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Publications (10 of 34) Show all publications
Nilsson, C., Wijk, H., Höglund, L., Sjöblom, H., Hessman, E. & Berg, M. (2020). Effects of birthing room design on maternal and neonate outcomes: a systematic review. Health Environments Research & Design Journal
Open this publication in new window or tab >>Effects of birthing room design on maternal and neonate outcomes: a systematic review
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2020 (English)In: Health Environments Research & Design Journal, ISSN 1937-5867, E-ISSN 2167-5112Article in journal (Refereed) Published
Abstract [en]

Aim: To summarize, categorize and describe published research on how birthing room design influences maternal and neonate physical and emotional outcomes.

Background: The physical healthcare environment has significant effects on health and wellbeing. Research indicates that birthing environments can impact women during labor and birth. However, summaries of the effects of different environments around birth are scarce.

Methods: We conducted a systematic review, searching 10 databases in 2016 and 2017 for published research from their inception dates, on how birthing room design influences maternal and neonate physical and emotional outcomes, using a protocol agreed a priori. The quality of selected studies was assessed, and data were extracted independently by pairs of authors and described in a narrative analysis.

Results: In total, 3373 records were identified and screened by title and abstract; 2063 were excluded and the full text of 278 assessed for analysis. Another 241 were excluded, leaving 15 articles presenting qualitative and quantitative data from six different countries on four continents. The results of the analysis reveal four prominent physical themes in birthing rooms that positively influence on maternal and neonate physical and emotional outcomes: 1) means of distraction, comfort, and relaxation; 2) raising the birthing room temperature; 3) features of familiarity; and 4) diminishing a technocratic environment.

Conclusions: The evidence on how birthing environments affect outcomes of labor and birth is incomplete. There is a crucial need for more research in this field.    

Keywords
systematic literature review, childbirth, birthing room, health-care environment, design, maternal and neonate outcomes, evidence-based design (EBD), outcomes – design, labor and delivery units
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22871 (URN)10.1177/1937586720903689 (DOI)
Projects
Room4Birth
Available from: 2020-02-22 Created: 2020-02-22 Last updated: 2020-03-04Bibliographically approved
Wigert, H., Nilsson, C., Dencker, A., Begley, c., Jangsten, E., Sparud-Lundin, C., . . . Patel, H. (2020). Women's experiences of fear of childbirth: a metasynthesis of qualitative studies. International Journal of Qualitative Studies on Health and Well-being, 15, Article ID 1704484.
Open this publication in new window or tab >>Women's experiences of fear of childbirth: a metasynthesis of qualitative studies
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2020 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 15, article id 1704484Article in journal (Refereed) Published
Abstract [en]

Purpose: Women’s experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women’s experiences of fear of childbirth.

Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers.

Results: The main results demonstrate a deepened understanding of women’s experiences of fear of childbirth interpreted through the metaphor “being at a point of no return”. Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear.

Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth.

Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other’s experiences will not happen to them.

Keywords
Fear after childbirth, fear of childbirth, meta-synthesis, requests for caesarean section, women experience
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22319 (URN)10.1080/17482631.2019.1704484 (DOI)2-s2.0-85076759406 (Scopus ID)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-10Bibliographically approved
Lundgren, I., Berg, M., Nilsson, C. & Olafsdottir, O. (2019). Health professionals' perceptions of a Midwifery Model of Woman-Centred Care implemented on a hospital labour ward. Women and Birth
Open this publication in new window or tab >>Health professionals' perceptions of a Midwifery Model of Woman-Centred Care implemented on a hospital labour ward
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article in journal (Refereed) Published
Abstract [en]

Background

Theoretical models as a basis for midwives’ care have been developed over recent decades. Although there are similarities between these models, their usefulness in practice needs to be researched in specific cultural contexts.

Aim

To explore whether, when adopted by midwives on labour wards, a midwifery model of woman-centred care (MiMo) was useful in practice from the viewpoint of a variety of health professionals.

