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  • 1.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Widström, Ann-Marie
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Breastfeeding support from partners and grandmothers: Perceptions of Swedish women2003In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 30, no 4, p. 261-266Article in journal (Refereed)
    Abstract [en]

    Background: Support from the mother’s network of relatives, friends, and professional caregivers during childbirth is likely to be important for breastfeeding success. Few studies have been conducted to examine mothers’ perceptions of breastfeeding support. The objective of this study was to describe breastfeeding support and feelings of confidence of primiparas and multiparas in relation to duration of breastfeeding. Methods: Mothers who

    delivered vaginally were eligible for inclusion. After receiving a questionnaire when their children were 9 to 12 months of age, 194 primiparas and 294 multiparas responded to questions on

    breastfeeding history and on perceived and overall breastfeeding support and feelings of confidence. Results: Feelings of overall breastfeeding support were correlated with duration of

    exclusive breastfeeding in both primiparas (p < 0.001) and multiparas (p < 0.001). Multiparas who knew how long they were breastfed as a child showed a longer duration of exclusive

    (p ¼ 0.006) and total (p ¼ 0.007) breastfeeding than multiparas who did not know. The time during which the partner was present after labor was correlated with the duration of exclusive

    (p < 0.001) and total breastfeeding (p ¼ 0.002) in primiparas. Feelings of confidence when the baby was 6 to12 months old, as retrospectively rated on a visual analog scale, was correlated

    with feelings of confidence in the partner during childbirth in both primiparas (p < 0.001) and multiparas (p < 0.001) and the experience of overall breastfeeding support (primiparas,

    p ¼ 0.002; multiparas, p < 0.001). Both groups were more content with breastfeeding information they received from midwives in the maternity wards, compared with that from antenatal midwives and postnatal nurses (p < 0.001). Conclusions: A helpful support strategy for mothers with respect to breastfeeding outcome is for health professionals to discuss the grandmother’s perception of breastfeeding with the mother. It is important for perinatal

    caregivers to provide an environment that enables the family to stay together after delivery. A helpful support strategy for health professionals might be to mobilize grandmothers with positive breastfeeding perception to provide support for their daughters’ breastfeeding. (BIRTH 30:4 December 2003)

  • 2.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Widström, Ann-Marie
    Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Does Continuity of Care by Well-Trained Breastfeeding Counselors Improve a Mother´s Perception of Support?2006In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 33, no 2, p. 123-130Article in journal (Refereed)
    Abstract [en]

    Background:Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Method:Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Results:Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both control groups. Conclusions:After implementation of a process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention guaranteeing continuity of care, the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care. (BIRTH 33:2 June 2006)

  • 3.
    Jangsten, Elisabeth
    et al.
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, S-40530 Gothenburg, Sweden.
    Bergh, Ingrid
    University of Skövde, School of Life Sciences.
    Mattsson, Lars - Ake
    Sahlgrens Univ Hosp, Dept Obstet & Gynecol, Gothenburg, Sweden.
    Hellstrom, Anna - Lena
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, S-40530 Gothenburg, Sweden .
    Berg, Marie
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, S-40530 Gothenburg, Sweden .
    Afterpains: A Comparison Between Active and Expectant Management of the Third Stage of Labor2011In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 38, no 4, p. 294-301Article in journal (Refereed)
    Abstract [en]

    Background: Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare womens experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains. Methods: A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n = 1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth. Results: At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p = 0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p < 0.001). Conclusions: Active management of the third stage of labor does not provoke more intense afterpains than expectant management. (BIRTH 38: 4 December 2011)

  • 4.
    Mårtensson, Lena
    University of Skövde, School of Life Sciences.
    The Patient Observer: Sterile Water Injections for Labor Pain2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 4, p. 334-336Article in journal (Refereed)
    Abstract [en]

    Several studies have reported a good pain relief effect from sterile water injections, especially for low back pain, during labor. The aim of this paper was to illustrate the use of the method in a clinical childbirth situation by means of a descriptive case report. The woman in the report described that the method provided a powerful pain relief effect, measured by a visual analog scale, and that her experience was highly positive.

