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  • 1.
    Akhavan, Sharareh
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Lundgren, Ingela
    Univ Gothenburg, Inst Hlth & Care Sci, S-40530 Gothenburg, Sweden.
    Midwives' experiences of doula support for immigrant women in Sweden: A qualitative study2012Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, nr 1, s. 80-85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: to describe and analyse midwives’ experiences of doula support for immigrant women in Sweden. Design: qualitative study, analysed using content analysis. Data were collected via interviews. Setting: interviews were conducted at the midwives’ workplaces. One midwife was interviewed at a cafe. Participants: ten midwives, who participated voluntarily and worked in maternity health care in western Sweden. Findings: the interview data generated three main categories. (1) ‘A doula is a facilitator for the midwife’ has two subcategories, ‘In relation to the midwife’ and ‘In comparison with an interpreter’, (2) ‘Confident women giving support, ’has two subcategories, ‘Personal characteristics and attitudes’ and ‘Good support,’ (3) ‘Doulas cover shortcomings’ has two subcategories, ‘In relation to maternity care’ and ‘In relation to ethnicity’. Key conclusion and implications for practice: The findings of this study show that midwives experience that doulas are a facilitator for them. Doulas provide support by enhancing the degree of peace and security and improving communication with the women in childbirth. Doulas provide increased opportunities for transcultural care. They may increase childbearing women’s confidence and satisfaction, help meet the diverse needs of childbearing women and improve care quality.

  • 2.
    Bergh, Ingrid H. E.
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Stener-Victorin, Elisabet
    Institute of Neuroscience and Physiology/Endocrinology, Sahlgrenska Academy, University of Gothenburg.
    Wallin, Gunnar
    Institute of Clinical Sciences, Department of Obstetrics and Gynaecology, Sahlgrenska Academy, University of Gothenburg.
    Mårtensson, Lena
    Högskolan i Skövde, Institutionen för vård och natur.
    Comparison of the PainMatcher and the Visual Analogue Scale for assessment of labour pain following administered pain relief treatment2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 1, s. E134-E139Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: during childbirth, it is necessary to assess and monitor experienced pain and to evaluate the effect of pain relief treatment. The aim of this study was to compare the PainMatcher® (PM) with the Visual Analogue Scale (VAS) for the assessment of labour pain and the effect of pain relief treatment.Design: randomised controlled trial.Setting: labour ward with approximately 2500 childbirths per year in western Sweden.Participants: 57 women with labour pain treated with acupuncture or sterile water injections scored their electrical pain threshold and pain intensity with the PM. Pain intensity was also assessed with the VAS. Electrical pain threshold and pain intensity were assessed immediately after a uterine contraction before and 30, 60, 90, 120, 150 and 180 minutes after treatment.Measurements and findings: the results showed a weak correlation (r=0.13, p<0.05) between the pain intensity scores on the PM and the VAS. The PM detected changes (decrease) in pain intensity to a lower degree than the VAS. Surprisingly, in over 10% of sessions, women scored their pain intensity during a uterine contraction lower than their electrical pain threshold with the PM. However, electrical pain thresholds with the PM correlated well throughout all measurements.Conclusions: the PM is a reliable tool for the assessment of electrical pain threshold; however, the VAS is more sensitive than the PM for recording changes in pain intensity when assessing the effects of treatment on labour pain.Implications for practice: the PM and the VAS are not interchangeable in the case of labour pain, and there is still a need for research in this area to find a more suitable assessment instrument for the evaluation of labour pain.

  • 3.
    Bergh, Ingrid
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Söderlund, Tina
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, SE-541 85 Skövde, Sweden.
    Vinterskog, Linda
    Department of Obstetrics and Gynaecology, Skaraborg Hospital, SE-541 85 Skövde, Sweden.
    Mårtensson, Lena B.
    Högskolan i Skövde, Institutionen för vård och natur.
    Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain2012Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, nr 5, s. e684-e688Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: to investigate the reliability and validity of the Acceptance Symptom Assessment Scale (ASAS) in assessing labour pain.

    Design: a test-retest approach was used to assess reliability and validity.

    Setting: labour ward with approximately 2,400 deliveries annually in western part of Sweden.

    Participants: forty-seven pregnant women in the latent or active phase of labour.

