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  • 1.
    Christianson, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Essén, Birgitta
    'Let men into the pregnancy': men's perceptions about being tested for Chlamydia and HIV during pregnancy2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 4, p. 351-358Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate how to prevent transmission of HIV and Chlamydia trachomatis (CT) by exploring whether screening of men during pregnancy may be an innovative way to reach men, to increase detection, and to avoid the present gendered responsibility.

    DESIGN: An explorative research strategy with in-depth interviews and an analysis informed by grounded theory principles was used.

    SETTING: The northern part of Sweden.

    PARTICIPANTS: Twenty men/becoming fathers in their twenties and early thirties were offered CT and HIV testing and were interviewed about their perceptions about being tested during pregnancy.

    FINDINGS: Six categories emerged that concerned the men's risk perceptions, reasons for not testing men, benefits and negative consequences associated with being tested, incentive measures for reaching men and the optional time for testing men during pregnancy. The majority of the men perceived their own risk for having CT or HIV to be close to zero, trusted their stable partner, and did not see men as transmitters. They did not understand how men could play a role in CT or HIV transmission or how these infections could negatively affect the child. However, few informants could see any logical reasons for excluding men from testing and the majority was positive towards screening men during the pregnancy.

    KEY CONCLUSIONS: Men's sexual health and behaviour on social and biological grounds will affect the health of women and their children during pregnancy and childbirth. As long as expectant fathers do not count in this 'triad', there is a risk that CT and HIV infections in adults and infants will continue to be an unsolved problem.

    IMPLICATIONS FOR PRACTICE: Knowledge from this research can contribute to influencing the attitudes among health-care providers positively, and inspiring policy changes.

  • 2.
    D'Ambruoso, Lucia
    et al.
    Immpact, University of Aberdeen, UK.
    Achadi, Endang
    Adisasmita, Asri
    Izati, Yulia
    Makowiecka, Krystyna
    Hussein, Julia
    Assessing quality of care provided by Indonesian village midwives with a confidential enquiry2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 5, p. 528-539Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to conduct a confidential enquiry to assess the quality of care provided by Indonesian village midwives and to identify opportunities for improvement.

    METHODS: local health-care practitioners assessed village-based care in obstetric emergencies in 13 cases of maternal death and near-miss from rural villages in West Java. The study focused on clinical quality of care, but also investigated the influence of the health system and social factors. The reviews were based on transcripts of interviews with health-care providers, family and community members involved in the cases. Both favourable and adverse factors were identified in order to recognise positive contributions, where they occurred. At the end of a series of case reviews, recommendations for practice were generated and disseminated.

    FINDINGS: in the cases reviewed, midwives facilitated referral effectively, reducing delays in reaching health facilities. Midwives' emergency diagnostic skills were accurate but they were less capable in the clinical management of complications. Coverage was poor; in some locations, midwives were responsible for up to five villages. Village midwives were also perceived as unacceptable to women and their families. Families and communities did not prepare for emergencies with finances or transport, partly due to a poorly understood health insurance system. The enquiry had learning effects for those involved.

    KEY CONCLUSIONS: village midwives should: receive appropriate support for the management of obstetric emergencies; engage with communities to promote birth preparedness; and work in partnership with formal and informal providers in the community. The enquiry was a diagnostic tool to identify opportunities for improving care. Practitioners had a unique insight into factors that contribute to quality care and how feasible interventions might be made.

  • 3.
    Edin, Kerstin
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Violence against pregnant women will remain hidden as long as no direct questions are asked.2002In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 18, no 4, p. 268-278Article in journal (Refereed)
  • 4.
    Ellberg, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umeå University, Faculty of Medicine, Department of Nursing.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lindh, Viveca
    Umeå University, Faculty of Medicine, Department of Nursing.
    “We feel like one, they see us as two”: new parents' discontent with postnatal care2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 4, p. 463-468Article in journal (Refereed)
    Abstract [en]

    Objective postnatal care has gone through remarkable changes, such as reducing the length of hospital stay and increasing the parents’ responsibility. Focusing on dissatisfaction, this study describes how new parents experience postpartum care.

