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  • 1.
    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 care2014Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 30, nr 6, s. 620-627Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 2.
    Georgsson, Susanne
    et al.
    Sophiahemmet Högskola / Karolinska Institutet.
    Linde, Anders
    Sophiahemmet Högskola / Karolinska Institutet.
    Pettersson, Karin
    Karolinska Institutet.
    Nilsson, Rebecca
    Sophiahemmet Högskola.
    Rådestad, Ingela
    Sophiahemmet Högskola.
    To be taken seriously and receive rapid and adequate care: womens' requests when they consult health care for reduced fetal movements2016Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 40, s. 102-108Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: decreased fetal movement is a reason for women to seek health care in late pregnancy.

    OBJECTIVE: to examine what pregnant women who present with decreased fetal movements want to communicate to health care professionals and to other women in the same situation.

    DESIGN: a qualitative descriptive study.

    SETTING AND PARTICIPANTS: questionnaires were distributed in all seven labour wards in Stockholm from 1 January to 31 December 2014 to women who consulted care due to decreased fetal movements. In total, 3555 questionnaires were completed of which 1 000 were included in this study. The women's responses to the open ended question: "Is there something you want to communicate to health care professionals who take care of women with decreased fetal movement or to women who experience decreased fetal movements?", were analysed with manifest content analysis.

    FINDING: three categories were revealed about requests to health care professionals: Pay attention to the woman and take her seriously, Rapid and adequate care and Improved information on fetal movements. Regarding what the women want to communicate to other pregnant women, four categories were revealed: Contact health care for check-up, Pay attention to fetal movement, Recommended source of information and Practical advice.

    CONCLUSION: pregnant women who consult health care due to decreased fetal movements want to be taken seriously and receive rapid and adequate care with the health of the infant as the primary priority. The women requested uniform information about decreased fetal movements. They wished to convey to others in the same situation the importance of consulting care once too often rather than one time too few.

  • 3.
    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 pregnancy2009Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, nr 3, s. 264-276Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4.
    Mattsson, Elisabet
    et al.
    Department of Public Health and Caring Sciences, Uppsala University.
    Funkquist, Eva-Lotta
    Department of Women׳s and Children׳s Health, Uppsala University.
    Wickström, Maria
    Children׳s Hospital, Uppsala University Hospital.
    Nyqvist, Kerstin H
    Department of Women׳s and Children׳s Health, Uppsala University.
    Volgsten, Helena
    Department of Women׳s and Children׳s Health, Uppsala University.
    Healthy late preterm infants and supplementary artificial milk feeds: Effects on breast feeding and associated clinical parameters.2015Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, nr 4, s. 426-431Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: to compare the influence of supplementary artificial milk feeds on breast feeding and certain clinical parameters among healthy late preterm infants given regular supplementary artificial milk feeds versus being exclusively breast fed from birth.

    DESIGN: a comparative study using quantitative methods. Data were collected via a parental diary and medical records.

    METHODS: parents of 77 late preterm infants (34 5/7-36 6/7 weeks), whose mothers intended to breast feed, completed a diary during the infants׳ hospital stay.

    FINDINGS: infants who received regular supplementary artificial milk feeds experienced a longer delay before initiation of breast feeding, were breast fed less frequently and had longer hospital stays than infants exclusively breast fed from birth. Exclusively breast-fed infants had a greater weight loss than infants with regular artificial milk supplementation. A majority of the mothers (65%) with an infant prescribed artificial milk never expressed their milk and among the mothers who used a breast-pump, milk expression commenced late (10-84 hours after birth). At discharge, all infants were breast fed to some extent, 43% were exclusively breast fed.

    KEY CONCLUSIONS: clinical practice and routines influence the initiation of breast feeding among late preterm infants and may act as barriers to the mothers׳ establishment of exclusive breast feeding.

  • 5.
    Olsson, Ann
    et al.
    Department of Clinical Sciences, Division of Caring Science, Danderyd Hospital, Karolinska Institutet.
    Robertson, Eva
    Department of Public Health, Karolinska Institutet; School of Health Science, University College of Borås.
    Falk, Katarina
    Röda Korsets Högskola.
    Nissen, Eva
    Department of Woman and Child Health, Karolinska Institutet; School of Life Science, University of Skövde.
    Assessing women's sexual life after childbirth: the role of the postnatal check2011Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, nr 2, s. 195-202Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective

    to describe midwives’ reflections on counselling women at the postnatal check with special focus on sexual life after childbirth.

    Design

    qualitative descriptive study with focus group discussions as the method of data collection.

    Setting

    antenatal clinics in Stockholm greater catchments’ area.

    Participants

    during 2006 and 2007, a voluntary sample of midwives from 10 different antenatal clinics were invited.

    Analysis

    content analysis was undertaken through identification of codes, categories and themes.

    Findings

    Two themes emerged: balancing between personal perceptions of the woman's needs and the health system restrictions and strategies for counselling about sexual life after childbirth’. The midwives tried to create a picture for themselves of the woman coming for the postnatal check and her needs before the consulation. This picture guided the midwives, but lack of time and knowledge restricted them when counselling on sexual life after childbirth. Two different strategies in counselling were identified, one task-oriented and one subject-oriented. Demands and time restrictions led midwives to distance themselves from their clients. A task-oriented approach was more visible in midwives’ encounters with foreign-born women, where linguistic difficulties, cultural diversity and narrow time frames restricted the midwives’ effectiveness and/or sensitivity as caregivers. In contrast, the subject-oriented strategy meant ‘getting in tune’, i.e. listening to the woman when she expressed her feelings and emotions, encouraging the woman to be an active participant in decisions involving her care. This strategy is used for women who arouse midwives’ empathy and when there is some form of recognition and understanding.

    Conclusion

    The picture created of the woman and her needs guided the midwives, but lack of knowledge and time limitations restricted counselling on sexual life after childbirth. Two counselling strategies were identified, one task-oriented and one subject-oriented. Balancing these two counselling strategies improves both the ethical aspects and the quality of the counselling.

  • 6.
    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 water2018Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 67, s. 26-31Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Ulfsdottir, Hanna
    et al.
    Karolinska Institutet / Sophiahemmet University.
    Saltvedt, Sissel
    Karolinska Institutet.
    Georgsson, Susanne
    Röda Korsets Högskola. Karolinska Institutet.
    Women's experiences of waterbirth compared with conventional uncomplicated births2019Inngår i: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 79, artikkel-id 102547Artikkel i tidsskrift (Fagfellevurdert)
    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.

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