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  • 1. Bogren Jungmarker, Emily
    et al.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hildingsson, Ingegerd
    Playing the second fiddle is okay: Swedish fathers' experiences of prenatal care2010In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 55, no 5, p. 421-429Article in journal (Refereed)
    Abstract [en]

    In Sweden, prospective fathers are encouraged and welcome to attend prenatal visits, and pregnant women assess their partners’ involvement in prenatal care as very important. The aim of this study was to describe expectant fathers’ experiences of and involvement in prenatal care in Sweden. Data were drawn from a 1-year cohort study of 827 Swedish-speaking fathers recruited during their partners’ mid-pregnancy and followed up two months after childbirth. The participants reported that the most important issues in prenatal care were the woman’s physical and emotional wellbeing and the support she received from her midwife. However, care was identified as deficient in nearly all aspects of information, medical care, and fathers’ involvement. “Excessive” care was also reported and related to how the father was treated by the midwife, mainly in terms of attention to his emotional wellbeing. Although fathers prioritize the needs of their pregnant partners, it is important for caregivers to assess fathers’ needs and incorporate a family-oriented approach to prenatal care.

  • 2.
    Erlandsson, Kerstin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Being a resource for both mother and child: fathers' experiences following a complicated birth2011In: The Journal of Perinatal Education, ISSN 1058-1243, Vol. 20, no 2, p. 91-99Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe fathers' experiences of being present on a postnatal ward and during the first days at home following a complicated birth. Fifteen fathers were interviewed, and content analysis was used for the analysis. The theme illustrated that fathers were a resource for both mother and child through practical and emotional engagement. The categories describe how the father empowers the mother and illustrates adapting to new family roles. Following complicated birth, fathers should be invited to stay around-the-clock on postnatal wards because it gives them the opportunity to place their resources at the disposal of mother and child. In antenatal courses, fathers should be prepared for their empowering role after a complicated birth

  • 3.
    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.

  • 4.
    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.
    Malm, Mari-Cristin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Davidsson-Bremborg, Anna
    Rådestad, Ingela
    Mothers experience of the time after the diagnosis of an intrauterine death until the induction of the delivery: a qualitative internet based study2011In: Journal of Obstetrics and Gynaecology, ISSN 0144-3615, E-ISSN 1364-6893, Vol. 37, no 11, p. 1677-1684Article in journal (Refereed)
    Abstract [en]

    Aim: This study aims to describe how mothers spend the period of time between being diagnosed with a dead baby in utero and the induction of the delivery.

    Material and Methods: Data were collected using a web questionnaire. Five hundred and fifteen women who had experienced a stillbirth after the 22nd week of gestation answered the open question: ‘What did you do between the diagnosis of the child's death and the beginning of the delivery?’ A qualitative content analysis method was used.

    Results: The results show that some mothers received help to adapt to the situation, while for others, waiting for the induction meant further stress and additional psychological trauma in an already strained situation.

    Conclusion: There is no reason to wait with the induction unless the parents themselves express a wish to the contrary. Health care professionals, together with the parents, should try to determine the best time for the induction of the birth after the baby's death in utero. That time may vary, depending on the parents' preferences.

  • 5. Hildingsson, Ingegerd
    et al.
    Rådestad, Ingela
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Birth preferences that deviate from the norm in Sweden: planned home birth versus planned cesarean section2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 4, p. 288-295Article in journal (Refereed)
    Abstract [en]

    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).

  • 6.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hemförlossningar2009In: Lärobok för barnmorskor / [ed] Kaplan, Annette; Hogg, Beatrice; Hildingsson, Ingegerd; Lundgren, Ingela, Stockholm: Studentlitteratur , 2009, p. 292-298Chapter in book (Other academic)
  • 7.
    Lindgren, Helena
    Karolinska institutet.
    Hemförlossningar i Sverige 1992-2005: Förlossningsutfall och kvinnors erfarenheter2008Doctoral thesis, monograph (Other academic)
    Abstract [sv]

