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  • 1. Ahlberg, M.
    et al.
    Nordlund, E.
    Weichselbraun, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Good obstetric care requires interdisciplinary collaboration2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed)
  • 2. Ahlberg, M.
    et al.
    Nordlund, E.
    Weichselbraun, M.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Svenska barnmorskeförbundet: God förlossningsvård kräver tvärprofessionellt samarbete2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 20-21Article in journal (Refereed)
  • 3. Askelsdottir, B.
    et al.
    Jonge, W. L. D.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Home care after early discharge: Impact on healthy mothers and newborns2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 8, p. 927-934Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

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

  • 7. Curtis, C.
    et al.
    Faundes, A.
    Yates, A.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Bokosi, M.
    Lacoste, M.
    Postabortion family planning progress: The role of donors and health professional associations2019In: Global Health Science and Practice, ISSN 2169-575X, Vol. 7, p. S222-S230Article in journal (Refereed)
  • 8. Ekström, Å.
    et al.
    Altman, D.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Larsson, C.
    Andolf, E.
    Planned cesarean section versus planned vaginal delivery: Comparison of lower urinary tract symptoms2008In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 19, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

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

  • 9. Grunewald, C.
    et al.
    Håkansson, S.
    Högberg, U.
    Luthander, C. M.
    Sandin-Bojö, A. -K
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Svensk förlossningsvård säkras i ett rikstäckande project2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 19, p. 956-959Article in journal (Refereed)
  • 10. Grunewald, C.
    et al.
    Håkansson, S.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Svensk förlossningsvård måste bli säkrare2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 4Article in journal (Refereed)
  • 11. Henriksson, C.
    et al.
    Bostrom̈, A. -M
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    What effect does breastfeeding have on coeliac disease?: A systematic review update2013In: Evidence-Based Medicine, ISSN 1356-5524, E-ISSN 1473-6810, Vol. 18, no 3, p. 98-103Article in journal (Refereed)
    Abstract [en]

    Objective: To update the evidence published in a previous systematic review and meta-analysis that compared the effect of breastfeeding on risk of coeliac disease (CD). Material and methods: A systematic review of observational studies published between 1966 and May 2004 on the subject was conducted in 2005. This update is a systematic review of observational studies published between June 2004 and April 2011. Pubmed, EMBASE and Cinahl were searched for published studies that examined the association between breastfeeding and CD. Results: After duplicates were removed 90 citations were screened. Four observational studies were included in the review. Two of three studies which had examined the duration of breastfeeding and CD reported significant associations between longer duration of breastfeeding and later onset of CD (OR ranged from 0.18 to 0.665). Breastfeeding during the introduction of gluten to the infant was reported to have a protective effect in two studies. Conclusions: Our findings support previous published findings that breastfeeding seems to offer a protection against the development of CD in predisposed infants. Breastfeeding at time of gluten introduction is the most significant variable in reducing the risk. Timing of gluten introduction may also be a factor in the development of CD.

  • 12. Hildingsson, I.
    et al.
    Westlund, K.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Burnout in Swedish midwives2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 3, p. 87-91Article in journal (Refereed)
    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.

  • 13. Hildingsson, I.
    et al.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Editorial2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 1Article in journal (Refereed)
  • 14. Jonas, W.
    et al.
    Nissen, E.
    Ransjö-Arvidson, A. -B
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Henriksson, P.
    Uvnäs-Moberg, K.
    Short- and long-term decrease of blood pressure in women during breastfeeding2008In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 3, no 2, p. 103-109Article in journal (Refereed)
    Abstract [en]

    Background and aims: The benefits of breastfeeding for infants are well known. Recently data have started to emerge showing that breastfeeding may also induce positive effects in the mother. This study aimed to investigate the pattern of maternal blood pressure before, during, and after a breastfeed 2 days postpartum. Additionally, blood pressure during the following 25-week breastfeeding period was investigated. Methods: Sixty-six primiparae with normal deliveries were consecutively recruited. Blood pressure was measured at -5, 10, 30, and 60 minutes in connection with a morning breastfeed. Thirty-three women continued to measure blood pressure before and after breastfeeding for 25 weeks. Results: Blood pressure fell significantly in response to breastfeeding 2 days after birth. The fall in systolic and diastolic blood pressure amounted to 8.8 (SD = 11.00) and 7.7 (SD = 9.3) mm Hg, respectively. During the 25-week follow-up period a significant fall of basal blood pressure (systolic, df = 3, F = 7.843, p < 0.001; diastolic, df = 3, F = 5.453, p = 0.002) was observed. The total fall in systolic and diastolic blood pressure amounted to a mean of 15 (SD = 10.4) mm Hg and 10 (SD = 9.7) mm Hg, respectively. In addition, blood pressure fell significantly in response to individual breastfeeding sessions during the entire observation period. Conclusions: In conclusion, both systolic and diastolic blood pressures fall during a breastfeeding session, and pre-breastfeeding blood pressure decreases during at least the first 6 months of a breastfeeding period in a homelike environment. This study lends further support to the health-promoting effects of breastfeeding. © 2008 Mary Ann Liebert, Inc.

