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  • 1.
    Akselsson, A
    et al.
    Karolinska Institutet / Sophiahemmet University.
    Lindgren, H
    Karolinska Institutet.
    Georgsson, Susanne
    The Swedish Red Cross University College. Karolinska Institutet.
    Pettersson, K
    Karolinska Institutet.
    Steineck, G
    Karolinska Institutet.
    Skokic, V
    University of Gothenburg.
    Rådestad, I
    Sophiahemmet University.
    Mindfetalness to increase women's awareness of fetal movements and pregnancy outcomes: a cluster-randomised controlled trial including 39 865 women2020In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, no 7, p. 829-837Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine whether a method for raising women's awareness of fetal movements, Mindfetalness, can affect pregnancy outcomes.

    DESIGN: Cluster-randomised controlled trial.

    SETTING: Sixty-seven maternity clinics in Stockholm, Sweden.

    POPULATION: Women with singleton pregnancy with birth from 32 weeks' gestation.

    METHODS: Women registered at a clinic randomised to Mindfetalness were assigned to receive a leaflet about Mindfetalness (n = 19 639) in comparison with routine care (n = 20 226). Data were collected from a population-based register.

    MAIN OUTCOME MEASURES: Apgar score <7 at 5 minutes after birth, visit to healthcare due to decrease in fetal movements. Other outcomes: Apgar score <4 at 5 minutes after birth, small-for-gestational-age and mode of delivery.

    RESULTS: No difference (1.1 versus 1.1%, relative risk [RR] 1.0; 95% CI 0.8-1.2) was found between the Mindfetalness group and the Routine care group for a 5-minute Apgar score <7. Women in the Mindfetalness group contacted healthcare more often due to decreased fetal movements (6.6 versus 3.8%, RR 1.72; 95% CI 1.57-1.87). Mindfetalness was associated with a reduction of babies born small-for-gestational-age (RR 0.95, 95% CI 0.90-1.00), babies born after gestational week 41+6 (RR 0.91, 95% CI 0.83-0.98) and caesarean sections (19.0 versus 20.0%, RR 0.95; 95% CI 0.91-0.99).

    CONCLUSIONS: Mindfetalness did not reduce the number of babies born with an Apgar score <7. However, Mindfetalness was associated with the health benefits of decreased incidence of caesarean section and fewer children born small-for-gestational-age.

    TWEETABLE ABSTRACT: Introducing Mindfetalness in maternity care decreased caesarean sections but had no effect on the occurrence of Apgar scores <7.

  • 2.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Lindgren, Helena
    Karolinska Institutet.
    Pettersson, Karin
    Karolinska Institutet.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Women's attitudes, experiences and compliance concerning the use of Mindfetalness- a method for systematic observation of fetal movements in late pregnancy2017In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 17, no 1, article id 359Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness.

    METHODS: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.

    RESULTS: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.

    CONCLUSION: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome.

  • 3.
    Akselsson, Anna
    et al.
    Sophiahemmet University / Karolinska Institutet.
    Lindgren, Helena
    Karolinska Institutet.
    Georgsson, Susanne
    The Swedish Red Cross University College. Karolinska Institutet.
    Pettersson, Karin
    Karolinska Institutet.
    Rådestad, Ingela
    Sophiahemmet University.
    Increased labor induction and women presenting with decreased or altered fetal movements - a population-based survey.2019In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 5, article id e0216216Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Women's awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction.

    MATERIAL AND METHODS: A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week's gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks' gestation in 2014 in Stockholm comprises the reference group.

    RESULTS: Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3-1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4-1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more.

    CONCLUSIONS: We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation.

  • 4.
    Akselsson, Anna
    et al.
    Sophiahemmet University.
    Lindgren, Helena
    Karolinska Institutet.
    Georgsson, Susanne
    The Swedish Red Cross University College. Karolinska Institutet.
    Pettersson, Karin
    Karolinska Institutet.
    Skokic, Viktor
    Sahlgrenska, Göteborgs universitet.
    Rådestad, Ingela
    Sophiahemmet University.
    Pregnancy outcomes among women born in Somalia and Sweden giving birth in the Stockholm area–a population-based study2020In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 13, no 1, article id 1794107Article in journal (Refereed)
    Abstract [en]

    Background: Studies report that women born in some African countries, after migrating to the Nordic countries, have worse pregnancy outcomes than women born in the receiving countries. With the aim of identifying unmet needs among Somali-born women, we here study this subgroup.

    Objective: We compared pregnancy outcomes among women born in Somalia to women born in Sweden. Further, we investigated whether the proactive maternal observation of fetal movements has effects on birth outcomes among women born in Somalia.

    Methods: In Stockholm, half of the maternity clinics were randomized to intervention, in which midwives were instructed to be proactive towards women by promoting daily self-monitoring of fetal movements. Data for 623 women born in Somalia and 26 485 born in Sweden were collected from a population-based register.

    Results: An Apgar score below 7 (with stillbirth counting as 0) at 5 minutes was more frequent in babies of women born in Somalia as compared to babies of women born in Sweden (RR 2.17, 95% CI 1.25–3.77). Babies born small for gestational age were more common among women born in Somalia (RR 2.22, CI 1.88–2.61), as were babies born after 41 + 6 gestational weeks (RR 1.65, CI 1.29–2.12). Somali-born women less often contacted obstetric care for decreased fetal movements than did Swedish-born women (RR 0.19, CI 0.08–0.36). The differences between women born in Somalia and women born in Sweden were somewhat lower (not statistically significant) among women allocated to proactivity as compared to the Routine-care group.

    Conclusions: A higher risk of a negative outcome for mother and baby is seen among women born in Somalia compared to women born in Sweden. We suggest it may be worthwhile to investigate whether a Somali-adapted intervention with proactivity concerning self-monitoring of fetal movements may improve pregnancy outcomes in this migrant population.

  • 5.
    Akselsson, Anna
    et al.
    Sophiahemmet Högskola.
    Lindgren, Helena
    Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Warland, Jane
    University of South Australia, Adelaide, Australia.
    Pettersson, Karin
    Karolinska Institutet.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Daily structured approach to awareness of fetal movements and pregnancy outcome - a prospective study2019In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 20, p. 32-37Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We investigated how women, seeking care due to decreased movements, had paid attention to fetal movements and if the method of monitoring was associated with pregnancy outcome.

    METHODS: A questionnaire was distributed to women from gestational week 28, who had sought care due to decreased fetal movements in Stockholm between January 1st and December 31st, 2014. Women were included in the study if the examination did not reveal any signs of a compromised fetus requiring immediate intervention. Birth outcome and sociodemographic data were collected from the obstetric record register.

    RESULTS: There were 29166 births in Stockholm in 2014, we have information from 2683 women who sought care for decreased fetal movements. The majority (96.6%) of the women stated that they paid attention to fetal movements. Some women observed fetal movements weekly (17.2%) and 69.5% concentrated on fetal movements daily (non-structured group). One in ten (9.9%) used counting methods daily for observing fetal movements (structured group). Women in the structured group more often had caesarean section before onset of labor (RR 1.6, 95% CI 1.2-2.2) and a lower risk of their baby being transferred to neonatal nursery (RR 0.25, 95% CI 0.03-0.94) compared to women in the non-structured group.

    CONCLUSIONS: Women, who had a daily and structured approach to awareness of fetal movements, were more likely to have a caesarean section but their babies were less likely to be transferred to a neonatal nursery as compared with women who used a non-structured method daily.

  • 6.
    Asplin, Nina
    et al.
    Karolinska Institutet / Ultragyn i Sverige AB.
    Wessel, Hans
    Karolinska Institutet / Ultragyn i Sverige AB.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 191-195Article in journal (Refereed)
  • 7.
    Asplin, Nina
    et al.
    Karolinska Institutet / Karolinska University Hospital / Sophiahemmet Högskola.
    Wessel, Hans
    Karolinska Institutet / Ultragyn i Sverige AB.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care2014In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, no 6, p. 620-627Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being.

    METHOD:

    an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps.

    SETTING:

    four fetal care referral centres in Stockholm, Sweden.

    PARTICIPANTS:

    11 women opting for pregnancy termination due to fetal malformation.

    FINDINGS:

    in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care.

    CONCLUSION AND IMPLICATIONS FOR PRACTICE:

    The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.

  • 8.
    Asplin, Nina
    et al.
    Karolinska Institutet / Karolinska University Hospital / Sophiahemmet Högskola.
    Wessel, Hans
    Karolinska Institutet / Wessel MediConsult AB / Ultragyn.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan2012In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 3, no 2, p. 73-78Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound.

    METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis.

    RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety.

    CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.

