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  • 1.
    Bergh, Ingrid H. E.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Johansson, Anna
    Univ Hosp Örebro, Dept Obstet, Örebro, Sweden.
    Bratt, Annelie
    Skaraborgs Hosp, Dept Obstet & Gynecol, Skövde, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Assessment and documentation of women's labour pain: A cross-sectional study in Swedish delivery wards2015In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 28, no 2, p. E14-E18Article in journal (Refereed)
    Abstract [en]

    Background: A woman's pain during labour plays a dominant role in childbirth. The midwife's role is to assess the degree of pain experienced during labour. When professionals respond to labour pain with acknowledgement and understanding, the woman's sense of control and empowerment is increased, which could contribute to a positive experience of childbirth. The aim of this study is to describe how labour pain in Swedish delivery wards is assessed and documented. Methods: This quantitative descriptive study was designed as a national survey performed through telephone interviews with the representatives of 34 delivery wards in Sweden. Results and conclusion: The majority of the participating delivery wards assessed and documented women's labour pain, but in an unstructured manner. The wards differed in how the assessments and documentation were performed. In addition, almost all the delivery wards that participated in the survey lacked guidelines for the assessment and documentation of the degree of pain during labour. The findings also showed that the issue of labour pain was sometimes discussed in the delivery wards, but not in a structured or consistent way. (C) 2015 Australian College of Midwives. Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd). All rights reserved.

  • 2.
    Blixt, Ingrid
    et al.
    Mälarhospital, Eskilstuna, Sweden.
    Mårtensson, Lena
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Process-oriented training in breastfeeding for health professionals decreases women’s experiences of breastfeeding challenges2014In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 9, no 15Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization recommends promoting exclusive breastfeeding for six months. Women much too often end breastfeeding earlier than they planned, but women who continue to breastfeed despite problems more often experience good support and counselling from health professionals. The aim in this study was to evaluate the effects of a process-oriented training in breastfeeding support counselling for midwives and child health nurses, in relation to women’s satisfaction with breastfeeding counselling, problems with insufficient breast milk, pain or nipple sores in relation to exclusive breastfeeding shorter or longer than 3 months.

    Methods: An intervention through process-oriented training for health professionals regarding support in childbearing and breastfeeding took part in the south west of Sweden. The present study was performed in Sweden, in 2000- 2003. Ten municipalities were paired, and within each pair, one was randomly assigned to the group of five intervention (IG) municipalities and one to the group of five control municipalities. Primiparas (n=540) were asked to participate in a longitudinal study to evaluate the care they received. A survey was distributed at 3 days, 3 months and 9 months postpartum. Data collection for control group A (n=162) started before the intervention was initiated. Data for control group B (n=172) were collected simultaneously with the intervention group (IG) (n=206).Women were also divided into two groups depending on whether they exclusive breastfed < 3 months or ≥ 3 months.

    Results: Women in IG were more satisfied with the breastfeeding counselling (p=0.008) and felt the breastfeeding counselling was more coherent (p=0.002) compared with control groups, when the exclusively breastfeeding was < 3 months. In addition fewer women in the IG, among the group exclusively breastfeeding < 3 months, had problems with insufficient breast milk compared to the control groups (p=0.01).

    Conclusion: A process-oriented training for health professionals in support influenced women's ability to solve breastfeeding problems such as the experience of insufficient breast milk production. Women with exclusive breastfeeding lasting ≥ 3 months more often had breastfeeding duration in conformity with their planned breastfeeding duration, compared with women who had breastfeeding duration < 3 months.

    Trial registration: ACTRN12611000354987

  • 3.
    Blixt, Ingrid
    et al.
    University of Skövde, School of Health and Education. Mälarsjukhuset Eskilstuna / Centrum för klinisk forskning i Sörmland, Uppsala universitet.
    Mårtensson, Lena
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Utbildning minskar amningsproblem2014In: Amningsnytt, ISSN 1102-7207, no 4, p. 4-5Article in journal (Other (popular science, discussion, etc.))
  • 4.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Life Sciences.
    Hertfelt Wahn, Elisabeth I.
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Two sides of breastfeeding support: experiences of women and midwives2010In: International Breastfeeding Journal, ISSN 1746-4358, E-ISSN 1746-4358, Vol. 5, p. Article number 20-Article in journal (Refereed)
    Abstract [en]

    Background: Midwives’ support of breastfeeding in maternity wards has been proven to provide an impact on women’s breastfeeding experiences. In previous studies women describe professional support unfavourably, with an emphasis on time pressures, lack of availability or guidance, promotion of unhelpful practices, and conflicting advice. Thus, the present study aims to investigate women’s experiences and reflections of receiving breastfeeding support and midwives’ experiences and reflections of giving breastfeeding support. Methods: This study was carried out in a county in southwestern Sweden during 2003-2004. A qualitative method, content analysis, was chosen for the study. The data came from interviews with women as well as interviews with midwives who were experienced in breastfeeding support. Results:  The women’s and midwives’ experiences and reflections of receiving and giving breastfeeding support were conceptualized as one main theme: “Individualized breastfeeding support increases confidence and satisfaction.” This theme contained three categories: “The unique woman,” ”The sensitive confirming process,” and “Consistency of ongoing support.” In order to feel confident in their new motherhood role, the women wanted more confirmation as unique individuals and as breastfeeding women; they wanted to be listened to; and they wanted more time, understanding, and follow-up from health professionals. In contrast, the midwives described themselves as encouraging and confirming of the women’s needs.  Conclusions:  If health care professionals responded to the woman’s unique needs, the woman felt that the breastfeeding support was good and was based on her as an individual, otherwise a feeling of uncertainty emerged. The midwives, however, expressed that they gave the women individual support, but they also expressed that the support came from different points of view, because the midwives interpreted women’s signals differently. 

  • 5.
    Bäckström, Caroline A.
    et al.
    University of Skövde, School of Life Sciences.
    Hertfelt Wahn, Elisabeth I.
    University of Skövde, School of Life Sciences.
    Ekström, Anette C.
    University of Skövde, School of Life Sciences.
    Zwei Seiten der Stillberatung: Erfahrungen von Frauen und Hebammen2012In: Laktation und Stillen, ISSN 1614-807X, Vol. 25, no 2, p. 56-62Article in journal (Refereed)
  • 6.
    Bäckström, Caroline
    et al.
    Kärnsjukhuset, Skövde.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Två perspektiv på amningsstöd2011In: Amningsnytt, ISSN 1102-7207, no 3, p. 4-5Article in journal (Other (popular science, discussion, etc.))
  • 7.
    Bäckström, Caroline
    et al.
    Skaraborgs sjukhus.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Två sidor av amningsstöd2012In: Jordemodern - Tema Amning, ISSN 0021-7468, no 3, p. 40-41Article in journal (Other (popular science, discussion, etc.))
  • 8.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Amning och vårdkvalitet2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The over all objectives of this thesis was to map factors of importance for breastfeeding such as maternal background factors, maternal perception of breastfeeding support, confidence, caring routines, breastfeeding attitudes of health care professionals, and to investigate whether a training intervention within the care team of

    the antenatal (ANC) and child health centres (CHC) would improve maternal perception of support and strengthen maternal feelings for the baby.

    Material and method: A questionnaire was sent to mothers when their babies were 9-12 months old (n=540). The questionnaire embraced questions regarding maternal background, caring routines, perception of support and duration of breastfeeding (I-II). Thereafter an attitudinal instrument was developed to measure breastfeeding attitudes in health care professionals (n=168). Four attitude dimensions were identified by factor analysis (III). Ten municipalities in a county of south west Sweden was paired and randomized to intervention or control (IV). Thus, all midwives and postnatal nurses working at the ANC or CHC in a randomised municipality were asked to participate in the study (n=81). Health professionals in the intervention group had a process-oriented training in breastfeeding counselling including planned continuity in family education and development of a common breastfeeding policy within the caring team. Changes in attitude were measured by the instrument developed in study III. For study V, mothers were recruited from the maternity and were allocated to intervention- or control group according to the randomization of municipalities in study IV (n=565). Questionnaires were sent out at three days, 3 and 9 months post partum to investigate how the care and counselling skills acquired by the health care professionals would be reflected in maternal perception of breastfeeding support and maternal feelings for and relation to the baby.