  • 15. Jonas, W.
    et al.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Nissen, E.
    Ransjö-Arvidson, A. -B
    Uvnäs-Moberg, K.
    Newborn skin temperature two days postpartum during breastfeeding related to different labour ward practices2007In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 83, no 1, p. 55-62Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate (1) the skin temperature pattern in newborns two days after birth in connection to breastfeeding and to examine (2) if the administration of epidural analgesia (EDA) and oxytocin (OT) infusion during labour influences this parameter at this point of time. Method: Forty-seven mother-infant pairs were included in the study: nine mothers had received OT stimulation during labour (OT group), 20 mothers had received an EDA and OT during labour (EDA group), while 18 mothers had received neither EDA nor OT stimulation during labour (control group). A skin temperature electrode was attached between the newborn's shoulder blades. The newborn was placed skin-to-skin on the mother's chest and covered with a blanket. The temperature was recorded immediately after the newborn was put on the mother's chest and at 5, 10, 20 and 30 min. Results: The temperature measured when the newborns were put skin-to-skin on their mothers' chest was significantly higher in the infants of the EDA group (35.07 °C) when compared to the control group (34.19 °C, p = 0.025). Skin temperature increased significantly (p = 0.001) during the entire experimental period in the infants belonging to the control group. The same response was observed in infants whose mothers received OT intravenously during labour (p = 0.008). No such rise was observed in infants whose mothers were given an EDA during labour. Conclusion: The results show that the skin temperature in newborns rises when newborns are put skin-to-skin to breastfeed two days postpartum. This effect on temperature may be hampered by medical interventions during labour such as EDA. © 2006 Elsevier Ireland Ltd. All rights reserved.

  • 16. Klint Carlander, A. -K
    et al.
    Andolf, E.
    Edman, G.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Impact of clinical factors and personality on the decision to have a second child. Longitudinal cohort-study of first-time mothers2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 2, p. 182-188Article in journal (Refereed)
    Abstract [en]

    Objective To investigate which factors related to the first birth influence subsequent reproduction within 5 years after the birth. Design Prospective cohort study. Setting University hospital, Stockholm, Sweden. Sample Cohort of 547 first-time singleton mothers with a normal pregnancy recruited prospectively of whom 451 women consented to follow-up 5 years later. Methods Data were collected by several questionnaires on sexual, reproductive and childbirth-related factors as well as on personality, postnatal depression, fear of childbirth and contact between mother/child. Medical records were also used. Associations between these factors and having a second child were analyzed using logistic regression. Main outcome measures Women's subsequent reproduction. Results Planning a second child at 9 months postpartum was most important in determining to have a second child. Women who had restored their sex life 9 months after birth and women who had a high score in the personality monotony avoidance scale, were less likely to give birth to a second child. No differences were observed regarding mode of delivery, factors related to birth and having a second child, nor was there an association between postnatal depression, fear of childbirth, a negative birth experience and self-estimated contact with the child and subsequent reproduction. Conclusions Circumstances in relation to the first birth, such as mode of delivery and a negative birth experience, did not affect subsequent reproduction. Planning another child by 9 months after birth was the strongest factor correlated with having a second child. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  • 17. 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 mothers2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 2, p. 83-89Article in journal (Refereed)
    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.

  • 18. Larsson, C.
    et al.
    Saltvedt, S.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Andolf, E.
    Planned Vaginal Delivery Versus Planned Caesarean Section: Short-Term Medical Outcome Analyzed According to Intended Mode of Delivery2011In: Journal of Obstetrics and Gynaecology Canada, ISSN 1701-2163, Vol. 33, no 8, p. 796-802Article in journal (Refereed)
    Abstract [en]

    Objective: To compare maternal medical outcome after planned vaginal delivery and planned Caesarean section. Methods: We conducted a prospective cohort study of healthy primiparous women in Stockholm, Sweden, who were either scheduled for a planned Caesarean section (for breech presentation or at maternal request) or admitted for a vaginal delivery. Data were analyzed according to intended mode of delivery. Results: A total of 541 women were included in the study; of these, 247 had a Caesarean section and 294 a vaginal delivery. There were sociodemographic differences between the groups. No difference in mean estimated blood loss or rate of infection was found Complications in the planned Caesarean section group were lower than previously reported. The difference in estimated blood loss between women undergoing planned Caesarean section and women who had a vaginal delivery was not more than 7%. Morbidity in the planned vaginal delivery group was mostly due to operative interventions The Caesarean section group had a longer hospital stay than women who delivered vaginally. Conclusion: We found no difference in short-term medical outcomes between primiparous women undergoing planned Caesarean section and those undergoing planned vaginal delivery after analysis according to the intended mode of delivery. © 2011 Society of Obstetricians and Gynaecologists of Canada.