  • 9.
    Asplin, Nina
    et al.
    Sophiahemmet Högskola / Karolinska Institutet / Karolinska University Hospital.
    Wessel, Hans
    Karolinska Institutet / Wessel MediConsult AB, Ultragyn i Sverige AB.
    Marions, Lena
    Karolinska Institutet / Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination2013In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 4, no 2, p. 79-84Article in journal (Refereed)
    Abstract [en]

    Objectives

    The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made.

    Design

    Descriptive study.

    Setting

    Four fetal care referral centres in Stockholm, Sweden.

    Population

    Pregnant women with a detected fetal malformation.

    Methods

    Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed.

    Results

    Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p⩽ 0.004) of previous abortions than those in the continuing group (23.2%).

    Conclusion

    The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

  • 10.
    Björklund, Ulla
    et al.
    Södersjukhuset.
    Marsk, Anna
    UltraGyn, Stockholm.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Does an information film about prenatal testing in early pregnancy affect women's anxiety and worries?2013In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 1, p. 9-14Article in journal (Refereed)
    Abstract [en]

    Objective: To explore if an information film about prenatal examinations affects pregnant women's worry and anxiety.

    Methods: Randomized controlled study. The intervention was an information film about prenatal examinations. Data was collected in gestational week 26 by a questionnaire including the STAI (State-Trait Anxiety Inventory) instrument and further questions about worry. A total of 184 women in the intervention group and 206 in the control group filled in the questionnaire.

    Results: There were no statistically significant differences between the groups neither in state nor trait anxiety. Regarding worry about the possibility of something being wrong with the baby and worry about giving birth, there were no statistically significant differences between the groups. The women stated that to see the film increased their worry rather than decreased it.

    Conclusion: An informational film as additional information to complement written and verbal information about prenatal testing does not appear to increase women's anxiety and worries. However, the informational film may cause worry at the time of viewing which should be taken into consideration.

  • 11.
    Björklund, Ulla
    et al.
    Södersjukhuset.
    Marsk, Anna
    Läkarhuset Odenplan.
    Levin, Charlotta
    Södersjukhuset.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Audiovisual information affects informed choice and experience of information in antenatal Down syndrome screening: a randomized controlled trial2012In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 86, no 3, p. 390-395Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the effects of an information film on making an informed choice regarding Down syndrome screening, and women's knowledge and experiences of information. METHODS: Randomized controlled trial including 184 women in the intervention group and 206 controls recruited from maternity units in Stockholm, Sweden. The intervention was an information film presented as a complement to written and verbal information. Data were collected via a questionnaire in gestational week 27. Three different measures were combined to measure informed choice: attitudes towards Down syndrome screening, knowledge about Down syndrome and Down syndrome screening, and uptake of CUB (combined ultrasound and biochemical screening). RESULTS: In the intervention group 71.5% made an informed choice versus 62.4% in the control group. Women in the intervention group had significantly increased knowledge, and to a greater extent than the control group, experienced the information as being sufficient, comprehensible, and correct. CONCLUSIONS: An information film tended to increase the number of women who made an informed choice about Down syndrome screening. Participants were more satisfied with the information received. PRACTICE IMPLICATIONS: Access to correct, nondirective, and sufficient information is essential when making a choice about prenatal diagnostics. It is essential with equivalent information to all women.

  • 12.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Information och psykologiska aspekter kring fosterdiagnostik2016In: Reproduktiv hälsa: barnmorskans kompetensområde / [ed] Helena Lindgren, Kyllike Christensson & Anna-Karin Dykes, Lund: Studentlitteratur AB, 2016, 1, p. 289-298Chapter in book (Other academic)
  • 13.
    Georgsson, Susanne
    et al.
    The Swedish Red Cross University College. Karolinska Institutet.
    Carlsson, Tommy
    The Swedish Red Cross University College, Department of Health Sciences. Uppsala Universitet.
    Quality of consumer-oriented websites containing information about the second trimester ultrasound examination during pregnancy2020In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 20, no 1, article id 235Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Providing information about prenatal tests is a clinical challenge and the public frequently accesses the Web to read pregnancy-related information. The overarching aim of this study was to investigate the quality of consumer-oriented websites addressing obstetric ultrasound examination in the second trimester of pregnancy.

    METHODS: Swedish websites were identified with Google, using 20 search strings and screening 400 hits (n = 71 included websites). Reliability and information about the examination were assessed with the DISCERN instrument, completeness was assessed according to national guidelines, and readability analyzed with the Readability Index. Popularity was determined with the ALEXA tool and search rank was determined according to Google hit lists.

    RESULTS: The mean total DISCERN score was 29.7/80 (SD 11.4), with > 50% having low quality for 15 of the 16 questions. The mean completeness score was 6.8/24 (SD 4.5). The Readability Index ranged between 22 and 63, with a mean of 42.7 (SD 6.8), indicating difficult readability. Weak and non-significant correlations were observed between ALEXA/search rank and the investigated quality variables, except for search rank and reliability.

    CONCLUSIONS: The quality of consumer-oriented websites addressing the second trimester ultrasound examination is low. Health professionals need to discuss this with expectant parents considering undergoing the examination. There is a need for efforts that aim to improve the poor quality of online sources in the field of prenatal examinations.

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  • 14.
    Georgsson, Susanne
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Sahlin, Ellika
    Karolinska Institutet.
    Iwarsson, Moa
    Karolinska Intitutet.
    Nordenskjöld, Magnus
    Karolinska Institutet.
    Gustavsson, Peter
    Karolinska Institutet.
    Iwarsson, Erik
    Karolinska Institutet.
    Knowledge and attitudes regarding non-invasive prenatal testing (NIPT) and preferences for risk information among high school students in Sweden2017In: Journal of Genetic Counseling, ISSN 1059-7700, E-ISSN 1573-3599, Vol. 26, no 3, p. 447-454Article in journal (Refereed)
    Abstract [en]

    Non-invasive prenatal testing (NIPT) was recently introduced for prenatal testing of genetic disorders. Cell-free fetal DNA is present in maternal blood during pregnancy and enables detection of fetal chromosome aberrations in a maternal blood sample. The public perspective to this new, simple method has not been illuminated. The views of young people (i.e. future parents) are important to develop suitable counseling strategies regarding prenatal testing. The aim was to explore Swedish high school students' attitudes, knowledge and preferences regarding NIPT. A questionnaire was completed by 305 students recruited from one high school in Stockholm, November and December 2014. Most students (80 %) considered prenatal testing as good. The majority (65 %) was positive or very positive towards NIPT and 62 % stated that they potentially would like to undergo the test if they or their partner was pregnant. The vast majority (94 %) requested further information about NIPT. Most students (61 %) preferred verbal information, whereas 20 % preferred information via the Internet. The majority of the high school students was positive towards prenatal testing and most was positive towards NIPT. Further, information was requested by the vast majority before making a decision about NIPT. Most of the students preferred verbal information and to a lesser extent information via the Internet. The attitudes, knowledge and preferences for risk information concerning NIPT in young adults are important, in order to increase knowledge on how to educate and inform future parents.

  • 15.
    Georgsson, Susanne
    et al.
    Sophiahemmet Högskola.
    Stenström Bohlin, Katja
    Den gravida patienten2016In: Omvårdnad & kirurgi / [ed] Christine Kumlien & Jenny Rystedt, Lund: Studentlitteratur AB, 2016, 1, p. 507-520Chapter in book (Other academic)
  • 16.
    Georgsson, Susanne
    et al.
    Sophiahemmet Högskola.
    Stenström Bohlin, Katja
    Gynekologi2016In: Omvårdnad & kirurgi / [ed] Christine Kumlien & Jenny Rystedt, Lund: Studentlitteratur AB, 2016, 1, p. 477-491Chapter in book (Other academic)
  • 17.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Fosterdiagnostik2009 (ed. 1)Book (Other academic)
  • 18.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Övriga fosterdiagnostiska undersökningar samt psykologiska aspekter2009In: Lärobok för barnmorskor / [ed] Annette Kaplan; Beatrice Hogg; Ingegerd Hildingsson & Ingela Lundgren, Lund: Studentlitteratur AB, 2009, 3, p. 214-215Chapter in book (Other academic)
  • 19.
    Georgsson Öhman, Susanne
    et al.
    The Swedish Red Cross University College. Sophiahemmet Högskola / Karolinska Institutet.
    Björklund, Ulla
    Södersjukhuset.
    Marsk, Anna
    Läkarhuset Odenplan.
    Does an informational film increase women's possibility to make an informed choice about second trimester ultrasound?2012In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 32, no 9, p. 833-839Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate effects of an informational film on making an informed choice regarding second trimester ultrasound.

    METHOD: Randomized controlled study. The intervention was an informational film about prenatal examinations. Data were collected at gestational week 26.

    RESULTS: A total of 184 women in the intervention group and 206 women in the control group participated in the study. Of those in the intervention group, 81.3% made an informed choice regarding second trimester ultrasound examination compared with 76.1% in the control group (p = 0.21). Women making an informed choice scored higher in knowledge about the examination (p < 0.001), had higher degree of education (p < 0.001), and spoke more frequently Swedish as mother tongue (89.5% vs 74.7%, p = 0.01).

