Supporting young women with menstrual pain – Experiences of midwives working at youth clinics

BackgroundMenstrual pain is relatively common among young girls. Many girls turn to youth clinics when seeking care for menstrual problems.ObjectiveThe objective of the study was to describe midwives’ experiences of supporting girls with menstrual pain.MethodsThis is a qualitative study with an inductive approach. Semi-structured interviews were conducted with 15 midwives working at Swedish youth clinics. Interviews were held in September 2021. The recordings were transcribed and analyzed using thematic analysis.ResultsTwo main themes, consisting of three subthemes each, emerged: Guiding and educating young women about menstrual pain and Striving toward pain relief. It was important to the midwives to increase young women’s knowledge of menstrual pain and coping strategies, and to guide them in finding a method for menstrual pain relief. Hormonal contraceptives were often a natural choice and an effective method for pain relief, although the midwives occasionally faced resistance from young women or their mothers when recommending this. The midwives also referred to a gynecologist if needed.ConclusionThe results highlight that midwives working at youth clinics have an important role in the care of young women with menstrual pain. The midwives found it important to increase young women’s knowledge about menstrual pain and coping strategies, since they had noticed knowledge gaps in these areas. The results suggest a need to improve education about menstrual pain and coping strategies for young women, preferably in school and in cooperation with healthcare professionals.     

Midwives’ experiences of providing contraception counselling to immigrant women

ObjectiveTo describe midwives’ experiences of providing contraception counselling to immigrant women.MethodsThe study was conducted with a qualitative design, based on interviews followed by inductive content analysis. Ten midwives were interviewed, working at midwife-led prenatal clinics in immigrant-dense areas in southern Sweden.ResultsMidwives require knowledge and understanding of cultures and religions in order to provide contraception counselling to immigrant women. It is important for the midwives to be aware that women have different values regarding sexual and reproductive health. The challenge for the midwives is to understand and to be curious about every woman’s lifeworld perspective, culture and religion. The midwives knowledge and understanding of cultures and religions is acquired through experience and shared between them. Knowledge makes a midwife confident in her role as the contraception counselling provider to immigrant women.ConclusionCultural and religious factors affect contraception counselling. According to the midwives, knowledge and awareness of these factors is crucial and leads to improved understanding of midwives providing contraception counselling, better compliance, fewer unwanted pregnancies and improved sexual and reproductive health among women.     

Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study

ObjectiveFear of childbirth is a well-known problem affecting women’s wellbeing and health. The prevalence of intense fear varies across countries from 4.8 to 14.8%. During the past 25 years in Sweden women with intense fear of childbirth have been offered counselling at specialised clinics staffed by midwives. Although the counselling demonstrates positive results, the training, education, supervision and organisation differ between clinics. It is still unclear which approaches and practices are the most beneficial. The aim was to explore and describe the counselling of women with intense fear of childbirth from the viewpoint of midwives who provide counselling in specialised fear of childbirth clinics in one region of Sweden.MethodsA qualitative study of 13 midwives using focus group interviews and inductive content analysis.ResultsThe midwives’ counselling of women with intense fear of childbirth is described as ‘striving to create a safe place for exploring fear of childbirth’, comprising the following categories: Providing a reliable relationship; Investigating previous and present fears; and A strong dedication to the women.ConclusionAlthough there are no guidelines for the counselling the midwives described similar frameworks. Some approaches were general, while others were specific and related to the individual woman’s parity. The midwives achieved professional and personal development through counselling experiences. The findings add to the existing literature on counselling and can be used to inform the development of midwife-led interventions for women with intense fear of childbirth and previous traumatic births, as well as for the formal education of midwives.     

A safe place – Adolescents’ and young adults’ perceptions of youth clinics in northern Sweden

Background/objectiveAdolescents and young adults are a diverse group with varied health needs. In Sweden, youth clinics are critical for improving their sexual, reproductive, mental, and general health. The aim of this qualitative study was to gain a deeper understanding of key conditions needed for youth friendliness, and to better understand youth-friendly health services from the perspective of adolescents and young adults in northern Sweden.MethodsInformation was collected through focus group discussions and interviews with 23 adolescents and young adults (aged 16 to 25) at youth clinics in each of the four northernmost regions of Sweden. Interviews were analysed inductively using Braun and Clarke’s thematic analysis.ResultsThree themes and six sub-themes emerged. A safe, empowering and holistic space, outlines how youth-friendly physical spaces and staff contributed to a sense of safety in contrast to other healthcare facilities. The theme Youth clinics are accessible – but reaching out is challenging, refers to low thresholds for visiting youth clinics and perceived barriers to access. The third theme “You feel a bit vulnerable” – the importance of privacy, highlights privacy dimensions and young people’s vulnerability when their privacy is compromised.ConclusionAdolescents and young adults perceived youth clinics as being youth-friendly. Key conditions for youth friendliness were safety, respect, a holistic and empowering approach, accessibility, and privacy. Youth-friendly opening hours and outreach to specifically target groups with access barriers are needed. Young people should be involved in the development of equitable youth-friendly health services.     