  • 19. Larsson, C.
    et al.
    Saltvedt, S.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Pahlen, S.
    Andolf, E.
    Estimation of blood loss after cesarean section and vaginal delivery has low validity with a tendency to exaggeration2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 12, p. 1448-1452Article in journal (Refereed)
    Abstract [en]

    Background. Excessive bleeding is one of the major threats to women at childbirth. The aim of this study was to validate estimation of blood loss during delivery. Methods. Bleeding was estimated after 29 elective cesarean sections and 26 vaginal deliveries and compared to blood loss measured by extraction of hemoglobin using the alkaline hematin method, according to Newton. Results. Inter-individual agreement of estimation showed good results. Estimated loss in comparison with measured loss resulted in an over-estimation. In vaginally delivered women, there was no correlation between estimated and measured blood loss (r2=0.13), and in women delivered by elective cesarean section, the correlation was moderate (r2=0.55). Agreement, according to Bland and Altman, indicated that measured blood loss could vary from 570 ml less to 342 ml more than estimated blood loss. Conclusions. The standard procedure of estimation of obstetric bleeding was found to be unreliable. In this study, blood loss was over-estimated in cesareans. In vaginal deliveries, there seemed to be no correlation. Estimated blood loss as a quality indicator or as a variable in studies comparing complications must be used with caution. For clinical purposes, estimation of blood loss and measurement of post partum hemoglobin is of low value and may lead to the wrong conclusions. © 2006 Taylor &amp; Francis.

  • 20. 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 study2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 1, p. 37-41Article in journal (Refereed)
    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..

  • 21. 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 section2017In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 11, p. 112-116Article in journal (Refereed)
    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.

  • 22. Sahlin, M.
    et al.
    Carlander-Klint, A. -K
    Hildingsson, I.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    First-time mothers' wish for a planned caesarean section: Deeply rooted emotions2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 5, p. 447-452Article in journal (Refereed)
    Abstract [en]

    Background: international estimates suggest that caesarean section on maternal request range from 4% to 18% of all caesarean section. An increasing number of surveys have investigated women's reasons for a caesarean section in the absence of a medical indication but few studies have solely studied first-time mothers motivation for this request. Objective: to describe the underlying reasons for the desire for a caesarean section in the absence of medical indication in pregnant first-time mothers. Method: a qualitative descriptive study, with content analysis of interviews with 12 first-time mothers. Findings: the overarching theme formulated to illustrate the central interpreted meaning of the underlying desire for a planned caesarean section was based on deeply rooted emotions'. Four categories were identified as related to the request for a caesarean section on maternal request. The categories was identified as 'always knowing that there are no other options than a caesarean section', 'caesarean section as a more controlled and safe way of having a baby', own negative experiences of health care and having problems dealing with other people's reaction about their mode of delivery. Conclusion: the results show that for these first-time mothers deeply rooted emotions described as stronger than fear of birth were behind their wish for a planned caesarean section. © 2012 Elsevier Ltd.

  • 23. 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.”2021In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 27, article id 100581Article in journal (Refereed)
    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.

  • 24. Salmelin, A.
    et al.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Bottinga, R.
    Brorsson, B.
    Ekman-Ordeberg, G.
    Grimfors, E. E.
    Hanson, U.
    Blom, M.
    Persson, E.
    Fetal monitoring with computerized ST analysis during labor: A systematic review and meta-analysis2013In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 92, no 1, p. 28-39Article in journal (Refereed)
    Abstract [en]