    CONCLUSIONS: An informational film does not increase women's knowledge or the number of women making an informed choice about the second trimester ultrasound. Women who did not make an informed choice about the second trimester ultrasound had a lower level of education and less knowledge about second trimester ultrasound screening.

  • 20.
    Georgsson Öhman, Susanne
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Grunewald, Charlotta
    Stockholm Söder Hospital.
    Waldenström, Ulla
    Karolinska Institutet.
    Perception of risk in relation to ultrasound screening for Down's syndrome during pregnancy2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 3, p. 264-276Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore how information about being at risk of carrying a fetus with Down's syndrome was understood, and whether the actual risk and the woman's perception of risk was associated with worry or depressive symptoms during and after pregnancy. DESIGN AND SETTING: observational study. The sample was drawn from the intervention group of a Swedish randomised controlled trial of ultrasound screening for Down's syndrome by nuchal translucency measurement. MEASUREMENTS: data were collected by three questionnaires. Questions were asked about recall of the risk score and perception of risk. The Cambridge Worry Scale and the Edinburgh Postnatal Depression Scale measured worry and depressive symptoms, respectively, on all three occasions. FINDINGS: of the 796 women who provided data for this study, one in five was unaware that the risk score was noted in her case record. In total, 620 women stated that they had received a risk score, but only 64% of them recalled the figure exactly or approximately. The actual risk was associated with the perceived risk, but of the 31 women who perceived the risk to be high, only 14 were actually at high risk. A high-risk score was not associated with worry or depressive symptoms in mid-pregnancy, in contrast to a woman's own perception of being at high risk. Two months postpartum, no associations were found between maternal emotional well-being and actual or perceived risk. CONCLUSIONS: information about fetal risk is complicated and women's perception of risk does not always reflect the actual risk, at least not when presented as a numerical risk score. The possibility that the information may cause unnecessary emotional problems cannot be excluded. IMPLICATIONS FOR PRACTICE: caregivers should ascertain that information about fetal risk is interpreted correctly by pregnant women.

  • 21.
    Georgsson Öhman, Susanne
    et al.
    Karolinska Institutet.
    Grunewald, Charlotta
    Södersjukhuset.
    Waldenström, Ulla
    Karolinska Institutet.
    Women's worries during pregnancy: testing the Cambridge Worry Scale on 200 Swedish women2003In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 2, p. 148-152Article in journal (Refereed)
    Abstract [en]

    The Cambridge Worry Scale (CWS) is an instrument including 16 items measuring women's major worries during pregnancy. The aim of the study was to test the scale, translated into Swedish, on pregnant women in Stockholm. We also wanted to explore whether these women were worried about any item not included in the scale. An additional aim was to study possible variation in women's worries related to gestational week. Two hundred women were recruited. The average age was 31 years and 56% were primiparas. Gestational age ranged from 8 to 42 weeks, with a median of 28 weeks. The reliability of the scale was satisfactory (Cronbach's alpha coefficient 0.81). The major worries were about the baby's health, giving birth and miscarriage. These items, all related to pregnancy outcomes, were followed by worries about financial matters. An additional concern not included in the scale was about the maternity services in Stockholm, i.e. that the hospital would be overbooked, the staff being too busy or the medical safety not being guaranteed. Few women worried about their relationship with their partner or if he would be present at birth. Some of the items showed a pattern with a period of less worry in midpregnancy.

  • 22.
    Georgsson Öhman, Susanne
    et al.
    Karolinska Institutet.
    Saltvedt, Sissel
    South General Hospital, Stockholm.
    Grunewald, Charlotta
    South General Hospital, Stockholm.
    Waldenström, Ulla
    Karolinska Institutet.
    Does fetal screening affect women's worries about the health of their baby?: a randomized controlled trial of ultrasound screening for Down's syndrome versus routine ultrasound screening2004In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 83, no 7, p. 634-640Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Screening for fetal abnormality may increase women's anxiety as attention is directed at the possibility of something being wrong with the baby. The aim of this study was to evaluate the effect of ultrasound screening for Down's syndrome on women's anxiety in mid-pregnancy and 2 months after delivery. METHOD: Two thousand and twenty-six women were randomly allocated to an ultrasound examination at 12-14 gestational weeks (gws) including risk assessment for Down's syndrome or to a routine scan at 15-20 gws. Questionnaires including the State-Trait Anxiety Inventory (STAI), the Cambridge Worry Scale (CWS), and the Edinburgh Postnatal Depression Scale (EPDS) were filled in at baseline in early pregnancy, at 24 gws and 2 months after delivery. RESULTS: No statistically significant differences were found between the trial groups regarding women's worries about the health of the baby, general anxiety and depressive symptoms during pregnancy or 2 months after delivery. Women's worries about something being wrong with the baby in the early ultrasound group and routine group, respectively, decreased from baseline (39.1% versus 36.0%) to mid-pregnancy (29.2% versus 27.8%), and finally to 2 months after delivery (5.2% versus 6.6%). CONCLUSION: Fetal screening for Down's syndrome by an early ultrasound scan did not cause more anxiety or concerns about the health of the baby in mid-pregnancy or 2 months after birth than in women who had a routine scan.

  • 23.
    Georgsson Öhman, Susanne
    et al.
    Karolinska Institutet.
    Saltvedt, Sissel
    South General Hospital, Stockholm.
    Waldenström, Ulla
    Karolinska Institutet.
    Grunewald, Charlotta
    South General Hospital, Stockholm.
    Olin-Lauritzen, Sonja
    Stockholm University.
    Pregnant women's responses to information about an increased risk of carrying a baby with Down syndrome2006In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 33, no 1, p. 64-73Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fetal screening for Down syndrome by an ultrasound examination, including measurement of fetal nuchal translucency, at 12 to14 weeks' gestation is presently being evaluated in a Swedish randomized controlled trial. Women at high risk were offered an amniocentesis to obtain a definite diagnosis. The aim of this study was to explore women's reactions and responses to information about being at high risk after the scan, with a special focus on reactions to a false positive test. METHOD: Interviews were conducted with 24 women within 1 week after the scan, in midpregnancy, and 2 months after the birth. The interviews were analyzed qualitatively. Down syndrome was confirmed in 4 women, who chose to terminate the pregnancy. The remaining 20 women had a false positive test. RESULTS: For the majority, the risk information caused strong reactions of anxiety and worries about the future. A typical way for women to cope was to "withhold" the pregnancy, to take a "timeout," and try to live as if they were not pregnant any longer. Some weeks later, when the women received normal results from the chromosome analysis, they resumed being pregnant. Six women ages more than 35 years who had a risk score lower than their age-related risk did not express similarly strong reactions. Two months after the birth of a healthy baby, most stated they would undergo the same procedure in a subsequent pregnancy. One woman still suffered from the experience when interviewed at 2 months after the birth, and another said she regretted participating in the fetal screening program. CONCLUSIONS: A false positive test of fetal screening for Down syndrome by ultrasound examination may cause strong reactions of anxiety and even rejection of the pregnancy. The prevalence of such reactions and possible long-term effects need further investigation.

  • 24.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Waldenström, Ulla
    Karolinska Institutet.
    Effect of first-trimester ultrasound screening for Down syndrome on maternal-fetal attachment: a randomized controlled trial2010In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 1, no 3, p. 85-90Article in journal (Refereed)
    Abstract [en]

    Objective: The objective was to investigate how ultrasound screening for Down syndrome (DS) in the first trimester, compared with a routine ultrasound examination in the second trimester, affected Maternal–Fetal Attachment (MFA) in mid-pregnancy. Method: This study of 2026 pregnant women was a sub-study of a larger RCT aiming at evaluating the effect of fetal screening for Down syndrome (DS) by means of an ultrasound scan, including measuring fetal nuchal translucency in gestational weeks 12–14. Women were randomly allocated either to the intervention or to a control group where routine care with an ultrasound scan in gestational week 17–20 was offered. Data were collected by questionnaires before randomization and in gestational week 24. MFA was measured by a modified version of the Cranley Maternal–Fetal Attachment Scale (CMFAS). Results: The mean score of MFA was 3.50 in the intervention group and 3.44 in the control group (p = 0.04). The mean scores on all subscales were slightly higher in the intervention group, but only statistically significant regarding “Differentiation of self from fetus” (p = 0.01). Conclusion: Ultrasound screening for DS in the first trimester may have a modest positive effect on MFA in mid-pregnancy, compared with a ultrasound scan in the second trimester.

