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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.

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.