    Background. Computerized ST analysis of fetal electrocardiography (ECG) combined with cardiotochography (CTG) has been introduced for intrapartum monitoring and is the prevailing method when ST analysis (STAN®) is used. Objective. To assess the evidence that computerized ST analysis during labor reduces the incidence of fetal metabolic acidosis, hypoxic ischemic encephalopathy, cesarean section, instrumental vaginal delivery or the number of instances where fetal scalp blood sampling is used as compared with CTG only. Methods. Search of PubMed, Cochrane Library, EMBASE, Web of Science, CINAHL and CRD databases. Selection criteria. CTG only compared with CTG + computerized ST analysis. Data collection and analysis. Studies were assessed using pre-designed templates. Meta-analyses of included randomized controlled trials were performed using a random effects model. Results. Risk ratio for cord metabolic acidosis with STAN® was 0.96 [95% confidence interval (CI) 0.49-1.88]. Risk ratio for cesarean sections or instrumental vaginal deliveries for fetal distress was 0.93 (95%CI 0.80-1.08) and for fetal scalp blood sampling 0.55 (95%CI 0.40-0.76). Encephalopathy cases were not assessed due to their low incidence. Conclusions. There is not enough scientific evidence to conclude that computerized ST analysis reduces the incidence of metabolic acidosis. Cesarean sections and instrumental vaginal deliveries due to fetal distress or other indications are the same, regardless of method, but STAN® reduces the number of instances which require scalp blood sampling. © 2012 The Authors © 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

  • 25.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Disrespect and abuse during birth and postnatal care2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 21Article in journal (Refereed)
  • 26.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Editorial2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 2Article in journal (Refereed)
  • 27.
    Wiklund, Ingela
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Högskolan Dalarna.
    Etik och barnmorskans arbete ur ett globalt perspektiv2021In: Etik för barnmorskor / [ed] Marie Oscarsson, Susanne Georgsson, Lund: Studentlitteratur AB, 2021, 1:1, p. 287-292-Chapter in book (Other academic)
  • 28.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Female Genital Mutilation and challenges in disseminating high quality healthcare guidelines2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, p. 1-2Article in journal (Refereed)
  • 29.
    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 health2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 3Article in journal (Refereed)
  • 30.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    New guidelines for cesarean section on maternal request2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 3Article in journal (Refereed)
  • 31.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Sexual and reproductive health and rights: A matter of life and death2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 4Article in journal (Refereed)
  • 32.
    Wiklund, Ingela
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    We have had remarkable success2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 2Article in journal (Refereed)
  • 33.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Ahlberg, M.
    Dahlström, A.
    Weichselbraun, M.
    Sjörs, G.
    Routine testing of umbilical cord blood after normal delivery should be discontinued2014In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 5, no 4, p. 165-166Article in journal (Refereed)
    Abstract [en]

    On many newborns in Sweden routine samples of blood are taken from the umbilical cord after birth to measure the acid-base balance. These tests were introduced with the aim to objectively measure the well-being and stress levels of the newborn. The information was to be used as a measurement of quality of care, for research and as a tool to help guide decisions around the care-needs of the newborn. After 10 years of routine analysis it has become clear that the results of these tests have limited clinical value and that they are a poor measurement of quality of care. © 2014 Elsevier B.V.

  • 34.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Andolf, E.
    Lilja, H.
    Hildingsson, I.
    Indications for cesarean section on maternal request - Guidelines for counseling and treatment2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 3, p. 99-106Article in journal (Refereed)
    Abstract [en]

    Aim: The aim was to find scientific evidence and, based on this, to develop national medical guidelines in Sweden for cesarean section on mother's request. Background: More than 17% of all births in Sweden in 2008 were cesarean sections, compared to 5% at the beginning of the 1970s. About 8% of the cesarean sections were performed at mother's request. The predominant reason for this preference is fear of childbirth. When deciding whether to perform an elective cesarean section, the obstetrician must emphasize the long- and short-term health consequences for the mother and her baby, as well as weigh the risks associated with the procedure itself against not performing the procedure. Clarification is needed to determine for which conditions it is appropriate to comply with the mother's request. Materials and method: A literature review was conducted to identify factors that were relevant as an argument to meet the request for cesarean section on maternal request. The authors analyzed these factors individually to determine. Findings: The guidelines suggest that it is appropriate to comply with a woman's request for cesarean section if the reason for her request is deemed sufficiently serious and if, after participating in a counseling program, the woman persists in her request for cesarean section. Conclusion: A request for cesarean section where no medical indication is present should not be met without considerations concerning the safety of the mother and her baby, while also weighing the risk of adverse outcomes for mother and baby. © 2012 Elsevier B.V..