    Design cross-sectional, population-based study, based on questionnaires.

    Participants 1474 parents.

    Measurements and findings the questionnaires, posted six months after childbirth, addressed how parents experienced postnatal care. The data were analysed with descriptive statistics and content analysis.

    Key conclusions a main finding was that the close emotional attachment between the parents was not always supported by staff. The father was treated as an outsider and the care was described as ‘a woman's world’. The asymmetric encounter between parents and staff was pronounced with respect to decision-making, and some designated this as ‘paternalism’. A great deal of the discontent with health care may be due to organisational failure, and the postnatal care should be more prioritised in the health-care organisation.

    Implications for practice midwives should acknowledge that parents, irrespective of gender, should have equal opportunities as parents during postpartum care as parenting is a joint project.

  • 5.
    Eriksson, Carola
    et al.
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Jansson, Lilian
    Umeå University, Faculty of Medicine, Nursing.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
    Women's experiences of intense fear related to childbirth investigated in a Swedish qualitative study.2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 3, p. 240-248Article in journal (Refereed)
  • 6. Everett-Murphy, Katherine
    et al.
    Paijmans, Jeske
    Steyn, Krisela
    Matthews, Catherine
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Peterson, Zaino
    Scolders, carers or friends: South African midwives' contrasting styles of communication when discussing smoking cessation with pregnant women2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 27, no 4, p. 517-524Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to investigate how midwives are currently communicating with women about smoking during pregnancy with a view to involving them in a smoking cessation intervention in antenatal clinics.

    DESIGN: a qualitative study using individual, in-depth interviews for data collection.

    SETTING AND PARTICIPANTS: 24 nurses providing antenatal care to pregnant smokers attending public sector clinics in five major cities in South Africa.

    FINDINGS: three archetypes of midwives, characterised by different styles of communication and approaches to smoking cessation, emerged from the analysis of the interview data. These were described as the 'Angry Scolders', the 'Benign Carers' and the 'Enthusiastic Friends'. The first type conformed to the traditional, authoritarian style of communication, where the midwife assumed a dominant, expert role. When women failed to comply with their advice, these midwives typically became angry and confrontational. The second type of midwife used a paternalistic communication style and emphasised the role of education in changing behaviour. However, these midwives had little confidence that they could influence women to quit. The third type embraced a patient-centred approach, consciously encouraging more interaction with their patients and attempting to understand change from their point of view. These midwives were optimistic of women's capacity to change and more satisfied with their current health education efforts than the first two types. The Benign Carers and Enthusiastic Friends were more open to participation in the potential intervention than the Angry Scolders.

    KEY CONCLUSIONS: the prevailing traditional, authoritarian style of communication is inappropriate for smoking cessation education and counselling as it provokes resistance and avoidance on the part of pregnant smokers. The paternalistic approach appears to be largely ineffectual, whereas the patient-centred approach elicits the most positive response from pregnant women and enhances the possibility of a trusting and cooperative relationship with the midwife. Midwives using this style are more open to fulfilling their role in smoking cessation.

    IMPLICATIONS FOR PRACTICE: smoking cessation interventions need to attend to not only what midwives say to pregnant women about smoking, but also how they communicate about the issue. The use of a patient-centred approach, such as brief motivational interviewing, is recommended as a means of improving counselling outcomes among pregnant smokers.