Methods

Data were collected from a variety of health professionals before and after an intervention of implementating MiMo at a hospital-based labour ward in Sweden, using nine focus group interviews with a total of 43 participants: midwives (n = 16), obstetricians (n = 8), assistant nurses (n = 11) and managers (n = 8). The text from interviews was analysed using content analysis.

Findings

From expressing no explicit need of a midwifery model of woman-centred care before the intervention, there was a shift in midwives, obstetricians and managers perceptions towards identifying advantages of using the MiMo as it gives words to woman-centred midwifery care. Such shift in perception was not found among the assistant nurses.

Discussion

Clarification of the various roles of health professionals is needed to develop the model. Heavy workloads and stress were barriers to implementing the model. Thus, more support is needed from organisational management.

Conclusions

The model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care.

Keywords
Woman-centred care, Models of care, Midwifery, Focus groups, Content analysis
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22324 (URN)10.1016/j.wombi.2019.01.004 (DOI)2-s2.0-85060349342 ()30686654 (PubMedID)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-10Bibliographically approved
Nilsson, C., Olafsdottir, O., Lundgren, I., Berg, M. & Dellenborg, L. (2019). Midwives’ Care on a Labour Ward Prior to the Introduction of a Midwifery Model of Care: A Field of Tension. International Journal of Qualitative Studies on Health and Well-being, 14, Article ID 1593037.
Open this publication in new window or tab >>Midwives’ Care on a Labour Ward Prior to the Introduction of a Midwifery Model of Care: A Field of Tension
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2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, Vol. 14, article id 1593037Article in journal (Refereed) Published
Abstract [en]

Purpose: There is a need to deepen knowledge about midwives’ care in obstetric-led labour wards in which midwives are responsible for normal births. This ethnographic study explores the content and meaning of midwives’ care of women in a hospital-based labour ward in Sweden prior to the introduction of a theoretical midwifery model of care. 

Methods: Data were gathered through participant observation, analysed through interpretation grounded in reflexivity discussions and are presented in the form of ethnographic descriptions. 

Results: The midwives’ care was provided in a field of tension in which they had to balance contrasting models of care, described in the themes: The birthing rooms and the office—Different rooms of care, Women giving birth or being delivered—Midwives’ expectations and relationships with women, Old and new caring roles of the midwife—Women giving birth in a “new age”, Being and doing—Different approaches to caring, and Holistic and reductionist care—Guided by contrasting models and guidelines. The midwives’ freedom to act as autonomous professionals was hindered by medical and institutional models of care and this led to uncertainty regarding their roles as midwives. 

Conclusions: Midwives having to balance their activities in a field of tension require midwifery models that can guide their practice.

Keywords
Midwifery, women, models of care, experiences, childbirth, ethnography, culture, woman-centred, work place
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22322 (URN)10.1080/17482631.2019.1593037 (DOI)000462776700001 ()2-s2.0-85063620147 (Scopus ID)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-10Bibliographically approved
Wulcan, A.-C. & Nilsson, C. (2019). Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study. Sexual and Reproductive Healthcare, 19, 24-30
Open this publication in new window or tab >>Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study
2019 (English)In: Sexual and Reproductive Healthcare, ISSN 1877-5756, Vol. 19, p. 24-30Article in journal (Refereed) Published
Abstract [en]

Objective

Fear 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.

Methods

A qualitative study of 13 midwives using focus group interviews and inductive content analysis.

Results

The 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.

Conclusion

Although 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.

Keywords
Fear of childbirth, Midwifery, Experiences, Content analysis, Treatment, Counselling
National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15506 (URN)10.1016/j.srhc.2018.12.001 (DOI)000465365500005 ()2-s2.0-85058061104 (Scopus ID)
Available from: 2018-12-18 Created: 2018-12-18 Last updated: 2020-01-31Bibliographically approved
Sundler, A. J., Lindberg, E., Nilsson, C. & Palmér, L. (2019). Qualitative thematic analysis based on descriptive phenomenology.. Nursing open, 6(3), 733-739
Open this publication in new window or tab >>Qualitative thematic analysis based on descriptive phenomenology.
2019 (English)In: Nursing open, ISSN 2054-1058, Vol. 6, no 3, p. 733-739Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this paper was to discuss how to understand and undertake thematic analysis based on descriptive phenomenology. Methodological principles to guide the process of analysis are offered grounded on phenomenological philosophy. This is further discussed in relation to how scientific rigour and validity can be achieved.

