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  • 1.
    Erlandsson, Kerstin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 1, p. 28-33Article in journal (Refereed)
    Abstract [en]

    Objective. To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition.

    Design. A mixed method approach.

    Setting. One thousand and thirty-four women answered a web questionnaire. Sample. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives.

    Main Outcome Measure. The premonition of an unwell unborn baby. Results. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check-up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check-up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby.

    Conclusions. Women need to know that a decrease in fetal movements is an important indicator of their unborn baby's health. Healthcare professionals should not delay an examination if a mother-to-be is worried about her unborn baby's wellbeing.

  • 2.
    Graner, Sophie
    et al.
    Karolinska Institutet, Umeå University.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Le Quyen, Duong
    Population Services/Vietnam, Hanoi, Vietnam.
    Krantz, Gunilla
    Department of Community Medicine and Public Health, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden .
    Mogren, Ingrid
    Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, .
    Pregnant women’s perception on signs and symptoms during pregnancy, and maternal health care in a rural low resource setting2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 9, p. 1094-1100Article in journal (Refereed)
    Abstract [en]

    Objective. Women’s understanding of pregnancy and antenatal care is influenced by their cultural context.  In low income settings women may have limited influence over their reproductive health including when to seek health care. Awareness of signs of pregnancy complications is essential to seek timely care. The use of antenatal care services in Vietnam has been studied with quantitative methods but there are few qualitative studies on the perceptions of pregnancy and maternal health care among Vietnamese women.

    Design. Four focus group discussions (FGD) with pregnant women were performed.

    SettingThe study was conducted in a rural district in northern Vietnam.

    PopulationPregnant women in the last trimester living in Bavi district, Vietnam.

    MethodThe data were analysed using manifest and latent content analysis.

    ResultThe latent theme ‘Securing pregnancy during normal course and at deviation’, consisting of the main categories ‘Ensuring a healthy pregnancy’ and ‘Separating the normal from the abnormal’ emerged.

    ConclusionThis qualitative study of pregnant women in rural Vietnam indicates how women create a strategy to promote a healthy pregnancy through lifestyle adjustments, gathering of information, and seeking timely medical care. Insight in pregnancy-related conditions were sought from various sources and influenced both by Vietnamese traditions and modern medical knowledge. Public knowledge about deviating symptoms during pregnancy and high confidence in maternal health care are most likely contributing factors to the relative good maternal health status in Vietnam.

     

     

     

  • 3.
    Iyengar, Kirti
    et al.
    Karolinska Institutet.
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska institutet.
    Iyengar, Sharad
    Action for Reserach in Health (ARTH).
    Paul, Mandira
    Uppsala Universitet.
    Essen, Birgitta
    Uppsala Universitet.
    Gemzell-Danielsson, Kristina
    Karolinska Institutet.
    Home use of misoprostol for early medical abortion in a low resource setting: secondary analysis of a randomized controlled trial2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 2, p. 173-181Article in journal (Refereed)
  • 4.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Christensson, Kyllike
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Outcome of planned home births vs hospital births in Sweden between 1992 and 2004.2008In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 87, no 7, p. 751-759Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this population based study was to measure the risk of adverse outcome for mother and child in planned home births in a Swedish population, irrespective of where the birth actually occurred, at home or in hospital after transfer. Design A population based study using data from the Swedish Medical Birth Register. Setting Sweden 1992-2004. Participants A total of 897 planned home births were compared with a randomly selected group of 11 341 planned hospital births. We also compared mortality rates with a national sample of 1 122 250 singleton, full-term babies. Main outcome measures Prevalence of mortality and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared. Results During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the home birth group and 0.7 in the hospital group (RR 3.6, 95% CI 0.2-14.7). No cases of emergency complications were found in the home birth group. The risk of having a sphincter rupture was lower in the planned home birth group (RR 0.2, 95% CI 0.0-0.7). The risk of having a caesarean section (RR 0.4, 95% CI 0.2-0.7) or instrumental delivery (RR 0.3, 95% CI 0.2-0.5) was significantly lower in the planned home birth group. Conclusion In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.

  • 5. Nilsen, Anne Britt Vika
    et al.
    Waldenström, Ulla
    Hjelmstedt, Anna
    Hjelmsted, Anna
    Rasmussen, Svein
    Schytt, Erica
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Characteristics of women who are pregnant with their first baby at an advanced age2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 3, p. 353-362xArticle in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the background characteristics of women who gave birth to their first child at an advanced and very advanced maternal age, including their sociodemographic background, social relationships, health behavior, physical and mental health, and reproductive history.

    DESIGN: Cross-sectional data from the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health.