    Results: Early initiation of suckling, late discharge from hospital (more than 72 hours) and perceived good support contributed positively to the duration of exclusive breastfeeding. Supplementation the first days after birth for other than medical reasons shortened the duration of breastfeeding. For primiparas, the partner’s presence after childbirth contributed positively to the duration of exclusive breastfeeding. Multiparas who were aware of their mothers breastfeeding history had a longer breastfeeding period than those who did not know of their mother’s breastfeeding history. Mothers were more satisfied with the breastfeeding information they had received at maternity than the breastfeeding information they got from the ANC and CHC (I-II). This induced the idea to develop an attitude instrument and start a training intervention for the care team at ANC and CHC. The attitudinal dimensions identified by the factor analysis were: The regulating factor comprising statements scheduling breastfeeding; the facilitating factor comprising statements showing confidence in the ability of the mother-infant dyad to breastfeed on their own; the disempowering factor comprising statements that objectified the woman and ascribed her no ability to breastfeed without guidance of the health care professional and the breastfeeding antipathy factor comprising statements that showed unwillingness and failing knowledge about breastfeeding (III). After training the health care professionals became less regulating and more facilitating (IV). Family classes provided the intervention mothers with better breastfeeding information, more knowledge about their social rights, the needs of the baby and a stronger social network than the control mothers (V). The postnatal nurse gave a better over all support, was a better listener, showed more understanding and provided the mother with better information about breastfeeding and the needs of the baby. Mothers in the intervention group reported that they interacted more with their baby. They had also more positive views on their baby and felt more confident and close with the baby than mothers in the control groups (V).

    Conclusion: This study showed that it is important to adopt caring routines, which will facilitate breastfeeding. The health care professional needs to find out the background of the mother to be able to provide her with adequate breastfeeding counselling. Caring routines should include early suckling. Supplementation of the baby the first week after birth should only be given on medical grounds. This study showed that a processoriented training in breastfeeding counselling alters attitudes of health care professionals in a positive way. The trained health care professionals organized continuity of family classes and developed a common breastfeeding policy and were more supportive in their encounters with the mothers. These behaviors strengthen the mother’s feelings for her baby and brought about a richer interaction with her baby. A model to provide continuity of family classes, conducted by trained antenatal midwives and postnatal nurses should thus be practiced within the caring team around first time parents.

  • 9.
    Ekström, Anette
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Abrahamsson, Hanna
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Eriksson, Rose-Marie
    Department of Obstetrics and Gynecology, Central Hospital, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Women’s use of nipple shields - their influence on breastfeeding duration after a process-oriented education for health professionals2014In: Breastfeeding Medicine, ISSN 1556-8253, E-ISSN 1556-8342, Vol. 9, no 9, p. 458-466Article in journal (Refereed)
  • 10.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Arvidsson, Kristina
    Department of Obstetrics and Gynaecology, Karlskoga Hospital, Sweden.
    Falkenström, Malin
    Department of Obstetrics and Gynaecology, Karlskoga Hospital, Sweden.
    Thorstensson, Stina
    University of Skövde, School of Life Sciences.
    Fathers’ feelings and experiences during pregnancy and childbirth: A qualitative study2013In: Journal of Nursing & Care, ISSN 2167-1168, Vol. 2, no 2, article id 136Article in journal (Refereed)
    Abstract [en]

    Background: Fathers feel excluded and insecure during childbirth and professional support for fathers can be inadequate. Therefore it is important to further understand fathers experience in order to develop professional support and to create a positive childbirth experience for both fathers and their partners.

    Aim: The aim of this study was to explore fathers’ feelings and experiences during pregnancy and childbirth.

    Materials and Methods: A qualitative method was used, with written interviews which were analyzed using a qualitative content analysis. Participants were eight fathers who wrote answers to two open questions.

    Results: The theme “Fathers have strong, mixed feeling while striving to become prepared and to participate during pregnancy and childbirth” crossed over into all the four categories: Being prepared gave security, Feeling needed, Feeling strong, mixed feelings during pregnancy, and Feeling strong, mixed feelings during childbirth. Fathers’ previous experiences from childbirth facilitated being prepared and increased sense of security.

    Conclusion: It was important for fathers to be prepared and to feel needed and to witness the birth of their baby was fantastic. Overall, the fathers were faced with handling their strong but mixed feelings while striving to prepare for and participate in pregnancy and childbirth.

    Implications: Healthcare professionals need to acknowledge that fathers have needs of their own during pregnancy and childbirth. Fathers also worry about the woman and the baby so they need explanations about normal changes as well as possible complications.

  • 11.
    Ekström, Anette C.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nilsson, Lena
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Apell, Caroline
    The Municipality of Alingsås, Sweden.
    Palmius, David
    Skaraborg Hospital Skövde, Skövde, Sweden.
    Mårtensson, Lena B.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nurses challenges to support hospitalized patients regarding sexual-health issues2016In: Journal of Nursing & Care, ISSN 2167-1168, Vol. 5, no 3, article id 1000344Article in journal (Refereed)
    Abstract [en]

    Background: The approach to nursing should be characterized by a holistic view of the human being which includes sexual health. From a nursing perspective, it is therefore of most importance to have a dialogue about factors associated with sexual health also among hospitalized patients. However, to our knowledge there is a lack of qualitative studies regarding nurses attitudes about dialogue with patients about sexual health.

    Objective: To investigate nurses attitudes towards dialogue with hospitalized patients about sexual health.

    Methods: A qualitative method was used and interviews were conducted which then were analyzed using a qualitative content analysis. Eleven registered nurses were included, the inclusion criteria was: at least one year of experience as a nurse and working on a medical or surgical ward in a hospital in the southwest of Sweden. The participants were in the ages 25-65 and had worked as nurses between 2 and 30 years. Nine of the participants were women. The data were collected during 2011.

    Results: The nurses experiences of and reflections on dialogue with patients about sexual health were presented as a single main theme: Nurses challenges to support hospitalized patients with sexual health issues. This theme had three categories: Feeling uncomfortable, Feeling inadequate and Task-oriented care with related subcategories respectively.

    Conclusions: Nurses attitudes towards their dialogues about sexual health with hospitalized patients were less challenging if they were initiated by the patients or if the patients were men with medical causes related to sexual health. Lack of knowledge and support from colleagues became reasons why nurses felt inadequate about discussing sexual health with their patients.

  • 12. Ekström, Anette
    et al.
    Gustafsson, A.
    Lundberg, O.
    Wahlberg, V.
    Upplevelsen av trygghet hos mödrar vars nyfödda barn vårdats i kuvös1998In: Tidsskrift for jordmødre, ISSN 0040-7089, Vol. 104, no 9, p. 18-20Article in journal (Refereed)
  • 13.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Guttke, Kristin
    Lenz, Marika
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Life Sciences.
    Long term effects of professional breastfeeding support - An intervention2011In: International Journal of Nursing and Midwifery, ISSN 2141-2456, Vol. 3, no 8, p. 109-117Article in journal (Refereed)
    Abstract [en]

    Professional support is important for women during pregnancy, but more research is needed to provide a better understanding of how this support affects the mother's experience of support and breastfeeding behavior the first days after birth and its relation to the duration of breastfeeding. This study aims to evaluate the effects of a professional support during pregnancy in relation to mothers’ perceived support at delivery and maternity ward, and on the number of breastfeeding sessions during the first three days after birth. These factors would be subsequently considered in relation to the duration of breastfeeding. Mothers in the Intervention group (IG) and Control group B (CGB) (November 2000 to April 2002) perceived significant better overall support, breastfeeding information and preparation for parenting from the professionals in the delivery and maternity wards compared with the Control group A (CGA) (April to October 2000), (p<0.001), (n = 540). The IG showed a higher frequency of breastfeeding sessions in the first 24 h compared with the mothers in the CGB (p<0.008) and a positive correlation between preparation for the parental role and duration of exclusive breastfeeding (p = 0.006).