Design: This is a discursive article on thematic analysis based on descriptive phenomenology.

Results: This paper takes thematic analysis based on a descriptive phenomenological tradition forward and provides a useful description on how to undertake the analysis. Ontological and epistemological foundations of descriptive phenomenology are outlined. Methodological principles are explained to guide the process of analysis, as well as help to understand validity and rigour. Researchers and students in nursing and midwifery conducting qualitative research need comprehensible and valid methods to analyse the meaning of lived experiences and organize data in meaningful ways.

Keywords
healthcare research, lifeworld, lived experiences, meanings, midwifery, nursing, phenomenology, qualitative, thematic analysis
National Category
Nursing
Identifiers
urn:nbn:se:hb:diva-21890 (URN)10.1002/nop2.275 (DOI)000476917700008 ()31367394 (PubMedID)2-s2.0-85069758075 (Scopus ID)
Available from: 2019-10-23 Created: 2019-10-23 Last updated: 2019-10-29Bibliographically approved
Berg, M., Goldkuhl, L., Nilsson, C., Wijk, H., Gyllensten, H., Lindahl, G., . . . Begley, C. (2019). Room 4 Birth - The effect of an adaptable birthing room on labour andbirth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden. Trials
Open this publication in new window or tab >>Room 4 Birth - The effect of an adaptable birthing room on labour andbirth outcomes for nulliparous women at term with spontaneous labour start: study protocol for a randomised controlled superiority trial in Sweden
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2019 (English)In: TrialsArticle in journal (Refereed) Published
Abstract [en]

Background

An important prerequisite for optimal healthcare is a secure, safe and comfortable environment. There is little research on how the physical design of birthing rooms affects labour, birth, childbirth experiences and birthing costs. This protocol outlines the design of a randomised controlled superiority trial (RCT) measuring and comparing effects and experiences of two types of birthing rooms, conducted in one labour ward in Sweden.

Methods/design

Following ethics approval, a study design was developed and tested for feasibility in a pilot study, which led to some important improvements for conducting the study. The main RCT started January 2019 and includes nulliparous women presenting to the labour ward in active, spontaneous labour and who understand either Swedish, Arabic, Somali or English. Those who consent are randomised on a 1:1 ratio to receive care either in a regular room (control group) or in a newly built birthing room designed with a person-centred approach and physical aspects (such as light, silencer, media installation offering programmed nature scenes with sound, bathtub, birth support tools) that are changeable according to a woman’s wishes (intervention group). The primary efficacy endpoint is a composite score of four outcomes: no use of oxytocin for augmentation of labour; spontaneous vaginal births (i.e. no vaginal instrumental birth or caesarean section); normal postpartum blood loss (i.e. bleeding < 1000 ml); and a positive overall childbirth experience (7–10 on a scale of 1–10). To detect a difference in the composite score of 8% between the groups we need 1274 study participants (power of 80% with significance level 0.05). Secondary outcomes include: the four variables in the primary outcome; other physical outcomes of labour and birth; women’s self-reported experiences (the birthing room, childbirth, fear of childbirth, health-related quality of life); and measurement of costs in relation to the hospital stay for mother and neonate. Additionally, an ethnographic study with participant observations will be conducted in both types of birthing rooms.

Discussion

The findings aim to guide the design of birthing rooms that contribute to optimal quality of hospital-based maternity care.

National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22321 (URN)10.1186/s13063-019-3765-x (DOI)000504430900001 ()31744523 (PubMedID)2-s2.0-85075285529 (Scopus ID)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-10Bibliographically approved
Lyckestam Thelin, I., Lundgren, I. & Nilsson, C. (2019). To challenge oneself as a childbearing woman—the lived experience of vaginal birth after caesarean section in Sweden. International Journal of Qualitative Studies on Health and Well-being, 14, Article ID 1605784.
Open this publication in new window or tab >>To challenge oneself as a childbearing woman—the lived experience of vaginal birth after caesarean section in Sweden
2019 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 14, article id 1605784Article in journal (Refereed) Published
Abstract [en]

Purpose: There is a need to gain deeper knowledge about women’s experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women’s experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate.

