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  • 1.
    Carlsson, Ing-Marie
    et al.
    Örebro University, School of Health and Medical Sciences. School of Social and Health Sciences, Halmstad University, Halmstad, Sweden; Halmstad County Hospital, Halmstad, Sweden.
    Ziegert, Kristina
    School of Social and Health Sciences, Halmstad University, Halmstad, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences.
    Nissen, Eva
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden; School of Life Science, University of Skövde, Skövde, Sweden.
    Maintaining power: women's experiences from labour onset before admittance to maternity ward2012In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 1, p. 86-92Article in journal (Refereed)
    Abstract [en]

    Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward.

    Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used.

    Findings: ‘Maintaining power’ was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: ‘to share the experience with another’, ‘to listen to the rhythm of the body’, ‘to distract oneselfand ‘to be encased in a glass vessel’, explained how the women coped and thereby maintained power.

    Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process.

  • 2.
    De Roose, Marjon
    et al.
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
    Tency, Inge
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent; Odisee University College, Department Midwifery, Belgium.
    Beeckman, Dimitri
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent.
    Van Hecke, Ann
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent; Nursing Science, Ghent University Hospital, Ghent, Belgium.
    Verhaeghe, Sofie
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
    Clays, Els
    Department of Public Health, Ghent University, Ghent, Belgium.
    Knowledge, attitude, and practices regarding miscarriage: A cross-sectional study among Flemish midwives2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 56, p. 44-52Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to examine the knowledge, attitude and practices (KAP) of Flemish midwives regarding miscarriage.

    DESIGN AND SETTING: a cross-sectional KAP study was conducted in 28 hospitals in Flanders (Northern region of Belgium) from September 2015 to January 2016.

    PARTICIPANTS: a total of 647 out of 1200 midwives (53.9%) working on maternity, labour and gynaecological wards, maternal and neonatal (intensive) care units, antenatal consultations, and reproductive medicine were recruited.

    MEASUREMENTS: data were collected using a semi-structured, self-administered questionnaire.

    FINDINGS: = 96.574, df = 1, p<0.001). The majority (72.4%) indicated a lack of knowledge regarding miscarriage. Almost 89% expressed a need for extra training.

    CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: midwives in Flanders assist in the care for couples with miscarriage and consider themselves as a key healthcare provider in the psychosocial support. This study highlighted several barriers regarding miscarriage care, e.g. a lack of knowledge and incapability. Adequate training in knowledge and communication skills is important and necessary in order to promote appropriate care to couples experiencing pregnancy loss and increase awareness among all health professionals involved in obstetric care. Further research should investigate to what extent miscarriage is included in the educational midwifery programmes, and how the current healthcare practice regarding miscarriage care is organised.

  • 3.
    Goemaes, Régine
    et al.
    University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Shawe, Jill
    School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, Surrey, UK.
    Beeckman, Dimitri
    University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Decoene, Elsie
    Cancer Centre, Ghent University Hospital, Ghent University Hospital, Ghent, Belgium.
    Verhaeghe, Sofie
    University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Van Hecke, Ann
    University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Nursing Science, Ghent University Hospital, Ghent, Belgium.
    Factors influencing the implementation of advanced midwife practitioners in healthcare settings: A qualitative study2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 66, p. 88-96Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore factors influencing the implementation of advanced midwife practitioner roles.

    DESIGN: Semi-structured individual face-to-face and focus group interviews were conducted. Data analysis was performed using the Framework Method.

    SETTING AND PARTICIPANTS: A purposive sample (n = 32) included chief nursing officers, middle managers, head midwives/nurses, primary care team leaders, midwives with and without advanced midwife practitioner roles, heads of midwifery educations, and obstetricians.

    FINDINGS: Budgetary constraints on a governmental and healthcare organizational level were mentioned as main barriers for role implementation. The current fee-for-service financing model of healthcare professionals was also seen as an impediment. Obstetricians considered the implementation of advanced midwife practitioner roles as a possible financial and professional threat. Documenting the added value of advanced midwife practitioner roles was regarded a prerequisite for gaining support to implement such roles. Healthcare managers' and midwives' attitudes towards these roles were considered essential. Participants warned against automatically transferring the concept of advanced practice nursing to midwifery. Although participants seldom discussed population healthcare needs as a driver for implementation, healthcare organizations' heightened focus on quality improvement and client safety was seen as an opportunity for implementation. University hospitals were perceived as pioneers regarding advanced midwife practitioner roles.

    KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Multiple factors influencing role implementation on a governmental, healthcare organizational, and workforce level illustrate the complexity of the implementation process, and highlight the need for a well-thought-out implementation plan involving all relevant stakeholders. Pilot projects for the implementation of advanced midwife practitioners in university hospitals might be useful.

