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Background/Aims Treatment for fear of birth during pregnancy demonstrates inconsistent results. Continuity models of care show promise in this area. The aim of this study was to evaluate satisfaction with treatment for fear of birth in a midwifery continuity model compared to standard counselling in Sweden. Methods A total of 175 purposively sampled women who received care using a continuity of care model between 2021 and 2023 and a historical cohort of 467 women in previous studies who received counselling completed questionnaires about their experiences. Differences between groups were calculated using odds ratios. Results Women with fear of birth who experienced the continuity model were more likely to be satisfied with counselling (adjusted odds ratio: 2.26; P=0.043) and report that their fear disappeared or decreased (adjusted odds ratio: 4.03; P=0.002). These women also rated medical (adjusted odds ratio: 2.06; P=0.034) and emotional (adjusted odds ratio: 2.45; P=0.007) aspects of intrapartum care higher than those who received standard counselling. Conclusions Women were more satisfied with care received in the continuity model compared to standard counselling. Implications for practice Women who fear birth may benefit from receiving care in midwifery continuity models during pregnancy and childbirth. Implementation of such models is encouraged. © 2026 The authors.

Background The advantages of midwifery continuity models of care during pregnancy, birth, and the postnatal period demonstrated in ‘low-risk’ women may also benefit those with fear of birth. The purpose of the study was to explore women’s assessment of the quality of intrapartum care when participating in a midwifery continuity of care (MCoC) project in a rural area of Sweden. An additional aim was to explore if the care differed between women who had a known midwife during labour and birth, versus not.

Methods A prospective longitudinal cohort study including 142 women with fear of birth who participated in an MCoC project was performed. Data was collected via two online questionnaires, gathering background data and birthrelated information. The instrument ‘Quality from the Patients’ Perspective’ was used to assess the perceived reality and the subjective importance of intrapartum care content.

Results Deficiencies between perceived reality and subjective importance were found in the following aspects of intrapartum care: perception of control (50%), involvement in decision-making (26%), access to preferred pain relief (26%), breastfeeding support (23%), and information about labour progress (22%). The midwife’s presence, involvement of the partner, possibilities to talk through the birth and breastfeeding support was rated better than expected. No major differences were found in the quality of intrapartum care, in relation to continuity. A total of 75% had a known midwife during labour and birth and were more likely to have had labour induced (aOR 5.31, 95% CI 1.68–16.79), to have used the method ‘Give birth without fear’ (aOR 3.21, 95% CI 1.05–9.83), and to have received an epidural (aOR 3.85, 95% CI 1.51–9.82), compared to women without a known midwife assisting.

Conclusion The quality of intrapartum care was assessed both deficient and excessive. Few differences were found between women who had a known midwife or not, but women with fear of childbirth who experienced continuity with a known midwife were exposed to more interventions, following Swedish regime to encourage women to have a vaginal birth. Aligning care content with women’s needs and values remains essential to improve satisfaction and outcomes in intrapartum care.

OBJECTIVES: Perinatal depressive symptoms affect both maternal and infant well-being and are associated with fear of giving birth. Midwifery continuity of care (MCoC) has shown potential in reducing anxiety and depression, particularly among vulnerable women. The aim of this study was to explore the trajectories of fear of birth and depressive symptoms, in relation to background, attitudes and birth-related data.

METHODS: A prospective longitudinal study was conducted among women with fear of birth or depressive symptoms who, after a screening procedure were offered care in a MCoC model. Fear of birth and depressive symptoms were assessed with the Fear of Birth Scale (FOBS) and Edinburgh Postnatal Depression Scale (EPDS) and measured at screening, in mid pregnancy and twice after birth. Chi-square tests and analysis of variance were used for comparing groups.

RESULTS: The questionnaires were completed by 175 women during pregnancy and by 140 postpartum. During screening 84% presented with fear of birth and 24% with depressive symptoms. The degree of fear of birth and the depressive symptoms changed over time with the highest prevalence during pregnancy and a decline after birth. The trajectory of depressive symptoms was mainly related to women's attitudes, while birth-related variables concerned fear of birth.