  • 35.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Edman, G.
    Andolf, E.
    Cesarean section on maternal request: Reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 4, p. 451-456Article in journal (Refereed)
    Abstract [en]

    Objective. The purpose of this study was to investigate first-time mothers undergoing cesarean section in the absence of medical indication, their reason for the request, self-estimated health, experience of delivery, and duration of breastfeeding. We also aimed to study if signs of depression postpartum are more common in this group. Method. In a prospective cohort study 357 healthy primiparas from two different groups, "cesarean section on maternal request" (n=91) and "controls planning a vaginal delivery" (n=266) completed three self-assessment questionnaires in late pregnancy, two days after delivery and 3 months after birth. Symptom scores from the Edinburgh postnatal depression scale at three months after birth were also investigated. Results. Women requesting cesarean section experienced their health ass less good (p<0.001) and were more often planning for one child only (p<0.001). They more often reported anxiety for lack of support during labor (p<0.001), for loss of control (p<0.001), and concern for fetal injury/death (p<0.001). After planned cesarean section women in this group reported a better birth experience compared to women planning a vaginal birth (p<0.001). They were breastfeeding to a lesser extent three months after birth (p<0.001). There were no differences in signs of postpartum depression between the groups three months after birth (p=0.878). Conclusion. The knowledge gained from this study may help in understanding why some women prefer to give birth with elective cesarean section. It also elucidates the need for awareness of professional support during vaginal birth. © 2007 Taylor & Francis.

  • 36.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Edman, G.
    Andolf, E.
    Reply: There is a need for a model of how to provide clinical guidance to women requesting cesarean section [4]2007In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 86, no 9, p. 1149-1150Article in journal (Refereed)
  • 37.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Edman, G.
    Larsson, C.
    Andolf, E.
    First-time mothers and changes in personality in relation to mode of delivery2009In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 65, no 8, p. 1636-1644Article in journal (Refereed)
    Abstract [en]

    Title. First-time mothers and changes in personality in relation to mode of delivery. Aim. This paper is a report of a study conducted to examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries. Background. Birth of the first child is a major life event, possibly influencing personality. The physiological and emotional processes that start in pregnant women have a major impact on the evolving mother-child relationship. Knowledge about changes in personality during pregnancy and motherhood is scarce. Method. A prospective, group-comparative cohort study including 314 healthy primiparas having either 'caesarean section on maternal request' (n = 74) or 'spontaneous vaginal delivery group' (n = 240). The self-report inventory Karolinska Personality Scales was mailed to participants at 37-39 gestational weeks in pregnancy and 9 months after delivery. Data were collected from January 2003 to June 2006. Results. All mean values of the personality variables were within the normal range. There was a statistically significant increase in Impulsivity (P = 0·046) and decrease in Socialization (P = 0·004). The scores developed differently depending on mode of delivery. Thus, women in the vaginal delivery group increased their scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery group decreased their scores. Although women in both groups became more impulsive and less socialized, personality remained comparatively stable in the transition from late pregnancy to motherhood. Conclusion. As interactive therapeutic midwife/client relationships and maternal/social role preparation have been shown to have a great effect on progress in becoming a mother, knowledge about how personality may affect this process is important so that healthcare professionals can attempt to reduce women's anxiety levels during pregnancy. © 2009 Blackwell Publishing Ltd.

  • 38.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Edman, G.
    Larsson, C.
    Andolf, E.
    Personality and mode of delivery2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 10, p. 1225-1230Article in journal (Refereed)
    Abstract [en]

    Background. Women's rights to request an elective cesarean section without a specific medical indication has been intensively debated during the last decade among healthcare professionals. The aim of this study was to investigate if women requesting a cesarean section differ in their personality from those who plan a vaginal delivery. The aim was also to study differences between the groups in age, perceived health, and place of birth, IVF treatment, and family size planning. Method. Three hundred and twenty-eight pregnant women from two different groups, "cesarean section on maternal request" (n = 84), and "vaginal delivery group" (n = 242) completed the self-report inventory Karolinska Scales of Personality at 37-39 gestational weeks in pregnancy. Results. A significant difference in age was found between the cesarean and the vaginal group (mean age 33.9 years versus 30.8, p <0.001). Analysis of covariance of personality traits showed that the subscales Monotony avoidance (p <0.003) and Socialization (p <0.002) differed significantly between women requesting cesarean section and women planning a vaginal delivery. There were no differences between the groups in variables concerning the anxiety proneness scale. Conclusion. Personality traits such as Socialization and Monotony avoidance differ significantly before birth between mothers who request a cesarean section and those who do not. © 2006 Taylor & Francis.

  • 39.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Edman, G.
    Ryding, E. -L
    Andolf, E.
    Expectation and experiences of childbirth in primiparae with caesarean section2008In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 115, no 3, p. 324-331Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience. Design: A prospective group-comparison cohort study. Setting: Danderyd Hospital, Stockholm, Sweden. Sample: First-time mothers (n = 496) were recruited to the study in week 37-39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between 'caesarean section on maternal request', 'caesarean section due to breech presentation' and 'controls planning a vaginal delivery'. Methods: The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Main outcome measures: Expectations prior to delivery and experiences at 3 months after birth. Results: Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001). Conclusions: Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support. © 2008 The Authors.