  • 25.
    Georgsson Öhman, Susanne
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Waldenström, Ulla
    Karolinska Institutet.
    Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample2008In: Ultrasound in Obstetrics and Gynecology, ISSN 0960-7692, E-ISSN 1469-0705, Vol. 32, no 1, p. 15-22Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focused specifically on reasons for women not having a positive experience. METHOD: Of 4600 eligible Swedish-speaking women, 3061 were recruited to the study in early pregnancy, during three 1-week periods spread evenly over 1 year (1999-2000), and these women completed a questionnaire at a mean of 16 weeks' gestation. A follow-up questionnaire at 2 months after delivery was completed by 2730 women. The representativeness of the sample was assessed by comparison with the total Swedish birth cohort of 1999. RESULTS: The most prominent expectation about the up-coming scan was confirmation that the baby was well, followed by confirmation that the pregnancy was real. Detailed information, such as date of delivery and sex of the baby, was mentioned less often, and very few wrote about the examination as an exciting and joyful experience. After the birth, a large majority was satisfied with information about why (88%) and how (87%) the examination was performed, but only 58% said they had received sufficient information about possible risks. 94% had a positive experience of the scan, and those who had not had more ambivalent feelings about their pregnancy. Women with negative feelings about the scan were more often single and of non-Swedish background, and emotional problems were more common in this group. CONCLUSION: Women's expectations of the routine second-trimester scan differ from those of caregivers, focusing on general reassurance rather than specific information. Level of satisfaction with the scan was high, but information given about risks could be improved. Women with ambivalent or negative feelings about pregnancy may have difficulties enjoying the examination.

  • 26.
    Gottvall, Maria
    et al.
    Swedish Red Cross University, Department of Health Sciences. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Fagerkvist, Kristina
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
    Lampic, Claudia
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Umeå University, Umeå, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Wettergren, Lena
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Including a discussion forum in a web-based intervention on fertility and sexuality following cancer - Usage and content2022In: Internet interventions, ISSN 2214-7829, Vol. 29, article id 100559Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of the study was to investigate how young adult survivors of childhood cancer used an online discussion forum as part of a web-based psycho-educational intervention. Specifically, we aimed to characterize users of the discussion forum, investigate how they used the discussion forum (type of usage) and content of the posted messages.

    Methods: This study is a part of a randomized controlled trial, Fex-Can Childhood RCT. Participants with self-reported sexual dysfunction or fertility-related distress were drawn from a population-based national cohort. Sociodemographic and clinical characteristics of the intervention group (n = 322) and data on usage of the discussion forum were analysed with descriptive statistics and compared between subgroups. Messages posted in the online discussion forum were analysed with qualitative thematic analysis.

    Results: Approximately half (48 %) of participants in the intervention group accessed the discussion forum and most of them (76 %) without writing own posts. Users of the discussion forum did not statistically differ in sociodemographic or clinical characteristics from the rest of the intervention group. The 97 written posts, written by 38 individuals, were mainly descriptions of own experiences and thoughts and concerned three themes: A changed body, Concerns around family building and Longing for support. Peer-support and interaction between participants were seen in some forum threads and the 'like'-function was frequently used, demonstrating engagement and activity. Participants expressed that they felt affinity with and appreciated sharing own experiences and to recognize themselves in others' stories.

    Conclusions: A discussion forum as part of a web-based intervention appears to be a valuable component by giving participants an opportunity to share intimate experiences and concerns related to surviving cancer.

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  • 27.
    Ingvoldstad, Charlotta
    et al.
    Uppsala University.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Lindgren, Peter
    Uppsala Univeristy / Karolinska Institutet.
    Implementation of combined ultrasound and biochemistry for risk evaluation of chromosomal abnormalities during the first trimester in Sweden2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 9, p. 868-73Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how the first trimester risk evaluation for Down syndrome is offered and performed.

    SETTING: Sweden.

    SAMPLE: All 52 known units working with obstetric ultrasound.

    METHODS: Study-specific questionnaire and descriptive statistical analyses.

    MAIN OUTCOME MEASURES: Routines for offering combined ultrasound and biochemistry (CUB), questions about information, questions about tests and analysis used for diagnosis.

    RESULTS: CUB was performed in 28 600 (26%) of the expected 110 000 pregnancies in Sweden during 2011. Of all pregnant women, 15% were living in a county not offering CUB (only invasive prenatal diagnosis); 44% regardless of age; 15% to women ≥33 years; 24% to women ≥35 years; and 2% to women ≥38 years old. Amniocentesis was the most common method offered when the risk was estimated as high. Of the 47 units that replied, 29 (61.7%) offered only amniocentesis. On the questions about information, 40 (95.2%) stated that they gave verbal information. In addition to verbal information, 17 (40.5%) gave written information. Forty-one of the units (71.9%) stated that the CUB is offered to non-Swedish-speaking women.

    CONCLUSION: Without consistent national guidelines, the prenatal diagnostic CUB method is offered in an inequitable manner to pregnant women in Sweden. More than half of all pregnant women live in a county where CUB is not offered or is only offered based on age. The results demonstrate the importance of national consistency before the introduction of new prenatal tests, to enhance equal care for all pregnant women.

  • 28.
    Kaplan-Sturk, Rebecka
    et al.
    Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm, Sweden.
    Åkerud, Helena
    Uppsala universitet, Obstetrik & gynekologi.
    Volgsten, Helena
    Uppsala universitet, Obstetrik & gynekologi.
    Hellström-Westas, Lena
    Uppsala universitet, Pediatrik.
    Wiberg-Itzel, Eva
    Department of Clinical Science and Education, Section of Obstetrics and Gynecology, Karolinska Institute, Soder Hospital, Stockholm, Sweden.
    Outcome of deliveries in healthy but obese women: obesity and delivery outcome2013In: BMC Research Notes, E-ISSN 1756-0500, Vol. 6, no 50Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Obesity among fertile women is a global problem. 25% of pregnant Swedish women are overweight at admission to the antenatal clinic and 12% of them are considered as obese. Previous studies have shown an increased risk of delivery complications with an elevated maternal BMI. The aim of this study was to evaluate delivery outcomes in relation to maternal BMI on admission to the antenatal clinic.

    A healthy group of 787 women with full-term pregnancies and spontaneous onset of labor were included in the study. Delivery outcome was assessed in relation to maternal BMI when attending the antenatal clinic.

    RESULTS:

    The results indicated that in deliveries where the maternal BMI was >30 a high frequency of abnormal CTG trace during the last 30 minutes of labor was shown. A blood sample for evaluation of risk of fetal hypoxia was performed in only eight percent of these deliveries. A spontaneous vaginal delivery without intervention was noted in 85.7%, and 12% of neonates were delivered with an adverse fetal outcome compared to 2.8% in the group with a maternal BMI<30 (p<0.001).

    CONCLUSION:

    These results indicate an increased risk at delivery for healthy, but obese women in labor. Furthermore, the delivery management may not always be optimal in these deliveries.

  • 29.
    Klink, Nicola
    Swedish Red Cross University.
    Obstetrisk omvårdnad inom intensivvård: En litteraturöversikt om patienters upplevelse av att vårdas inom intensivvård i samband med graviditet och förlossning2022Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background. Specialist nurses in intensive care may feel insecure when caring for obstetric patients, partly because they lack experience for the patient group, and partly because they lack knowledge about physiological changes during pregnancy. To achieve a holistic view of nursing, the aim of this study was to examine obstetric patients' experiences of being cared for in ICU. The method applied was a literature study and was conducted by analyzing the results of seven scientific articles with a qualitative and quantitative approach. The results of this study can be divided into two main categories. The first category was about feelings and experiences of obstetric patients at the ICU, including for example worries, anxiety, disappointment, stress, shame, and confusion. The second category deals with nursing interventions that obstetric patients consider benefiting their well-being during the ICU period. These include transparent information, person-centered encounters, presence of next-of-kin, contact with the newborn, breastfeeding-support, spiritual/existential support, and a calm environment. Based on these results, the conclusion is that obstetric patients in ICU are particularly exposed to negative experiences and have an increased risk of depression. A holistic nursing approach aimed at this patient group can increase the patient's well-being and lead to better mother-child-attachment.

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  • 30.
    Linde, Anders
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Georgsson, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Pettersson, Karin
    Karolinska Intitutet.
    Holmström, Sofia
    Sophiahemmets Högskola.
    Norberg, Emma
    Sophiahemmets Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Fetal movement in late pregnancy - a content analysis of women's experiences of how their unborn baby moved less or differently2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1, article id 127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Pregnant women sometimes worry about their unborn baby's health, often due to decreased fetal movements. The aim of this study was to examine how women, who consulted health care due to decreased fetal movements, describe how the baby had moved less or differently.

    METHODS: Women were recruited from all seven delivery wards in Stockholm, Sweden, during 1/1 - 31/12 2014. The women completed a questionnaire after it was verified that the pregnancy was viable. A modified content analysis was used to analyse 876 questionnaires with the women's responses to, "Try to describe how your baby has moved less or had changes in movement".