    Methods: a total of five pain assessments with both the ASAS and the VAS were conducted in three sessions.

    Main outcome measures: correlation between ASAS and VAS.

    Findings: both scales demonstrated high and significant test–retest correlations (r=0.83–0.92; p<0.001). High and significant alternative-form reliability correlations (r=0.76–0.93, p<0.001) were found between ASAS and VAS ratings at all five assessments. Construct validity was established when both the ASAS and the VAS identified a pain reduction(p<0.001) 2 hrs after birth, compared to the previous assessment. Over two-thirds of the women preferred the ASAS to the VAS ,mainly(n=30) because the ASAS provided more choices relating to the pain experience, making it possible to label pain acceptable/unacceptable.

    Conclusions: the ASAS is interchangeable with the VAS for assessing labour pain. Over two-thirds of the women preferred it to the VAS.

  • 4.
    Binder, Pauline
    et al.
    Högskolan i Skövde, Institutionen för vård och natur. Department of Women’s and Children’s Health (IMCH), Akademiska Hospital/Uppsala University, Uppsala, Sweden.
    Gustafsson, Annica
    Department of Woman and Child Health/Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Uvnäs-Moberg, Kerstin
    Swedish University of Agriculture, Skara, Sweden.
    Nissen, Eva
    Department of Woman and Child Health/Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden.
    Hi-TENS combined with PCA-morphine as post caesarean pain relief2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 4, s. 547-552Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:  to examine effectiveness and overall opiate consumption between high-sensory transcutaneous  electrical  nerve  stimulation  (Hi-TENS)  combined  with  patient-controlled  analgesia  with morphine and patient-controlled analgesia with morphine alone following elective (e.g. scheduled) caesarean birth. Design:  randomised, controlled study. Setting:  a county hospital in south-west Sweden. Participants:  42 multiparous women. Measurements and findings:  participants were randomly assigned and connected to patient-controlled analgesia  with  morphine  alone  or  in  combination  with  Hi-TENS  apparatus.  Levels  of  morphine consumed were calculated every third hour during the first 24 hours post partum. Pain and sedation were assessed by visual analogue scale at one, three, six, nine, 12 and 24 hours post partum. Total consumption  of  morphine  differed  significantly  between  the  groups:  morphine  with  TENS  was 16.2+/-12.6 mg and morphine alone was 33.1+/-20.9 mg (p = 0.007). Assessment of pain relief showed no  significant  difference.  Sedation  differed  significantly  between  the  groups  (p = 0.045),  especially between three and 12 hours post partum (p = 0.011). Key conclusions and implications for practice:  pain relief from a combination of Hi-TENS and patient-controlled analgesia with morphine was as effective as patient-controlled analgesia with morphine alone, produced less sedation and reduced morphine use by approximately 50%. Women undergoing a caesarean section should be given the opportunity to make an informed choice about post operative pain relief before surgery. A presumed benefit of this treatment combination is that the mother is more alert and better able to interact with her newborn during the first hours after birth without drowsiness due to large doses of opiates.

  • 5.
    Bäckström, Caroline
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Hertfelt Wahn, Elisabeth
    Högskolan i Skövde, Institutionen för vård och natur.
    Support during labour: first-time fathers' descriptions of requested and received support during the birth of their child2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 1, s. 67-73Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:  to explore how first-time fathers describe requested and received support during a normal birth. Design:  qualitative research design. Ten first-time fathers were interviewed during the first postpartum week.  Individual  open-ended  interviews  were  used  to  explore  the  fathers’  descriptions,  and  the interviews were analysed using qualitative analysis. Setting:  a labour ward at one hospital in a south-western county of Sweden in November and December 2006. Participants:  first-time  fathers  who  had  experienced  a  normal  birth  at  the  hospital  during  the study period. Findings:  the support described is presented as one main theme, ‘being involved or being left out’, which included four underlying categories: ‘an allowing atmosphere’, ‘balancing involvement’, ‘being seen’ and ‘feeling left out’. Key conclusions:  fathers perceived that they were given good support when they were allowed to ask questions during labour, when they had the opportunity to interact with the midwife and their partner, and when they could choose when to be involved or to step back. Fathers want to be seen as individuals who are part of the labouring couple. If fathers are left out, they tend to feel helpless; this can result in a feeling of panic and can put their supportive role of their partner at risk. Implications  for practice:  the  results  of  this  study could  initiate  discussions  about  how  health-care professionals can develop support given to the labouring couple, with an interest in increasing paternal involvement.