  • 14.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Kylberg, Elisabeth
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    University of Skövde, School of Life Sciences. Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
    A Process-Oriented Breastfeeding Training Program for Healthcare Professionals to Promote Breastfeeding2010In: Proceedings of the Second Biannual Uppsala Symposium on lactation research in mammals and humans: The mammary gland in health and disease with particular focus on the mammary gland close post partum including indicators of inflammation and pathogens of the mammary gland / [ed] Sigrid Agenäs, Gunilla Hallberg, Elisabeth Kylberg, Karin Perss on Waller & Bodil Ström Holst, Uppsala: CRU , 2010, p. 9-Conference paper (Refereed)
    Abstract [en]

    Introduction: The impact of giving an infant food other than breast milk depends on several factors. Evidence to date supports the recommendation for exclusive breastfeeding for six months.

    The aim of the this study was to evaluate the effect of a process-oriented training in support during childbirth and breastfeeding for midwives and postnatal nurses in relation to  the time of initial breastfeeding session, introduction of breast milk substitute and solids effects on  the duration of breastfeeding.

    Materials and methods: Ten municipalities in Sweden were randomized to either intervention (IG) or control groups (CGA and CGB). The intervention included a process-oriented training program* for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) who were living at either site were asked to respond to questionnaires at three days, three and nine months postpartum. Data collection for mothers in CGA (n=162) started before effects of the intervention could be studied, CGB (n=172) was collected simultaneously with the IG (n=206).

    Results: Preliminary results showed that fewer infants in the IG received breast milk substitute (the first week of life) without medical reasons (p=0.01) and were older (3.8 months) when breast milk substitute was introduced after discharge compared with the infants in the control groups (CGA 2.3 months p= 0.01 and CGB 2.5 months p= 0.03).

    Discussion and Conclusion: A process-oriented training program for midwives and postnatal nurses (by changed attitudes among health staff and changing mothers self imaging) reduced the number of infants who got breastmilk substitute during the first week without medical reasons and delayed the introduction of breast milk substitute after the first week.

     

  • 15.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Kylberg, Elisabeth
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    A process-oriented breastfeeding training program for healthcare professionals to promote breastfeeding: an intervention study2012In: Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine, ISSN 1556-8342, Vol. 7, no 2, p. 85-92Article in journal (Refereed)
    Abstract [en]

    Abstract Aim: The aim of the study was to evaluate the effects of process-oriented training in supportive breastfeeding counseling for midwives and postnatal nurses on the time lapse between the initial breastfeeding session, introduction of breastmilk substitutes and solids, and the duration of breastfeeding. Materials and Methods: Ten municipalities in Sweden were randomized to either the intervention or control groups. The intervention included a process-oriented training program for midwives and postnatal nurses in the intervention municipalities. Primiparas (n=540) living in either an intervention or control municipality were asked to participate in a longitudinal study to evaluate the care given. Data collection for control group A (CGA) (n=162) started before the intervention was initiated. Data for control group B (CGB) (n=172) were collected simultaneously with the intervention group (IG) (n=206). The mothers responded to questionnaires at 3 days, 3 months, and 9 months postpartum. Results: As a result of the process-oriented training program for midwives and postnatal nurses, the IG mothers had a significantly longer duration of exclusive breastfeeding, even if the initial breastfeeding session did not occur within 2 hours after birth, than the corresponding group of CGA mothers (p=0.01). Fewer infants in the IG received breastmilk substitutes (in the first week of life) without medical reasons compared with the control groups (p=0.01). The IG infants were significantly older (3.8 months) when breastmilk substitutes were introduced (after discharge from the hospital) compared with the infants in the control groups (CGA, 2.3 months, p=0.01; CGB, 2.5 months, p=0.03). Conclusion: A process-oriented training program for midwives and postnatal nurses was associated with a reduced number of infants being given breastmilk substitutes during the 1st week without medical reasons and delayed the introduction of breastmilk substitutes after discharge from the hospital.

  • 16.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Kylberg, Elisabeth
    University of Skövde, School of Life Sciences.
    Svensson, Kristin
    Karolinska institutet.
    Föräldrar vill ha amningsstöd baserat på fakta2012In: Jordemodern - Tema Amning, ISSN 0021-7468, no 3, p. 27-29Article in journal (Other (popular science, discussion, etc.))
  • 17.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Matthiesen, Ann-Sofi
    Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden / Department of Statistics, University of Stockholm, Stockholm, Sweden.
    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.
    Breastfeeding attitudes among counselling health professionals: Development of an instrument to describe breastfeeding attitudes2005In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 33, no 5, p. 353-359Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to develop an instrument that can be used for accurate assessment of nurses' and midwives' attitudes toward breastfeeding in a group of midwives, maternity-nursing staff and postnatal nurses experienced in breastfeeding counselling. Method: An instrument based on WHO standards was developed to measure breastfeeding attitudes. In all, 168 healthcare professionals filled in the instrument. A factor analysis using maximum likelihood and varimax rotation was performed. Spearman's correlation was used to correlate factorial dimensions and self-described interest in breastfeeding. Results: By means of factor analysis four factors were identified: the "regulating" factor focused on regulating the mothers' breastfeeding management, the "facilitating" factor focused on making it easy for mothers to manage their breastfeeding, the "disempowering" factor focused on giving advice, disregarding the needs of the mother being counselled, and the "breastfeeding antipathy" factor focused on insufficient, basic, breastfeeding knowledge and aversive reactions to breastfeeding. Midwives rated higher on the facilitating factor and breastfeeding antipathy factor and lower on the regulating factor than postnatal nurses. Breastfeeding interest was positively correlated with the facilitating factor, and negatively with the disempowering factor and the breastfeeding antipathy factor. Conclusion: This instrument provides a picture of health professionals' attitudes towards breastfeeding. Four factors were identified in order of importance: regulating, facilitating, disempowering, and breastfeeding antipathy factors. Harmful attitudes were identified and suggested a need for educational programmes to help health professionals to reconcile damaging values, in order to improve breastfeeding counselling

  • 18.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    A Mother's feelings for Her Infant Are Strengthened by Excellent Breastfeeding Counseling and Continuity of Care2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 118, no 2, p. e309-e314Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE. Continuous support during the childbirth process ultimately may strengthen the mother's self-esteem and her capacity to interact with and nurture her infant and also may improve paternal involvement in general. In the present study, we investigated whether mothers, who were attended by midwives and nurses who had had a process-oriented training program in breastfeeding counseling, perceived stronger maternal feelings for their infant than mothers who had received only routine care.

    METHODS. In a previous study, an intervention that included a process-oriented program on breastfeeding counseling for health professionals and continuity in family classes through childbirth was conducted. The 10 largest municipalities were classified in pairs that were similar in size and had similar figures of breastfeeding duration. The municipalities were randomized pairwise to either an intervention or a control group. The present study is a follow-up study on women's feelings for their infants in relation to the kind of care that they had had and was undertaken between April 2000 and January 2003. The sampling frame was based on women who were cared for at either the intervention clinic or control clinics. The mothers at the control clinics had received standard routine care and had attended family classes through the point of birth. Data collection for control group A started before effects of the intervention could be studied. Data for control group B were collected simultaneously with data collection for the intervention group (n = 540). The mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. Background data of the mothers were collected. The perception of support that was provided by the health professionals and the perception of mother–infant relationship and feelings for the infant were rated on Likert scales.