    RESULTS: Four categories and six subcategories were identified: "Frequency" (decreased frequency, absence of kicks and movement), "Intensity" (weaker fetal movements, indistinct fetal movements), "Character" (changed pattern of movements, slower movements) and "Duration". In addition to the responses categorised in accordance with the question, the women also mentioned how they had tried to stimulate the fetus to move and that they had difficulty in distinguishing fetal movements from contractions. Further, they described worry due to incidents related to changed pattern of fetal movements.

    CONCLUSION: Women reported changes in fetal movement concerning frequency, intensity, character and duration. The challenge from a clinical perspective is to inform pregnant women about fetal movements with the goal of minimizing unnecessary consultations whilst at the same time diminishing the length of pre-hospital delay if the fetus is at risk of fetal compromise.

    TRIAL REGISTRATION: Not applicable.

  • 31.
    Linde, Anders
    et al.
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Pettersson, K
    Hagelberg, L
    Georgsson, Susanne
    Sophiahemmet Högskola.
    Better safe than sorry: Reasons for consulting care due to decreased fetal movements2017Conference paper (Other academic)
  • 32.
    Linde, Anders
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    Pettersson, Karin
    Karolinska Intitutet.
    Hagelberg, Linn
    Sophiahemmets Högskola.
    Georgsson, Susanne
    Sophiahemmet Högskola.
    "Better safe than sorry"-Reasons for consulting care due to decreased fetal movements2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 5, p. 376-381Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Experience of reduced fetal movements is a common reason for consulting health care in late pregnancy. There is an association between reduced fetal movements and stillbirth.

    AIM: To explore why women decide to consult health care due to reduced fetal movements at a specific point in time and investigate reasons for delaying a consultation.

    METHODS: A questionnaire was distributed at all birth clinics in Stockholm during 2014, to women seeking care due to reduced fetal movements. In total, 3555 questionnaires were collected, 960 were included in this study. The open-ended question; "Why, specifically, do you come to the clinic today?" was analyzed using content analysis as well as the complementary question "Are there any reasons why you did not come to the clinic earlier?"

    RESULTS: Five categories were revealed: Reaching dead line, Receiving advice from health care professionals, Undergoing unmanageable worry, Contributing external factors and Not wanting to jeopardize the health of the baby. Many women stated that they decided to consult care when some time with reduced fetal movements had passed. The most common reason for not consulting care earlier was that it was a new experience. Some women stated that they did not want to feel that they were annoying, or be perceived as excessively worried. Not wanting to burden health care unnecessarily was a reason for prehospital delay.

    CONCLUSION: Worry about the baby is the crucial reason for consulting care as well as the time which has passed since the women first experienced decreased fetal movements.

  • 33.
    Melas, Philippe A
    et al.
    Karolinska Institutet.
    Georgsson Öhman, Susanne
    Karoliska Institutet / Sophiahemmet Högskola.
    Juth, Niklas
    Karolinska Institutet.
    Bui, The-Hung
    Karolinska University Hospital.
    Information related to prenatal genetic counseling: interpretation by adolescents, effects on risk perception and ethical implications2012In: Journal of Genetic Counseling, ISSN 1059-7700, E-ISSN 1573-3599, Vol. 21, no 4, p. 536-546Article in journal (Refereed)
    Abstract [en]

    Being raised in the genomic era may not only increase knowledge of available genetic testing but may also have an impact on how genetic information is perceived. However, little is known about how current adolescents react to the language commonly used by health care professionals providing prenatal counseling. In addition, as risk communication is related to numbers and figures, having different educational backgrounds may be associated with variability in risk perceptions. In order to investigate these issues, a previously developed questionnaire studying different ways of being told about hypothetical anomalies in a baby and corresponding risks (Abramsky and Fletcher Prenatal Diagnosis 22(13):1188-1194, 2002) was administered to high-school students in Sweden. A total of 344 questionnaires were completed by students belonging to a natural science or a social science program. The data show that teenage participants found technical jargon and words such as rare and abnormal more worrying than the presented comparison terms. Negative framing effects and perception differences related to numeric risk formats were also present. Additionally, participants' gender and educational program did not seem to have an effect on risk assessment. In addition to reporting the questionnaire results, we discuss the ethical implications of the data based on the norm of non-directiveness and make some recommendations for practice. In general, genetic counselors should be aware that the language used within clinical services can be influential on this group of upcoming counselees.

  • 34.
    Molin, Beata
    et al.
    Karolinska Institutet, Karolinska University Hospital / Sophiahemmet University.
    Sand, Anna
    Karolinska Institutet, Karolinska University Hospital.
    Berger, Anna-Karin
    Swedish Red Cross University.
    Georgsson, Susanne
    Swedish Red Cross University. Karolinska Institutet.
    Raising awareness about chronic pain and dyspareunia among women - a Swedish survey 8 months after childbirth2020In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 20, no 3, p. 565-574Article in journal (Refereed)
    Abstract [en]

    Background and aims: Although several studies have been conducted, knowledge about chronic pain and dyspareunia after childbirth is still limited. The aim of this study was to explore the prevalence of chronic pain 8 months after childbirth in a cohort of Swedish women. The characteristics of chronic pain, such as, pain intensity, localization and frequency as well as pain interference with daily activities were examined. An additional aim was to describe the prevalence and intensity of dyspareunia.

    Methods: Data were obtained through two self-administered questionnaires and the patient record system, Obstetrix. The first questionnaire was distributed on the maternity ward, 24-36 h after labour, to Swedish-speaking women who had given birth to a living child (n = 1,507). The second questionnaire was sent by post 8 months after childbirth. We collected data about demographic and social characteristics, pain presence and its onset, as well as pain intensity, frequency, bodily localization and pain interference with activities of women's daily life.

    Results: In total, 1,171 (77.7%) responded to both questionnaires and were included in the analysis. Eight months after giving birth, totally 16.7% (195/1,171) of the women reported chronic pain related to childbirth. Of these, 9.1% (106/1,171) of women reported chronic pain with onset during pregnancy, 4.5% (53/1,171) experienced chronic pain with onset following labour and 3.1% (36/1,171) of women had both chronic pain with onset during pregnancy and chronic pain with onset following labour (each participant could only appear in one of the groups). Women reported a lower prevalence of chronic pain after vaginal delivery than caesarean section (61/916, 6.7% vs. 28/255, 11%, p = 0.021, OR 1.73, 95% CI 1.1-2.8). Moreover, 19.2% (211/1,098) of women experienced dyspareunia. There was no difference regarding prevalence of dyspareunia and the mode of delivery. Of those women who had a vaginal delivery, 19.5% (167/858) experienced pain during intercourse and the corresponding number for women after caesarean section was 18.3% (44/240) (p = 0.694, OR 0.929, CI 0.6-1.3). Approximately 80% of women with chronic pain, and 60% of women that experienced dyspareunia, rated their worst pain as moderate or severe (NRS 4-10). The corresponding number regarding average chronic pain was between 50 and 70%. More than 35% of the women with chronic pain scored pain interference with daily activities as ≥4 on a 0-10 NRS.

    Conclusions: In our study, chronic pain 8 months after childbirth was reported by one in six women and one in five of the women experienced dyspareunia. The intensity of both chronic pain and dyspareunia was reported as moderate to severe in a significant proportion of women and chronic pain interfered considerably with daily activities.

    Implications: There is a need to raise awareness among healthcare providers of this clinical problem as well as to revise and upgrade education regarding pain after childbirth to prevent potential long-term health problems, women's suffering and increased need for health care. The development of strategies for prevention, follow-up and treatment of pain is warranted. More research, including women's experiences of pain as well as intervention studies, are also needed.

  • 35.
    Molin, Beata
    et al.
    Karolinska University Hospital, Sweden; Sophiahemmet University, Sweden.
    Zwedberg, Sofia
    Sophiahemmet University, Sweden; Karolinska University Hospital, Sweden.
    Berger, Anna-Karin
    Swedish Red Cross University.
    Sand, Anna
    Karolinska Institutet, Sweden.
    Georgsson, Susanne
    Swedish Red Cross University. Karolinska Institutet, Sweden.
    Disempowering women - a mixed methods study exploring informational support about pain persisting after childbirth and its consequences2022In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 22, no 1, article id 510Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Access to information is essential to achieving individual empowerment; meaning the ability to exercise control, manage one's own condition and make informed decisions. However, studies have shown that information provided to women regarding physiological changes during the postpartum period and postpartum health was inadequate, incorrect, or inconsistent.

    METHODS: The aim of this study was to explore informational support about pain persisting after childbirth and its consequences. A sequential explanatory mixed methods design was used. In the first, quantitative phase, 1,171 women, who gave birth eight months earlier, completed a self-administered questionnaire. In the second, qualitative phase, 20 women who experienced chronic pain were interviewed. Descriptive statistics and qualitative content analysis were used to analyse the data.