    Hemförlossningar i Sverige 1992-2005. Förlossningsutfall och kvinnors erfarenheter. Detta är den första nationella undersökningen av planerade hemförlossningar i Sverige. I studierna har vi avsett att studera kvinnor som fött eller planerat att föda barn hemma under perioden 1/1 1992 till och med 30/6 2005. Kvinnor som födde barn hemma skiljde sig från kvinnor som födde barn på sjukhus i vissa avseenden (Studie I). Data från det svenska medicinska födelseregistret för perioden 1992 till 2001, för 352 kvinnor som fött utanför sjukhus jämfördes med data från 1760 kvinnor som fött på sjukhus. Kvinnorna som fött utanför sjukhus födde fler barn, hade högre utbildningsnivå men en lägre sammanlagd familjeinkomst och de yrkesarbetade i mindre omfattning jämfört med kvinnor som födde barn på sjukhus. Kvinnorna som fött barn utanför sjukhus var oftare födda i ett annat europeiskt land än Sverige men mer sällan utanför Europa. Förekomsten av hemförlossningar i Sverige baserat på registerkod ”född utanför sjukhus” var 0.38 per tusen födslar. Genom barnmorskor som bistår hemförlossningar, annonsering och via en intresseförening för dem som vill föda hemma, identifierades 757 kvinnor med sammanlagt 1045 planerade hemförlossningar under perioden 1/1 1992 till 30/6 2005. Av de tillfrågade kvinnorna svarade 99 procent att de ville delta i studien. Data insamlades genom frågeformulär. Totalt 100 av de tillfrågade kvinnorna med sammanlagt 141 planerade hemförlossningar återfanns inte i det medicinska födelseregistret. Förekomsten av planerade hemförlossningar baserat på data för kvinnor som identifierats via hemförlossningsbarnmorskor och annonsering, var 0.95 per tusen födslar. Förekomsten av planerade hemförlossningar baserat på registerdata för dessa kvinnor var 0.85 per tusen födslar. Överföring till sjukhus under eller direkt efter förlossningen skedde vid 12.5 procent av de planerade hemförlossningarna (studie II). De vanligaste orsakerna till överföringen var långsam progress (46%) samt att barnmorskan inte kunde komma när förlossningen hade startat (14%). Var fjärde förstföderska avslutade sin planerade hemförlossning på sjukhus och den vanligaste orsaken för överföring bland förstföderskor var att en annan barnmorska än den kvinnan besökt för vård under graviditeten kom för att bistå förlossningen. Faktorer som påverkade överföring hos omföderskor var att tidigare ha genomgått kejsarsnitt och för både förstföderskor och omföderskor att graviditeten var överburen. Data från det svenska medicinska födelseregistret jämfördes för 897 förlossningar identifierade genom datainsamlingen till studie II och 11 341 sjukhusförlossningar (kontrollgrupp). Kriteriet för urval av kontrollgruppen var enkelbörd i graviditetsvecka 37 - 42 samt att förlossningen startat spontant. Kvinnor som planerat att föda hemma födde oftare spontant vaginalt och hade mer sällan allvarliga bristningar i underlivet efter förlossningen (studie III). Risker i samband med valet av förlossningsplats hade övervägts av tre fjärdedelar av kvinnorna (studie IV). Genom egen förberedelse, samtal främst med sin partner och hemförlossningsbarnmorskan, hanterade kvinnorna tankar om att de själva eller deras barn skulle kunna skadas eller dö vid förlossningen. Kvinnorna undvek att diskutera risker med personal inom den konventionella vården. Konklusioner: I Sverige, under åren 1992 – 2005, planerade omkring 100 kvinnor att föda barn i hemmet varje år. En fjärdedel av förstföderskorna avslutade sin planerade hemförlossning på sjukhus och den totala förekomsten av överföringar var 12,5 procent. Kvinnorna hade övervägt risker med en hemförlossning men undvek att diskutera dem med personal inom sjukvården. Den neonatala mortaliteten bland nyfödda vid planerad hemförlossning var 2,2 per tusen inom fyra veckor efter förlossningen jämfört med 0,6 per tusen i sjukhusgruppen. Kvinnor som planerade en hemförlossning hade oftare en spontan vaginal förlossning med färre allvarliga bristningar i underlivet efter förlossningen jämfört med kvinnor som födde på sjukhus.