  • 40.
    Wiklund, Ingela
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health. Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm.
    Fernández, Soledad Alarcón
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden..
    Jonsson, Markus
    Centre for Cultural Evolution, Stockholm University, Stockholm, Sweden.
    Midwives’ ability during third stage of childbirth to estimate postpartum haemorrhage2022In: European Journal of Obstetrics and Gynecology and Reproductive Biology: X, ISSN 2590-1613, Vol. 15, article id 100158Article in journal (Refereed)
    Abstract [en]

    Objective: Correctly assessing the amount of blood loss is crucial in order to adequately treat postpartum haemorrhage (PPH) at an early stage and diminish any related symptoms and/or complications. The aim of our study is to analyse correctness in visually estimated blood loss during labour and to measure the differences between subjectively measured and weighted blood losses (ml). Design: Cross-sectional study Setting: A Swedish maternity unit with 6000 annual births Participants: Midwives employed at a big maternity unit at a hospital in northern Stockholm, Sweden. Intervention: Midwives assisting 192 vaginal births were asked to visually estimate the blood loss from the assisted delivery. Coasters and sanitary pads were weighed following the birth. We analysed if there were any differences between subjective measured blood loss (ml) and weighted blood loss. These two methods were also compared to quantify concordance between estimated blood volume and the actual volume. Findings: The number of overestimates of blood loss was 45.3 % (n=87) with an average of 72.9 ml; the number of underestimates was 49.4 % (n=95) with an average of 73.8 ml. Exact correct estimations of blood loss were done in 5.2 % of the cases (n=10). The largest overestimation of a postpartum bleeding was by 520 ml; the largest underestimation was by 745 ml. Conclusion: There was both underestimation and overestimation of blood loss. We found small but significant overestimates in PPH < 300 ml (16 ml). In PPH > 300 ml, there was a small but not significant underestimates (34 ml). Based upon our findings, we conclude that it is reasonable to start weighing blood loss when it exceeds 300 ml. © 2022 The Authors

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  • 41.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Lindvall, K.
    Sachs, M. A.
    The Stockholm county council refunds home births in specific cases2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 51-52, p. 4272-4277Article in journal (Refereed)
  • 42. Wiklund, Ingela
    et al.
    Malata, A. M.
    Cheung, N. F.
    Cadée, F.
    Appropriate use of caesarean section globally requires a different approach2018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10155, p. 1288-1289Article in journal (Refereed)
  • 43.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Matthiesen, A. -S
    Klang, B.
    Ransjö-Arvidson, A. -B
    A comparative study in Stockholm, Sweden of labour outcome and women's perceptions of being referred in labour2002In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 18, no 3, p. 193-199Article in journal (Refereed)
    Abstract [en]

    Objective: to study the outcome of labour and women's perceptions of being referred after onset of labour. Design: a comparative study carried out between October 1998 and April 1999. Setting: prospective parents in Stockholm, Sweden are offered a choice of which of the five hospitals in which they want to give birth. In reality, there is a lack of maternity beds in Stockholm to implement this policy and therefore nearly 10% of labouring women are being referred during labour. Participants: the study population was selected from one of the five hospitals. Included in the study were 266 labouring women, with a 37-42 weeks uncomplicated pregnancy, fetus presenting by the vertex and spontaneous onset of labour. During pregnancy, all the women had chosen the same labour ward where they planned to deliver. However, at the onset of labour half of the women, case group I (n = 133) were referred to another maternity unit due to lack of space in the labour ward. For every referred woman a control woman matched for age, parity and date of delivery was selected, with the same inclusion criteria, except being referred, control group II (n = 133). Methods: a questionnaire with closed and open questions was posted to the women after birth and used to collect quantitative and qualitative data on the outcome of labour and the women's perceptions of referral during labour. Findings: routines such as epidural analgesia (EDA) (p < 0.002), episiotomies (p < 0.015) and morphine/pethidine during labour (p < 0.023) were more common in the referred group. The women in the referred group considered to a higher extent that referral during labour had affected their emotional state (p < 0.001). Women in both groups had been worried during pregnancy by the thought of having to be referred when labour had started and the referral had caused practical problems, stress and a feeling of not being welcome in the referral labour ward. Key conclusion and implications for practice: referral during established normal labour may affect labour outcome, and the possibility that they may be referred worries women during pregnancy. Maternity policies and practices should be organised so that caring goals, such as continuity of care and women's' participation in birth planning, can be met. © 2002 Elsevier Science Ltd. All rights reserved.