    RESULTS: The majority of the women did not receive information about pain persisting after childbirth, or the information was insufficient or incorrect. They did not know when and where to seek help and did not consult health care professionals. In addition, the lack of information had a negative impact on women's psychological well-being. All women expressed the need to be informed by health care professionals, irrespective of the individual risk of developing chronic pain.

    CONCLUSIONS: Health services should ensure availability of information to give the women opportunity to achieve empowerment to make good health decisions, increase control over their health and well-being as well as to enhance their self-efficacy. We propose that a booklet or leaflet with relevant information about the risk of developing chronic pain, symptoms and treatment, along with advice about appropriate health care settings should be provided as part of antenatal or postnatal care.

  • 36.
    Niklasson, Boel
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Arnelo, Catarina
    Karolinska Institutet.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Segerdahl, Märta
    Karolinska Institutet.
    Blanck, Agneta
    Karolinska Institutet.
    Oral oxycodone for pain after caesarean section: A randomized comparison with nurse-administered IV morphine in a pragmatic study2015In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 7, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Background and aims

    The present randomized open label parallel group study was conducted to evaluate if an oral oxycodone (OXY) regimen can be at least equally effective and as safe for postoperative analgesia after caesarean section (CS) as a standard of care program using nurse-administered intravenous morphine (IVM), followed by oral codeine.

    Methods

    Eighty women (40 + 40) were scheduled for elective CS under spinal anaesthesia. All patients received postoperative multimodal analgesic therapy, including ibuprofen and paracetamol. The OXY group got standardized extended release and short acting oral treatment (and in a few cases intravenous OXY) as needed and the other group received current standard of care, IVM as needed for 24 h, followed by codeine. Opioid treatment lasted maximum five days. Outcome measures were pain intensity (numerical rating scale, NRS), opioid requirements, duration of administering opioids and safety for mother and newborn. All opioids in the study were expressed in OXY equivalents, using a conversion table. As the bioavailability of each opioid has a certain extent of interindividual bioavailability this conversion represents an approximation. The possible influence of opioids on the newborns was evaluated by the Neurological Adaptive Capacity Score at birth and at 24 and 48 h.

    Results

    During the first 24 h, there were no differences between treatments in opioid requirements or mean pain intensity at rest but pain intensity when asking for rescue medication was lower in the OXY than in the IVM group (mean ± SD; 5.41 ± 6.42 vs. 6.42 ± 1.61; p = 0.027). Provoked pain (uterus palpation) during the first 6 h was also less in the OXY group (3.26 ± 2.13 vs. 4.60 ± 2.10; p = 0.007). During the 25–48 h period postoperatively, patients on OXY reported significantly lower pain intensity at rest (2.9 ± 1.9 vs. 3.8 ± 1.8; p = 0.039) and consumed less opioids (OXY equivalents; mg) (31.5 ± 9.6 vs. 38.2 ± 38.2; p = 0.001) than those on IVM/codeine. The total amount of opioids 0–5 days postoperatively was significantly lower in the OXY than in the IVM/codeine group (108.7 ± 37.6 vs. 138.2 ± 45.1; p = 0.002). Duration of administering opioids was significantly shorter in the OXY group. Time to first spontaneous bowel movement was shorter in the OXY group compared with the IVM/codeine group. No serious adverse events were recorded in the mothers but the total number of common opioid adverse effects was higher among women on IVM/codeine than among those receiving OXY (15 vs. 3; p = 0.007). No adverse outcomes in the newborns related to treatment were observed in either group.

    Conclusions

    In a multimodal protocol for postoperative analgesia after CS better pain control and lower opioid intake was observed in patients receiving oral OXY as compared to those on IVM/codeine. No safety risks for mother and child were identified with either protocol.

    Implications

    Our findings support the view that use of oral OXY is a simple, effective and time saving treatment for postoperative pain after CS.

  • 37.
    Niklasson, Boel
    et al.
    Karolinska Institutet.
    Börjesson, Astrid
    Karolinska University Hospital.
    Carmnes, Ulla-Britt
    Karolinska University Hospital.
    Segerdahl, Märta
    Karolinska Institutet.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Blanck, Agneta
    Karolinska Institutet.
    Intraoperative injection of bupivacaine-adrenaline close to the fascia reduces morphine requirements after cesarean section: a randomized controlled trial2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 12, p. 1433-1439Article in journal (Refereed)
    Abstract [en]

    Objective. The purpose of this study was to investigate whether a single injection of bupivacaine with adrenaline close to the fascia could decrease opiate consumption and pain in patients undergoing cesarean section in spinal anesthesia. Design. Randomized double-blind controlled study. Settings. Karolinska University Hospital, Huddinge, Sweden. Population. 260 women scheduled for elective cesarean section were enrolled in the study. Methods. The treatment group (n= 130) received 40 mL bupivacaine (2.5 mg/mL) with adrenaline (5 μg/mL) (Marcain® adrenalin) and the control group (n= 130) received 40 mL saline solution (0.9%), which was, in both groups, injected close to the fascia before closure of the wound. Main outcome measures. Morphine consumption and mean resting pain intensity numerical rating scale at 12 and 24 hours were the primary outcome variables. Other assessments for pain as well as mobilization parameters were considered secondary. Results. Morphine requirements were significantly less in the bupivacaine group, 19.0 mg/woman, compared with 24.0 mg/woman in the placebo group, during the first 12 postoperative hours. During this time period there was also a trend towards a difference between groups in mean pain intensity, but significant only during the first six hours. Over the whole first postoperative 24 hours, there were no differences in either morphine requirement or pain intensity between groups. Conclusions. A single injection of bupivacaine with adrenaline in the surgical wound decreases the need for morphine requirements for the first 12 postoperative hours and contributes to safe and effective pain management in women undergoing cesarean section.

  • 38.
    Niklasson, Boel
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Segerdahl, Märta
    Karolinska Institutet.
    Blanck, Agneta
    Karolinska Institutet.
    Risk factors for persistent pain and its influence on maternal wellbeing after cesarean section2015In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 6, p. 622-628Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the overall incidence and risk factors for persistent pain and its interference with daily life after cesarean section.

    DESIGN: Prospective long-term follow-up study.

    SETTING: Karolinska University Hospital, Stockholm, Sweden.

    POPULATION: 260 healthy women who underwent elective cesarean section.

    METHODS: Information on demographics, medical history, postoperative pain and analgesic requirements was collected. A questionnaire consisting of the Brief Pain Inventory was posted at 3, 6 and 12 months after surgery. Women rated pain intensity as well as interference with factors related to general function and quality of life.

    MAIN OUTCOME MEASURES: The overall incidence and risk factors for persistent postoperative pain at three time points. Persistent pain was considered a secondary outcome.

    RESULTS: At 3, 6 and 12 months 40%, 27% and 22% of patients, respectively, reported pain in one or more locations, in the surgical site as well as in other areas. A psychological indication, as well as a first cesarean section, increased the risk for pain at 3 months. Severe postoperative pain in the immediate postoperative period or undergoing a first cesarean section were significant independent risk factors for the development of persistent pain up to 6 months after cesarean section. Parameters related to quality of life were significantly impaired in women with persistent pain.

    CONCLUSION: Several factors, including severe postoperative pain, were shown to influence the risk for persistent pain after cesarean section. Long-term pain markedly affected women's wellbeing. This article is protected by copyright. All rights reserved.

  • 39.
    Rådestad, Ingela
    et al.
    Sophiahemmet Högskola.
    Akselsson, Anna
    Sophiahemmet Högskola / Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Lindgren, H
    Karolinska Institutet.
    Pettersson, K
    Karolinska Institutet.
    Steineck, G
    University of Gothenburg / Karolinska Institutet.
    Rationale, study protocol and the cluster randomization process in a controlled trial including 40,000 women investigating the effects of mindfetalness2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 10, p. 56-61Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Shortening pre-hospital delay may decrease stillbirth rates and rates of babies born with a compromised health. Stillbirth may be preceded by a decrease in fetal movements. Mindfetalness has been developed as a response to the shortcomings of kick-counting for the monitoring of fetal movements by the pregnant woman. We do not know if practicing Mindfetalness may diminish pre-hospital delay. Nor do we know if practicing Mindfetalness may increase or decrease the percentage of women seeking health care for unfounded, from a medical perspective, worry for her fetus' well-being.

    METHODS:

    This article describes the rationale, study protocol and the randomization process for a planned study randomly allocating 40,000 pregnant women to receive, or not receive, proactive information about practicing Mindfetalness. The unit of randomization is 63 antenatal clinics in the Stockholm area. Midwives in the antenatal clinics randomized to Mindfetalness will verbally inform about practicing Mindfetalness, hand out brochures (printed in seven languages) and inform about a website giving information about Mindfetalness. Routine care will continue in the control clinics. All information for the analyses, including the main endpoint of an Apgar score below 7 (e.g., 0-6 with stillbirth giving a score of 0), measured five minutes after birth, will be retrieved from population-based registers.