  • 8.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Home births in the Nordic countries: focus on Denmark2011In: Hjemmefödsler i Danmark, Köpenhamn, 2011Conference paper (Other academic)
  • 9.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Home births in the Nordic countries: praxis and guidelines2011In: Sexuell och reproduktiv hälsa, Stockholm, 2011Conference paper (Refereed)
  • 10.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Brink, Åsa
    Klingberg-Allvin, Marie
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Fear causes tears – perineal injuries in home birth settings: a Swedish interview study2011In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 11, no 6Article in journal (Refereed)
    Abstract [en]

    Background: Perineal injury is a serious complication of vaginal delivery that has a severe impact on the quality of life of healthy women. The prevalence of perineal injuries among women who give birth in hospital has increased over the last decade, while it is lower among women who give birth at home. The aim of this study was to describe the practice of midwives in home birth settings with the focus on the occurrence of perineal injuries.

    Methods: Twenty midwives who had assisted home births for between one and 29 years were interviewed using an interview guide. The midwives also had experience of working in a hospital delivery ward. All the interviews were tape-recorded and transcribed. Content analysis was used.

    Results: The overall theme was "No rushing and tearing about", describing the midwives' focus on the natural process taking its time. The subcategories 1) preparing for the birth; 2) going along with the physiological process; 3) creating a sense of security; 4) the critical moment and 5) midwifery skills illuminate the management of labor as experienced by the midwives when assisting births at home.

    Conclusions: Midwives who assist women who give birth at home take many things into account in order to minimize the risk of complications during birth. Protection of the woman's perineum is an act of awareness that is not limited to the actual moment of the pushing phase but starts earlier, along with the communication between the midwife and the woman.

  • 11.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Christensson, Kyllike
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Walley-Byström, K
    Perceptions of risk and risk management among 735 women who opted for a home birth2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 2, p. 163-172Article in journal (Refereed)
    Abstract [en]

    Home birth is not included in the Swedish health care system and the rate for planned home births is less than one in a thousand. The aim was to describe women’s perceptions of risk related to childbirth and the strategies for managing these perceived risks. Design and setting A nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. Participants A total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. Measurements Two open questions regarding risk related to childbirth and two questions answered by using a scale were investigated by content analysis. Findings Regarding perceived risks in a hospital birth, three categories, all related to loss of autonomy, were identified: 1) being in the hands of strangers; 2) being in the hands of routines and unnecessary interventions and 3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help; 1) worst case scenario and 2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour and by avoiding discussions concerning risks with health care professionals. Conclusion Women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health care professionals. Implications for practice To understand why women choose to give birth at home, health care professionals must learn about the perceived beneficial effect of doing so.

  • 12.
    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.

  • 13.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Woman and Child Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    From belonging to belonging through a blessed moment of love for a child: the birth of a child from the fathers' perspective2009In: Journal of Men's Health, ISSN 1875-6867, E-ISSN 1875-6859, Vol. 6, no 4, p. 338-344Article in journal (Refereed)
    Abstract [en]

    Background: Over the years the involvement of the partner in the childbirth process has resulted in an increasing interest in the partner’s role. Research into the partner’s experiences is still limited. This study aimed to describe the experiences of fathers at the birth of their child from the father’s perspective.

    Method: Sixteen fathers were interviewed about their experiences at the birth of their child between 8 days and 6 weeks after the birth. The interviews were analysed using a phenomenological approach.

    Results: The findings not only recount that the moment of birth was a life changing and overwhelming moment characterised by feelings of love and belonging, but go further in revealing the birth of a child as a movement from belonging to belonging through a blessed moment of love for a child.

    Conclusion: What this finding indicates is that the birth of a child is an important experience in the quality of life of men, calling for their participation at the birth of the child and for a strategy of leaving the family alone right after this outstanding lifemoment of a newbirth.

  • 14.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mälardalens högskola, Akademin för hälsa, vård och välfärd.
    She leads, he follows - fathers' experiences of a planned home birth: a Swedish interview study2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 2, p. 65-70Article in journal (Refereed)
    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.

  • 15.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Department of Women’s and Children’s Health, Karolinska Institutet.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Women’s experiences of empowerment in a planned home birth: a Swedish population-based study2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 4, p. 309-317Article in journal (Refereed)
    Abstract [en]

    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.