  • 7.
    Kasenga, Fyson
    et al.
    Malamulo Seventh Day Adventist Hospital, Makwasa, Malawi.
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    HIV-positive women's experiences of a PMTCT programme in rural Malawi2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 1, p. 27-37Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore women's experiences of a prevention of mother-to-child transmission (PMTCT) programme in rural Malawi. DESIGN, SETTING AND PARTICIPANTS: an exploratory, qualitative study using in-depth interviews with 24 purposively selected women infected with human immunodeficiency virus (HIV). The women were in three groups of eight: (1) those who delivered at the hospital and took nevirapine (NVP) before birth and whose babies received NVP within 72 hours of birth; (2) those who birthed at home and took NVP before birth but their babies never received NVP; and (3) those who birthed at home and did not take NVP and whose babies did not receive NVP. Data were analysed using content analysis. FINDINGS: four themes emerged: (1) 'a wish to confirm and protect' refers to women's decisions to take the HIV test, (2) 'a revelation for action' is an illustration of how the testing may be part of an empowering process, (3) 'a dilemma between silence and openness' points to the dilemma that women are facing in their decision to share or not to share their HIV status with spouse, family, friends and community, and (4) 'a desire challenged by circumstances, chance and tradition' refers to the circumstances and actions which prevent these women from actually delivering at the hospital to protect their babies from HIV infection. CONCLUSIONS: the PMTCT programme influences women's lives profoundly, and the importance of quality counselling and strengthening male involvement is stressed as the programme is implemented by an increasing number of service providers.

  • 8.
    Lindqvist, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Persson, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nilsson, Margareta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynecology.
    Uustal, Eva
    Lindberg, Inger
    'A worse nightmare than expected' - a Swedish qualitative study of women's experiences two months after obstetric anal sphincter muscle injury2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 61, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Objective: this study explores women's experiences of the first two months after obstetric anal sphincter injury ( OASIS) during childbirth with a focus on problematic recovery. Methods: this qualitative study used inductive qualitative content analysis to investigate open-ended responses from 1248 women. The data consists of short and comprehensive written responses to open-ended questions focusing on recovery in the national quality register, the Perineal Laceration Register, two months after OASIS at childbirth. Results: the theme 'A worse nightmare than expected' illustrated women's experiences of their life situation. Pain was a constant reminder of the trauma, and the women had to face physical and psychological limitations as well as crushed expectations of family life. Furthermore, navigating healthcare services for help added further stress to an already stressful situation. Conclusions: we found that women with problematic recovery two months after OASIS experienced their situation as a worse nightmare than expected. Extensive pain resulted in physical and psychological limitations, and crushed expectations of family life. Improved patient information for women with OASIS regarding pain, psychological and personal aspects, sexual function, and subsequent pregnancy delivery is needed. Also, there is a need for clear organizational structures and information to guide help-seeking women to needed care.

  • 9. Manithip, Chanthanom
    et al.
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sihavong, Amphoy
    Wahlström, Rolf
    Wessel, Hans
    Poor quality of antenatal care services: is lack of competence and support the reason? An observational and interview study in rural areas of Lao PDR2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 3, p. 195-202Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to explore the health-care providers' performance and their own perceptions of the ANC services they provide. DESIGN, SETTING AND PARTICIPANTS: this cross-sectional exploratory survey was carried out in 2009 at four district hospitals and 18 health centres in Khammouane and Champasack provinces in rural areas of Laos. MEASUREMENTS AND FINDINGS: combinations of quantitative and qualitative methods were used: (i) 59 observations of ANC sessions (components performed and equipment used); (ii) 26 semi-structured interviews with health-care providers engaged in ANC services, interpreted through content analysis. The findings indicated an overall poor quality and performance of ANC services in rural health facilities with lack of routines, scarce or insufficient equipment and limited skills among providers. The health-care providers gave an often pessimistic picture of their competence and motivation to work with ANC. Some articulated a resignation due to lack of feedback from the patients and they expressed a need for support from health-care superiors. Compared to the district hospitals, the health centres were less well-equipped and supplied, and the providers had a heavier workload, because all activities including ANC were carried out by the same provider. The average consultation time for each woman was 5mins. CONCLUSIONS: the quality of ANC services in rural health facilities in Laos was poor due to lack of resources, the providers' limited skills concurrent with inadequate routines and insufficient backup from superiors. IMPLICATIONS FOR PRACTICE: to comply with national and international recommendations for ANC services, our suggestion is to improve the quality of the rural health facilities in Laos by providing basic equipment, support from experienced superiors and in-service training.