CONCLUSION: This study showed that fear of birth as well as depressive symptoms changed over time. These changes may represent natural progression but might be associated with the intervention. Working with women's attitudes might change the trajectories, especially in women with both fear of birth and depressive symptoms.

Aim: National guidelines in Sweden suggest that certain ‘priority’ groups of pregnant women, including women with fear of childbirth (FOC), may benefit from increased continuity in midwifery care. Although comorbidity indeed exists between FOC and mental health problems, it might also be mediated by individual resources. The purpose of the study was to identify profiles of women based on FOC, depressive symptoms, major worries and sense of coherence (SOC) and to study those profiles in relation to women’s perceptions of changes occurring during pregnancy.

Methods: A longitudinal cohort study was conducted on 171 pregnant women with FOC or depressive symptoms in a rural area of Sweden, whose care was following a midwifery continuity of care (MCoC) model. After collecting data using two online questionnaires (in mid-pregnancy and 2 months after birth), addressing background and including validated instruments measuring FOC, depressive symptoms, major worries and SOC, a k-means cluster analysis was conducted to define profiles of women.

Results: The three identified clusters: Emotionally healthy, Fearful with resources and Emotionally fragile, showed no differences in socio-demographic background or type of MCoC model. However, major differences did emerge in women’s feelings and perceptions of changes during pregnancy, along with minor differences in health-related variables. Women in the Emotionally fragile cluster had less positive scores for most questionnaire items.

Conclusion: The results indicate levels of vulnerability within certain priority groups. In response, healthcare professionals should examine pregnant women’s backgrounds beyond screening in order to more fully understand their emotional states.

BACKGROUND: Midwifery continuity models are highly recommended. Women with fear of birth living in rural areas might have difficulties accessing such care. Technology can play a role in enhancing contact with midwives during pregnancy and childbirth for these women.

OBJECTIVE: The aim of this study was to elucidate women's experiences of participating in a digital continuity of care model designed for pregnant women with fear of birth.

METHODS: A qualitative interview design, employing interviews with 15 women participating in a midwifery continuity project directed towards women with fear of birth. The participants used e-health tools for communication with midwives during their pregnancy and childbirth. Reflexive thematic analysis was used.

RESULTS: The analysis resulted in an overarching theme: 'A digital continuity model of midwifery care for women with fear of birth in a rural area is attractive'. The model created positive outcomes in terms of sustainability and use of resources. The women reported enhanced autonomy and reduced stress. Continuity of care fostered confidence and security throughout childbirth for the women, supported by a strong relationship with their midwives. The individualised care, which addressed mental health challenges and fears stemming from past childbirth experiences, led to positive outcomes.

CONCLUSION: A model with continuity using digital e-health could be a solution to meet women's needs in rural areas during childbirth, who suffer from fear of birth or have mental health problems. Care models need to be tailored to regional conditions, considering factors such as midwifery availability and geographical challenges.

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

Background: the opportunity for women to give birth in water vary globally, and in Sweden waterbirth is offered in some of the maternityclinics in the country. An increased demand of water birth from pregnant women have been noticed. Research on waterbirth mainly focuses onwomen's experiences, but rarely on midwives' knowledge and perception.

Aim: the aim of this study was to describe midwives' experience of, and knowledge about waterbirth. With a qualitative method and inductiveapproach, 16 midwives with varying experience, working in a clinic that provides waterbirths, were interviewed. The interviews were analyzed withcontent analysis.

Results: The difficulty of estimating bleeding in water was perceived as a challenge. Also, the surveillance of the baby when CTG was usedwas another challenge. The working environment for the midwife working in positions where they had to lean into the pool was also mentionedas a challenge. The state of education and knowledge was varying, but trusting one's skills in assisting a waterbirth was based both in the level ofexperience as a midwife and in the number and frequency of assisting waterbirths. The clinic's policies and guidelines on waterbirth also played apart in the perceived safety.

Conclusion: midwifes experienced of waterbirths was that waterbirth is positive both for the woman and the midwife herself. Knowledge wasobtained mainly through practical experience, other midwives, and clear guidelines.

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

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.