Method: This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth.

Results: The essential meaning of the studied phenomenon is “to challenge oneself as a childbearing woman”, which is further described by its four constituents: “striving for support from professionals”, “desiring the experience”, “contrasting and comparing memories of two different births” and “being part of the birthing culture”.

Conclusions: The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS.

Keywords
VBAC, Women, caesarean section, childbirth, experiences, phenomenology
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-22323 (URN)10.1080/17482631.2019.1605784 (DOI)000466720900001 ()31046655 (PubMedID)2-s2.0-85065307046 (Scopus ID)
Available from: 2019-12-20 Created: 2019-12-20 Last updated: 2020-01-10Bibliographically approved
Nilsson, C., Dencker, A., Begley, C., Jangsten, E., Mollberg, M., Patel, H., . . . Sparud-Lundin, C. (2018). Causes and outcomes in studies of fear of childbirth: A systematic review. Women and Birth
Open this publication in new window or tab >>Causes and outcomes in studies of fear of childbirth: A systematic review
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2018 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

PROBLEM:

Fear of childbirth negatively affects women during pregnancy and after birth.

AIM:

To summarise the findings of published studies regarding possible causes/predisposing factors and outcomes of fear of childbirth for childbearing women.

DESIGN:

A systematic review, searching five databases in March 2015 for studies on causes/predisposing factors and outcomes of fear of childbirth, as measured during pregnancy and postpartum. Quality of included studies was assessed independently by pairs of authors. Data were extracted independently by reviewer pairs and described in a narrative analysis.

FINDINGS:

Cross-sectional, register-based and case-control studies were included (n=21). Causes were grouped into population characteristics, mood-related aspects, and pregnancy and birth-related aspects. Outcomes were defined as mood-related or pregnancy and birth-related aspects. Differing definitions of fear of childbirth were found and meta-analysis could only be performed on parity, in a few studies.

CONCLUSIONS:

Stress, anxiety, depression and lack of social support are associated with fear during pregnancy. Need for psychiatric care and presence of traumatic stress symptoms are reported outcomes together with prolonged labour, longer labours, use of epidural and obstetric complications. Nulliparous and parous women have similar levels of fear but for different reasons. Since the strongest predictor for fear in parous women is a previous negative birth experience or operative birth, we suggest it is important to distinguish between fear of childbirth and fear after birth. Findings demonstrate the need for creating woman-centred birthing environments where women can feel free and secure with low risk of negative or traumatic birth experiences and consequent fear.

National Category
Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15305 (URN)10.1016/j.wombi.2018.07.004 (DOI)000464514100021 ()30115515 (PubMedID)2-s2.0-85051394322 (Scopus ID)
Available from: 2018-11-12 Created: 2018-11-12 Last updated: 2020-01-30Bibliographically approved
Nilsson, C., Hessman, E., Sjöblom, H., Dencker, A., Jangsten, E., Mollberg, M., . . . Begley, C. (2018). Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy and Childbirth, 18(1), Article ID 29329526.
Open this publication in new window or tab >>Definitions, measurements and prevalence of fear of childbirth: a systematic review
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2018 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 29329526Article in journal (Refereed) Published
Abstract [en]

Background

Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings.

Methods

Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared.

Results

In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001).

Conclusions

Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required.

Keywords
FOBS, Fear of childbirth, Prevalence, Request for caesarean section, Systematic review, W-DEQ
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-13554 (URN)10.1186/s12884-018-1659-7 (DOI)000422729400003 ()29329526 (PubMedID)2-s2.0-85040361801 (Scopus ID)
Available from: 2018-01-17 Created: 2018-01-17 Last updated: 2018-12-07
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3195-5702

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