    RESULTS. At 3 days postpartum, both the intervention group and control group B versus the control group A thought that their understanding of the infant was better, they perceived more strongly that the infant as their own, and they enjoyed more breastfeeding and resting with the infant. Although there was no significant difference between the intervention group and control group B at 3 days and 3 months observation, mothers in the intervention group talked more to their infant, perceived their infant to be more beautiful than other infants, and perceived more strongly that the infant was their own than did the mothers in control group B at 9 months observation. In addition, the mothers in the intervention group felt significantly more confident with the infant and felt the infant to be closer than did the mothers in control group B.

    CONCLUSION. A process-oriented breastfeeding training program for antenatal midwives and postnatal nurses that included an intervention that guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant.

  • 19.
    Ekström, Anette
    et al.
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Process-oriented training in breastfeeding attitudes and continuity of care improve mothers perception of support2007In: Health Education Research Trends / [ed] Peter R. Hong, Nova Science Publishers, Inc., 2007, p. 211-225Chapter in book (Refereed)
  • 20.
    Ekström, Anette
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nurses and midwives professional support increases with improved attitudes - design and effects of a longitudinal randomized controlled process-oriented intervention2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 1, article id 275Article in journal (Refereed)
    Abstract [en]

    Background: Becoming parents for the first time is challenging. Mothers need both social and professional support to handle these challenges. Professionals’ attitudes affect quality of care and support. So to improve professional support, an intervention consisting of a process-oriented training was performed. Due to the positive results of the intervention there is a need to illuminate the methodological approach further. The overall aim was therefore to describe a methodological approach to improve and evaluate health care professionals’ attitudes toward breastfeeding and parental support in order to improve quality of care in childbearing.

    Methods: This study was a longitudinal randomized control intervention study, in which groups of mothers received care in childbearing from midwives and child health nurses. These health professionals had gone through a process-oriented training, or not. In order to improve attitudes of health professionals the training was based on evidence, practical skills and reflective processes (both private and professional experiences) in relation to breastfeeding and parental support. Included in the longitudinal study were health professionals from five intervention municipalities n = 36 and health professionals from five control municipalities n = 45. All mothers who fulfilled the inclusion criteria were consecutively identified from the hospital register and asked to participate in the study. Mothers who accepted to participate were included in the interventions group (n = 206) or control groups (n = 162, n = 172 respectively) based on which municipality they belonged to.

    Results: The results of the process-oriented training improved the professionals’ attitudes toward breastfeeding and parental support. These improved attitudes in health professionals increased intervention-group mother’s satisfaction with professional and social support. Intervention-group mother’s relation to and feelings for their baby as well as breastfeeding was also improved.

    Conclusion: These results stress the importance of professionals’ attitude in quality of care during childbearing, as well as pointing to the possibility to improve professionals’ attitudes with a process-oriented training.

    Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), trial registration:ACTRN12611000354987.

  • 21.
    Ekström, Anette
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Validation of Measurement Scales in Health Care2015In: Journal of Nursing & Care, ISSN 2167-1168, Vol. 4, no 2, article id 1000236Article in journal (Other academic)
  • 22.
    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)

  • 23.
    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)

  • 24.
    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.
    Duration of Breastfeeding in Swedish Primiparous and Multiparous Women2003In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 19, no 2, p. 172-178Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the effects of sociodemographicfactors and maternity ward practices on the duration of breastfeedingin Swedish primiparas (n = 194) and multiparas (n = 294), consecutivelyselected from hospital birth files for 3 months, who respondedto a questionnaire 9 to 12 months after childbirth. The impactof sociodemographic data and maternity ward practices on exclusiveand any breastfeeding were examined. Smoking and supplementationwithout medical reasons influenced the duration of both exclusiveand any breastfeeding negatively, whereas early first breastfeedinginfluenced the duration of both exclusive and any breastfeedingpositively, and parity had no significant influence. Late hospitaldischarge influenced the duration of exclusive breastfeedingpositively, and higher maternal age influenced the durationof any breastfeeding positively. These variables altogetherexplained 11.4% (P <.001) of the variance in the durationof exclusive breastfeeding and 8.2% (P <.001) of the durationof any breastfeeding

  • 25.
    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.
    Process-oriented training in breastfeeding alters attitudes to breastfeeding in health professionals2005In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 33, no 6, p. 424-431Article in journal (Refereed)
    Abstract [en]

    Aim: The purpose of the study was to measure the attitudes of antenatal midwives and postnatal nurses to breastfeeding before and after common, process-oriented breastfeeding training. Method: Antenatal centres and child-health centres in 10 municipalities were randomized to either an intervention or a control group. The antenatal midwives and postnatal nurses in the intervention group were together given process-oriented breastfeeding training and were, in addition, asked to develop a common breastfeeding policy. A previously developed instrument was used to measure the effects of a training programme on breastfeeding attitudes among midwives and postnatal nurses. It consisted of four scales measuring a person's attitudes toward breastfeeding in four dimensions: regulating, facilitating, disempowering, and breastfeeding-antipathy attitudes. A mean score was calculated for each individual on these four dimensional scales. The higher the score, the stronger the attitude. Results: After one year, the intervention group reduced their scores on the regulating scale when compared with the control group (p<0.001). The intervention group decreased their scores on the regulating scale and increased their scores on the facilitating scale over the first year after training. The control group also significantly increased their scores on the facilitating scale. When the results were analysed profession-wise, the postnatal nurses in the intervention group decreased their scores on the regulating and disempowering scales and increased their scores on the facilitating scale. In contrast, the midwives in the intervention group decreased their scores only on the breastfeeding antipathy scale. The control group midwives decreased their scores on the disempowering scale. No differences were found among the postnatal nurses in the control group. Conclusion: Process-oriented breastfeeding training made both antenatal midwives and postnatal nurses better disposed to breastfeeding; postnatal nurses in particular improved their attitudes. Attitudes to breastfeeding tended to be stable over time, but process-oriented training lowered the scores a little on the regulating scale, suggesting that after this kind of training counsellors would find it less necessary to schedule and control the mothers' breastfeeding behaviour.

  • 26.
    Handlin, Linda
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Muller, Jasmin
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Promoting health of Swedish workers by complementary methods: example of a study design of a longitudinal randomized controlled intervention study2017In: Medical Research Archives, ISSN 2375-1916, Vol. 5, no 8, p. 1-13Article in journal (Refereed)
    Abstract [en]

    Background: When designing, implementing, and evaluating a work site health promotion program, it is necessary to ensure that the program is evidence based. The present article aims to present in-depth information on the design of a longitudinal randomized controlled complementary intervention pilot study that follows the Consort recommendations to evaluate possible effects of a health promotive intervention in healthy workers.

    Methods: Employees from four different workplaces were randomly assigned to one of the following groups: i) Massage and mental training (sitting in the armchair and receiving mechanical massage while listening to mental training programs, n=19), ii) Massage (sitting in the armchair and receiving mechanical massage only, n=19), iii) Mental training (sitting in the armchair and listening to mental training programs only, n=19), iv) Pause (sitting in the armchair but not receiving mechanical massage or listening to mental training programs, n=19), v) Control (not sitting in the armchair at all, n=17). The study lasted for eight weeks. Immediately before the randomization, after four weeks and after eight weeks the participants responded to statements from the Swedish Scale of Personality and had their heart rate, blood pressure and fingertip temperature measured.

    Results: Receiving mechanical massage and listening to mental training programs, either separately or in combination, during working hours had some positive effects on the employees’ own evaluation of their health, as well as their heart rate, blood pressure and fingertip temperature. However, the intervention need to be evaluated further.