  • 44.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Mohlkert, P.
    Edman, G.
    Evaluation of a brief cognitive intervention in patients with signs of postnatal depression: A randomized controlled trial2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 8, p. 1100-1104Article in journal (Refereed)
    Abstract [en]

    The effectiveness of a brief intervention based on individual cognitive behavioral counseling in mothers with signs of postnatal depression was evaluated. Patients undergoing a complicated delivery were invited to participate. Women who scored above a cut-off level (>12) on Edinburgh Postnatal Depression Scale (EPDS) were randomized to either a brief individual cognitive behavioral counseling comprising three weekly 1 hour sessions (n=33) or standard care (n=34). Measures of postnatal depression were collected from EPDS, 1 month after birth and 1 month after treatment. Both groups showed a significant decline from baseline to follow-up, mean scores declined from 16.9 to 7.6 (intervention group) vs. 13.6 to 9.9 (control group; p < 0.001). There was a significant interaction effect (Group*Time) between the intervention and the control group showing a more rapid decline of EPDS scores for the intervention group (p < 0.001). The results suggest that brief cognitive behavioral counseling is an effective treatment in women at risk for developing postnatal depression. © 2010 Informa UK Ltd.

  • 45.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Nordström, L.
    Norman, M.
    Vårdprogram för avnavling av nyfödda barn2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 45, p. 3208-3210Article in journal (Refereed)
  • 46.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Norman, M.
    Uvnäs-Moberg, K.
    Ransjö-Arvidson, A. -B
    Andolf, E.
    Epidural analgesia: Breast-feeding success and related factors2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 2, p. e31-e38Article in journal (Refereed)
    Abstract [en]

    Objective: to compare the early breast-feeding behaviours of full-term newborns whose mothers had received epidural analgesia (EDA) during an uncomplicated labour, with a group of newborns whose mothers had not received EDA. Design and setting: a retrospective comparative study design was used and the study was carried out in a labour ward in Stockholm, Sweden between January 2000 and April 2000. The ward has about 5500 deliveries per year. Participants: all maternity records of women who had received EDA during labour (n=585) were included in the study. For each EDA record, a control record was selected, matched for parity, age and gestational age at birth. Women with emergency caesarean section, vacuum extraction/forceps, twin pregnancy, breech presentation or an intra-uterine death, as well as neonates with an Apgar score <7 at 5 mins were excluded. After exclusion, the study population consisted of 351 healthy women and babies in each group. Method: logistic regression was performed. The dependent variables: (1) initiation of breast feeding after birth; (2) artificial milk given during hospital stay; and (3) breast feeding at discharge were studied in response to: (a) parity; (b) gestational age at birth; (c) length of first and second stage of labour; (d) administration of oxytocin; (e) administration of EDA; and (f) neonatal weight, as independent variables. Findings: significantly fewer babies of mothers with EDA during labour suckled the breast within the first 4 hours of life [odds ratio (OR) 3.79]. These babies were also more often given artificial milk during their hospital stay (OR 2.19) and fewer were fully breast fed at discharge (OR 1.79). Delayed initiation of breast feeding was also associated with a prolonged first (OR 2.81) and second stage (OR 2.49) and with the administration of oxytocin (OR 3.28). Fewer newborns of multiparae received artificial milk during their hospital stay (OR 0.58). It was also, but to a lesser extent, associated with oxytocin administration (OR 2.15). Full breast feeding at discharge was also positively associated with multiparity (OR 0.44) and birth weight between 3 and 4 kg (OR 0.42). Key conclusions: the study shows that EDA is associated with impaired spontaneous breast feeding including breast feeding at discharge from the hospital. Further studies are needed on the effects of EDA on short- and long-term breast-feeding outcomes. © 2007 Elsevier Ltd. All rights reserved.

  • 47.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Sahar, Z.
    Papadopolou, M.
    Löfgren, M.
    Parental experience of bedside handover during childbirth: A qualitative interview study2020In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 24, article id 100496Article in journal (Refereed)
    Abstract [en]

    Background: It has been described that bedside reporting can contribute to patient safety and increase patient involvement in healthcare. To our knowledge, however, there is no existing research on bedside handover during labour. Aim: The aim of this study was to examine the patient's experiences of bedside handover during labour. Method: A qualitative design was used. Nineteen couples were interviewed after childbirth regarding their experiences of bedside handover during delivery. Twelve of those had experienced bedside handover and were, thereby, included in the study. The interviews were performed in a delivery ward in Stockholm during January 2018. The material was analysed according to content analysis. Results: Four main categories emerged from the data: non-verbal communication, verbal communication, concerns, and birth experience. In general, bedside handover was perceived to be positive, the participants felt they were treated professionally, and that they had been involved during the handover. One advantage with the handover was the possibility for parents to confirm the sharing of information during the handover, which made them feel secure. Moreover, most of the parents reported they received good treatment and had a good labour experience. Parents’ experiences of bedside handover and midwives’ support were summarised as follows: midwives used common words and avoided using medical terminology, and they kept eye contact with the woman and her partner. Conclusion: Bedside handover was experienced by both parents as a way of being positively included in the care of their newborn. The caregivers were described as being attentive, respectful, and were good listeners. © 2020 Elsevier B.V.