    RESULTS:

    We have randomized 33 antenatal clinics to Mindfetalness and 30 to routine care. In two clinics a pilot study has been performed. One of the clinics randomly allocated to inform about Mindfetalness will not do so (but will be included in the intention-to-treat analysis). In October 2016 we started to recruit women for the main study.

    CONCLUSION:

    The work up to now follows the outlined time schedule. We expect to present the first results concerning the effects of Mindfetalness during 2018.

  • 40.
    Sahlin, Ellika
    et al.
    Karolinska Institutet.
    Nordenskjöld, Magnus
    Karolinska Institutet.
    Gustavsson, Peter
    Karolinska Institutet.
    Wincent, Josephine
    Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Iwarsson, Erik
    Karolinska Institutet.
    Positive Attitudes towards Non-Invasive Prenatal Testing (NIPT) in a Swedish Cohort of 1,003 Pregnant Women2016In: PLOS ONE, E-ISSN 1932-6203, Vol. 11, no 5, article id e0156088Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The clinical utilization of non-invasive prenatal testing (NIPT) for identification of fetal aneuploidies is expanding worldwide. The aim of this study was to gain an increased understanding of pregnant women's awareness, attitudes, preferences for risk information and decision-making concerning prenatal examinations with emphasis on NIPT, before its introduction into Swedish healthcare.

    METHOD: Pregnant women were recruited to fill in a questionnaire, including multiple-choice questions and Likert scales, at nine maternity clinics located in different areas of Stockholm, Sweden.

    RESULTS: In total, 1,003 women participated in the study (86% consent rate). The vast majority (90.7%) considered examinations aiming to detect fetal abnormalities to be good. Regarding NIPT, 59.8% stated that they had heard about the method previously, yet 74.0% would like to use the test if available. The main factor affecting the women's decision to undergo prenatal chromosomal screening was worry about the baby's health (82.5%), followed by the urge to have as much information as possible about the fetus (54.5%). Most women (79.9%) preferred to receive NIPT information orally.

    CONCLUSION: The overwhelming majority of a cohort of 1,003 pregnant women considered prenatal examinations good. Moreover, the majority had a positive attitude towards NIPT and would like to use the test if available.

  • 41.
    Sandberg, Christina
    et al.
    Danderyd Karolinska University Hospital.
    Georgsson Öhman, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Development of an observational instrument to assess gastro-esophageal reflux disease in premature infants2014In: International Journal of Child Health and Nutrition, ISSN 1929-4247, Vol. 3, no 2, p. 84-92Article in journal (Refereed)
    Abstract [en]

    Abstract: Background: Premature infants are at increased risk of developing Gastroesophageal Reflux Disease (GERD), which for these children is associated with a number of severe symptoms. There is great need for effective instruments and clear symptom criteria to assess the presence and degree of severity of GERD.

    Aim: To develop and pilot test an observation instrument for early detection of symptoms of GERD in premature infants.

    Method: A combination of three research methods was used – systematic literature review, observation instrument development and a pilot test.

    Results: The systematic review identified specific symptoms of GERD. The development of the observational instrument started with the establishment of concordance between the criteria of symptoms according to the literature review and to NIDCAP, “Newborn Individualized Developmental Care and Assessment Program”. In the pilot test the criteria of symptoms were revised by comparing the result and the criteria between infants that clinically were estimated to have had a reflux problem and the ones who did not.

    Conclusion: An observation instrument was developed. The clinical evaluation by a pilot test showed that the instrument could be useful to record significant symptoms and combinations of symptoms that may occur in premature infants assessed as having reflux problems.

  • 42.
    Sjögren Forss, Katarina
    et al.
    Malmö University.
    Stjernberg, Louise
    The Swedish Red Cross University College.
    Physical Activity Patterns Among Women and Men During Pregnancy and 8 Months Postpartum Compared to Pre-pregnancy: A Longitudinal Study2019In: Frontiers In Public Health, ISSN 2296-2565, Vol. 7, article id 294Article in journal (Refereed)
    Abstract [en]

    Background: Realizing the essential prerequisite of regular physical activity (PA) it is essential to have knowledge about how different life change events may influence individual's participation. Many studies have documented that pregnancy and the transition to parenthood are life change events associated with decreased PA among women however, the examination of changes of PA in the male parent during this major life change event has been largely neglected in scientific literature and a significant research gap can be found. In the light of this, this longitudinal study aimed to follow changing PA patterns among women and men during pregnancy and 8 months postpartum compared to pre-pregnancy. Methods: In this study, 123 women and 112 men (partners of the women) that lived in the municipality of Karlskrona, Sweden, were included. Data were collected between 2008 and 2010. The self-reported amount of PA performed outdoors and indoors before pregnancy throughout the entire pregnancy, and 8 months postpartum, were measured. Results: We found similar changes in PA patterns among both women and men during pregnancy and 8 months postpartum when compared to pre-pregnancy. In almost all the activities studied except for walking/strolling, a significant decline was found. Conclusions: Our findings contribute new knowledge about changes in men's PA patterns from pre-pregnancy to pregnancy and postpartum. As couples seem to change activity patterns similarly, it is important to promote family-based PA initiatives and encourage couples to be active together during pregnancy and postpartum.

  • 43. Svantesson, Lena
    et al.
    Georgsson Öhman, Susanne
    Sophiahemmet Högskola.
    Psykologiska aspekter på fosterdiagnostik2009In: Lärobok för barnmorskor / [ed] Annette Kaplan; Beatrice Hogg; Ingegerd Hildingsson & Ingela Lundgren, Lund: Studentlitteratur AB, 2009, 3, p. 216-217Chapter in book (Other academic)
  • 44.
    Ulfsdottir, Hanna
    et al.
    Department of Women's Health Karolinska University Hospital, Stockholm, Sweden; Division of Obstetrics and Gynecology, ep, Stockholm, Sweden.
    Saltvedt, Sissel
    Department of Women's Health Karolinska University Hospital, Stockholm, Sweden; Division of Obstetrics and Gynecology, ep, Stockholm, Sweden.
    Edqvist, Malin
    Department of Women's Health Karolinska University Hospital, Stockholm, Sweden; Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm Sweden.
    Georgsson, Susanne
    Swedish Red Cross University, Department of Health Sciences. Department of Clinical science, Intervention and technology, Karolinska Institutet, Stockholm, Sweden.
    Management of the active second stage of labor in waterbirths compared with conventional births - a prospective cohort study2022In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 107, article id 103283Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The management of the active second stage in labor and perineal protection varies between countries and is rarely described regarding waterbirths. The objective of this study was to describe how midwives manage the active second stage of labor in waterbirths compared to conventional births. A secondary aim was to compare clinical outcomes between the two groups.

    METHODS: A prospective cohort study, based on 323 women who gave birth at three clinics in Sweden, between Dec 2015-May 2019. The women were both primiparous and multiparous; 153 gave birth in water and 170 had a conventional uncomplicated birth. A protocol was completed by the attending midwife after birth, describing characteristics and management of the active second stage of labor as well as perineal protection.

    RESULTS: The active second stage of labor differed in several aspects between waterbirths and conventional births. Maternal pushing was spontaneous to a higher extent among women giving birth in water and the use of manual perineal protection was lower. The technique of manual perineal protection differed as well as birth positions. Giving birth in water was associated with less second-degree tears among primiparous women but with no differences among multiparas.

    CONCLUSIONS: In waterbirth, the midwife took the role of a more watchful attendee, making less interventions. Waterbirths were associated with less directed pushing and less manual perineal protection. However, there was still a widespread use of manual perineal protection, showing it is possible to use in the same way as in conventional births if needed.

  • 45.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet Högskola.
    Saltvedt, Sissel
    Ekborn, Marie
    Karolinska University Hospital Huddinge.
    Georgsson, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Like an empowering micro-home: A qualitative study of women's experience of giving birth in water2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, p. 26-31Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe women´s experiences and perceptions of giving birth in water.

    DESIGN: A qualitative study with in-depth interviews three to five months after the birth. A content analysis of the interviews was made.

    SETTING: One city-located hospital in Stockholm, offering waterbirth to low risk women.

    PARTICIPANTS: 20 women, 12 primiparas and 8 multiparas, aged 27-39.

    MEASUREMENTS AND FINDINGS: The overall theme emerging from the analysis was, "Like an empowering micro-home", which describes the effect of being strengthened, enabled and authorized in the birth process. Three categories were found: "Synergy between body and mind", "Privacy and discretion", and "Natural and pleasant".

    KEY CONCLUSIONS: The immersion in warm water provided the women with conditions that helped them to cope and feel confident during labour and birth. The homelike and limited space of a bathtub helped give a relaxed feeling of privacy, safety, control and focus for the women.

