Sense of coherence in pregnant and new mothers – A longitudinal study of a national cohort of Swedish speaking women

BackgroundPrevious research shows inconsistent results about the stability of SOC during the childbearing period, and few studies have focused on longitudinal measures. There are contradictory results regarding the association between SOC and birth outcome. The link between levels of SOC and parental stress needs to be further explored.AimThe aim of this study was to investigate changes in SOC from early pregnancy to one year after birth and associations with background characteristics, birth outcome and parental stress.MethodsA longitudinal survey of a national cohort of Swedish speaking women during 3 weeks in 1999–2000. Data were collected by questionnaires in early pregnancy, 2 months and 1 year after birth.ResultsSOC increased from pregnancy to 2 months after birth but decreased 1 year after birth. SOC was associated with women's background characteristics, emotional wellbeing and attitudes, but not with labour outcome. Women with low SOC reported higher parental stress after one year.ConclusionSense of coherence is not stable during the childbearing period and is associated with women's sociodemographic background, emotional health and attitudes, but not with reproductive history or birth outcome. Parental stress is negatively correlated with SOC, and some important characteristics are similar in women having low SOC and high parental stress. Identifying women with low SOC in early pregnancy could be a means to prevent later parental stress.     

The perceived role of clinicians in pregnancy prevention among young Black women

ObjectiveThe purpose of this study is to identify young Black women's attitudes toward clinicians and understand how they affect contraceptive behavior.Study design and main outcome measuresWe conducted semi-structured qualitative interviews with women aged 18–23 who self-identified as Black or African-American and analyzed data using techniques informed by grounded theory. Initial codes were grouped thematically, and these themes into larger concepts.ResultsParticipants discussed two salient concepts related to pregnancy prevention: (1) sexual responsibility and self-efficacy and (2) the perceived limited role of health care clinicians. Women portrayed themselves as in control of their contraceptive decision-making and practices. Many viewed their life plan, to finish school and gain financial stability, as crucial to their resolve to use contraception. Participants gathered information from various sources to make their own independent decision about which method, if any, was most appropriate for their needs. Most had limited expectations of clinicians and considered in-depth conversations about details of contraceptive use to be irrelevant and unnecessary.ConclusionThese findings help understand factors contributing to contraceptive decision-making. The patient–clinician interaction is a necessary focus of future research to improve sexual health discussions and understand if and what aspects of this interaction can influence behavior.     

Swedish women’s expectations about antenatal care and change over time – A comparative study of two cohorts of women

A decade ago a national cohort of Swedish-speaking women were surveyed about their expectations on antenatal care. Today, antenatal care in Sweden still operates under similar circumstances while changes have occurred in society and the pregnant population.ObjectiveTo compare expectations of antenatal care in pregnant women recruited 2009–2010 to those of pregnant women from a national cohort in 1999–2000. An additional aim was to compare antenatal expectations in women recruited to a clinical trial and subsequently received group based or standard antenatal care.MethodsA cross-sectional pre-study of 700 women recruited to a clinical trial and a historical cohort of 3061 women from a Swedish national survey. Data was collected by a questionnaire in early pregnancy for both cohorts and before the clinical trial started.ResultsIn early pregnancy 79% of the women in the study sample reported a preference for the recommended number of visits, which is slightly higher than in the national cohort (70%). Continuity of the caregiver was still important with 95% vs 97% of the women rated it important to meet the same midwife at subsequent antenatal visits. The content of care rank order showed a change over time with lower expectations in health check-ups and emotional content and higher expectations in information needs, respect and partner involvement.ConclusionWomen approached in early pregnancy had lower expectations about medical and emotional check-ups and parent education but higher expectations regarding information, being met with respect and the involvement of the partner compared to women 10 years ago. Continuity of a midwife caregiver was still important and women seem more willing to follow the recommended number of antenatal visits.Clinical implicationsAsking women about their expectations regarding antenatal care could be a means to individualize the care.     

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.     