  • 16.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Hildingsson, Ingegerd
    Haglund, Bengt
    Rådestad, Ingela J
    Characteristics of women giving birth at home in Sweden: a national register study.2006In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 195, no 5, p. 1366-1372Article in journal (Refereed)
    Abstract [en]

    Objective: The objective of the study was to estimate the proportion of planned home births in Sweden and to identify maternal characteristics of women giving birth at home. Study design: This case-control study included register data of births from 1992 to 2001 in 352 women giving birth at home and 1760 women giving birth in a hospital. Results: Four hundred thirty-nine out-of-hospital births were found during the study period (0.5%). The proportion of planned home births was less than 0.4%. Women with home birth were more likely to have 4 children or more (odds ratio 3.7 [1.4 to 9.9]), be born in a European country outside Sweden (odds ratio 3.5 [1.8 to 6.8]), have a family income below the median (odds ratio 2.9 [2.0 to 4.1]), not work outside the home (odds ratio 2.4 [1.7 to 3.5]), have a high level of education (odds ratio 2.1 [1.5 to 3.0]), and be older than 35 years (odds ratio 1.7 [1.1 to 2.5]). Conclusion: Women with planned home births appear to be a group having a different lifestyle, compared with Swedish women in general.

  • 17.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hildingsson, Ingegerd
    Rådestad, Ingela
    A Swedish interview study: parents' assessment of risks in home births.2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 1, p. 15-22Article in journal (Refereed)
    Abstract [en]

    Objective: to describe home-birth risk assessment by parents. Design: interviews using a semi-structured interview guide. Data were analysed using a phenomenological approach. Setting: independent midwifery practices in Sweden. Participants: five couples who had had planned home births. Findings: the parents had a fundamental trust that the birth would take place without complications, and they experienced meaningfulness in the event itself. Risks were considered to be part of a complex phenomenon that was not limited to births at home. This attitude seems to be part of a lifestyle that has a bearing on how risks experienced during the birth were handled. Five categories were identified as counterbalancing the risk of possible complications: (1) trust in the woman’s ability to give birth; (2) trust in intuition; (3) confidence in the midwife; (4) confidence in the relationship; and (5) physical and intellectual preparation. Key conclusions: although the parents were conscious of the risk of complications during childbirth, a fundamental trust in the woman’s independent ability to give birth was central to the decision to choose a home birth. Importance was attached to the expected positive effects of having the birth at home. Implications for practice: knowledge of parents’ assessment can promote an increased understanding of how parents-to-be experience the risks associated with home birth.

  • 18.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Birth preferences that deviate from the norm - a comparison between women who choose home birth versus caesarean section in a culture where vaginal delivery in a hospital is the norm.2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536XArticle in journal (Refereed)
    Abstract [en]

    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.

  • 19.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Hildingsson, Ingegerd
    Rådestad, Ingela
    Christensson, Kyllike
    Transfers in planned home births related to midwife availability and continuity.2008In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 35, no 1, p. 9-15Article in journal (Refereed)
    Abstract [en]

    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.

  • 20.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Det är trångt: kvinnors upplevelser av barnets rörelser i fullgången graviditet2011In: Sexuell och Reproduktiv hälsa, Stockholm, 2011Conference paper (Refereed)
  • 21.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Hildingsson, Ingegerd
    Transfer in planned home births in Sweden – effects on the experience of birth: A nationwide population-based study2011In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 2, no 3, p. 101-105Article in journal (Refereed)
    Abstract [en]

    Objective More than 10% of all planned home births in high-income countries are completed in the hospital. The aim of this study was to compare the birth experiences among women who planned to give birth at home and completed the birth at home and women who were transferred to hospital during or immediately after the birth. Methods All women in Sweden who had a planned home birth between 1998 and 2005 (n = 671) were invited to participate in the study. The women who agreed to participate received one questionnaire for each planned home birth. Mixed methods were used for the analysis. Results Women who had been transferred during or immediately after the planned home birth had a more negative birth experience in general. In comparison with women who completed the birth at home, the odds ratio for being less satisfied was 13.5, CI 8.1–22.3. Reasons for being dissatisfied related to organizational factors, the way the women were treated or personal ability. Conclusion Being transferred during a planned home birth negatively affects the birth experience. Treatments as well as organizational factors are considered to be obstacles for a positive birth experience when transfer is needed. Established links between the home birth setting and the hospital might enhance the opportunity for a positive birth experience irrespective of where the birth is completed.