  • 4.
    Goossens, Joline
    et al.
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
    Beeckman, Dimitri
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
    Van Hecke, Ann
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent, Belgium; Nursing Science, University Hospital Ghent, Ghent, Belgium.
    Delbaere, Ilse
    VIVES University College, Kortrijk, Belgium.
    Verhaeghe, Sofie
    University Centre for Nursing&Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.
    Preconception lifestyle changes in women with planned pregnancies2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 56, p. 112-120Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: (1) to study preconception lifestyle changes and associated factors in women with planned pregnancies; (2) to assess the prevalence of risk factors for adverse pregnancy outcomes in women not reporting any preconception lifestyle changes; and (3) to explore the need for and use of preconception-related advice.

    DESIGN: secondary data analysis of a cross-sectional study about pregnancy planning.

    SETTING: six Flemish Hospitals (Belgium).

    PARTICIPANTS: four hundred and thirty women with a planned pregnancy ending in birth.

    MEASUREMENTS: preconception lifestyle changes were measured during the first 5 days postpartum using the validated London Measure of Unplanned Pregnancy. The following changes were assessed: folic acid or multivitamin intake, smoking reduction or cessation, alcohol reduction or cessation, caffeine reduction or cessation, eating more healthily, achieving a healthier weight, obtaining medical or health advice, or another self-reported preconception lifestyle change.

    FINDINGS: most women (83%) that planned their pregnancy reported ≥1 lifestyle change in preparation for pregnancy. Overall, nulliparous women (OR 2.18, 95% CI 1.23-3.87) and women with a previous miscarriage (OR 2.44, 95% CI 1.14-5.21) were more likely to prepare for pregnancy, while experiencing financial difficulties (OR 0.20, 95% CI 0.04-0.97) or having a lower educational level (OR 0.56, 95% CI 0.32-0.99) decreased the likelihood of preparing for pregnancy. Half of the women (48%) obtained advice about preconception health, and 86% of these women received their advice from a professional caregiver. Three-quarters (77%) of the women who did not improve their lifestyle before conceiving reported one or more risk factors for adverse pregnancy outcomes.

    KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: multiparous women and women of lower socio-economic status were less likely to change their lifestyle before conception. Strategies to promote preconception health in these women need to be tailored to their needs and characteristics to overcome barriers to change. It may be advantageous to reach these women through non-medical channels, such as schools or other community organizations.

  • 5.
    Goossens, Joline
    et al.
    University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
    Van Hecke, Ann
    University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Nursing Science, University Hospital Ghent, Ghent, Belgium.
    Beeckman, Dimitri
    Örebro University, School of Health Sciences. University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Belgium; School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Ireland.
    Verhaeghe, Sofie
    University Centre for Nursing & Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; VIVES University College, Department Health Care, Roeselare, Belgium.
    The intention to make preconception lifestyle changes in men: Associated socio-demographic and psychosocial factors2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 73, p. 8-16Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine which socio-demographic and psychosocial factors are associated with the intention for preconception healthily behavioral changes in the general population of reproductive-aged men.

    DESIGN: A cross-sectional, multicenter study.

    SETTING: Four secondary schools, 4 Public Centers for Social Welfare, 7 Community Health Centers, and online. All data was collected in the X.

    PARTICIPANTS: A convenience sample of 304 reproductive-aged men were recruited between July 2015 and July 2016.

    MEASUREMENTS AND FINDINGS: An existing questionnaire was adapted and validated to assess the intention, self-efficacy, attitude, social influence, knowledge, and barriers towards 10 preconception health behaviors. Simple and multiple logistic and linear regression analyses were performed. The overall intention to make preconception lifestyle changes was high (median score: 0.7 on the 0-1 scale). The multiple linear regression revealed that self-efficacy (p < 0.001), social influence of the close social environment (p = 0.02), and attitude (p = 0.05) were associated with a higher intention score. Experiencing negative emotions and beliefs about pre-pregnancy preparations was associated with less intention for preconception health behaviors (p = 0.001). None of the socio-demographic factors was significantly associated with the intention score.

    KEY CONCLUSIONS: The overall intention to make preconception lifestyle changes was high, and associated with different psychosocial factors including self-efficacy, social influence, and attitude.

    IMPLICATIONS FOR PRACTICE: Preconception interventions should target the identified factors to improve preconception health behaviors in men and negative emotions and beliefs about preconception. Interventions about preconception health care should primarily suggest that men bear the same responsibility as women, which will address the current gender politics and could have -in second instance- a positive outcome on pregnancy outcomes. Because socio-demographic characteristics were of no influence, a general approach should be used.