    Conclusion: The approach described makes it possible to design, implement and evaluate a work site health promotion program, also on pilot-study level and these results should be seen as a first step towards larger randomized studies. This types of studies need to focus on healthy participants and special care should be taken to guarantee adequately powered study groups and their homogeneity.

  • 27.
    Hrybanova, Yana
    et al.
    Högskolan Väst.
    Ekström, Anette
    Högskolan Väst.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    First-time fathers’ experiences of professional support from child health nurses2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Article in journal (Refereed)
    Abstract [en]

    Nowadays, in Sweden, fathers are expected to be active in their father role and to share caring responsibilities for their children equally with mothers. This active role of a father in a family can be challenging, especially for the first-time fathers. Child health nurses’ support is an important factor for fathers to become confident caregivers. The Father Perceived Professional Support scale (FaPPS scale) can be used in nursing practice for better understanding father’s needs of professional support.

    The aim of this study was to describe first-time fathers’ experiences of the professional support received from child health nurses and to validate the instrument: ‘FaPPS scale’. A qualitative design, with inductive and deductive approaches, was used in this study.

    Twelve first-time fathers participated in the semi-structured interviews, thereafter grading the FaPPS scale items and commenting on them. The fathers experienced nurses’ support positively when nurses provided practical information and stimulated them to be involved in care of their children. In contrast, the support was experienced negatively because of nurses’ lack of commitment, availability and adaptation to the fathers’ individual needs. The fathers also felt inequality between the support received by fathers and by mothers. Although some fathers perceived it as negative, others considered it fair, believing that mothers needed more support. In addition, fathers expect nurses to actively offer support to them and supervise them in childcare. The fathers also needed meeting other parents, for example in parental groups.This study also indicates that FaPPS scale can be used both in research and clinical practice, though still needing further development.

  • 28.
    Huusko, Linda
    et al.
    Närhälsan Skövde Women's Health Clinic, Skövde, Sweden.
    Sjöberg, Sandra
    Women's Health Clinic, Umeå, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Health Sciences, University West, Trollhättan, Sweden.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    First-Time Fathers’ Experience of Support from Midwives in Maternity Clinics: An Interview Study2018In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, article id 9618036Article in journal (Refereed)
    Abstract [en]

    Background: Research shows that first-time fathers want to take part in preparation for birth and parenthood but they describe being excluded by health professionals. Aim: The aim of this study was to illustrate first-time fathers’ experiences of support from midwives in maternity clinics as a step in the validation of “The Father Perceived-Professional-Support” (The FaPPS) scale. Methods: A qualitative content analysis with an inductive and deductive approach was used; seven first-time fathers were strategically selected and interviewed. In the inductive part the following open question was asked: “How did you perceive the support from the antenatal midwife/midwives?” In the deductive part, the fathers were asked to respond to the FaPPS scale, in order to receive their thoughts and understanding of the scale, inspired by the “Think-aloud” method. Findings. The inductive results showed two main categories: Experience of not knowing what support they needed and Experience of being excluded. The fathers found support from other fathers in parental education classes, but they lack time to discuss. Overall it seems as if the fathers answered both from their own perspective and from the mothers’ perspective. This was not evident in the deductive results. The FaPPs scale should therefore include professionals’ ability to strengthen social support from other first-time fathers and professionals’ ability to offer support to the mother. Conclusion and Clinical Implications. The fathers experienced exclusion both by themselves and also by midwives. Midwives should offer both parents the opportunity to pose questions. It is important for expectant fathers that time for discussion is planned in parental education classes. The FaPPS scale is useful but needs further development. Parts of our result are in line with earlier research, for decades; therefore it is necessary to focus more on support for fathers.

  • 29.
    Laanterä, Sari
    et al.
    University of Eastern Finland.
    Pietilä, Anna-Maija
    University of Eastern Finland.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Pölkki, Tarja
    University of Oulu, Finland.
    Confidence in Breastfeeding Among Pregnant Women2012In: Western Journal of Nursing Research, ISSN 0193-9459, E-ISSN 1552-8456, Vol. 34, no 7, p. 933-951Article in journal (Refereed)
    Abstract [en]

    Little is known about prenatal breastfeeding confidence, although such knowledge is necessary for developing the content of counseling and tailoring it for individuals. The purpose of this study was to describe women’s prenatal breastfeeding confidence and how their sociodemographic characteristics, breastfeeding knowledge, and attitudes relate to it. The electronic confidence scale was used in data collection, and 123 Finnish women filled in the questionnaire. The mean confidence score was 83.88 when the maximum possible score was 120. Confidence scores varied when parity, breastfeeding knowledge, and attitudes were involved. Variables regarding breastfeeding as difficult, regarding breastfeeding as exhausting, and parity explained 38.1% of the variation of the breastfeeding confidence scores. Pregnant women need information about managing potential breastfeeding problems and the physiology of breastfeeding. Interventions designed to promote breastfeeding confidence need to be focused on primiparas and women with a lack of breastfeeding knowledge.

  • 30.
    Laanterä, Sari
    et al.
    Piikivenkuja 5, 50600 Mikkeli, Finland.
    Pölkki, Tarja
    Institute of Health Sciences, Faculty of Medicine, University of Oulu, PO Box 5000, FI-90014 University of Oulu, Finland.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Pietilä, Anna-Maija
    Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Social and Health Care Center of Kuopio, PO Box 1627, FI-70211, Kuopio, Finland.
    Breastfeeding attitudes of Finnish parents during pregnancy2010In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 10, p. Article Number: 79-Article in journal (Refereed)
    Abstract [en]

    Background: Breastfeeding attitudes are known to influence infant feeding but little information exists on the prenatal breastfeeding attitudes of parents. The purpose of this study was to describe Finnish parents’ prenatal breastfeeding attitudes and their relationships with demographic characteristics.  Methods: The electronic Breastfeeding Knowledge, Attitude and Confidence scale was developed and 172 people (123 mothers, 49 fathers) completed the study. The data were analysed using factor analysis and nonparametric methods.  Results: Breastfeeding was regarded as important, but 54% of the respondents wanted both parents to feed the newborn. The mean rank values of breastfeeding attitudes differed significantly when parity, gender, education, age, breastfeeding history and level of breastfeeding knowledge were considered. The respondents who were expecting their first child, were 18–26 years old or had vocational qualifications or moderate breastfeeding knowledge had more negative feelings and were more worried about breastfeeding than respondents who had at least one child, had a higher vocational diploma or academic degree or had high levels of breastfeeding knowledge. Respondents with high levels of breastfeeding knowledge did not appear concerned about equality in feeding.  Conclusions: Both mothers and fathers found breastfeeding important. A father’s eagerness to participate in their newborn's life should be included in prenatal breastfeeding counselling and ways in which to support breastfeeding discussed. Relevant information about breastfeeding should focus on the parents who are expecting their first child, those who are young, those with low levels of education or those who have gaps in breastfeeding knowledge, so that fears and negative views can be resolved.