  • 22.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjöblom, Ingela
    Idvall, Ewa
    Changing attitudes – women’s experiences of negative reactions to their decision for home birth2012In: Sexual and Reproductive Health Care, ISSN 1877-5764, Vol. 3, no 1, p. 55-56Article in journal (Refereed)
    Abstract [en]

    Being confronted with negative attitudes influences the self-concept of pregnant women. Few women in Sweden give birth at home, and Sweden does not have national home birth guidelines. This study describes women’s experiences concerning reactions to their decision to give birth at home. One in five women experienced negative attitudes to a high extent from health care staff during the study period (1992–2005). Fewer women reported this during the latter part of the period compared to the earlier part. The change in attitudes may be related to the introduction in 2002 of guidelines for planned home births in Stockholm County Council.

  • 23.
    Lindgren, Helena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sjöblom, Ingela
    Rådestad, Ingela
    Idvall, Ewa
    A provoking choice: Swedish women’s experiences of reaction regarding their planned home birth2012In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, p. E-pub ahead of printArticle in journal (Refereed)
  • 24.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Ingela, Rådestad
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    To lose contact with your unborn child2010In: The 18th Congress of the Nordic Federation of Midwives, Copenhagen, 2010Conference paper (Refereed)
    Abstract [en]

    Background: A dead child can not move. When a mother experiences that the movement pattern of her unborn child changes, or is absent, this can be a sign that the child has died. There is a lack of knowledge about how mothers experiences that something has happened their child intrauterine. Purpose: To study the mothers experiences of the period of time that preceded them being told that their child has died intrauterine. Method: In-depth interviews with 26 mothers whose children died prior birth, analysed with content analysis. Results: Twenty two of the 26 interviewied mothers had experienced a premonition that something might be wrong with their unborn child, prior to them being told that their child had died. The overall theme "Something is not right" emerged in the analysis. The mothers premonitions can be described as a process from a vaugh to a increasingly strong feeling that something was not wright with their child. For some mothers the feeling developed in to a realization that the life of the child might be threatened, but for most mothers it was incomprehensible that a child could die prior birth. In the analysis, six categories describing the experiences of the mothers,were identified; 1. Feeling no contact with the child; 2. Feeling anxiety; 3. Feeling that something is wrong; 4. Not comprehending the incomprehensible; 5. Wanting to know; 6. Being certain that the child is dead. Conclusion: The mothers had a feeling that something was not right, prior to being told of the death of their child. Thay felt an anxiety that they tried to control by normalazing the absence of movement by the child. The mothers anxiety was met by family and health care personnel with the explanation that expecting mothers generally feel anxious, and they should wait. The absent of fetal movement was given the explanation that the children move less, or not at all, at the end of a pregnancy. Implications: Expecting mothers should be encouraged to seek medical care when their child meves less or not at all at the end of the pregnancy. There is a lack of evidence in order to normalize the experience of mothers that feel that their child moves less at the end of the pregnancy.

  • 25.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    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.
    Quality of fetal movements in full term pregnancy: A Swedish population-based study among pregnant women within standrad antenatal care2012In: The 2012 international conference on stillbirth, SIDS ant infant survival: Helping babies survive & thrive: Conference programe book / [ed] Kelly Neal Mariotti, USA: The division of reproductive health, centers for disease control and prevention U.S Department of health and human services. Award number 200-2-12-M-50770 , 2012, p. 113-113Conference paper (Refereed)
    Abstract [en]

    Aim: To investigate the perceptions of fetal movements among women in full term pregnancy.

    Methods: A population-based study. Data were collected by distributing questionnaires including one open question: “Please describe your perception of the baby´s movements during this gestational weekto be answered in writingAll antenatal clinics in one of the counties in Sweden participated. Altogether 505 pregnant women were eligible and fulfilled the inclusion criteria for this study. A matrix, listing seven types of movements was used for the content analysis. Categorization of types of movements was performed with regard to the context described by the women.

    Results: 393 (79%) women responded to the open question. Altogether 383 (96%) women perceived fetal movements that were sorted as powerful: firm (78%), slow (24%), stretching (23%), from side to side (18 %) and large (18 %) movements. Most women described movements that corresponded to more than one type of movement. Fifty-three women (13%) also described light movements and seven (2%) startled movements, categorized as non-powerful.  Only ten (4%) women described movements that did not include any of the types of movements in the powerful category. 

    Conclusions: In full term pregnancy, fetal movements should include the following three criteria: presence, frequency and intensity.