  • 10.
    Nystedt, Astrid
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Some Swedish women's experiences of prolonged labour.2006In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 1, p. 56-65Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to elucidate women's experiences of prolonged labour. DESIGN: qualitative research interviews were conducted and thematic content analysis was applied. PARTICIPANTS: 10 primiparae who, 1-3 months previously, had a prolonged labour with assisted vaginal or caesarean delivery. FINDINGS: the narratives about giving birth were interpreted and formulated into three themes and six sub-themes. The first theme, 'being caught up in labour', described the sense of not making progress during labour. The second theme was 'being out of control', and was related to the women's insufficient control of their own bodily processes, and consisted of descriptions of exhaustion and powerlessness. The third theme was 'being dependent on others', and described the women's dependence on care and on the support of the caregivers, and included descriptions of caregivers' assistance with birth as an experience of being relieved from pain and distress. KEY CONCLUSIONS: the experience of giving birth was not the experience of a healthy woman in labour, but one of severe labour pains that seemed to go on forever. The experience of prolonged labour could be understood as an experience of suddenly falling ill or finding oneself in a life-threatening condition associated with intractable pain, dependence on others and an overwhelming fear of losing oneself. IMPLICATIONS FOR PRACTICE: women with prolonged labour are more dependent on their caregivers than are women without prolonged labour. They have a special need for extra support and encouragement during the delivery as well as increased nursing and midwifery care.

  • 11.
    Petersen, Zainonisa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Everett, Katherine
    Medical Research Council of South Africa, P.O. Box 19070, Tygerberg 7505, Cape Town, South Africa.
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 4, p. 382-391Article in journal (Refereed)
    Abstract [en]
    Objective

    to explore barriers to and possibilities for interactive communication between midwives and pregnant women regarding smoking behaviour during pregnancy.

    Design

    the study was based on a qualitative research design aiming at a Grounded Theory analysis of interviews with pregnant women.

    Setting

    public sector antenatal clinics in Cape Town, South Africa predominantly providing care to women of mixed ancestry.

    Informants

    in-depth interviews with 12 pregnant women purposively selected on the basis of smoking behaviour, age and marital status to reach maximum variation.

    Findings

    the findings indicated low levels of transparency and trust in antenatal visits. Lack of trust was related to categories such as conflicting personal capabilities and socio-cultural and medical expectations, combined with a didactic approach from caregivers. The unworthy woman was identified as the core category of the interviews describing how women feel in their relationship with midwives. A theoretical model illustrates possibilities for change in relation to an ideal situation where a supportive caregiver, congruent expectations and capabilities result in women feeling visible.

    Key conclusions and implications for practice

    culturally appropriate smoking cessation interventions should be of high priority. Training in patient-centred counselling for midwives is necessary for creating an open dialogue with pregnant mothers about their smoking habits. The time constraint experienced by midwives also suggests that other methods apart from midwife counselling should be investigated for inclusion in the clinical setting.

  • 12.
    Petersen, Zainonisa
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nilsson, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Steyn, Krisela
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Identifying with a process of change: a qualitative assessment of the components included in a smoking cessation intervention at antenatal clinics in South Africa2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 7, p. 751-758Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: previous research has suggested that pregnant women prefer a person-centred approach for smoking cessation interventions. However few studies have illustrated the mechanism through which such an approach has an influence on quitting or reduction rates among pregnant women in resource poor settings. PURPOSE: to explore the role of different components included in a smoking cessation intervention delivered to disadvantaged pregnant women with high smoking rates attending public health antenatal clinics in South Africa. METHODS: a qualitative design consisting of focus-group discussion with women exposed to the intervention was used. Women were purposively selected from four antenatal clinics and one tertiary hospital to represent different experiences of the intervention. Focus group discussions with four groups of smokers and four groups of quitters were conducted and a total of 41 women were interviewed. Data were analysed using content analysis. MAIN FINDINGS: the main theme describing the intervention effect that emerged from the interviews was, 'Making identification with change possible'. The categories 'An impulse for change', 'An achievable recipe', 'A physical reminder' and 'A compassionate companion' further described how each intervention component was perceived by women and how it contributed to behaviour change. CONCLUSIONS: behaviour change interventions that are directly informed by the target population with regards to its design, content and delivery offer great opportunities for positive behaviour change. Women positively evaluated all the components employed in this intervention but rated the social support they received from peer-counsellors as the overriding aspect of the intervention.