  • 31.
    Muller, Jasmin
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Harlén, Mikael
    University of Skövde, School of Engineering Science. University of Skövde, The Virtual Systems Research Centre.
    Lindmark, Ulrika
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Handlin, Linda
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mechanical massage and mental training program effect employees' heart rate, blood pressure and fingertip temperature: An exploratory pilot study2016In: European Journal of Integrative Medicine, ISSN 1876-3820, E-ISSN 1876-3839, Vol. 8, no 5, p. 762-768Article in journal (Refereed)
    Abstract [en]

    Introduction: Inability to relax and recover is suggested to be a key factor for stress-related health problems. This study aimed to investigate possible effects of mechanical massage and mental training, used either separately or in combination during working hours. Methods: Employees were randomly assigned to one of the following groups: i) Mechanical massage combined with mental training (n = 19), ii) Mechanical massage (n = 19), iii) Mental training (n = 19), iv) Pause (n = 19), v) Control (n = 17). The study lasted for eight weeks. Heart rate, blood pressure and fingertip temperature were measured at start, after four and after eight weeks. Results: Between-group analysis showed that heart rate differed significantly between the groups after 4 weeks (p = 0.020) and tended to differ after eight weeks (p = 0.072), with lowest levels displayed in the massage group and the control group. Blood pressure and fingertip temperature did not differ between the groups. Within-group analysis showed that mechanical massage decreased heart rate (p = 0.038) and blood pressure (systolic p = 0.019, diastolic p = 0.026) and increased fingertip temperature (p = 0.035). Mental training programs reduced heart rate (p = 0.036). Combining the two methods increased diastolic blood pressure (p = 0.028) and decreased fingertip temperature (p = 0.031). The control group had a significant decrease in systolic blood pressure during the first four weeks of the study (p = 0.038) Conclusion: Receiving mechanical massage and listening to mental training programs, either separately or in combination, during working hours had some positive effects on the employees’ heart rate, blood pressure and fingertip temperature. The effects were especially strong for employees who received mechanical massage only.

  • 32.
    Muller, Jasmin
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Handlin, Linda
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Harlén, Mikael
    University of Skövde, School of Engineering Science.
    Lindmark, Ulrika
    School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Mechanical massage and mental training programmes affect employees´ anxiety, stress susceptibility and detachment – a randomised explorative pilot study2015In: BMC Complementary and Alternative Medicine, ISSN 1472-6882, E-ISSN 1472-6882, Vol. 15, no 1, article id 302Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Working people's reduced ability to recover has been proposed as a key factor behind the increase in stress-related health problems. One not yet evidence-based preventive method designed to help employees keep healthy and be less stressed is an armchair with built-in mechanical massage and mental training programmes, This study aimed to evaluate possible effects on employees' experience of levels of "Anxiety", "Stress Susceptibility", "Detachment" and "Social Desirability" when using mechanical massage and mental training programmes, both separately and in combination, during working hours.

    METHODS:

    Employees from four different workplaces were randomly assigned to one of the following groups: i) Massage and mental training (sitting in the armchair and receiving mechanical massage while listening to the mental training programmes, n=19), ii) Massage (sitting in the armchair and receiving mechanical massage only, n=19), iii) Mental training (sitting in the armchair and listening to the mental training programmes only, n=19), iv) Pause (sitting in the armchair but not receiving mechanical massage or listening to the mental training programmes, n=19), v) Control (not sitting in the armchair at all, n=17). In order to discover how the employees felt about their own health they were asked to respond to statements from the "Swedish Scale of Personality" (SSP), immediately before the randomisation, after four weeks and after eight weeks (end-of-study).

    RESULTS:

    There were no significant differences between the five study groups for any of the traits studied ("Somatic Trait Anxiety", "Psychic Trait Anxiety", "Stress Susceptibility", "Detachment" and "Social Desirability") at any of the occasions. However, the massage group showed a significant decrease in the subscale "Somatic Trait Anxiety" (p=0.032), during the entire study period. Significant decreases in the same subscale were also observed in the pause group between start and week eight (p=0.040) as well as between week four and week eight (p=0.049) and also in the control group between the second and third data collection (p=0.014). The massage and mental training group showed a significant decrease in "Stress Susceptibility" between week four and week eight (p=0.022). The pause group showed a significant increase in the subscale "Detachment" (p=0.044).

    CONCLUSIONS:

    There were no significant differences between the five study groups for any of the traits studied. However, when looking at each individual group separately, positive effects in their levels of "Anxiety", "Stress Susceptibility" and "Detachment" could be seen. Although the results from this pilot study indicate some positive effects, mechanical chair massage and mental training programmes used in order to increase employee's ability to recover, needs to be evaluated further as tools to increase the employees ability to recover.

  • 33.
    Muller, Jasmin
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Handlin, Linda
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Harlén, Mikael
    University of Skövde, School of Engineering Science. University of Skövde, The Virtual Systems Research Centre.
    Lindmark, Ulrika
    Högskolan i Jönköping, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    The value of armchairs in providing mechanical massage and mental relaxation programmes is not established for workplace health promotion2016In: Focus on Alternative and Complementary Therapies, ISSN 1465-3753, E-ISSN 2042-7166, Vol. 21, no 1, p. 44-45Article in journal (Other academic)
  • 34.
    Mårtensson, Lena B.
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ek, Kristina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Bergh, Ingrid H. E.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Midwifery students' conceptions of worst imaginable pain2014In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 27, no 2, p. 104-107Article in journal (Refereed)
    Abstract [en]

    Background: The Visual Analogue Scale (VAS) is one of the most widely used pain assessment scales in clinical practice and research. However, the VAS is used less frequently in midwifery than in other clinical contexts. The issue of how people interpret the meaning of the VAS endpoints (i.e. no pain and worst imaginable pain) has been discussed. The aim of this study was to explore midwifery students' conceptions of 'worst imaginable pain'. Methods: A sample of 230 midwifery students at seven universities in Sweden responded to an open-ended question: 'What is the worst imaginable pain for you?' This open-ended question is a part of a larger study. Their responses underwent manifest content analysis. Results: Analysis of the midwifery students' responses to the open-ended question revealed five categories with 24 sub-categories. The categories were Overwhelming pain, Condition-related pain, Accidents, Inflicted pain and Psychological suffering. Conclusions: The midwifery students' conceptions of 'worst imaginable pain' are complex, elusive and diverse. © 2014 Australian College of Midwives.

  • 35.
    Nilsson, Lena
    et al.
    University of Skövde, School of Life Sciences.
    Thorsell, Tina
    Department of Obstetrics and Gynecology, Skaraborg Hospital Skövde, Sweden.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Factors influencing positive birth experiences of first-time mothers2013In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2013, article id 349124Article in journal (Refereed)
    Abstract [en]

    Objectives. The objective of this study was to describe first-time mothers’ experiences and reflections of their first birth. Study Design. This study is a part of a larger study which was carried out in southwestern Sweden in 2008. A qualitative method with content analysis was chosen for this study. The unit of data was 14 written narratives from the first-time mothers. Results. The theme “To be empowered increases first-time mothers’ chances for a positive birth experience” crossed over into all the three categories: “To trust the body and to face the pain,” “Interaction between body and mind in giving birth,” and “Consistency of support.” Conclusion. In order to feel confident in their first childbirth, the women wanted to be confirmed and seen as unique individuals by the professionals and their partner. If professionals responded to the individual woman’s needs of support, the woman more often had a positive birth experience, even if the birth was protracted or with medical complications.

  • 36.
    Nilsson, Lena
    et al.
    University of Skövde, School of Life Sciences.
    Thorsell, Tina
    Department of Obstetrics and Gynecology, Skaraborg Hospital, SE 541 85, Kärnsjukhuset, Skövde, Sweden.
    Zandren Hammar, Petra
    University of Skövde, School of Life Sciences.
    Pethrus, Kristina
    Department of Obstetrics and Gynecology, Skaraborg Hospital, SE 541 85, Kärnsjukhuset, Skövde, Sweden.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Most Important for First Time Mothers during Labor is to be Respected for their Needs, to Feel Involved in the Care and Support from their Partners2012In: Journal of Nursing and Care, ISSN 2167-1168, Vol. 1, no 4, p. 114-Article in journal (Refereed)
    Abstract [en]

    Background: Further research is needed about the women’s experience of support during labor in order for health professionals to respond to a woman’s unique needs.

    Aim: To explore first time mothers experience of giving birth as well as professional and social support during labor.