    SETTING: Norway. Sample. 41 236 Norwegian-speaking nulliparous women.

    METHODS: Data were collected by the first questionnaire distributed in week 17 of pregnancy during the recruitment period 1999-2008. The distribution of descriptive variables in relation to age was investigated, by means of bivariate and multivariate logistic regression analyses.

    MAIN OUTCOME MEASURES: Advanced (33-37 years) and very advanced (≥38 years) maternal age.

    RESULTS: Women who had their first baby at an advanced or very advanced age differed from the younger women with regard to a wide range of background characteristics, and this difference was most pronounced for the very advanced group. Problems related to physical aging were more common (infertility, physical health problems, sleep problems, depression and fatigue). Of the sociodemographic factors; high annual income and low level of education were most strongly correlated with high maternal age, followed by single status, unemployment, unsatisfactory relationship with partner and unplanned pregnancy.

    CONCLUSIONS: Besides having more age-related reproductive and physical health problems, women who had their first baby at an advanced or very advanced age constituted a heterogeneous group characterized by either socioeconomic prosperity or vulnerability.

  • 6.
    Persson, Margareta
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hornsten, Asa
    Winkvist, Anna
    Mogren, Ingrid
    'Dealing with ambiguity': the role of obstetricians in gestational diabetes mellitus2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 4, p. 439-446Article in journal (Refereed)
    Abstract [en]

    Objective. Gestational diabetes mellitus is a pregnancy-related complication and therefore obstetricians counsel and manage the maternal health care for these women. This study describes obstetricians experiences of management of pregnant women with gestational diabetes mellitus.

    Design. Interview study. Setting. Hospital-based specialist maternal health care clinics in Sweden. Population. A consecutive purposive national sample of 17 obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus.

    Methods. Interviews were recorded and transcribed. The data were analyzed using qualitative content analysis.

    Result. The overall theme describing the experiences of the obstetricians was labeled Dealing with ambiguity. This ambiguity permeated all aspects of working as an obstetrician within the maternal health care; the role of the obstetrician, the context of organization, the multifaceted maternal and fetal interests to balance, and lack of consensus, recommendations and evidence-based knowledge.

    Conclusions. The study revealed the ambiguous situation experienced and managed by obstetricians providing maternal health care to pregnant women diagnosed with gestational diabetes mellitus. This indicates a need for national guidelines and standardized maternal health care services regarding gestational diabetes mellitus to fulfill the intentions of the health care system. Such recommendations may be beneficial and supportive for the health care professionals as well as for the mother-to-be and her fetus.

  • 7.
    Schytt, Erica
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
    Halvarsson, Anna
    Pedersen-Draper, Christina
    Mårtensson, Lena
    Incompleteness of Swedish local clinical guidelines for acupuncture treatment during childbirth2011In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 1, p. 77-82Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the presence and content of local clinical guidelines for acupuncture treatment in Swedish labor and postnatal wards.

    DESIGN: A Swedish national survey.

    MAIN OUTCOME MEASURES: Presence and content of clinical guidelines for acupuncture. Setting. All Swedish labor and postnatal wards at the time of data collection (April 2007-March 2008).

    MATERIAL AND METHODS: Enquiry was made on local clinical guidelines for acupuncture treatment at 50 labor and 50 postnatal wards. The standards for reporting interventions in controlled trials of acupuncture document was used to identify core aspects of acupuncture treatment and the proportion of wards with guidelines on these aspects was evaluated.

    RESULTS: Guidelines were obtained from 27 labor wards and 22 postnatal wards. Descriptions of the core aspects of acupuncture treatment, such as acupuncture rationale, needling details and treatment regimens, were limited in most. All local guidelines included indications for treatment, but these were not based on scientific evidence of effect, and only two mentioned the importance of achieving de-qi - a feeling of soreness reflecting an effective treatment. Few clinical guidelines required that the practitioners' acupuncture education should be on an academic level and relevant references based on clinical trials were lacking in all guidelines.

    CONCLUSION: Swedish local clinical guidelines on acupuncture for childbirth-related symptoms lack sufficient information to support midwives and obstetricians in administering acupuncture treatment. The content of the guidelines was unclear, inconclusive and, in some cases, irrelevant, and a majority lacked important information on indications and technique.

  • 8.
    Schytt, Erica
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindmark, Gunilla
    Waldenström, Ulla
    Symptoms of stress incontinence 1 year after childbirth associations with self-rated health: prevalence and predictors in a national Swedish sample2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 10, p. 928-936Article in journal (Refereed)
  • 9.
    Schytt, Erica
    et al.
    Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Lindmark, Gunilla
    Waldenström, Ulla
    Symptoms of stress incontinence 1 year after childbirth: prevalence and predictors in a national Swedish sample2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 10, p. 928-36Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aims of the present study were to describe the prevalence of stress incontinence, as described by women themselves, 1 year after childbirth in a national sample of Swedish-speaking women, and to identify possible predictors.

