questionnaire for each planned home birth. A total of 1038 questionnaires were sent to the women. The written birth stories were analyzed using content analysis and descriptive statistics.

Results: In the analysis of the participants’ birth experience four categories and one overall theme emerged from the stories. The categories identified were 1) sensations, 2) guidance, 3) tacit support and 4) identification of needs. Greater emphasis was put on guidance among first-time mothers than among with multiparas, for whom tacit support was identified as the most empowering factor. The overall theme was identified as “resting in acceptance of the process”. The empowerment they express by achieving and maintaining a sense of control allows them to rest in acceptance of the efforts that are part of a normal birth.

Conclusion: Women who choose to give birth at home find empowering sources within themselves, from their environment and from the active and passive support of persons they have chosen to be present at the birth. They create their own birth setting ahead of the birth, so that they can let go of control when it actually happens.

Background: Opting for a home birth or a caesarean section in a culture where vaginal birth in a hospital is the norm challenges the health care system. The aim of this study is to describe women with a planned home birth and women with a planned caesarean section on maternal request regarding background factors, experience of care, and the birth experience. Methods: A descriptive study of a secondary analysis of data comprising three cohorts of women who gave birth from1997-2008, including 671 women with a planned home birth and 126 women with planned caesarean sections, where maternal request was present. Data was collected by means of questionnaires. Logistic regression with crude and adjusted Odds Ratios with a 95% confidence interval was calculated. Results: Women with a planned home birth were less likely to have a high Body Mass Index (OR 0.2; 95% CI 0.1-0.6), and less likely to be smokers (OR 0.2; 0.1-0.6) as compared to women with planned caesarean sections. When adjusted for background variables, women with a planned home birth felt safer in terms of feeling less threat to the baby’s life during birth (OR 0.1; 0.03-0.4), satisfied with participation in decision making (OR 6.0; 95% CI 3.3-10.7), more satisfied with support from midwife (OR 3.9 (2.2-7.0), more in control (OR 3.3; 1.6-6.6), had a more positive birth experience (OR 2.9; 1.7-5.0) and were more satisfied with intrapartum care (OR 2.3; 1.3-4.1)compared to women who had their wishes of a planned caesarean section fulfilled. Conclusions: Women who planned a home birth and women who have a caesarean section on maternal request are, from a characteristic point of view, two entirely different groups of mothers. Although women who had their wishes about mode of delivery fulfilled, in a birth context that neither promotes home birth nor caesarean section without medical reasons, most studied variables favoured home birth with more involvement in decision making and a more positive birth experience.

Background: Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. Methods: A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. Results: Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8–3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1–9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1–9.4) and multiparas (RR 3.4; 95% CI 1.3–9.0). Conclusions: The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife’s unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred.

BACKGROUND: In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners.

METHODS: A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS.

RESULTS: A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians.

CONCLUSIONS: The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.