    Method: This study was carried out in southwestern Sweden in 2008. A qualitative method with content analysis was chosen for the study. The unit of data is from 14 women’s written narratives.

    Results: Results show that the women’s experiences of being involved in decisions and the relationship to professional and social support during their first labor can be conceptualized as one main theme: "Most important for first time mothers’ during labor is to be respected for their needs, to feel involved in the care, and support from their partner". This theme contained three categories: "To be respected for their needs", "To be involved in the care" and "Support from the partner". A safe and calm environment positively influenced the women’s sense of support, and the ability to have her partner physically present positively influenced the sense of support.

    Conclusion: When healthcare professionals responded to a woman’s unique needs during labor, the woman felt that the support was based on her as an individual and possibility to being involved in decisions; otherwise a feeling of uncertainty emerged. If the woman’s partner was able to offer support, then it was essential that he was physically present in the room throughout the birth.

  • 37.
    Ranch, Matilda Möller
    et al.
    Neonatal Care Unit, NÄL Hospital Trollhättan, Sweden.
    Jämtén, Sofia
    Pediatric Healthcare Setting, Capio, Lysekil, Sweden.
    Thorstensson, Stina
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström-Bergström, Anette C.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Health Sciences, University West, Sweden.
    First-Time Mothers Have a Desire to Be Offered Professional Breastfeeding Support by Pediatric Nurses: An Evaluation of the Mother-Perceived-Professional Support Scale2019In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2019, article id 8731705Article in journal (Refereed)
    Abstract [en]

    Background. Although the World Health Organization recommends exclusive breastfeeding for six months, the rate of breastfeeding has decreased worldwide. Breastfeeding is the natural way of feeding a baby, but it is a process that has to be learnt. It is not unusual for problems to occur and hence support for breastfeeding is vital. The aim of this study was to explore first-time mothers' experiences of the breastfeeding support offered by pediatric nurses, as well as to develop and evaluate the Mother Perceived Support from Professionals (MoPPS) scale. Methods. A qualitative design involving both inductive and deductive approaches was chosen. Nine first-time mothers were interviewed regarding their experiences of the breastfeeding support offered by pediatric nurses. Semistructured interviews were conducted. The mothers were also asked to grade their experiences of breastfeeding support on the MoPPS scale. A qualitative content analysis was applied when analyzing the data obtained using both the inductive (interviews) and deductive (MoPPS scale) approaches. Results. The results revealed that the mothers felt the desire to breastfeed, although they all experienced some difficulties. They wanted the pediatric nurses to be perceptive and provide professional support based on their own experiences. When the pediatric nurses took time and booked extra appointments, the mothers felt supported. The inductive analysis resulted in one theme: When wanting to breastfeed, mothers have a desire to be offered professional breastfeeding support. Two main categories were identified, namely Mothers wanted but lacked breastfeeding support and Mothers received professional support. The deductive analysis of the MoPPS scale showed similar results, and the questions were perceived as relevant to the aim. The mothers considered it important that the pediatric nurses had sufficient knowledge about breastfeeding. It was also considered important that the pediatric nurses involved the mothers' partners in the breastfeeding support. Therefore, we suggest that these areas should be included in the MoPPS scale for pediatric nurses. Conclusions. The MoPPS scale can be a useful tool for helping pediatric nurses to offer mothers professional breastfeeding support. Indeed, when offering breastfeeding support, pediatric nurses can use the items included on the MoPPS scale as guidance.

  • 38.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Andersson, Anna
    Karlskoga Hospital, Karlskoga, Sweden.
    Israelsson, Sofie
    University Hospital, Örebro, Sweden.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    To build a bridge between two worlds: Mothers' experiences of professional support at the maternity ward2016In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 37, no 10, p. 1067-1081Article in journal (Refereed)
    Abstract [en]

    We studied the experience of professional support among first-time mothers in relation to a scale measuring professional support in maternity care. We used a qualitative study with both an inductive and deductive approach and interviewed nine mothers. Our findings, both inductive and deductive, suggest that first-time mothers expect professional support in their transition into motherhood, building a bridge between two worlds. The first meeting, acknowledging individual needs, and supporting partner participation were important for good support. Maternity care should be organized with a focus on availability and professional support for mothers and the increased participation of their partners. Our scale of measurement can be useful but needs some development.

  • 39.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Claesson, Amanda
    Mölndal labour ward, Sahlgrenska University Hospital, Göteborg, Sweden.
    Packalen, Anna
    Kvinnokliniken, Skaraborgs Sjukhus Skövde, Sweden.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Validating the Mother-to-Infant Relation and Feelings' scale by first-time mothers' descriptions three months after birth2014In: Journal of Women's Health, Issues & Care, ISSN 2325-9795, Vol. 3, no 6, article id 1000173Article in journal (Refereed)
  • 40.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Support as a Concept and with a Focus on Childbearing2012In: Journal of Nursing and Care, ISSN 2167-1168, Vol. 1, no 4, p. e109-Article in journal (Refereed)
  • 41.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    To be Supportive or to Care for2014In: Journal of Nursing & Care, ISSN 2167-1168, Vol. 3, no 6, article id 1000e114Article in journal (Other academic)
  • 42.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Life Sciences. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Lundgren, Ingela
    Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Life Sciences.
    Exploring Professional Support Offered by Midwives during Labour: An Observation and Interview Study2012In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2012, p. Article ID 648405-Article in journal (Refereed)
    Abstract [en]

    Support in labour has an impact on the childbirth experience as well as on childbirth outcomes. Both social and professional support is needed. The aim of this study was to explore professional support offered by midwives during labour in relation to the supportive needs of the childbearing woman and her partner. The study used a qualitative, inductive design using triangulation, with observation followed by interviews. Seven midwives were observed when caring for seven women/couples in labour. After the observations, individual interviews with midwives, women, and their partners were conducted. Data were analysed using hermeneutical text interpretation. The results are presented with three themes. (1) Support as a professional task seems unclear and less well defined than medical controls. (2) Midwives and parents express somewhat different supportive ideas about how to create a sense of security. (3) Partner and midwife interact in support of the childbearing woman. The main interpretation shows that midwives' supportive role during labour could be understood as them mainly adopting the "with institution" ideology in contrast to the "with woman" ideology. This may increase the risk of childbearing women and their partners perceiving lack of support during labour. There is a need to increase efficiency by providing support for professionals to adopt the "with woman" ideology.

  • 43.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Life Sciences. School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Langius-Eklöf, Ann
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden / Department of Neurology, Care Sciences and Society, Division of Nursing, Karolinska institutet, Stockholm, Sweden.
    Evaluation of the Mother-to-Infant relation and feeling scale: Interviews with first-time mothers' for feelings and relation to their baby three days after birth2012In: International Journal of Nursing and Midwifery, ISSN 2141-2456, Vol. 4, no 1, p. 8-15Article in journal (Refereed)
    Abstract [en]

    Mothers’ perception of their relationship with their baby might affect sensitive parenting. This study aimed to explore first time mothers’ feelings for and their relation to the baby associated with how they responded to the "mother to infant relation and feelings (MIRF) scale" as a step in the validation process of the scale. Interviews with ten first-time mothers, three days after birth, were performed, using open questions followed by questions directly from the MIRF scale items. An inductive and deductive approach inspired by the "Think aloud" method guided the study. Results describe main category; New mothers bewilderment and anticipation which contained four categories; Natural and great but mixed, Maternal instinct and kinship, Ability and expectations and Not yet for real. When mothers responded to MIRF scale items they describe talking to their baby which they did not in their open answers. Answering the MIRF scale helped mothers in differentiating between their own mixed feelings of becoming mothers and their relation to and feelings for the baby. The MIRF scale appears valid in reflecting important aspects of mothers’ feelings for and relation to their baby. The MIRF scale could be used in research and when evaluating care routines as well as in dialogue with new mothers to support mother-to-infant interactions.