  • 6.
    Hatakka, Mathias
    et al.
    Örebro University, Örebro University School of Business. School of Technology and Business Studies, Dalarna University, Falun, Sweden.
    Osman, Fatumo
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Erlandsson, Kerstin
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Byrskog, Ulrika
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Egal, Jama
    School of Health Science, Hargeisa University, Hargesia, Somaliland.
    Klingberg-Allvin, Marie
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    "Change-makers in midwifery care": Exploring the Differences Between Expectations and Outcomes – a qualitative study of a Midwifery Net-based Education Programme in the Somali region2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 69, p. 135-142Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study is to explore midwifery educators’ expected outcomes in the net-based master's programme, the programmes’ realised outcomes and the reported difference regarding the increased choices for the graduates and the effect on their agency.

    Design: In this case study, we focused on a net-based master's programme in sexual and reproductive health in Somalia. Somalia suffers from a shortage of skilled birth attendants and there is a need for building up the capacity of midwifery educators.

    Setting and participants: Data was collected in focus group discussions at the start of the programme and eight months after the students graduated. The data were analysed through the lens of the choice framework, which is based on the capability approach.

    Findings: Findings show that many of the graduates’ expectations were met, while some were more difficult to fulfil. While the midwives’ choices and resource portfolios had improved because of their role as educators, the social structure prevented them from acting on their agency, specifically in regards to making changes at the social level. Several of the positive developments can be attributed to the pedagogy and structure of the programme.

    Conclusion: The flexibility of net-based education gave the midwifery educators a new educational opportunity that they previously did not have. Students gained increased power and influence on some levels. However, they still lack power in government organisations where, in addition to their role as educators, they could use their skills and knowledge to change policies at the social level.

  • 7.
    Thorstensson, Stina
    et al.
    Örebro University, School of Health and Medical Sciences.
    Nissen, Eva
    School of Life Sciences, University of Skövde, Box 408, SE 541 28 Skövde, Sweden; Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
    Ekström, Anette
    School of Life Sciences, University of Skövde, Box 408, SE 541 28 Skövde, Sweden.
    An exploration and description of student midwives' experiences in offering continuous labour support to women/couples2008In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 24, no 4, p. 451-459Article in journal (Refereed)
    Abstract [en]

    Aim

    to explore and describe the student midwife's experiences in offering continuous labour support. 

    Design

    a qualitative research design was chosen. Each student midwife offered continuous labour support to five women/couples and wrote narratives about each of these occasions. Written narratives from 11 student midwives were analysed using qualitative content analysis.

    Findings

    when student midwives offer continuous labour support to women/couples, they try to establish rapport. When this works, their presence, their sense of confidence and their ability to offer reassurance increase. If establishing rapport does not work, students experience a sense of powerlessness, a need for reassurance and a lack of confidence. Key conclusions offering continuous labour support to women and/or their partners made the students aware of the importance of establishing rapport, and it made them realise the impact that their mere presence in the room could have. The students had a need for reassurance which could hamper their efforts to establish rapport. Experiencing a lack of confidence made students focus more strongly on their clinical skills and on their perceived role as a student midwife.Implications for practice this study can initiate discussions about how student midwives learn to be supportive, as well as about the role models that students encounter during their clinical training in Sweden.

  • 8.
    Tingström, Joanna
    et al.
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Henriksson, Elisabet Welin
    Division of Nursing, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden.
    Sonesson, Sven-Erik
    Department of Women and Child Health, Karolinska Institutet, Stockholm, Sweden.
    Wahren-Herlenius, Marie
    Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ro52 autoantibody-positive women's experience of being pregnant and giving birth to a child with congenital heart block2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 1, p. 18-23Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: congenital heart block may develop in the fetus of women with Ro/SSA autoantibodies. The aim of this study was to investigate how women expecting a child with congenital heart block (CHB) experienced their pregnancy and post-partum period.

    DESIGN, SETTING AND PARTICIPANTS: women giving birth to a child with CHB in Sweden during 2000-2009 were identified in a population-based manner and individually interviewed post-pregnancy using a semi-structured interview guide. The interviews (n=21) were audiotaped, transcribed verbatim and analysed by qualitative content analysis.

    FINDINGS: three categories emerged from the responses: learning, suspense and facing. Learning contained both learning about the child's heart block, but frequently also about autoantibody-positivity and a potential rheumatic diagnosis in the mother (16/21). The medical procedures and information differed considerably depending on the area of residence and who was encountered in the health-care system. In many cases, ignorance about this rare condition caused a delay in treatment and surveillance. Suspense described the women's struggle to cope with the feeling of guilt and that the child had a serious heart condition and might not survive the pregnancy. Facing included the post-partum period, leaving the hospital and adjusting to everyday life. The women had tended to put their pregnancies 'on hold', and some described that they needed prolonged time to bond with their newborn child.

    CONCLUSION: increased awareness and knowledge of CHB are needed to provide adequate care. Offering psychological support by a health-care professional to facilitate early bonding with the child should be considered.

    IMPLICATIONS FOR PRACTICE: there is a need for structured programs for surveillance of the pregnancies. Such programme should implement guidelines for the involved personnel in the chain of care and make relevant information accessible for the women and families.

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