  • 6.
    Carlsson, Ing-Marie
    et al.
    Halmstad Univ, Sch Social & Hlth Sci, SE-30118 Halmstad, Sweden / Univ Orebro, Sch Hlth & Med Sci, SE-70182 Orebro, Sweden / Halmstad Cty Hosp, SE-30185 Halmstad, Sweden .
    Ziegert, Kristina
    Halmstad Univ, Sch Social & Hlth Sci, SE-30118 Halmstad, Sweden .
    Sahlberg-Blom, Eva
    Univ Örebro, Sch Hlth & Med Sci, SE-70182 Örebro, Sweden .
    Nissen, Eva
    Högskolan i Skövde, Institutionen för vård och natur.
    Maintaining power: Women's experiences from labour onset before admittance to maternity ward2012Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, nr 1, s. 86-92Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward. Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used. Findings: 'Maintaining power' was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: to share the experience with another', to listen to the rhythm of the body', to distract oneself and to be encased in a glass vessel', explained how the women coped and thereby maintained power. Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process. (C) 2010 Elsevier Ltd. All rights reserved.

  • 7.
    Hadjigeorgiou, Eleni
    et al.
    Department of Nursing, School of Health Sciences, Cyprus University of Technology, PO Box 12715, Code 2252, Latsia, Nicosia, Cyprus.
    Kouta, Christiana
    Department of Nursing, School of Health Sciences, Cyprus University of Technology, PO Box 12715, Code 2252, Latsia, Nicosia, Cyprus.
    Papastavrou, Evridiki
    Department of Nursing, School of Health Sciences, Cyprus University of Technology, PO Box 12715, Code 2252, Latsia, Nicosia, Cyprus.
    Papadopoulos, Irena
    Department of Nursing, School of Health Sciences, Cyprus University of Technology, PO Box 12715, Code 2252, Latsia, Nicosia, Cyprus.
    Mårtensson, Lena
    Högskolan i Skövde, Institutionen för vård och natur.
    Women's perceptions of their right to choose the place of childbirth: an integrative review2012Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, nr 3, s. 380-390Artikkel, forskningsoversikt (Fagfellevurdert)
    Abstract [en]

    Objective: to provide a critical synthesis of published research concerning women's experiences in choosing where to give birth.

    Method: an integrative literature review was conducted using three databases (MEDLINE, CINAHL and Ovid) for 1997–2009. Inclusion criteria were: (1) publication in the English language; (2) research article; (3) focus on women's perceptions for their birthplace choices; and (4) data collected during pregnancy, at birth and post partum.

    Findings: twenty-one research-based papers met the inclusion criteria, and these used a range of approaches and methods. Four themes were derived from the data: choice of birthplace and medicalisation of childbirth; the midwifery model of care and the rhetoric of birthplace choices; perceptions of safety shaped women's preferences; and choice is related to women's autonomy.

    Conclusion: there is considerable evidence that women worldwide wish to be able to exercise their rights and make informed choices about where to give birth. The medical model remains a strong and powerful influence on women's decisions in many countries. The midwifery model offers birthplace choices to women, while policies and culture in some countries affect midwifery practise. Perceptions of safety shaped women's preferences, and women's autonomy facilitated birthplace choices.

    Implications for practise: these findings can be seen as a challenge for health professionals and policy makers to improve perinatal care based on women's needs. Local research is advisable due to cultural and health system differences.