  • 44.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Nilsson, Maria
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Olsson, Linda
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Hertfelt Wahn, Elisabeth
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Ekström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education.
    Women's Experiences of Midwifery Support during Pregnancy A step in the Validation of the Scale: "The Mother Perceived Support from Professionals"2015In: Journal of Nursing & Care, ISSN 2167-1168, Vol. 4, no 2, article id 1000241Article in journal (Refereed)
    Abstract [en]

    Background: Pregnancy can be physically and emotionally stressful for the parents, which means they need adequate professional support. Easy-to-use, validated scales are important in order to develop professional support in Antenatal care as well as in research.

    The aim: Our aim was to illuminate pregnant women’s experience of professional support at the Antenatal care, in relation to the Mother-Perceived-Professionals-Support (MoPPS) scale.

    Method: A qualitative study design using the method “Think aloud” with both inductive and deductive approaches, was used. Five first-time mothers were interviewed with open questions followed by questions related to the MoPPS scale items. Data was analyzed using inductive and deductive qualitative content analyses.

    Results: The inductive analysis resulted in one theme: “Professional support from midwives made women created a feeling of security and unique or rejected and lonely during pregnancy” and three categories: “Continuity and competence”, “Perceiving trust or not” and “Parental groups or individual visits”. The deductive analysis described the mothers’ understanding of each item. However, coherence between the inductive and deductive analyses varied and the MoPPS-scale needs development.

    Conclusion: The result shows that women's experience of professional support affects their sense of feeling safe or lonely during pregnancy. Important for midwives were to meet the women’s unique individual needs. The MoPPS scale was considered to be relevant and easy to understand, but it needs development to include questions about continuity, parental groups and the perception of midwives’ competence, which all were important for the women during their pregnancies.

    Clinical implications: To offer adequate professional support for women during pregnancy, midwives need to meet the women’s unique individual needs with both medical and supportive knowledge.

  • 45.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    University of Skövde, School of Life Sciences.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    An exploration and description of student midwives' experiences in offering continuous labour support to women/couples2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 4, p. 451-459Article in journal (Refereed)
    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.

  • 46.
    Thorstensson, Stina
    et al.
    University of Skövde, School of Life Sciences.
    Nissen, Eva
    Department of Women’s and Children’s Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
    Ekström, Anette
    University of Skövde, School of Life Sciences.
    Professional Support in Pregnancy Influence Maternal Relation to and Feelings for the Baby after Cesarean Birth: An Intervention Study2012In: Journal of Nursing and Care, ISSN 2167-1168, Vol. 1, no 4, p. 112-Article in journal (Refereed)
    Abstract [en]

    Background: Cesarean birth may negatively affect mother-infant interactions, while professional support may positively affect these interactions. The aim of this study was to evaluate the effects of a process-oriented training program for antenatal midwives and postnatal nurses on first time mothers’ perceptions of professional support and on their relation to and feelings for their baby after a cesarean or a normal birth. Methods: An intervention through process-oriented training for health professionals regarding professional support in childbearing was conducted between 1999 and 2003. Ten municipalities were paired and within each pair, randomly assigned to intervention (five) or control (five) municipality. Mothers having caesarean (n=94) or normal birth (n=301) were included. Mothers received routine care (Control Group=CG) or care from health professionals having received training (Intervention Group=IG). The mothers answered questionnaires three days, three and nine months after birth. Factor analysis identified three factors: “Taking in baby,” “Confidence in relation to baby,” and “Feelings for baby.” Results: Mothers in the IG with cesarean birth reported more positive for the “Taking in baby” factor (p=0.002) three days after birth, more positive for the “Confidence in relation to baby” factor (p=0.004) and for the “Feelings for baby” factor (p=0.004) nine months after birth compared to Mothers in the CG. Mothers in the IG reported stronger professional support from health professionals compared to CG. Conclusion: Our result suggests that improved professional support during pregnancy may buffer negative effects of caesarean birth for first-time mothers in relation to and feelings for the baby.

  • 47.
    Uvnäs-Moberg, Kerstin
    et al.
    University of Agriculture (SLU), Uppsala, Sweden.
    Ekström-Bergström, Anette
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Health Sciences, University West, Trollhättan, Sweden.
    Berg, Marie
    Institute of Health and Care Sciences, University of Gothenburg, Sweden / Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Buckley, Sarah
    School of Public Health, University of Queensland, Brisbane, Australia.
    Pajalic, Zada
    Faculty of Health Sciences, Oslo and Akershus University, College of Applied Sciences, Oslo, Norway.
    Hadjigeorgiou, Eleni
    Faculty of Health Sciences, Cyprus, University of Technology, Limassol, Cyprus.
    Kotłowska, Alicja
    Faculty of Health Sciences with Subfaculty of Nursing, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Gdańsk, Poland.
    Lengler, Luise
    Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany.
    Kielbratowska, Bogumila
    Faculty of Medical Sciences, Medical University of Gdańsk, Gdańsk, Poland.
    Leon-Larios, Fatima
    Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
    Magistretti, Claudia Meier
    Department of Social Work Center for Health Promotion and Social Participation, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland.
    Downe, Soo
    Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, Preston, United Kingdom.
    Lindström, Bengt
    Norwegian University of Science and Technology, Trondheim, Norway.
    Dencker, Anna
    Institute of Health and Care Sciences, University of Gothenburg, Sweden / Centre for Person-Centred Care, University of Gothenburg, Sweden.
    Maternal plasma levels of oxytocin during physiological childbirth: A systematic review with implications for uterine contractions and central actions of oxytocin2019In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, no 1, article id 285Article, review/survey (Refereed)
    Abstract [en]

    Background: Oxytocin is a key hormone in childbirth, and synthetic oxytocin is widely administered to induce or speed labour. Due to lack of synthetized knowledge, we conducted a systematic review of maternal plasma levels of oxytocin during physiological childbirth, and in response to infusions of synthetic oxytocin, if reported in the included studies. Methods: An a priori protocol was designed and a systematic search was conducted in PubMed, CINAHL, and PsycINFO in October 2015. Search hits were screened on title and abstract after duplicates were removed (n = 4039), 69 articles were examined in full-text and 20 papers met inclusion criteria. As the articles differed in design and methodology used for analysis of oxytocin levels, a narrative synthesis was created and the material was categorised according to effects. Results: Basal levels of oxytocin increased 3-4-fold during pregnancy. Pulses of oxytocin occurred with increasing frequency, duration, and amplitude, from late pregnancy through labour, reaching a maximum of 3 pulses/10 min towards the end of labour. There was a maximal 3- to 4-fold rise in oxytocin at birth. Oxytocin pulses also occurred in the third stage of labour associated with placental expulsion. Oxytocin peaks during labour did not correlate in time with individual uterine contractions, suggesting additional mechanisms in the control of contractions. Oxytocin levels were also raised in the cerebrospinal fluid during labour, indicating that oxytocin is released into the brain, as well as into the circulation. Oxytocin released into the brain induces beneficial adaptive effects during birth and postpartum. Oxytocin levels following infusion of synthetic oxytocin up to 10 mU/min were similar to oxytocin levels in physiological labour. Oxytocin levels doubled in response to doubling of the rate of infusion of synthetic oxytocin. Conclusions: Plasma oxytocin levels increase gradually during pregnancy, and during the first and second stages of labour, with increasing size and frequency of pulses of oxytocin. A large pulse of oxytocin occurs with birth. Oxytocin in the circulation stimulates uterine contractions and oxytocin released within the brain influences maternal physiology and behaviour during birth. Oxytocin given as an infusion does not cross into the mother's brain because of the blood brain barrier and does not influence brain function in the same way as oxytocin during normal labour does. 

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