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.     

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.     

Midwives’ experience of encountering women with posttraumatic stress symptoms after childbirth

ObjectiveTo describe midwives’ experience of encountering women with posttraumatic stress symptoms after childbirth.Study designSemi-structured interviews with eight midwives with experiences of encountering women with posttraumatic stress symptoms after childbirth. Data were analyzed using thematic content analysis.ResultThe midwives encountered women with severe experiences after a childbirth, which had affected their lives. The midwives thought that they had to reflect on their own attitude and use their gentleness as they responded to the women’s stories. By listening to and enabling the women to express their feelings and tell their stories, the midwives thought that they could confirm the women’s experience. The midwives thought that they could support women who had lost confidence to give birth but also thought that cesarean section did not solve the women’s problems.ConclusionTraining of midwives is necessary to increase awareness of the cause of women’s posttraumatic stress symptoms. It is urgent to optimize the implementation of new research into practical reality to raise the quality of care of women with fear of childbirth. Childbirth is an important experience that can influence a woman’s well-being and her connection to the child. Posttraumatic stress symptoms should be identified in an early stage/pregnancy to allow early treatment on the right level of care.     

Young women’s experiences of managing self-treatment for anogenital warts

ObjectivesThe purpose of this study is to explore the experiences of self-treatment for anogenital warts from the perspective of a group of young women who received it.Study designTen young Swedish women were interviewed in the study, aged between16 and 21. The young women had been diagnosed with anogenital warts and self-managed their treatment with 0.5% podophyllotoxin solution.ResultsSelf-management using 0.5% podophyllotoxin solution poses numerous difficulties. The nature of the treatment as a topical liquid is particularly testing for young women in terms of both application and genital pain, with implications for continuation of the treatment regime. The self-treatment challenges both personal integrity as well as interpersonal relations and creates a personal responsibility which appears to be somewhat overwhelming at times.ConclusionsHealth care professionals need to recognize the challenge that self-treatment poses to their clients. The issues that create difficulty in relation to topical liquid treatment regimes and importantly can lead to poor adherence to the treatment regime and discontinuation could easily be overcome by the use of different preparations. Continuity of care provider across treatments and alternative mechanisms of support would not only address some of the aspects that young women raise as particularly embarrassing and shameful, but also improve quality of care and increase general satisfaction with service provision.     

Primiparous women’s expectations and experiences of early labour: A qualitative study

ObjectivesTo gain a deeper understanding of primiparous women’s preparation for early labour as well as their expectations and experiences of symptoms of onset of labour.MethodsA qualitative study using focus group discussion was conducted with n = 18 first-time mothers within the first six months of giving birth. Discussions were transcribed verbatim and coded and summarised into themes by two researchers using qualitative content analysis.ResultsThe statements of the participants revealed four themes: ‘Preparing for the unpredictable’, ‘Expectations and reality’, ‘Perception and wellbeing’ and ‘Experiencing the beginning of birth’. Many women could not distinguish the preparation for early labour from that for the whole birth. Relaxation techniques to prepare for early labour were found to be very helpful. For some women, it was a big challenge that expectations often did not correspond to the experienced reality. Pregnant women faced many different physical and emotional symptoms of onset of labour with striking variability. Emotions ranged from positively excited to having fears. Not being able to sleep for hours was a huge problem for the labour process of some women. While early labour at home was experienced positively, early labour in hospital was sometimes difficult, because women had the feeling of being in the second rank.ConclusionThe study clearly identified the individual character of experiencing onset of labour and early labour. The variety of experiences highlighted the need for individualised, woman-centred early labour care. Further research should investigate new paths for assessing, advising, and caring for women during early labour.     

Life’s pregnant pause of pain: Pregnant women’s experiences of pelvic girdle pain related to daily life: A Swedish interview study

IntroductionPelvic girdle pain (PGP) is a universally disabling condition affecting three of 10 pregnant women. Qualitative studies on the subject are lacking.ObjectiveTo describe pregnant women’s experiences of PGP as related to daily life.MethodsIn all, 27 women with PGP participating in a randomised controlled study were interviewed during 2010–2011. Qualitative content analysis was used.ResultsFive main categories emerged: PGP affects the ability to cope with everyday life; Coping with motherhood; Relationships between partners often reached the breaking point; Questioning one’s identity as defined by profession and work, and Lessons learned from living with PGP. The categories illustrate how women’s everyday lives were interrupted. Their inability to meet their own and others’ expectations put a strain on their lives causing disappointment, sadness and frustration. It made them question and doubt their roles and identities as mothers, partners and professionals, and kept them from looking forward to future pregnancies, in the absence of effective treatment for PGP. Knowledge gained was that women with PGP should seek help immediately, listen to their bodies, and acknowledge their limitations.ConclusionPGP severely affects pregnant women’s everyday lives. There appears to be a lack of knowledge and awareness in general, as well as among caregivers and employers of PGP that needs to be highlighted and rectified. There is also a great need to learn how to support those suffering from it. Appropriate support during this important and rare phase in a woman’s life is highly warranted.     