  • 13.
    Sandström, Marianne
    et al.
    Private Practice, Umeå Utveckling AB, Sweden.
    Wiberg, Britt
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Wikman, Marianne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Willman, Anna-Klara
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    A pilot study of eye movement desensitisation and reprocessing treatment (EMDR) for post-traumatic stress after childbirth2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 1, p. 62-73Article in journal (Refereed)
    Abstract [en]

    Objective: to explore the possibility of using eye movement desensitisation and reprocessing (EMDR) to treat women who have experienced post-traumatic stress after childbirth.

    Design: the pilot study consisted of a ‘before and after’ treatment design combined with follow-up measurements 1–3 years after EMDR treatment. Quantitative data from questionnaires (Traumatic Event Scale [TES]) were collected. In addition, qualitative data from individual interviews with the participants were collected as well as data from the psychotherapist's treatment notes of the EMDR treatment sessions.

    Setting: the north of Sweden.

    Participants: four women with post-traumatic stress disorder (PTSD) after childbirth (one pregnant and three non-pregnant).

    Findings: all participants reported reduction of post-traumatic stress after treatment. After 1–3 years, the beneficial effects of EMDR treatment remained for three of the four women. Symptoms of intrusive thoughts and avoidance seemed most sensitive for treatment.

    Implications for practice: EMDR might be a useful tool in the treatment of non-pregnant women severely traumatised by childbirth; however, further research is required.

  • 14.
    Wennberg, Anna Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundqvist, Anette
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Högberg, Ulf
    Uppsala Univ, Dept Womens & Childrens Hlth Obstet & Gynecol, SE-75105 Uppsala, Sweden.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Hamberg, Katarina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Women's experiences of dietary advice and dietary changesduring pregnancy2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 9, p. 1027-1034Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe women's experiences of dietary information and the change of dietary habits during pregnancy. DESIGN: a qualitative design was used. In 2007 we conducted six focus group interviews using open-ended questions. SETTINGS: five rural and city antenatal clinics in northern Sweden were included PARTICIPANTS: twenty-three women in mid-pregnancy participated in groups of three to seven FINDINGS: three domains were found 'Dietary information gain', 'Reactions to dietary information' and 'Dietary management'. The women had to discover dietary information by themselves, and only when health problems or symptoms occurred did they receive guidance from the midwife. Their reactions to the dietary information were 'being confused', 'feeling fear and guilt' and 'being monitored', summed up in 'being uncertain'. The diet was managed by 'checking food content', 'following bodily signals', 'using common sense', and 'making exceptions', summed up as 'being responsible but with a pinch of salt'. KEY CONCLUSIONS: the women expressed problems with dietary changes, but they could mostly manage them on their own. The pregnant women experienced that the midwives gave dietary information and advice first when problems arise. When struggling with diet, the women experienced confusion, and they had to seek information by themselves. IMPLICATIONS FOR PRACTICE: sources of information about diet during pregnancy were experienced as inconsistent and contradictory. Midwives are important in motivation for healthy lifestyle during pregnancy and with sufficient dietary knowledge and counselling skills they can help pregnant women effect dietary changes by providing guidance and support in early pregnancy.

  • 15.
    Westergren, Agneta
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. The Graduate School of Gender Studies, Umeå University, Umeå, Sweden.
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Walsh, Denis
    Christianson, Monica
    Umeå University, Faculty of Medicine, Department of Nursing.
    Autonomous and dependent–The dichotomy of birth: a feminist analysis of birth plans in Sweden2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 68, p. 56-64Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To elicit pregnant women's perceptions of childbirth as expressed in their birth plans, and through a feminist lens analyse their wishes, fears, values, and beliefs about childbirth, as well as their expectations on partner and midwife.

    DESIGN: This study used qualitative content analysis, identifying subcategories, categories, and an overall theme in data gathered from women's written birth plans. A feminist theoretical framework underpinned the research.

    SETTING: A middle-sized city in northern Sweden.

