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Background: Midwifery continuity of care (MCoC) has been associated with reduced burnout and increased work satisfaction among midwives. Despite these benefits, MCoC is not common in Sweden.

Aim: This study aimed to explore midwives' profiles based on burnout levels and attitudes towards midwifery continuity of care, considering various background and work-related factors.

Methods: A national cross-sectional digital survey was conducted among midwives in Sweden. The questionnaire covered the Copenhagen Burnout Inventory (CBI), attitudes towards MCoC and background variables. Cluster analysis identified a set of profiles, which were then compared by calculating odds ratios and 95 % confidence intervals for various background and work-related factors. Logistic regression examined the factors most associated with each profile.

Findings: A three-cluster solution for the 1,983 midwives surveyed was suggested, labelled as Reserved, Visionary, and Sensitive. Midwives in the Reserved cluster exhibited negative attitudes towards MCoC, through negative scores on both components and negative scores on the CBI. Within the Visionary cluster, midwives showed positive scores on the Relational component of MCoC, but negative scores on the Practical and Organisational component and the CBI. In the Sensitive cluster, midwives exhibited the highest scores on the CBI and negative scores on the Practical and Organisational component of MCoC, with just slightly positive scores on the Relational component. Cluster membership was associated with length of work experience (p<0.001) and work domain (p<0.001).

Conclusion: Based on the CBI and attitudes towards MCoC, three distinct clusters of midwives were identified, with different factors contributing to membership in each cluster. Understanding how midwives relate to MCoC can facilitate the implementation of the model, potentially improving midwives' work-related health.

Background: Stillbirth occurs at a rate of 3.0 per thousand in Sweden. However, few studies have focused on the initial experiences of parents facing a stillbirth. The aim of this qualitative study is to deepen and broadly explore parents’ initial experiences, perceptions, internal processes and strategies from the moment of suspicion or awareness of stillbirth until one month after the event.

Methods: Ten individual in-depth interviews were conducted between 2021 and 2023, and data were evaluated using thematic network analysis.

Results: Two key themes emerged: ‘Following the journey – from suspicion to acceptance’ and ‘Support, structured activities and processes after stillbirth’. These themes captured the significant consequences of a sudden, unexpected and devastating end to pregnancy. The suspicion and eventual diagnosis of stillbirth were initially associated with sudden discomfort, fear, overwhelming grief, and intense pain. Nevertheless, a vaginal birth was regarded as the optimal mode of delivery for both physical and emotional wellbeing. Caring for the stillborn baby through physical proximity for an extended period of time helped parents comprehend and cope with their grief, while also affirming their sense of parenthood.

Conclusions: This study sheds light on the profound and devastating impact of stillbirth on parents who are confronted with the loss of their long-awaited and cherished baby. The intense grief and pain experienced by parents during the first month after stillbirth were described as an ongoing heavy burden, persisting day and night, and reflected in poor/very poor mental health. Despite the immense challenges faced by parents, the study highlights the importance of developing individual coping strategies to deal with this tragic and irreversible life-changing event.

Background: In Sweden, women often meet with different midwives during antenatal, intrapartum, and postpartum care, due to the structure of maternity care, with few alternatives which provide continuity. This study aims to explore women’s interest in having a midwife they know present during labor and birth and to identify the characteristics of women who prefer this option.

Methods: A comparative study was conducted involving two Swedish nationwide cohorts of Swedish-speaking pregnant women. The first cohort included 3,061 women, and the second 1,812 women. Descriptive statistics and odds ratios were calculated.

Results: In total, 4,873 pregnant women completed the survey. Most participants were aged 25–35 years, living with a partner, and born in Sweden. Interest in having a midwife they know increased from 53% in 1999 to 76% in 2024. Key factors associated with this preference included primiparity (OR 3.80; 95% CI 3.27–4.40), being pregnant in 2024 (OR 3.21; 2.70–3.86), being born outside Sweden (OR 2.73; 2.11–3.54), and fear of birth (OR 2.03; 1.56–2.63).

Conclusions: Interest in having a known midwife during childbirth has grown significantly in Sweden, highlighting the need for policy changes that promote awareness and expand this option for women.

Background: Midwifery continuity models are highly recommended. Women with fear of birth living in rural areas might have difficulties accessing such care. Technology can play a role in enhancing contact with midwives during pregnancy and childbirth for these women.

Objective: The aim of this study was to elucidate women's experiences of participating in a digital continuity of care model designed for pregnant women with fear of birth. Methods: A qualitative interview design, employing interviews with 15 women participating in a midwifery continuity project directed towards women with fear of birth. The participants used e-health tools for communication with midwives during their pregnancy and childbirth. Reflexive thematic analysis was used.

Results: The analysis resulted in an overarching theme: ‘A digital continuity model of midwifery care for women with fear of birth in a rural area is attractive’. The model created positive outcomes in terms of sustainability and use of resources. The women reported enhanced autonomy and reduced stress. Continuity of care fostered confidence and security throughout childbirth for the women, supported by a strong relationship with their midwives. The individualised care, which addressed mental health challenges and fears stemming from past childbirth experiences, led to positive outcomes.