A qualitative study of new fathers’ experiences of care in relation to complicated childbirth

ObjectivesThe objective of the study was to describe new fathers’ experiences with care related to complicated childbirth.MethodsA qualitative approach consisting of individual interviews using a semi-structured interview guide with open-ended questions was applied. A purposive sample of eight fathers participated. The interview text was subjected to qualitative thematic content analysis.ResultsAnalysis revealed the following three categories: (1) feeling scared and uncared for during acute situations; (2) appreciating the opportunity to participate in care and becoming a family; and (3) needing continued care. Based on these three categories, a recurring theme was identified: struggling to be recognized by care staff as a partner in the family was revealed.ConclusionAlthough fathers lack support and understanding from care staff, they strive to fulfill their roles as fathers by guarding their families and keeping them together. Caregivers involved in the childbirth process should realize that by acknowledging and encouraging fathers in these roles, they in turn support the entire family unit. Interventions developed for fathers and family care requires further development. Additional research concerning how midwives and critical care nurses (CCNs) view the presence of fathers in the emergency situations that may accompany childbirth is also needed.     

A Swedish study of midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan

ObjectivesThe aim was to describe midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan in pregnancy weeks 18–20.Study designsA qualitative content analysis with an inductive approach and 13 semi-structured interviews were used for data collection from these three domains: midwives at an ultrasound department, midwives at a maternity clinic and nurses at a gynecological ward. Content analysis resulted in six codes, four categories and one primary theme.Main outcome measuresThe four categories identified were: the interviewees’ experiences of women’s reactions, support from the midwife and nurse, the interviewees’ experiences of men’s reactions and communication between care providers and women. The main theme focused on the interviewees’ noting that women had a premonition that something was wrong with their pregnancy. This could for example have been in the form of minor bleeding or the fact that pregnancy symptoms had receded and there were no movements by the fetus. The midwives carried out a follow-up with assessment.ConclusionsWomen need confirmation of their premonitions of a missed miscarriage so that a diagnosis can be made as early as possible in their pregnancy. Women and their partners who have suffered a missed miscarriage need extended support on an individual basis in addition to follow-up assistance as assessed by the midwives.     

Traveling to California from out of state to receive abortion services at a hospital-based clinic: A qualitative study of people’s experiences

ObjectivePeople seeking abortion care in the Western United States face unique challenges. We conducted a qualitative study among people who traveled to California from out of state to receive abortion services, with the aim of characterizing the interplay of motivators, costs, and facilitators to accessing abortion in this region.MethodsWe recruited English-speaking people residing outside of California who accessed care at an urban abortion clinic in San Francisco between October 2017 and May 2018. Interested participants completed a brief demographic survey and in depth semi-structured telephone interview. We relied on grounded theory methods to perform thematic analysis and stopped recruitment upon reaching thematic saturation.ResultsWe conducted 18 in-depth interviews. People mostly had to travel to California for abortion due to local clinic gestational age limits, medical necessity, and to reduce cost. Participants also lamented that travel necessitated unwanted disclosure of their abortion, however this disclosure enabled them to get the logistical support needed for travel. People mostly relied on their networks of family and friends to facilitate these logistics.ConclusionsThis study highlights the interplay of motivators, costs, and facilitators people who travel to California from nearby states face when seeking abortion services.ImplicationsWe position the concept of ‘unwanted disclosure’ as both an emotional cost and an operator that often served to enable people to get the support (logistical, financial, professional) they needed to actualize their abortion in California. These people may benefit from additional financial and social support services in order to actualize their abortion.     

Exploring the psychosocial impact of the Covid-19 pandemic on women’s perinatal experiences and wellbeing: A qualitative study

ObjectiveWhile many studies have investigated the clinical impact of the Covid-19 pandemic on pregnant women’s mental health, little attention has been paid to the exploration of women’s experiences during the perinatal period from a psychosocial perspective in the Italian context. Thus, the present study aimed to explore the psychosocial changes associated with the pandemic in the perinatal context.MethodsTwenty-one Italian women who gave birth between March and November 2020 took part in this research by participating in semi-structured interviews, exploring their childbirth experiences. Our data were analysed using a Grounded Theory approach.ResultsOur findings revealed the enhanced importance of social support as a protective factor against uncertainties, which strongly characterised all phases of the perinatal period during the pandemic. Such uncertainties were mainly linked to the discontinuity in intrapartum care, as well as to concerns of being infected with Covid-19 combined with other pregnancy-specific worries. The main sources of social support were represented by loved ones – most of all partners – along with health care staff and peer networks.ConclusionsOur results suggest the importance of implementing evidence-based policies and interventions to improve women’s wellbeing in the perinatal period during the pandemic, as well as of guaranteeing intrapartum care continuity and the presence of social support.     

