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Introduction: Severe perineal trauma (SPT), defined as third- or fourth-degree lacerations during childbirth, is a known risk factor for adverse postpartum health-related quality of life (HRQoL). Although HRQoL may improve within six months postpartum, up to 30% of affected women in Sweden report long-term health problems beyond one year. While qualitative studies highlight the broad negative impact, quantitative findings remain inconclusive, particularly regarding the role of pelvic floor symptoms and the degree of SPT, underscoring the need for further research. The aim is to assess and compare HRQoL in a sample of women with SPT, and to identify predictors of physical and mental health at least 18 months postpartum.

Methods: A nationwide cross-sectional study was conducted in Sweden using an online questionnaire to assess HRQoL via the validated RAND-36 instrument. Linear regression analysis was employed to explore associations.

Results: Two hundred and twenty-one women with SPT and varying symptom bother from SPT, at least 18 months after the childbirth, responded. The study population exhibited worse-than-average RAND-36 scores across most dimensions (apart from physical functioning and pain) compared to normative data for women in Sweden. Further, the mean physical health score was significantly lower in our study sample (M = 70.7, SD = 22.1) compared to the reference population of women in Sweden (M = 73.63, SD = 29.45), t [df (degrees of freedom) 220] = −1.99, p = 0.047, Cohen's d = 0.13. The mean mental health score was significantly lower in our study sample (M = 63.2, SD = 21.4) compared to normative Swedish women (M = 71.7, SD = 27.15), t (df 220) = −5.90, p < 0.001, Cohen's d = 0.40. Health change over the past year remained relatively static with a slight trend towards improvement (mean 54.5; SD 21.6; CI 95% 51.6–57.4). Physical health was predicted by the extent of symptom bother, perceived work ability, educational attainment, and level of physical activity. Mental health was predicted by age, extent of symptom bother, and perceived work ability.

Conclusions: These findings underscore the need for individualized, multidisciplinary care strategies that address both physical and psychological dimensions of recovery after sustaining SPT at childbirth. Future research should investigate the barriers and facilitators influencing HRQoL, to enhance HRQoL and support the reintegration of women with SPT into their social and professional spheres. A deeper understanding of the socioeconomic and occupational contexts of affected women is essential to promote more equitable health outcomes.

Objective: Existing literature offers fragmented insights into working life following severe perineal trauma (SPT), suggesting positive and negative implications. No research has systematically examined work ability or potential risk factors associated with impaired work ability. This study assessed and compared work ability among women with SPT more than 18 months postpartum and identified potential risk factors for impaired work ability.

Methods: An exploratory cross-sectional pilot study was conducted in Sweden. Participants were recruited via digital platforms (n = 197) and included women who sustained SPT during childbirth more than 18 months before data collection. Data were collected via an online questionnaire and analysed using multivariable logistic regression.

Results: Nearly one-third of participants reported impaired work ability. Absence of reconstructive surgery, increased life impact of pelvic floor disorders, and history of sick leave in adult life were identified as risk factors for impaired work ability.

Conclusions: The complexity of health problems following SPT may affect women’s ability to work. Given the exploratory nature and limited sample size of this pilot study, larger longitudinal studies – using national registers or multicentre recruitment – are needed to confirm the observed associations and deepen understanding of the multifaceted consequences of health problems following SPT.

BACKGROUND: During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred.

METHODS: In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis.

RESULTS: Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered.

CONCLUSIONS: Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare.

Background: In Sweden, persistent physical and psychological health problems occur in about three in ten women who sustain severe perineal trauma (SPT) during childbirth. As most Swedish women work outside the home, the question of if and how SPT-related morbidity influences working life needs exploration. This study aims to qualitatively explore how women with persistent SPT-related morbidities experience and conceptualise their problems concerning working life. Further, we theorise the findings by applying Simone de Beauvoir’s feminist framework of immanence and transcendence as well as authentic and inauthentic life.

Methods: Ten interviews with women recruited via a Swedish social media community for perineal trauma were analysed according to Charmaz’s constructivist approach to grounded theory.

Results: The theoretical model and related core category ‘Negotiating the ambiguity of an (in)authentic working life’ reflected the women’s negotiations of immanence as ‘the silent covert object’ versus transcendence as the ‘the resourceful overt subject’. The model also mirrored the conflict of (in)authenticity in working life. An inauthentic working life was experienced when women were denied their subjectivity at work or constructed themselves as subjects in denial of their SPT. On the other hand, women who acknowledged their SPT and were constructed as subjects by ‘others’ achieved an authentic working life despite SPT.

Conclusions: The conflicting gendered process of ‘the silent covert object’ versus ‘the resourceful overt subject’ problematised women’s vulnerability at work. Aspects that enable subjectification and transcendence are essential for policymakers, employers, healthcare services, and society to eradicate the taboo of SPT and create a working environment characterised by understanding, support, and flexibility. Further, access to adequate care, sick leave, and occupational rehabilitation are essential. Such measures support transcendence towards an authentic working life and, consequently, a more gender-equal working environment that does not deprive women of career opportunities due to a physical ailment.