  • 5.
    Mårtensson, Lena
    et al.
    University of Skövde, School of Life Sciences. Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Göteborg’s, Göteborg.
    Wallin, Gunnar
    Attending Obstetrician, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Use of Acupuncture and Sterile Water Injection for Labor Pain: A Survey in Sweden2006In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 33, no 4, p. 289-296Article in journal (Refereed)
    Abstract [en]

    Acupuncture and sterile water injections are nonpharmacological pain relief methods used for labor pain in Swedish delivery wards. Their use has changed over time, the reasons for which are unclear, and acupuncture is currently in more common use than sterile water injections. The aim of this study was to elucidate the clinical use of acupuncture and sterile water injections as pain relief and relaxation during childbirth in Sweden. Methods: Twelve hundred questionnaires were sent out to all delivery wards in Sweden. Nine hundred sixty midwives fulfilled the inclusion criteria, and the response rate was 565 (59%). Results: Acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The midwives' own choice of pain relief during childbirth for a possible future delivery was similar to their choice of method in clinical practice. Conclusions: Our study shows that acupuncture was used for both pain relief and relaxation, whereas sterile water injections were used almost exclusively for pain relief. The results also indicate a weakness in midwives' awareness and use of scientific knowledge and general recommendations about these methods

  • 6.
    Rådestad, Ingela
    et al.
    Malardalens Univ, Dept Caring Sci & Publ Hlth, S-63105 Eskilstuna, Sweden.
    Olsson, Ann
    Karolinska Inst, Danderyd Hosp, Div Caring Sci, Dept Clin Sci, Solna, Sweden.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Rubertsson, Christine
    Malardalens Univ, Dept Caring Sci & Publ Hlth, S-63105 Eskilstuna, Sweden.
    Tears in the vagina, perineum, sphincter ani, and rectum and first sexual intercourse after childbirth: A Nationwide Follow-up2008In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 35, no 2, p. 98-106Article in journal (Refereed)
    Abstract [en]

    Background: The first sexual intercourse after childbirth may be challenging for women, especially if the birth resulted in injuries in the genital area. The purpose of this study was to investigate whether or not tears in the vagina, perineum, sphincter ani, or rectum hindered sexual intercourse during the year after childbirth. Methods: We obtained information from 2,490 women in a population-based cohort identified at antenatal care. Information about first sexual intercourse was collected by means of a questionnaire sent 1 year after birth to the women and about women's tears reported in the population-based Swedish Medical Birth Register. Results: Adjusted relative risks with 95 percent confidence intervals for not having had sexual intercourse within 3 and 6 months, respectively, after childbirth were 1.5 (95% CI 1.2–1.8) and 1.6 (95% CI 1.2–2.3) for tears in the vagina, 1.4 (95% CI 1.1–1.6) and 1.5 (95% CI 1.1–2.1) for tears in the perineum, and 2.1 (95% CI 1.4–3.1) and 2.2 (95% CI 1.1–4.6) for tears in the sphincter ani and rectum. No statistically significant differences were found at 1-year follow-up. No associations between episiotomy and delay in resuming intercourse were found after adjusting the relative risks. Conclusions: Tears in the vagina, perineum, sphincter ani, or rectum are associated with a delay in women's resumption of sexual intercourse 6 months after childbirth in Sweden

  • 7.
    Velandia, Marianne
    et al.
    Karolinska Institute.
    Matthisen, Ann-Sofi
    Karolinska Insitute.
    Uvnäs-Moberg, Kerstin
    University of Agricultural Sciences, Skara.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Onset of Vocal Interaction Between Parents and Newborns in Skin-to-Skin Contact Immediately After Elective Cesarean Section2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 3, p. 192-201Article in journal (Refereed)
    Abstract [en]

    Background: Cesarean  section  is  associated  with  delayed  mother-infant interaction  because  neither the mother nor the father routinely maintains skin-to-skin contact with  the  infant  after  birth. The  aim  of the  study was  to  explore  and compare  parent-newborn vocal interaction when the infant is placed in skin-to-skin contact either with the mother or the father immediately after a planned cesarean section.  Methods: A total of 37 healthy  infants  born  to  primiparas  were  randomized  to  30 minutes  of  skin-to-skin  contact either  with  fathers  or  mothers  after  an  initial  5 minutes  of  skin-to-skin  contact  with  the mothers after birth. The newborns’ and parents’ vocal interaction were recorded on a vid-eotape and audiotape. The following variables were explored: newborns’ and parents’ soliciting, newborns’ crying and whining, and parental speech directed to the other parent and to   the   newborn.  Results: Newborns’   soliciting   increased   over   time   (p = 0.032).   Both fathers  and  mothers  in  skin-to-skin  contact  communicated  more  vocally  with  the  newborn than did fathers (p = 0.003) and mothers (p = 0.009) without skin-to-skin contact. Fathers in skin-to-skin contact also communicated more with the mother (p = 0.046) and performed more  soliciting  responses  than  the  control  fathers  (p = 0.010).  Infants  in  skin-to-skin  con-tact  with  their  fathers  cried  significantly  less  than  those  in  skin-to-skin  contact  with  their mothers (p = 0.002) and shifted to a relaxed state earlier than in skin-to-skin contact with mothers (p = 0.029).  Conclusions: Skin-to-skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin-to-skin  contact  and  exposed  to  the  parents’  speech,  the  infants  initiated  communication  with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin-to-skin contact after cesarean section, to support the early onset of the first vocal communication.

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