Syrian women’s experiences of being pregnant and receiving care at antenatal clinics in Sweden for the first time after migration

ObjectiveTo describe Syrian women’s experiences of being pregnant and receiving care at antenatal clinics for the first time after migration.MethodsA phenomenological lifeworld approach was used. Eleven women from Syria enrolled at antenatal clinics, who were experiencing their first pregnancy in Sweden but who may have given birth before in other countries, were interviewed in 2020. The interviews were open and based on one initial question. Data were inductively analysed using a phenomenological method.ResultsThe essence of Syrian women’s experiences of being pregnant and receiving care at antenatal clinics for the first time after migration was the importance of being met with understanding to create trust to build a sense of confidence. The following four constituents capture the essence of the women’s experiences: “It was important to feel welcomed and to be treated like an equal”; “A good relationship with the midwife strengthened self-confidence and trust”; “Good communication despite language difficulties and cultural differences was important”; and “Previous experience of pregnancy and care influenced the experience of the care received”.ConclusionSyrian women's experiences reveal a heterogeneous group with different experiences and background. The study highlights the first visit and emphasises the importance of this visit for future quality of care. It also points out the negative occurrence of the transferring guilt from the midwife to the migrant woman in case of cultural insensitivity and clashing norm systems.     

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.     

‘The waiting mode’: First-time mothers’ experiences of waiting for labour onset

PurposeTo explore first-time mothers’ experiences of waiting for labour onset, and to contribute to the discussion of existing practices surrounding perinatal care.MethodsA qualitative study of 17 women in Norway. Diaries written by the informants and in-depth interviews were analysed in a tradition of life-world phenomenology.ResultsThe participants entered a state of active waiting, “the waiting mode”, in the days around the estimated date of delivery. When the women entered the mode there was a marked change in the way they interpreted bodily sensations. The women experienced being in a state of constant bodily alertness, their bodies felt all-consuming and they experienced themselves as being “more and more body”. This generated a sense of being enclosed in the body, intensely trying to identify the signs of labour. Being in the waiting mode seemed to draw labour closer in a manner that opened up for the birthing process and helped the women to prepare for labour.ConclusionsThe findings indicate that the estimated date of delivery is pivotal in shaping women’s experiences of waiting. It raises concerns related to how women who are giving birth for the first time are prepared for labour, and a worry that too much weight is put on the exact date. A stronger emphasis on the diversity of women’s experiences might be in place. Pregnant women could be encouraged to explore and interpret bodily experiences on their own terms, not merely in relation to the estimated date of delivery.     

Trends of contraception use among married reproductive age women: Tehran lipid and glucose cohort study 2002–2011

ObjectivesThis study aimed to examine the trends of contraception use among married reproductive age women in Tehran Lipid and Glucose study between 2002 and 2011.MethodsThis analysis investigated a proportion of women users and non-users of family planning, using data from 10 year population-based Tehran Lipid Glucose Study from surveys conducted in 2002, 2005, 2008, and 2011.Of the 6813, 6993, 7077, and 6789 women in the four phases mentioned, 34.1%, 33.9%, 33.5% and 35% of participants in each phase preferred to use contraception. Number of participants studied were 2506 women in 2002, 2529 women in 2005, 2594 women in 2008 and 2525 women in 2011.ResultsTypes of methods and patterns of change in contraception differed across time. The percentage of women using traditional methods increased significantly from 25.7% in 2002 to 34.6% in 2011 (p value for trend = 0.001). Accordingly, modern contraception use showed a reverse trend. From 2002 to 2011, 61.4%, 61%, 57.7%, and 51% of married women reported currently using various modern contraceptives, respectively (p value for trend = 0.001). The proportion of users relying on condoms showed a significant increase during this decade, being 10.9% in 2002, 15.2% in 2005, 20% in 2008 and 21.9% in 2011. The prevalence of non-users for contraception was generally low; 12.7%, 8.2%, 8% and 14.3%, respectively from 2002 to 2011, but increased significantly across time (p = 0.005)ConclusionRelying on less effective contraceptive methods has increased rapidly among women in the Tehran Lipid and Glucose cohort study, a trend that could be a warning to policy makers about the possibility of higher unsafe abortion and maternal mortality/morbidity rates in the near future.