Midwives' strategies in challenging dietary and weight counselling situations

ObjectiveBy enhancing maternal nutritional status, midwives can help women lower the risks of pregnancy complications and adverse birth outcomes as well as improve maternal health during pregnancy and in the long run. Dietary counselling is, on the other hand, not reported to be effective. Poor communication and conflicting messages are identified as possible barriers to adherence with recommendations. Midwives' experiences of providing dietary advice and counselling during pregnancy are sparsely reported. The aim of this study was therefore to explore midwives' strategies when faced with challenging dietary counselling situations.MethodsSeventeen midwives from different parts of Sweden and working within antenatal health care were interviewed by telephone. The interviews were analysed using qualitative content analysis.ResultsChallenges were commonly experienced when counselling women who were overweight, obese, had eating disorders or were from different cultures. The midwives talked in terms of “the problematic women” when addressing counselling problems. Strategies used in challenging counselling situations were Getting acquainted; Trying to support and motivate; Pressure to choose “correctly”; Controlling and mastering; and Resigning responsibility.ConclusionsThe results indicate that Swedish midwives' counselling strategies are quite ambiguous and need to be questioned and that counselling of vulnerable groups of women should be highlighted. We could identify a need for education of practicing midwives to develop person-centred counselling skills.     

Knowledge,experience, and utilisation of sexual and reproductive health services amongst Nepalese youth living in the Kathmandu Valley

ObjectiveYouth have the right to utilise sexual and reproductive health (SRH) services and information to protect themselves from negative SRH outcomes. This study aimed to assess knowledge, experience and use of SRH services amongst youth living in urban areas of the Kathmandu Valley.MethodsWe conducted a two stage cluster sampling cross-sectional household survey of young men and women aged 15–24 living in the Kathmandu Valley using a structured questionnaire.ResultsAmongst the 680 young men and 720 young women participants, less than two-thirds had knowledge about the fertile period and less than a half about pregnancy risk at first sex. Over three quarters of young men and women had knowledge of condoms, and pills but less than half knew about implants or intrauterine devices. Age at first sex was similar for men and women but women were significantly less likely to have participated willingly in their first sexual encounter and were less likely to have used any contraception (for both p < 0.001). Almost all men and women (97.9%) had heard of sexually transmitted infections (STIs) but only 8% had heard about the most common STI, Chlamydia. Over 90% of youth reported feelings of shame as the major barrier to accessing SRH services.ConclusionsGaps exist between youth SRH knowledge and practices which leave them vulnerable to sexual ill health. This may indicate a lack of confidence in SRH services but also likely reflects the cultural and religious environment that hampers open expression of sexual and reproductive issues, particularly for young women.     

Young women’s decision-making process for HPV vaccination

ObjectivesTo explore young women’s decision-making process for HPV vaccination and to identify their beliefs about HPV vaccination.MethodsThis study employs a qualitative design. Data was collected by audio-taped interviews with 16 HPV vaccinated Swedish women, 17–26 years old. The data was analysed using latent content analysis.ResultsThree themes emerged from the data: “Fear of cancer”, “Reliance on vaccination” and “Mother – the main motivational factor”. One of the major reasons for taking the decision to be HPV vaccinated was fear of cancer: vaccination was seen as a way to protect oneself against this. The young women’s decision-making surrounding HPV vaccination was based on reliance on vaccination and trust in health care. Support from the mothers of the young women and mothers’ sponsorship of costs initiated HPV vaccination. Other motivational factors were advertisements and friends. Despite having been vaccinated, the young women were unaware of the relation between cervical cancer, sexual behaviour and HPV.ConclusionThese HPV vaccinated young women had limited knowledge about HPV. Therefore it is important that health professionals provide comprehensible information about HPV vaccination in attaining informed consent. In order to avoid misunderstandings, health care professionals in youth clinics and schools need to initiate discussion with young women, clarifying the relation between cervical cancer, HPV and sexual transmission.     

Accessing sexual and reproductive health care and information: Perspectives and recommendations from young Asian American women

ObjectivesUnderstanding the influence of culture on how sexual and reproductive health is perceived and addressed in Asian American communities is important for the effective provision of care and health information. This study aimed to explore how and when sexual and reproductive health information is shared within Asian American families and communities, barriers and facilitators to accessing sexual and reproductive health care and information for young Asian American women, and their recommendations to improve access.MethodsQualitative data were collected through six focus groups conducted with a total of 33 young Asian American women.ResultsThe majority of participants reported that stigma created a barrier to discussing these topics within their families and communities, and discussed ways in which they confidentially seek out care and information. Responses varied with respect to participants' preferred means of increasing access to care and information; some recommended strategies that would increase communication about these issues in their families and communities, while others expressed a desire to maintain confidentiality.ConclusionsThese findings suggest that diversified strategies are needed to connect Asian American women with sexual and reproductive health care and information in order to meet their varied preferences, including strategies that are community-driven and culturally appropriate.     

Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden

ObjectivesThe aim of this study was to investigate the contraceptive methods 46-year-old women in Sweden had chosen during different phases of their reproductive lifecycle and, the factors affecting their choice.Study designThe design was a retrospective cross-sectional study and targeted 46-year-old women. Five hundred Swedish women were randomly selected from a national population-based register and sent a questionnaire with 18 multiple response questions: the response rate was 47%.ResultsThe women used different contraceptive methods during different phases of their reproductive lifecycle. Women mainly used oral contraceptive pills and condoms before pregnancy, copper-IUD between pregnancies and, hormonal- and copper IUD after pregnancy. Condoms were used during all phases of women’s fertile period. Women with early sexual debut were more likely to have used condom as their first contraceptive method than women with late sexual debut, and women who had children were more likely to use IUD as current contraception than women without children. High efficacy, accessibility and advice from a counselor were the most cited reasons for choosing a particular method. The most common reasons for discontinuing contraceptive use were a wish to be pregnant and concerns about side effects. The partner had little or no influence on choice of method, but advice from a gynecologist or midwife was influential.Conclusions46-year-old women in Sweden had chosen different contraceptive methods during different phases of their reproductive lifecycle. Partners appear to have limited influence over this choice. Individualized counseling by health care providers seems important.     

Experiences of Norwegian community midwives with caring for vulnerable pregnant women – A national cross-sectional study

ObjectivesThe study aimed to describe Norwegian community midwives’ care for vulnerable pregnant women. It assessed vulnerability factors midwives identified and the type of care they provided. Factors associated with use of identification tools and care of vulnerable pregnant women were investigated.MethodA quantitative, cross-sectional study. Data collected via an anonymous online survey conducted spring 2020. Of approximately 700 eligible community midwives in Norway, 257 (36.7%) participated.ResultsCommunity midwives who worked primarily in the community, in close to full-time positions (>80%) and who were responsible for >100 women a year in large community clinics were more likely to identify vulnerable pregnant women than midwives who worked in combined hospital and community posts, less than 80% in the community and at smaller community centres. Attended a training progam called ‘Early Start’ (Tidlig Inn) was associated with an increased use of standardized identification tools. Almost all community midwives reported providing vulnerable women with more frequent consultations, individual and culturally personalized care, and relevant information about support options.ConclusionCommunity midwives appeared to be aware of their role as a midwife in the care of vulnerable pregnant women. They reported encountering vulnerable pregnant, identifying them by actively using methods to do so and addressing their needs in various ways. This study suggests that specific training increases midwives‘ ability to identify vulnerable pregnant women. Further research is needed to assess how midwives experience interdisciplinary collaboration in caring for these women.     

Integrating reproductive planning with primary health care: An exploration among low-income,minority women and men

IntroductionDespite recommendations to integrate reproductive and preconception health care services with primary health care, integration of such services is uncommon. The purpose of this study was to explore the acceptability and utility of integrating an assessment of reproductive plans into primary care encounters.MethodologyUsing a purposive sampling strategy, we purposively selected 144 African-American and Hispanic females and males from publicly-funded clinics. We assessed their desire for a child and contraceptive practices via a reproductive plans questionnaire. Patients’ written responses were attached to the medical record for provider use. After the encounter, we administered semi-structured interviews to elicit patients’ opinions about the questionnaire. We audio-recorded and transcribed verbatim responses and qualitatively analyzed them by content analysis.ResultsOverall, 58/72 (81%) of females and 30/72 (42%) of males reported the reproductive plans assessment was important to their encounter, with variation in the reason according to reported desire for a child. According to reported contraceptive practices, >45% who reported never wanting a child or not wanting a child for at least one year were ‘at-risk for unintended pregnancy.’ A substantial proportion of patients reported uncertainty about desiring a child, and a minority of these reported consistent contraception use.DiscussionQuestions to assess patients’ reproductive plans were viewed as important by the majority of female and a substantial proportion of male primary care patients, and a substantial proportion were at-risk for unintended pregnancy. Primary care practices should consider implementing a reproductive plans assessment to facilitate linkage of patients to appropriate family planning, preconception, and sexually-transmitted infection services.     