  • 48.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Wallin, J.
    Vikström, M.
    Ransjö-Arvidson, A. -B
    Swedish midwives' rating of risks during labour progress and their attitudes toward performing intrapartum interventions: A web-based survey2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 4, p. e516-e520Article in journal (Refereed)
    Abstract [en]

    Objective: to study how Swedish midwives working in low-risk labour ward units rate intrapartum risks compared to their midwifery colleagues working in standard care labour wards. A second aim was to describe midwives' attitudes toward performing different types of interventions during a normal labour. Design: an explorative study was carried out in 2009, using a web-based questionnaire containing 31 questions on midwives' risk ratings and attitudes to interventions during labour, as well as personal comments. Setting: four labour ward units in Stockholm, Sweden. Two labour ward units with expected normal deliveries ('low-risk') and two standard care units with all types of deliveries. Participants: seventy-seven registered clinically practicing midwives. Findings: midwives in all units stated that factors to be considered for risk estimation were: previous delivery outcome, result of cardiotocography test (CTG) on admission to labour ward and quality of amniotic fluid. Midwives working at the low-risk units preferred to be more expectant during normal birth than their colleagues working at the standard care units. Examples of this were regarding second vaginal examination during labour (p=0.001) and/or amniotomy (p=0.012). Furthermore, midwives working at the low-risk units more often considered that first-time mothers could give birth without epidural analgesia during labour (p=0.019) and that the labouring woman should be encouraged to push according to her own spontaneous urge (p=0.040). Midwives at low-risk units were more reluctant to use an intravenous vein catheter than their colleagues at standard care units (p=0.001) and also to use oxytocin in order to augment contractions (p=0.013). Further, the open-ended question showed that attitudes to different types of interventions differed between midwives working at low-risk units or the standard care units working with all types of deliveries. Conclusion: the Swedish midwives estimated risks similarly regardless of whether they worked in low-risk or in standard care units, but midwives working at low-risk units reported that they perform less routine interventions and have a more expectant attitude towards performing interventions. © 2011 Elsevier Ltd.

  • 49.
    Wiklund, Ingela
    et al.
    Division of Obstetrics and Gynecology, Karolinska Institutet, Danderyd Hospital.
    Wiklund, J.
    Pettersson, V.
    Boström, A. -M
    New parents’ experience of information and sense of security related to postnatal care: A systematic review2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 35-42Article in journal (Refereed)
    Abstract [en]

    Background: Becoming a parent is often a tumultuous experience and a great challenge. The transition when a child is born is described affecting the parents and their relationship psychically, physically, mentally and emotionally. Information within care should be relevant and supportive. Furthermore information within the context of care should be relevant, supportive and helpful to parents in handling their new situation and increasing their self-reliance. Aim: To provide a contextualised understanding of how parents experience postnatal care in relation to information and sense of security”. Method: A systematic search was undertaken at PubMed and CINAHL database for literature published between January 2002 and August 2017. Inclusion criteria focused on postnatal care. Eight of the studies used qualitative methods and two of the studies used quantitative methods, as a result the findings could not be combined using meta-analysis or meta-synthesis, instead narrative synthesis of the findings were used. Results: Ten studies were included. The analysis revealed three categories related to parent's experience of information and sense of security during the postnatal period. These categories were; Expectations on the care; Own resources; and Confirmation. Support from staff and family is described as significant for the parents' sense of security. During the first postnatal week, the emotions were characterized by anxiety and/or fear. Parents prefer a “non-judgmental” attitude from the staff and to be met as an individual. Conclusion: Family -centred care such as continuity, participation, individually adaptation, consistent, information and preparation for parenting appear to be important components for parents' sense of security in postnatal care. © 2018

  • 50.
    Wiklund, Ingela
    et al.
    Dalarna University, School of Health and Welfare, Sexual Reproductive Perinatal Health.
    Äng, Björn
    Dalarna University, School of Health and Welfare, Medical Science.
    Future challenges in securing sustainable workforce in healthcare2023In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 37, article id 100901Article in journal (Other academic)
12 1 - 50 of 52
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