The use of dermatologic drugs in pregnancy and lactation

Physicians are generally reluctant to prescribe dermatologic drugs to pregnant or nursing women because treatment is often elective and can be harmful to the patient, her fetus, or nursing infant; concerns for potential litigation also give pause. Yet, some effective dermatologic drugs have been determined to be safe during pregnancy and lactation. Of great practicality is an easily accessed reference guide that condenses information on such drugs into a set of tables that list pregnancy and teratogenicity ratings. Indications and contraindications are ordered in relation to the phases and trimesters of pregnancy. A discussion of the necessity of considering stages of childbearing in choosing drug therapies introduces the tables. A summary list of cautions spells out the steps physicians should take in treating women of childbearing age.     

Women’s views of high risk pregnancy under threat of preterm birth

ObjectiveTo gain an understanding of the experiences of pregnant women at risk of having a preterm birth (PTB) who were attending a specialist preterm antenatal clinic and to elicit their views on treatment to prevent PTB.Study designA qualitative interpretive approach was adopted, utilizing focus groups and one-to-one interviews. The semi-structured interview schedule focused on two main areas; risk and treatment for preterm birth. Fourteen pregnant women were recruited from a preterm antenatal clinic at a major tertiary referral centre in the North West of England. All interviews were audio recorded, with consent, and transcribed verbatim before carrying out thematic analysis.ResultsAnalysis revealed 3 main themes. Women struggled with ‘balancing the risks’ associated with the threat of preterm birth, they developed ‘personal coping strategies to survive the pregnancy’ and they watched as the strain made their ‘whole family crumble’.ConclusionWomen’s journey through pregnancy after a previous PTB experience is one of emotional and physical endurance. Women embrace the ‘high risk’ identity as it offers the opportunity for regular assessment and clinical reassurance. However, emotional and psychological needs must also be addressed to reduce stress and anxiety. By setting mutually agreed short term goals, significant milestones can be reached so that women feel they are successfully progressing through a high risk pregnancy through a series of ‘baby steps’.     

Interventions during labor and birth in the United States: A qualitative analysis of women's experiences

ObjectiveTo explore and describe hospital-birthing women's understandings of and experiences with interventions during labor and birth.MethodsQualitative data was collected as part of a larger ethnographic study of childbirth in the United States. The grounded theory method was employed to analyze interviews with 59 women from three states who had recently given birth in hospitals with physicians or certified nurse-midwives in attendance.ResultsFour themes emerged from the data. The themes safety/risk and provider match, described women's expectations regarding intervention and their interactions with providers. A third theme addressed how women experienced interventions and their perceptions of control over decision-making. A final theme characterized women's satisfaction with maternity care.ConclusionsWomen who received interventions expressed varying levels of comfort or apprehension associated with both expectations of maternity care and provider match. Women whose expectations matched those of the provider reported more positive experiences. Regardless of provider match, women expressed ambivalence about the use of interventions and confusion over their appropriate place. Women's ability to make sense of interventions was related to how well they navigated a complicated and bureaucratic maternity system. Increasing attention needs to be paid to the impact of these factors on women's perceptions of care during pregnancy and childbirth.     

Reasons women give for contemplating or undergoing abortion: A qualitative investigation in Victoria,Australia

ObjectiveTo increase understanding of women’s perspectives on considering or undergoing elective abortion.DesignQualitative study.SettingA large public women’s hospital in the state of Victoria, Australia.SampleSixty women who had contacted a public pregnancy advisory service in Victoria, Australia, seeking information, advice, or appointments in relation to an unplanned or unwanted pregnancy.MethodsQualitative telephone interviews. The iterative qualitative analysis employed the five stages of a thematic framework approach.Main outcome measuresThemes in women’s accounts of considering or undergoing elective abortion.ResultsWomen’s accounts emphasized their reasons for considering or seeking abortion. Decisions were made in the context of their lives as a whole; influences were usually contingent and multiple. Reasons related to the woman herself, the potential child, existing children, her partner and other significant relationships, and financial matters.ConclusionsThis research used qualitative methods to produce the only recent study of its kind in Australia. Women’s accounts reveal the complex personal and social contexts within which reproductive events must be comprehended and the thoughtfulness with which they make decisions. Results of this research will assist health-care professionals to increase their insights into women’s reproductive experiences.     