  • 26.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindgren, Helena
    Sahlgrenska Akademin Göteborgs Universitet.
    Rubertsson, Christine
    Kvinnors och barns hälsa, Uppsala Universitet.
    Ingegerd, Hildingsson
    Mittuniversitetet.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Women's perception of fetal movements in full term pregnancy: A Swedish population-based study2012In: The 2012 International Conference on Stillbirth, SIDS and infant survival: Hosted by first candle. Helping babies survive & thrive / [ed] Rachel Y. Moon and Ruth Fretts, Baltimore, 2012, p. 113-Conference paper (Refereed)
    Abstract [en]

    Objective: To investigate the perceptions of fetal movements among women in full term pregnancy.

    Design: A population-based study.

    Setting: All antenatal clinics in one of the counties in Sweden March 1, 2011 to October 31, 2011.

    Population: Altogether 505 pregnant women were eligible and fulfilled the inclusion criteria for this study.

    Methods: Data were collected by distributing questionnaires including one open question: “Please describe your perception of the baby´s movements during this gestational weekto be answered in writingA protocol, listing seven types of movements was used for the content analysis.

    Main outcome measures: Perception of fetal movements among women in full term singleton pregnancy.

    Results: 393 (79%) women responded to the open question. Altogether 383 (96%) women perceived five different types of fetal movements that were sorted as powerful: strong (78%), slow (24%), stretching (23%), from side to side (18 %) and large (18 %) movements. Most women described movements that corresponded to more than one type of movement. Fifty three (13%) women also described light movements and seven (2%) startled movements, categorized as non-powerful.  Only ten (4%) women described movements that did not include any of the types of movements in the powerful category. 

    Conclusion: In full term pregnancy, fetal movements are usually recognized as powerful.

    Key Message box: An assessment of fetal movement should include the following three criteria: presence, frequency and intensity.

  • 27.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Att förlora kontakten med sitt ofödda barn: Mammors erfarenheter innan de får besked om att deras barn dött intrauterint2011In: Svenska Barnmorskeförbundets jubileumskonferens 2011. Reproduktiv hälsa, Stockholm, 2011Conference paper (Refereed)
    Abstract [sv]

    Bakgrund Om mamman uppplever att rörelsemönstret hos sitt väntade barn förändras eller uteblir kan det vara ett tecken på att barnet mår dåligt eller har dött i livmodern. Syfte Att studera mammors erfarenheter under den tid som föregick beskedet om att deras barn dött intrauterint. Metod Djupintervjuer med 26 mammor vars barn dött före födelsen, analyserade med innehållsanalys. Resultat Tjugotvå mammor beskrev en föraning om att något kunde ha hänt deras barn, föraningen grundades i ett uteblivet rörelsemönster hos barnet. Sex kategorier som beskriver mammornas väg mot insikten om att deras barn kunde vara hotat identifierades: Inte känna kontakt med barnet; Oro; Något är fel; Inte begripa det ofattbara; Vilja ha besked; Säker på att barnet dött. Det är något som inte stämmer; formulerades som ett sammanfattande tema på mammornas föraning och processen mot insikten skildras som steg nedåt i en trappa. Konklusion Mammorna försökte tygla sin oro genom att normalisera barnets uteblivna rörelser. Lugnande besked både från anhöriga och från sjukvården, fördröjde en undersökning av barnets hälsotillstånd. Mammorna kunde inte förstå det ofattbara; att barnet hade dött intrauterint. Implikationer: Blivande mammor bör uppmans att lita på sin instinkt och att kontakta sjukvården direkt om de är bekymrad över att barnet rör sig mindre i livmodern

  • 28.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Fosterrörelsernas kvalité i slutet av graviditeten2012In: Nationell konferens om fosterrörelser- Hur kan andelen barn som dör före födelsen minskas?, Stockholm, 2012Conference paper (Refereed)
    Abstract [sv]

    Background: Decreased fetal movements are associated with adverse outcome. Besides the frequencies of fetal movements, enhanced knowledge about the quality of fetal movements may contribute to better tools to identify fetus at risk. Aim: The aim of this study is to investigate women’s perceptions of the quality of fetal movements in full term pregnancy and within standard antenatal care. Method: 393 women with uncomplicated pregnancies participate in this study. Data were collected by questionnaires, the women answered one open question: “Describe how you perceive your child's movements usually been during the current week of pregnancy”. The answers were analyzed using content analysis. Results: 315 (78 %) of women in gestational week 37-42 describe the movements in terms of power and in equal words irrespective of parity. Conclusion: A fetal movement anamnesis can besides the frequencies also includes questions about the quality of the movements.