Examining the influence of mental health on dual contraceptive method use among college women in the United States

ObjectivesTo examine mental health influences on dual contraceptive method use (i.e., the use of a hormonal contraceptive or intrauterine device with a condom barrier) among college women.Study designData from N = 307 sexually active women who completed the 2014 National College Health Assessment at a large mid-Atlantic university were analyzed. Following chi-square tests of associations, multivariate logistic regressions examined the relation between mental health and sociodemographic factors and dual contraceptive method use.ResultsAmong all women, 27% utilized a dual contraceptive method during last vaginal intercourse. A prior depressive disorder diagnosis was significantly associated with lower odds of dual method use compared to use of other contraceptive methods combined (aOR, 0.39; 95% CI: 0.19–0.79), use of no method (aOR, 0.12; 95% CI: 0.03–0.55), or use of hormonal contraceptives only (aOR, 0.39; 95% CI: 0.18–0.85).ConclusionsMental health is an important contributor to contraceptive method use. Health care providers should consider the role of mental health when counseling women about contraceptive options during routine gynecological visits. Results suggest that mental health screenings may be helpful in identifying those most at risk for not using dual contraceptive methods.     

Association between contraceptive use and socio-demographic factors of young fecund women in Bangladesh

ObjectiveThis study aimed to explore the association between socio-demographic factors and contraceptive use among fecund women under 25 years old.MethodsThis study utilized a cross-sectional data (n = 3744) extracted from the Bangladesh Demographic and Health Survey 2011. Differences in the use of contraceptives by socio-demographic characteristics were assessed by χ² analyses. Binary logistic regression was used to identify the determinants of contraceptive use among young women.ResultsThis study observed that 71% fecund women aged below 25 years used contraceptives. Getting family planning (FP) methods from FP workers increases the likelihood of using contraceptives among young women because outreach activities by FP workers and accessibility of FP related information pave the way of using contraceptives. Husband-wife joint participation in decision making on health care increases the likelihood of using contraceptives. Participation of women in decision making on health care could be achieved by promoting higher education and gainful employment for women.ConclusionsReproductive and sex education should be introduced in schools to prepare the young for healthy and responsible living. Moreover, policy makers should focus on developing negotiation skills in young women by creating educational and employment opportunities since husband-wife joint participation in decision making increases contraceptive use.     

Assisted reproduction and midwives: Student and certified midwives’ educational needs on reproductive biology

BackgroundAs midwives’ public health role evolves they may constitute a first source of enquiry for women seeking infertility treatment. The study aimed to investigate student and certified midwives’ knowledge and educational needs regarding assisted reproduction issues.MethodsParticipants, 609 certified midwives (CMs) and 234 midwifery students, were recruited from the Midwifery department of the Highest Technological Institute of Thessaloniki. The questionnaire used assessed midwives’: knowledge and educational needs about assisted reproduction technologies (ART) and opinion on their involvement in infertility treatment.ResultsStudents were 4.3 (95% CI 2.65-7.21, p < .001) times more likely to lack information on ART. CMs were at least twice more likely to report that they need information on: infertility history taking (OR: 2.39, 95% CI 1.11–5.10), ART application (OR: 2.95, 95% CI 1.39–6.23) and provision of psychological support (OR: 2.75, 95% CI 1.33–5.70). CMs were more positive (p < .01) towards their involvement in infertility treatment.ConclusionsThe present study indicated that midwives’ lack knowledge on a range of ART issues and they appear to be ignorant as to their professional role in the field of ART. To successfully meet the needs of a growing clinical role, midwifery curricula continuing education programs should encompass issues pertaining to the entire reproductive health sector.     

An important task: Midwives’ experiences of identifying children at risk of neglect

BackgroundNeglect is a form of child abuse in which the child’s basic needs are not met. Early identification of the risk factors and protective factors is key to intervention strategies when a child is at risk of neglect. Few international studies describe midwives’ experiences of identifying children at risk of neglect, and no Swedish studies have been found.ObjectivesThe aim was to describe midwives’ experiences of identifying children at risk of neglect.MethodA qualitative method with a phenomenological reflective lifeworld approach. Interviews with ten midwives from two hospitals and six antenatal clinics in the western part of Sweden, with six from antenatal care and four from postpartum care.ResultsThe essential structure of midwives’ experiences is described as an important dimension of their profession that is a difficult, complex, ambiguous, and divided task. There is a fear of losing the relationship with the woman and worry about misinterpreting signals. Professional differences may arise when midwives are questioned by colleagues on decisions they have made when identifying children at risk of neglect. Midwives expressed their desire to work in a cohesive maternity healthcare system so that the women experience continuity during pregnancy, childbirth, and postpartum care.ConclusionsThe study shows how midwives, during both antenatal and postpartum care, have an important but difficult task in identifying children at risk of neglect. During pregnancy and postpartum care, midwives in Sweden meet almost all women and therefore have a unique opportunity for early detection and action.