  • 8.
    Hermansson, Evelyn
    et al.
    Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
    Mårtensson, Lena
    Högskolan i Skövde, Institutionen för vård och natur. Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden / College of Nursing, University of Rhode Island, RI, USA.
    Empowerment in the midwifery context - a concept analysis2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 6, s. 811-816Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: the concept empowerment is difficult to understand, define and translate into different contexts. Therefore, the purpose of this paper was to analyze the empowerment concept in the midwifery context, focused on the childbearing period, aimed at clarifying its meaning in order to enable comprehension and use in clinical practice, education and research. Design: semi structured interviews and written text. Setting: prenatal clinics, delivery and maternity wards in western Sweden. Participants: nine midwives and 12 couples. Measurements and findings: a concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically elucidated in the fieldwork phase. The final step was to describe criteria and attributes, illustrative cases, antecedents and consequences of the concept. The following tentative criteria and attributes of empowerment in the midwifery context are described: developing a trustful relationship; starting an awareness process, making it possible to reflect on the changing situation; acting based on the parents' situation on their own terms, getting them involved and able to make informed choices; confirming the personal significance of becoming parents. Finally, empowerment in the midwifery context was redefined. Key conclusion: midwives use empowerment in education and research as well as strategies on both the micro and macro levels in practice. Implications for practice: empirical findings from the concept analysis confirm the concept's relevance in the midwifery context.

  • 9.
    Hertfelt Wahn, Elisabeth
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    von Post, Iréne
    Department of Caring Science, Åbo Akademi, Vasa, Finland.
    Nissen, Eva
    Högskolan i Skövde, Institutionen för vård och natur.
    A description of Swedish midwives' reflections on their experience of caring for teenage girls during pregnancy and childbirth2007Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, nr 3, s. 269-278Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    to describe Swedish midwives' reflections on their experiences of caring for teenage girls during pregnancy and childbirth.

    Design

    a hermeneutical approach was used, with focus-group discussions as the method of data collection.

    Setting

    three focus-group discussions were conducted in a county comprising urban, suburban and rural districts in south-western Sweden.

    Participants

    a voluntary sample of 24 midwives, aged 32–61 years, who were caring for women in different birth settings, participated in 2004.

    Findings

    two main themes, with three sub-themes each, were generated by the midwives: (1) the teenage mother, as ‘teenagers who are proud of becoming mothers’, ‘teenagers who are unprepared for becoming mothers’ and ‘teenagers with an immigrant background’, and (2) ‘the midwives’ wish to care for the teenage mother’, as ‘taking the teenage mother seriously’, ‘being an important person for the teenage mother’, and ‘being a help for the teenage mother’.

    Key conclusions and implications for practice

    the findings provide some understanding of the unique characteristics of caring for teenage mothers. For the midwives, the most important aspects of caring for the teenage mother included taking the teenage mother seriously, allowing the midwife herself to become an important person for the teenage mother, and being a help to the mother. This help requires the midwife to balance the different needs of each teenage mother.

  • 10.
    Lee, Nigel
    et al.
    School of Nursing, Midwifery and Social Work, University of Queensland, Australia / Mater Research Institute UQ, Queensland, Australia.
    Jomeen, Julie
    Faculty of Health Sciences, University of Hull, Cottingham, United Kingdom.
    Mårtensson, Lena B.
    Högskolan i Skövde, Institutionen för hälsa och lärande. Högskolan i Skövde, Forskningsspecialiseringen Hälsa och Lärande.
    Emery, Vanessa
    Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, United Kingdom.
    Kildea, Sue
    School of Nursing, Midwifery and Social Work, University St Lucia, Australia / Mater Research Institute UQ, Aubigny Place, South Brisbane, Australia / Mater Mothers’ Hospital, Mater Health Services, Australia.
    Knowledge and use of sterile water injections amongst midwives in the United Kingdom: A cross-sectional study2019Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 68, s. 9-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The use of sterile water injections (SWI) for the relief of pain in labour is popular amongst midwives in countries such as Sweden and Australia. Anecdotal reports suggest the procedure is used less commonly in the United Kingdom (UK) and that a number of barriers to introducing the practice may exist. Objective: The objective of this study was to explore the awareness and use of SWI amongst midwives in the UK. Design: A cross-sectional study using an internet-based questionnaire. Participants: Midwives with Nursing and Midwifery Council Registration and currently practicing. Setting: The questionnaire was distributed via the Royal College of Midwives Facebook page and Twitter account. Invitations to participate were also sent to Heads of Midwifery to distribute to staff. Findings: Three hundred and ninety-eight midwives completed the survey. Eighty-two percent of midwives did not use SWI in practice although 69% would consider learning the procedure. There was considerable variation in techniques amongst midwives that did provide SWI. The lack of available practice guidelines and the advice from the National Institute for Health and Care Excellence to not use SWI were cited as the main barriers. Key conclusions: SWI use is uncommon in the UK although midwives are interested in incorporating the procedure into practice. Implications for practice: National guidance on SWI and the lack of information and training is restricting the use of the procedure in practice, despite SWI being widely used in other countries and being effective in the treatment of pain in labour.