    IMPLICATIONS FOR PRACTICE: This study contributes to a deeper understanding of what waterbirth offers to women. For some women, waterbirth may be a way to accomplish an empowering and positive birth experience, and could work as a tool that preserves the normality of, and increases self-efficacy in, childbirth.

  • 46.
    Ulfsdottir, Hanna
    et al.
    Sophiahemmet Högskola.
    Saltvedt, Sissel
    Karolinska Institutet.
    Georgsson, Susanne
    Karolinska Institutet / Sophiahemmet Högskola.
    Testing the waters: A cross-sectional survey of views about waterbirth among Swedish health professionals2020In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 33, no 2, p. 186-192Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: For women with low risk births, waterbirth is an alternative that is requested and provided in approximately a hundred countries. However, in some countries, including Sweden, waterbirth is not generally available.

    AIM: To explore the experiences, knowledge and attitudes regarding waterbirth among midwives, obstetricians/gynaecologists and neonatologists.

    METHODS: A cross-sectional study was conducted in Sweden, using a web-based survey distributed via The Swedish Association of Midwives and the Heads of department of all Swedish maternity wards between April and June 2016. The respondents (n = 1609) answered a combination of Likert-scale and open-ended questions. The responses were analysed with descriptive statistics and quantitative content analyses.

    FINDINGS: Both midwives and physicians stated a lack of experience, knowledge and clinical guidelines related to attending and assisting waterbirths. Overall, midwives had more positive attitudes to waterbirth (38.8% vs 4.5%) as well as towards providing and implementing waterbirth, compared to physicians (71.0% vs 14.9%). Midwives stated significantly more benefits and fewer risks for women and babies, compared to physicians who requested more evidence.

    CONCLUSIONS: Opinions regarding waterbirth are to some extent based on attitudes rather than actual experience and knowledge. There are diverse interpretations of the strength of evidence and a lack of updating in the research field of waterbirth. As waterbirth is requested by women, health professionals need to update their knowledge in this topic in order to give coherent and evidence-based information and care to prospective parents.

  • 47.
    Ulfsdottir, Hanna
    et al.
    Karolinska Institutet / Sophiahemmet Högskola.
    Saltvedt, Sissel
    Karolinska Institutet.
    Georgsson, Susanne
    Sophiahemmet Högskola / Karolinska Institutet.
    Waterbirth in Sweden - a comparative study2018In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 97, no 3, p. 341-348Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The literature describes advantages for mothers giving birth in water, but waterbirth is controversial in Sweden and has not been offered at hospitals until recently. This study aimed to describe and compare the characteristics and outcome of waterbirths with spontaneous vaginal births at the same clinics.

    MATERIAL AND METHODS: A retrospective cohort study was conducted on all waterbirths at two maternity units in Sweden from March 2014 to November 2015 (n=306), and a consecutively selected comparison group of 306 women having conventional spontaneous vaginal births. Logistic regression was used to analyze the primary outcome; second-degree perineal tears.

    RESULTS: Women giving birth in water had a lower risk of second-degree perineal tears (adj. OR 0.6 [95% CI 0.4-0.9]). Their labor was shorter (6:03 hrs. vs 7:52 hrs.) and there were significantly less interventions than in the comparison group; amniotomy (13.7% vs. 35.3%), internal cardiotocography (11.1% vs.56.8%), and augmentation with oxytocin (5.2% vs.31.3%). There were no differences in Apgar scores or admissions to neonatal intensive care unit. The experience of childbirth, measured with a numeric rating scale, was higher in the waterbirth group indicating a more positive birth experience. Three newborns born in water had an umbilical cord avulsion.

    CONCLUSIONS: In this low-risk population, waterbirth is associated with positive effects on perineal tears, the frequency of interventions, the duration of labor and women's birth experience. Midwives handling waterbirth should be aware of the risk of umbilical cord avulsion. This article is protected by copyright. All rights reserved.

  • 48.
    Ulfsdottir, Hanna
    et al.
    Karolinska Institutet / Sophiahemmet University.
    Saltvedt, Sissel
    Karolinska Institutet.
    Georgsson, Susanne
    The Swedish Red Cross University College. Karolinska Institutet.
    Women's experiences of waterbirth compared with conventional uncomplicated births2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 79, article id 102547Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare childbirth experiences between women having a waterbirth and women having an uncomplicated conventional birth.

    DESIGN: A prospective cohort study using the validated Childbirth Experience Questionnaire (CEQ) six weeks postpartum. The 22-item questionnaire assesses four domains of the childbirth experience; Own capacity, Professional support, Perceived safety and Participation. These four domains constituted the main outcome of the study. Further, supplementary questions about the second stage of labour were added to the web-questionnaire.

    SETTING: One city-located hospital in Stockholm and one small-town hospital in Southern Sweden offering waterbirth to low risk women.

    PARTICIPANTS: 215 women; 99 nulli- and 116 multiparas. 111 gave birth in water and 104 had an uncomplicated conventional birth.

    MEASUREMENTS AND FINDINGS: The total CEQ score did not differ between the groups, while women having a waterbirth scored significantly higher in the domain, "Own capacity" and lower in the domain, "Professional support". Women having a waterbirth rated less pain and higher scores of being in control in the second stage of labour.

    KEY CONCLUSIONS: A waterbirth seems to empower and enhance women's capacity for those who choose this alternative. Waterbirth can improve their birth experience and can possibly make women less dependent on the midwife.

    IMPLICATIONS FOR PRACTICE: To provide waterbirth could be a way of empowering women and giving them a positive birth experience.

  • 49.
    Volgsten, Helena
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Mood Disorders, Personality and Grief in Women and Men undergoing in vitro Fertilization Treatment2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Psychological problems are common in infertile women undergoing in vitro fertilization (IVF) treatment.  The aim of this thesis was to determine the prevalence of psychiatric disorders, such as mood and anxiety disorders, and related risk factors and personality traits in women and men undergoing IVF.

    Participants were 1090 consecutive women and men, 545 couples, attending a fertility clinic in Sweden during a two-year period. The Primary Care Evaluation of Mental Disorders (PRIME-MD), based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), was used for evaluating mood and anxiety disorders. The participation rate was 862 (79 %) subjects.

    Any psychiatric disorder was present in 31 % of females and in 10 % of males. Major depression was prevalent in 11 % of females and 5 % of males. Only 21 % of the subjects with a psychiatric disorder had some form of treatment. A negative pregnancy test and obesity (BMI ≥ 30) were risk factors for mood disorders in women and the only risk factor for depression in men was unexplained infertility. Anxiety disorders were less common than in the general population and no IVF-related risk factors were identified. The Swedish universities Scales of Personality (SSP), a self-rating questionnaire, was used for evaluation of personality traits. High scores of personality traits related to neuroticism were associated with mood and/or anxiety disorders among both women and men.

    Another objective was to explore the experience of childlessness three years after unsuccessful IVF by a qualitative-approach, assessing data by interviews. Failure after IVF was experienced by women in terms of grief, whereas men took upon themselves a supportive role not expressing grief. A need for professional support and counselling in how to handle grief was described. An unstructured end after IVF treatment left unanswered questions. Three years after the end of treatment, men and women were still processing and had not adapted to childlessness, indicating the grieving process was unresolved.

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  • 50.
    Volgsten, Helena
    et al.
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Ekselius, Lisa
    Uppsala universitet, Psykiatri, Akademiska sjukhuset.
    Sundström Poromaa, Inger
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Skoog Svanberg, Agneta
    Uppsala universitet, Institutionen för kvinnors och barns hälsa.
    Personality traits associated with depressive and anxiety disorders in infertile women and men undergoing in vitro fertilization treatment2010In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 89, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess which personality traits are associated with depressive and/or anxiety disorders in infertile women and men undergoing in vitro fertilization (IVF). DESIGN: Prospective study. SETTING: A university hospital in Sweden. POPULATION: A total of 856 eligible women and men, 428 couples, were approached to participate. Overall 643 (75.1%) subjects filled out the Swedish Universities Scales of Personality (SSP) questionnaire. The response rates were 323 women (75.5%) and 320 men (74.8%). METHODS: The SSP, a self-rating personality trait questionnaire, was used for evaluation. Main outcome measures. Personality traits associated with depression and/or anxiety disorders. RESULTS: Higher mean scores on all neuroticism-related personality traits were found in women and men with depressive and/or anxiety disorders compared to women and men with no diagnosis. High scores of neuroticism and a negative pregnancy test after IVF were associated with depressive and/or anxiety disorders among women. Among men, high scores of neuroticism and unexplained or male infertility factor were associated with depressive and/or anxiety disorders. High neuroticism scores were negatively associated with live birth (p < 0.05). CONCLUSION: High scores on neuroticism-related personality traits were associated with depressive and/or anxiety disorders in women and men undergoing IVF.

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