The experience of being a partner to a childbearing woman whose pregnancy is complicated by pre-eclampsia: A Swedish qualitative study

BackgroundPre-eclampsia affects 3–5% of all pregnant women and is among the leading causes of maternal morbidity and mortality as well as iatrogenic preterm birth worldwide. Little is known about the experience of partners of women whose pregnancy is complicated by pre-eclampsia.AimTo describe partners’ experience of having a spouse whose pregnancy was complicated by pre-eclampsia.MethodsA qualitative study with in-depth interviews. Eight partners of women whose pregnancy was complicated by pre-eclampsia were interviewed and data were analysed using content analysis.FindingsPartners found themselves in an unfamiliar and unexpected situation. They experienced an information gap in which they tried to make sense of the situation by interpreting subtle signs. The situation left them feeling emotionally stretched, feeling like an outsider while trying to provide support for their extended family. The partners experienced a split focus after the baby was born, prioritising the baby while worrying about their spouse. Post-partum, they expressed needing time to process and heal after childbirth. A need for professional support was highlighted and concerns about a future pregnancy were voiced.ConclusionHaving a spouse who is diagnosed with pre-eclampsia is challenging and overwhelming. Our findings imply a need to develop a model of care for women with pre-eclampsia that includes their partner, i.e., the other parent.     

Opting for natural birth: A survey of birth intentions among young Icelandic women

ObjectiveTo describe and analyse factors associated with natural birth intentions in a sample of pre-pregnant Icelandic women.MethodsAn internationally validated tool was used to survey pre-pregnant women about their attitudes towards birth. The online survey was sent to all students at the University of Iceland in November 2014. Log binomial regression was used to calculate crude and adjusted relative risks (RR_a), and corresponding 95% confidence intervals (CI), for intentions of natural birth (defined as vaginal birth without epidural analgesia) by high, moderate and low childbirth fear and by high, moderate and low confidence in birth knowledge. Models were adjusted for socio-demographic and psychological factors.Results410 eligible women completed the cross-sectional survey. Women with low fear of birth were more likely to have natural birth intentions when compared to women with moderate (RR_a = 2.83; 95% CI; 1.48–5.41) and high (RR_a = 4.86; 95% CI; 1.37–17.27) fear. Women with high confidence in their birth knowledge were more likely to have natural birth intentions compared to women with moderate (RR_a = 2.81; 95% CI; 1.51–5.22) and low (RR_a = 3.42; 95% CI; 1.43–8.18) confidence in their birth knowledge.ConclusionPre-pregnant women with low fear of birth and high confidence in their birth knowledge are more likely to have natural birth intentions. Addressing concerns about pain, safety, the perceived unpredictability of birth and worries about the physical impact of childbirth may strengthen natural birth intentions.     

Women's experiences with managing advice on gestational diabetes - a qualitative interview study

ObjectiveThis study aims to gain insight into women's experiences with gestational diabetes and their strategies to cope with advice for changing lifestyle. Further, health care professionals' approach to women with gestational diabetes is discussed.MethodsSemi-structured interviews with nine women with gestational diabetes were conducted at a university hospital, adopting a phenomenological approach.ResultsThree themes were created: 1) Experience of control, 2) personal strategies, and 3) unintended consequences. Women experienced that the monitoring at the outpatient clinic was associated with surveillance and safety and adopted different strategies to cope with gestational diabetes. Some women experienced feeling different and labelled due to the monitoring and their eating habits. Some women expressed concern for the baby and the risk of getting diabetes after birth. Women's experiences and how they transfer and cope with information about gestational diabetes at an outpatient obstetric clinic are brought forward, and it became evident that individual needs in gestational diabetes care are not being met in all situations.ConclusionWomen experienced surveillance and safety while being monitored at the outpatient clinic. At the same time, self-monitoring seemed to stimulate feelings of concern about other's reactions to the condition. In addition, we found that women's strategies for behaviour change included limited food intake, controlling food purchases, and being physically active. Concerning the management of gestational diabetes, some women felt that the information was not sufficiently adapted to their individual needs, thus health professionals' approach to gestational diabetes should be based on the women's perspective.     