Objective: Policy documents govern how the prevention and care of obstetric anal sphincter injuries (OASIS) are implemented. Thus, in the absence of Swedish national guidelines on OASIS, differing views may be visible in the regional and local policy documents. Therefore, we aimed to analyse regional and local policies, guidelines, and care programs on the prevention of OASIS and care for OASIS-affected women in a Swedish context by applying a critical frame analysis inspired by Verloo.

Design and setting: A cross-sectional study of existing policy documents from Swedish healthcare regions was performed. The documents were analysed using Verloo's critical frame analysis.

Findings: We found that OASIS was framed as a preventable problem addressed by skilled protective manoeuvres of the healthcare staff. Education, communication, and teamwork were three frames of crucial solutions to minimise the prevalence of OASIS. However, complicating power dimensions between professional groups and between professionals and birthing women were identified. Furthermore, several discursive struggles were found, predominantly regarding the scientific evidence for the suggested prevention and care.

Conclusion: The policy documents emphasised that OASIS is preventable, and improved education, communication, and teamwork could diminish the OASIS prevalence. Nevertheless, power dimensions and discursive struggles may challenge the preventive efforts. Furthermore, each Swedish region has the sovereignty to develop its policies, which was reflected in our findings and may imply inequities in care provision. Thus, there is an urgent need to develop comprehensive national high-quality guidelines of high quality for OASIS prevention and care so that all women giving birth have access to equal care and treatment in Sweden.

Background: Agile projects are statistically more likely to succeed then waterfall projects. The overall aim of this study was to explore the nursing staffs’ experiences with an agile development process, from its initial requirements to the deployment of its outcome of ICT solutions aimed at supporting discharge planning.

Methods: An explorative design with quantitative and qualitative methods was used. Qualitative data was collected through seven focus group interviews. Quantitative data was collected via an ICT-system, and with an evaluation form submitted by fourteen registered nurses and nine district nurses.

Results: Qualitative result of the experiences with the agile development process and its outcome resulted in one theme, four categories, and ten subcategories. The theme was found to be about time and timing, namely the amount of time for the different activities and the timing of activities within and between organisations. The agile development process increased the participants’ readiness for change by offering time to learn, practice, engage and reflect, and then adopt the ICT as a support to daily practice. Quantitative results showed a variated adoption of the ICT.

Conclusion: There is a need for time to prepare, understand and adopt new tools, services and procedures and a need for additional time to prepare, understand and adopt the new among individuals, collectives, organizations, and sometimes even between different collectives or organizations. The agile development process offered the end-users involvement through the development process, which gave them time to change it both individually and collectively. However, there is a need for close collaboration between the development project team and management to reach an organizational change that is timely for both the individual and the collective change. When time or timing fails in the development or implementation process, there is a huge risk of non-adoption of new tools, services, or procedures or among the end-users.

OBJECTIVE: This study explores women's experience of having a second degree perineal tear and related consequences to daily life during the first eight weeks after childbirth.

METHOD: Written responses to open-ended questions in a questionnaire distributed about eight weeks postpartum and completed by 1,007 women with second degree perineal tears were excerpted from the national quality register, Perineal Laceration Register. Inductive qualitative content analysis was applied to the data.

RESULT: The theme Taken by surprise illustrates women's experience of the first two months after having a second degree perineal tear at childbirth. Women were not prepared for the inconveniences and expressed concerns about their bodies. Further, they expressed distress about their physical and psychological recovery as well as how to return to a pre-childbirth condition.

CONCLUSIONS: Although many women recovered fairly well the first months after a second degree perineal tear at childbirth, it was evident that a substantial number of women were unprepared for the pain and discomfort they experienced. It is apparent that also women with the "minor" perineal tears at childbirth need improved postpartum care with tailored analgesia and improved information, but also check-ups and reassurance of recovery from healthcare professionals. Health care professionals need to identify women with persisting problems so that they can be referred to inpatient care for additional assessments of the injury.

Objective: This study aimed to explore women’s experiences related to recovery from obstetric anal sphincter muscle injuries (OASIS) one year after childbirth.

Method: This is a qualitative study based on written responses from 625 women approximately one year after childbirth in which OASIS occurred. Data was obtained from a questionnaire distributed by the national Perineal LacerationRegister (PLR) in Sweden. Inductive qualitative content analysis was applied for analysis.

Results: The theme “Struggling to settle with a damaged body” indicated that the first year after OASIS involved a struggle to settle to and accept living with a changed and sometimes still-wounded body. Many participants described problems related to a non-functional sexual life, physical and psychological problems that left them feeling used and broken, and increased worries for their future health and pregnancies. However, some women had adjusted to their situation, had moved on with their lives, and felt recovered and strong. Encountering a supportive and helpful health care professional was emphasized as vital for recovery after OASIS.

Conclusion: This study provides important insights on how women experience their recovery approximately one year after having had OASIS at childbirth, wherein many women still struggled to settle into their damaged bodies. Clear pathways are needed within health care organizations to appropriate health care services that address both physical and psychological health problems of women with prolonged recovery after OASIS.