  • 11.
    Mårtensson, Lena
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Kvist, Linda J.
    Department of Health Sciences, Lund University, Lund, Sweden / Department of Obstetrics & Gynaecology, Helsingborg Hospital, Helsingborg, Sweden.
    Hermansson, Evelyn
    Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Göteborg, Sweden.
    A national survey of how acupuncture is currently used in midwifery care at Swedish maternity units2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 1, s. 87-92Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: it is known how acupuncture is used in midwifery care in Sweden and what kind of requirements health-care providers have for midwives and acupuncture training programmes. The aims of this study were to survey indications for the use of acupuncture in midwifery care in Sweden, and to examine the criteria and requirements used for purchase of acupuncture education programmes.

    Design: a postal survey using a structured questionnaire.

    Setting: 45 maternity units in Sweden.

    Participants: the midwife-in-charge of the units.

    Measurements and findings: the most common indications for the use of acupuncture were relaxation, pain relief, retained placenta, after pains, milk stasis during lactation, hyperemesis and pelvic instability. Specific requirement for acupuncture education were provision of a short course during weekdays including a follow-up course.

    Key conclusion: acupuncture is widely used for many indications in Swedish maternity units despite weak or no evidence to support effectiveness in midwifery care. Requirements for acupuncture education did not seem to be in accordance with what might be expected for this type of qualified intervention.

    Implications for practice: the use of acupuncture in midwifery care should not persist until systematic evaluation of the effect of this method is carried through.

  • 12.
    Mårtensson, Lena
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Kvist, Linda J.
    Department of Health Sciences, Lund University, Lund, Sweden / Department of Obstetrics and Gynaecology, Helsingborg Hospital, Helsingborg, Sweden.
    Hermansson, Evelyn
    Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Box 457, SE-405 30 Göteborg, Sweden.
    National survey of how acupuncture education is organised for Swedish midwives2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 1, s. 93-98Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: In Sweden, acupuncture education is required before midwives can use the method in clinical practice. Courses in acupuncture are usually organised by private individuals or companies, and each health facility decides on the adequacy of the educational package. Therefore, there is no overall standard or quality control for free-standing courses of acupuncture education for midwives. The aim of this study was to survey the education given to Swedish midwives in the use of acupuncture treatment in the obstetric area. Design:  a postal survey using a structured questionnaire. Setting:  organisers of acupuncture education. Participants:  18 acupuncture instructors. Measurements  and  findings:  acupuncture  courses  were  usually  organised  outside  universities  and colleges. The courses were similar in terms of extent and content, and were mainly based on a Western medical approach. The recommended indications were extensive despite a lack of scientific evidence.The most common instructor profile was a midwife without any academic degree. Key conclusions and implications for practice:  courses differed considerably in the extent to which they were research based. Continuing professional education for midwives should be given at the same academic level, at least, as basic midwifery education.

  • 13.
    Olsson, Ann
    et al.
    Department of Clinical Sciences, Division of Caring Science, Danderyd Hospital, Karolinska Institutet, Solna, Sweden / Department of Woman and Child Health, Karolinska Institutet, SE-17177 Stockholm, Sweden.
    Robertson, Eva
    Department of Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden / School of Health Science, University College of Borås, Borås, Sweden.
    Falk, Katarina
    The Red Cross University College, Stockholm, Sweden.
    Nissen, Eva
    Högskolan i Skövde, Institutionen för vård och natur.
    Assessing women's sexual life after childbirth: the role of the postnatal check2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 2, s. 195-202Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: to describe midwives' reflections on counselling women at the postnatal check with special focus on sexual life after childbirth. Design: qualitative descriptive study with focus group discussions as the method of data collection. Setting: antenatal clinics in Stockholm greater catchments' area. Participants: during 2006 and 2007, a voluntary sample of midwives from 10 different antenatal clinics were invited. Analysis: content analysis was undertaken through identification of codes, categories and themes. Findings: Two themes emerged: balancing between personal perceptions of the woman's needs and the health system restrictions and strategies for counselling about sexual life after childbirth'. The midwives tried to create a picture for themselves of the woman coming for the postnatal check and her needs before the consulation. This picture guided the midwives, but lack of time and knowledge restricted them when counselling on sexual life after childbirth. Two different strategies in counselling were identified, one task-oriented and one subject-oriented. Demands and time restrictions led midwives to distance themselves from their clients. A task-oriented approach was more visible in midwives' encounters with foreign-born women, where linguistic difficulties, cultural diversity and narrow time frames restricted the midwives' effectiveness and/or sensitivity as caregivers. In contrast, the subject-oriented strategy meant 'getting in tune', i.e. listening to the woman when she expressed her feelings and emotions, encouraging the woman to be an active participant in decisions involving her care. This strategy is used for women who arouse midwives' empathy and when there is some form of recognition and understanding. Conclusion: The picture created of the woman and her needs guided the midwives, but lack of knowledge and time limitations restricted counselling on sexual life after childbirth. Two counselling strategies were identified, one task-oriented and one subject-oriented. Balancing these two counselling strategies improves both the ethical aspects and the quality of the counselling. (C) 2009 Elsevier Ltd. All rights reserved.