  • 29.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Losing contact with one’s unborn baby: mothers’ experiences prior to receiving news that their baby has died in utero2011In: Omega : Journal of Death and Dying, ISSN 1541-3764, Vol. 62, no 4, p. 353-367Article in journal (Refereed)
    Abstract [en]

    Background: A change in the pattern of movement of her unborn baby could be indicative that the baby might die.

    Aim: To study mothers' experiences during the time prior to receiving news that their baby has died.

    Method: Interviews with 26 mothers.

    Results: Premonition that something had happened to their baby, a sense based on a lack of movements were experienced. Six categories describe the mother's insight that the baby's life was threatened: not feeling in touch with their baby; worry' feeling something is wrong; not understanding the unbelievable; wanting information; and being certain that their baby had died. The overarching theme "There is something wrong" was formulated.

    Conclusion: The mother could not understand the unbelievable: that the baby had died in utero. Implications: Mother's should be cautioned to trust their insights and seek medical advice if they are concerned over the lack of movement from the unborn baby.

  • 30.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mälardalens Högskola.
    Lindgren, Helena
    Sahlgrenska Akademin, Göteborgs Universitet.
    Waiting in no-man's-land: mother's experiences before the induction of labour after their baby has died in utero2012Conference paper (Refereed)
    Abstract [en]

    Objective: Carrying death instead of life is beyond understanding and a huge psychological challenge for a pregnant mother. The period from the time when information is received about the death of an unborn baby until labour is induced has an impact on the mother’s future well-being. The aim of this study was to investigate the mothers’ experiences of the time from the diagnosis of the death of their unborn baby until induction of labour.

    Method: In-depth interviews were conducted with 21 mothers whose babies had 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 no-man’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 without information about what is to come; ‘handling the unimaginable’ concerns the confusing state of finding oneself in the worst-case scenario and yet having to deal with the birth; ‘broken expectations’ is about the loss not only of the baby but also of future family life; and ‘courage to face life’ describes the determination to go on and face reality with strength.

    Conclusions The mothers’ experiences were understood as a sense of being abandoned in no-man’s-land. This time period was characterized by waiting – not knowing for what and not knowing for how long.  Information about the process and the forthcoming encounter with the baby is essential and decisions regarding time of induction should be based on the parents’ requests, not on hospital routines.  

  • 31.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. School of Health, Care and Social Welfare, Mälardalen University, Västerås.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Waiting in no-man's-land: mothers´experiences before the induction of labor after their baby has died in utero2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 2, p. 51-55Article in journal (Refereed)
    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.
    Malm, Mari-Cristin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Rådestad, Ingela
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Losing contact with one´s unborn baby: Mothers experiences prior to receiving news that their baby has died in utero2010In: ISA aand ISPID Joint Conference, Sydney, 2010Conference paper (Refereed)
    Abstract [en]

    Introduction:If a mother experiences a change in the pattern of movement of here unborn baby, it could be indicative that the baby is unwell or has died in utero. Aim: To study mother´s experiences during the time prior to receiving news that their unborn baby has died in utero. Method: In- depth interviews ware conducted with 26 mothers whose babies died prior to birth, witch were then analysed using content analysis. Results: Twent-two mothers descriebed a premoniation that something had happened to their unborn baby, a sense based on al lack of movement from the baby. Six cathegories were constructed from the analysis of the interviews decribing the mother´s insight that the babys life was in threatened; 1. Not feelning in touch with their baby 2. Worry 3. Wanting information 4. Not understanding the unbelievable 5. Wanting information 6. being certain that their baby had died. The overarching theme- "There is something wrong" was formulated. The mother´s experiences can be illustrated as a gradually descending a staircase towards the insight that their baby´s life was threatened. Conclusion: The mothers tried to curb their worry by normalising the baby´s lack of movement. Additionally, reassurance frpm fa,ily and healt-care proefessionals delayed an investigation of the baby´s wellbeing. The mother could not understand the unbelievable; that the baby had died in utero.

  • 33. Rådestad, Ingela
    et al.
    Lindgren, Helena
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Women’s perceptions of fetal movements in full-term pregnancy2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 3, p. 113-116Article in journal (Refereed)
1 - 33 of 33
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