Conclusion: A model with continuity using digital e-health could be a solution to meet women's needs in rural areas during childbirth, who suffer from fear of birth or have mental health problems. Care models need to be tailored to regional conditions, considering factors such as midwifery availability and geographical challenges.

Objective: To identify clusters of women based on anxiety, depression, fear of birth, and childbirth self-efficacy and factors associated with the clusters.

Design: Cross-sectional survey.

Setting: Online in Sweden. Participants: Pregnant women (N = 1,419).

Methods: We collected data through online questionnaires. We included scales to measure anxiety, depression, worries about and fear of birth, and self-efficacy in a kappa-means cluster analysis. We calculated odds ratios with 95% confidence intervals between clusters and background variables.

Results: We identified 4 clusters based on severity: Resourceful-Robust, Resourceful-Fearful, Vulnerable-Fearful, and Fragile-Fearful. Participants in the Resourceful-Fearful and Vulnerable-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Vulnerable-Fearful and Fragile-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Fragile-Fearful cluster were more likely to be multiparous, report that their pregnancy was not normal, and prefer cesarean birth than those in the Resourceful-Robust cluster.

Conclusions: Women with childbirth fear may be vulnerable to anxiety and depression during the perinatal period, although the severity might vary. Self-efficacy might be a mediator against mental health problems. Findings demonstrated levels of severity, and the one-size-fits-all approach in Swedish health care may benefit from a more targeted approach for women with fear of childbirth.

Background: Previously developed instruments measuring the quality of postnatal care, based on women’s experiences and views, are mainly country-specific which makes it important to have studies for specific populations. The aim of this study was to explore validity and reliability evidence of a previously developed postnatal questionnaire for women living in Sweden.

Method: A cross-sectional study based on self-report questionnaire. The questionnaire included the Early Postnatal Questionnaire (EPQ), and was administered to 1061 women who gave birth in two regional hospitals in Swedish during 2017. Validity evidence of the EPQ was undertaken using principal component analysis. Regarding reliability, Cronbach’s alpha was used.

Results: The questionnaire was returned by 483 postnatal women. The analysis resulted in three components: Information, Postnatal Environment and Caring Relationship. The Cronbach alpha values of the components ranged from 0.762 to 0.879. Foreign-born women scored higher (more positively) in all three components, compared to women born in Sweden.

Conclusions: The results of this study suggest that the instrument EPQ is a psychometrically useful tool, suitable for both research and clinical settings. The three-component structure provides researchers with the opportunity to conduct a more detailed exploration of various aspects of postnatal care to develop postnatal care. Further studies focusing on foreign-born women’s experiences of postnatal care are warranted.

Background: Previous research indicates disparities in the care of bereaved parents and siblings following a stillbirth in the family. The aim of this systematic review was to assess the effects of interventions aimed at reducing psychological distress among parents or siblings in high-income countries after experiencing a stillbirth.

Methods: The databases CINAHL, Medline, PsycInfo, Cochrane Library, and EMBASE were searched in August 2022.

Results: Four intervention studies from the United States (US), the United Kingdom (UK), Finland, and Australia, met the inclusion criteria. The interventions comprised a perinatal grief support team; a perinatal counselling service; a grief support program; and a support package including contacts with peer supporters and health care staff. No studies of interventions for siblings were found. The results could not be synthesised due to disparities in interventions and outcome measures. The risk of bias was assessed as high in all four studies and the certainty for all outcomes was rated as very low.

Conclusion: More controlled trials with rigorous methods are needed to evaluate the effect of bereavement support interventions in parents and siblings after stillbirth. Future studies should include a core outcome set to make them more comparable. Most of the studies in this review were assessed to have an overall high risk of bias, mainly due to problems with missing outcome data; thus, future studies could specifically target this problem.

INTRODUCTION Although high-quality postnatal care provides information and recognizes women's personal and cultural contexts, foreign-born women are more exposed to poor health and adverse birth outcomes. The aim of this study was to compare the length and model of postnatal care, along with the content of care, between foreign-born and native-born women living in Sweden. Another aim was to explore factors associated with being very satisfied with various aspects of postnatal care.

METHODS This was a descriptive cross-sectional study of 483 postnatal women in two Swedish hospitals in 2017. Women completed a questionnaire comprising background data, pregnancy and birth related variables and the Early Postnatal Questionnaire. Data were analyzed using descriptive statistics, analysis of variance and multivariate logistic regression analyses.

RESULTS Foreign-born women were more likely to have a shorter (<24 h) or longer (>48 h) length of postnatal stay than women born in Sweden. No differences in birth outcomes emerged between the two groups. Foreign-born women rated the medical (OR=1.77; 95% CI: 1.04–3.03) and emotional (OR=2.0; 95% CI: 1.17–3.40) aspects of postnatal care as being more important than Swedish-born women did. The most important aspect of overall satisfaction was the content of care, and the subscale Caring Relationship (AOR=8.15; 95% CI: 4.87–14.62) outscored all other aspects.

CONCLUSIONS Important factors of satisfactory experiences with postnatal care in a Swedish context were receiving information, professional care, and a hospital environment that facilitates recovery after labor and birth. Culturally sensitive and individualized postnatal care with continuity should therefore be prioritized.