Mothers’ satisfaction with group antenatal care versus individual antenatal care – A clinical trial

ObjectiveThe aim of this study was to compare women’s satisfaction with group based antenatal care and standard care.DesignA randomised control trial where midwives were randomized to perform either GBAC or standard care. Women were invited to evaluate the two models of care. Data was collected by two questionnaires, in early pregnancy and six months after birth. Crude and adjusted odds ratios with a 95% confidence interval were calculated by model of care.SettingsTwelve antenatal clinics in Sweden between September 2008 and December 2010.ParticipantsWomen in various part of Sweden (n = 700).FindingsIn total, 8:16 variables in GBAC versus 9:16 in standard care were reported as deficient. Women in GBAC reported significantly less deficiencies with information about labour/birth OR 0.16 (0.10–0.27), breastfeeding OR 0.58 (0.37–0.90) and time following birth OR 0.61 (0.40–0.94). Engagement from the midwives OR 0.44 (0.25–0.78) and being taken seriously OR 0.55 (0.31–0.98) were also found to be less deficient. Women in GBAC reported the highest level of deficiency with information about pregnancy OR 3.45 (2.03–5.85) but reported less deficiency with time to plan the birth OR 0.61 (0.39–0.96). In addition, women in GBAC more satisfied with care in supporting contact with other parents OR 3.86 (2.30–6.46) and felt more support to initiate breastfeeding OR 1.75 (1.02–2.88).ConclusionsWomen in both models of care considered the care as deficient in more than half of all areas. Variables that differed between the two models favoured group based antenatal care.     

Women’s experiences of abnormal Pap smear results – A qualitative study

ObjectivesTo describe women’s experiences of abnormal Pap smear result.MethodsTen women were recruited from a women’s health clinic. Qualitative interviews based on six open-ended questions were conducted, transcribed verbatim, and analyzed by content analysis.ResultsThe women believed that their abnormal Pap smear result was indicative of having cancer. This created anxiety in the women, which resulted in the need for emotional support and information. Testing positive with human papillomavirus (HPV) also meant consequences for the relatives as well as concerns about the sexually transmitted nature of the virus. Finally, the women had a need to be treated with respect by the healthcare professionals in order to reduce feelings of being abused.ConclusionsIn general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results. Women who receive abnormal Pap smear results need oral information, based on the individual women’s situation, and delivered at the time the women receive the test result. It is also essential that a good emotional contact be established between the women and the healthcare professionals.     

An exploration of obese pregnant women’s views of being referred by their midwife to a weight management service

Midwives have previously reported concerns about discussing and referring obese pregnant women to weight management services, with some women stating that this referral can be upsetting. The current study interviewed obese women who had declined a weight management service during pregnancy to explore if it was the referral process that made them decline the service. Fifteen women participated and reported that being informed about and referred to a service by their midwife was acceptable to them. Participants also mentioned they would expect this information from their midwife. No participants reported being upset by this referral.     

Family planning practices and women’s impression of the reproductive life plan in Eswatini

ObjectiveFamily planning is limited and unplanned pregnancies are common in Eswatini. The Reproductive Life Plan (RLP) is a counselling tool to improve pregnancy planning. Mentor mothers, i.e. community health workers, were trained in using an adapted RLP and introduced it into family planning discussions with their clients. This study evaluates the clients’ impression of the RLP and investigates their family planning practices.MethodData were collected in 2018 from anonymous questionnaires filled out by the clients: mothers or pregnant women aged 15–44 years. The questionnaire comprised 20 questions on demographic background, fertility desires, pregnancy planning as well as quality and perceived need for family planning support. Chi-square tests or Fisher’s exact test were used for group comparisons.Results199 women were included. Most women (74%) chose the option that family planning discussions using the RLP had helped them ‘very much’. A majority also had a perceived need for these discussions as 70% wanted to have more support from their mentor mother and 92% wanted more information about family planning. Women with lower educational level and younger women wanted more support compared to women with higher educational level and older women (p < 0.001 and p = 0.028). The unmet need for family planning was 22%.ConclusionThe introduction of the RLP used by mentor mothers was well received among women but most of them requested more family planning support. Using the RLP may help women in this context achieve their reproductive goals.