  • 14.
    Robertson, Eva
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Johansson, Sven-Erik
    Karolinska Inst, CeFAM, SE-14183 Huddinge, Sweden.
    Use of complementary, non-pharmacological pain reduction methods during childbirth among foreign-born and Swedish-born women2010Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, nr 4, s. 442-449Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: to investigate the association between country of origin of women and their use of complementary pain reduction methods (i.e. non-pharmacological) during childbirth in Sweden. Design: cross-sectional design. Setting: a national register-based study. Participants: 215,497 singleton deliveries (including the first birth of each woman during the period) of women aged 18-47 years in Sweden between 1996 and 1998, divided into 12 subgroups of countries or regions. Measurements: the use of complementary pain reduction methods during childbirth was analysed by logistic regression, adjusting for parity, level of education, number of antenatal care visits, complications in pregnancy, complications during childbirth, use of any pharmacological methods and use of epidural/spinal analgesia during childbirth. Findings: all subgroups of foreign-born women, except those from Finland, had lower odds of complementary pain reduction methods during childbirth than Swedish-born women. Women from Bosnia, Arab countries, Sub-Saharan Africa, Turkey, Iranand Asia had about 40% lower odds for use of complementary pain reduction methods during childbirth than Swedish-born women. Women who used epidural analgesia had higher odds for use of complementary pain reduction methods during childbirth than women who did not use any pharmacological methods. Key conclusion: most subgroups of foreign-born women showed lower odds for and a different pattern in the use of complementary pain reduction methods during childbirth than Swedish-born women. These findings raise questions of whether the Swedish health-care system and care providers have sufficient awareness of and insight into the socio-cultural context of giving birth. (c) 2008 Elsevier Ltd. All rights reserved.

  • 15.
    Thorstensson, Stina
    et al.
    Högskolan i Skövde, Institutionen för vård och natur.
    Nissen, Eva
    Högskolan i Skövde, Institutionen för vård och natur.
    Ekström, Anette
    Högskolan i Skövde, Institutionen för vård och natur.
    An exploration and description of student midwives' experiences in offering continuous labour support to women/couples2008Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, nr 4, s. 451-459Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: to explore and describe the student midwife's experiences in offering continuous labour support.Design: a qualitative research design was chosen. Each student midwife offered continuous labour support to five women/couples and wrote narratives about each of these occasions. Written narratives from 11 student midwives were analysed using qualitative content analysis.Findings: when student midwives offer continuous labour support to women/couples, they tyr to establish rapport. When this works, their presence, their sense of confidence and their ability to offer reassurance increase. If establishing rapport does not work, students experience a sense of powerlessness, a need for reassurance and a lack of confidence. Key conclusions: offering continuous labour support to women and/or their partners made the students aware of the importance of establishing rapport, and it made them realise the impact that their mere presence in the room could have. The students had a need for reassurance which could hamper their efforts to establish rapport. Experiencing a lack of confidence made students focus more strongly on their clinical skills and on their perceived role as a student midwife. Implications for practice: this study can initiate discussions about how student midwives learn to be supportive, as well as about the role models that students encounter during their clinical training in Sweden.

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