    METHODS: A cohort study, including 2390 women recruited from 593 antenatal clinics in Sweden during three 1-week periods evenly spread over 1 year (1999-2000), representing 53% of women eligible for the study and 75% of those who consented to participate. Data were collected by means of questionnaires in early pregnancy, 2 months and 1 year after the birth, and from the Swedish Medical Birth Register.

    RESULTS: One year after the birth, 22% of the women had symptoms of stress incontinence but only 2% said it caused them major problems. The strongest predictor was urinary incontinence (overall leakage) 4-8 weeks after a vaginal delivery (OR 5.5, CI 95% 4.1-7.4) as well as after a cesarean section (OR 11.9, CI 95% 2.9-48.1). Other predictors in women with a vaginal delivery were: multiparity (OR 1.4; CI 95% 1.1-1.8), obesity (OR 1.6; CI 95% 1.1-2.4) and constipation 4-8 weeks postpartum (OR 1.4; CI 95% 1.1-1.9).

    CONCLUSION: Stress incontinence 1 year after childbirth is a common symptom, which could possibly be reduced by identifying women with urinary leakage at the postnatal check-up.

  • 10.
    Schytt, Erica
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Waldenström, Ulla
    Epidural analgesia for labor pain: whose choice?2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 2, p. 238-42Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To test the hypothesis that the decision to use epidural analgesia during labor is influenced not only by the woman and her background but also by the local cultural practice in the delivery unit.

    DESIGN: Population-based cohort study.

    SETTING: All delivery units in Sweden.

    POPULATION: A nationwide sample of 2,529 women.

    METHODS: Data were collected by questionnaires in early pregnancy and two months after birth, and from the Swedish Medical Birth Register. Logistic regression analysis was conducted, adjusted for gestational age, induction of labor and infant birthweight.

    MAIN OUTCOME MEASURES: Epidural analgesia during labor.

    RESULTS: The odds of having an epidural analgesia were more than twice as high in the Stockholm region (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.7-3.4) and three times higher in middle-north Sweden (OR 3.0; 95% CI 1.7-5.3) compared with the south of Sweden. Of the maternal factors, nulliparity was the strongest predictor (OR 6.3; 95% CI 5.1-7.9), followed by a prenatal belief that epidural analgesia would be needed (OR 3.5; 95% CI 2.8-4.4).

    CONCLUSION: The hypothesis of the study was confirmed. The woman and her background as well as the local cultural practice in the delivery unit matter with regard to the use of epidural analgesia.

  • 11. Zasloff, Eva
    et al.
    Schytt, Erica
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
    Waldenström, Ulla
    First time mothers' pregnancy and birth experiences varying by age2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 11, p. 1328-1336Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to provide a comprehensive picture of the young to the old first time mother as she presents to the clinician in terms of background, expectations, experiences and outcome of labour.

    METHODS: A longitudinal cohort study was conducted, including 1,302 primiparous women recruited at their first booking visit, at 593 antenatal clinics in Sweden (97% of all clinics), during three 1-week periods, evenly spread over 1 year in 1999 and 2000. Two questionnaires were posted and completed: in the second trimester and 2 months after the birth. Women were divided into 5 age groups, with women aged 26-29 as reference.

    RESULTS: The very young women, aged 15-20 years, had the most negative expectations of the upcoming birth. During pregnancy they were more worried and a depressive mood was more common than in the reference group, as were social problems such as unemployment and lack of support. After the birth, they remembered being more afraid and experiencing more pain and lack of control during labour. In spite of this, their overall experience of childbirth did not differ from the reference group. In contrast, the oldest women, aged 35-43 years, did not have negative feelings about the upcoming birth during pregnancy, and did not remember being afraid or experiencing more pain than the reference group, but experienced childbirth overall as more difficult. Only 57% of the oldest women had a normal vaginal delivery compared with 77% of the youngest women. In addition, 7% of the newborns in the oldest group were transferred to the neonatal clinic after the birth, which was almost 3 times as often as in the reference group.

    CONCLUSION: This study showed that expectations and experiences of childbirth vary by maternal age. Whereas the youngest women were more exposed to social and psychological problems, which may have affected their expectations and experiences during labour, the oldest women may have suffered from the biological disadvantage of high maternal age, which is associated with a more complicated delivery. When looking back at labour and birth, the youngest women probably felt that the total experience was better than expected, whereas the opposite may have been the case for the oldest group.

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