    PARTICIPANTS: 132 women who gave birth in an obstetrician-led hospital labour ward between March and June 2016 and consented to grant access to their birth plans and antenatal and intrapartum electronic medical records.

    FINDINGS: Three categories emerged: 'Keeping integrity intact through specific requests and continuous dialogue with the midwife', 'A preference towards a midwife-supported birth regardless of method of pain relief", and '"Help my partner help me" - Women anticipating partner involvement.' The overall theme linking the categories together was: 'Autonomous and dependent - The dichotomy of birth', portraying women's ambiguity before birth -expressing a wish to remain in control while simultaneously letting go of control by entrusting partner and midwifewith decision-making regarding their own bodies.

    KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women primarily desired a natural, midwife-supported birth and favoured a relationship-based, woman-centred model of care, based on the close interaction between woman, partner, and midwife. Midwives need to be aware of women's ambiguous reliance on them and the power they have to influence women's birth choices and birth experiences. Feminist theory and values in midwifery practice may be useful to inspire a maternity care based on women's wishes and expectations, acknowledging and valuing women's voices, and embracing the sanctity of birth and of the birthing woman's body.

  • 16.
    Wiklund, H
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Aden, A S
    Högberg, U
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Wikman, M
    Dahlgren, L
    Somalis giving birth in Sweden: a challenge to culture and gender specific values and behaviours.2000In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 16, no 2, p. 105-15Article in journal (Refereed)
    Abstract [en]

    The Somalis' experiences of childbirth in Sweden can be understood by using the theoretical concept of gender, rather than culture. Our own and other studies show that women and men may have different frames of reference in childbirth, where the women mainly focus on biological circumstances and the men on the social and cultural aspects of birth. The Somali couple were found to be vulnerably positioned, with the professionals having the important role of supporting and empowering Somali parents.

  • 17. Wilson, Ingrid M.
    et al.
    Eurenius, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Edin, Kerstin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Edvardsson, Kristina
    Is there an association between pregnant women's experience of violence and their partner's drinking?: A Swedish population-based study2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 84-91Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Pregnancy is a time of heightened vulnerability for women, especially for experiencing violence in their close and intimate relationships. Alcohol misuse by a male intimate partner is a known contributor to increased risk and severity of intimate partner violence generally, however less is known about the relationship between partner drinking patterns and women's experience of violence in their relationship, and particularly in early pregnancy. This study aimed to explore these associations in a large, population-based sample of Swedish expectant parents.

    DESIGN, SETTING AND PARTICIPANTS: Data for this cross-sectional study were drawn from 11 461 couples (22 922 participants) enrolled in Salut, a child health promotion programme in Västerbotten County Council, Sweden. Data were collected at women's antenatal care visits during the first trimester of pregnancy.

    MEASUREMENTS: Questionnaires included male partners' self-reported drinking patterns using AUDIT (Alcohol Use Disorders Identification Test) and pregnant women's reports of violence. Descriptive and logistic regression analyses were undertaken to examine prevalence of reported violence and association with partner drinking patterns.

    FINDINGS: There was a strong association between male partner alcohol misuse and the odds of pregnant women experiencing violence in general, experiencing violence since becoming pregnant, and fear for their own safety at the time of enrolment in ANC. The odds of having experienced being controlled or physically hurt in a relationship, or having ever experienced sexual violence, were higher with more serious alcohol misuse by the male partner. Most striking was that women whose partners reported hazardous drinking or alcohol dependence had nearly nine times higher odds of experiencing being physically hurt by a partner since becoming pregnant, compared to women whose partners reported non-harmful alcohol use (OR 8.50, CI 2.39-30.17, p = 0.001). Fearing for current safety was also strongly linked to more severe alcohol use by their current male partner (OR 7.65, CI 1.02-57.24, p = 0.048).

    KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study contributes population-level evidence that the risk for women of experiencing violence in general or in early pregnancy is exacerbated when a male partner drinks in harmful ways. Health professionals and those supporting pregnant women should pay attention to the role of risk factors such as partner alcohol use. Ensuring the health of pregnant women and safety in their relationships is important for maternal, foetal and infant health and family functioning.

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