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  • 1. Berg, M
    et al.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Värdegrunden har betydelse för vårdandet2007In: Vårdfacket, ISSN 0347-0911, Vol. MarsArticle in journal (Other academic)
  • 2. Hildingsson, I
    et al.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Karlström, A
    Lundgren, I
    A Longitudinal Survey of Childbirth-Related Fear and Associated Factors2011In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 40, no 5, p. 532-543Article in journal (Refereed)
    Abstract [en]

    To investigate the prevalence of childbirth-related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth-related fear. Design A longitudinal regional survey. Setting Three hospitals in a northern part of Sweden. Participants Six hundred ninety-seven (697) women who completed four questionnaires. Methods Data were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times. Results There was a statistically significant increase in childbirth fear from 12.4% in mid-pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups. Conclusion Women with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.

  • 3.
    Lundgren, Ingela
    et al.
    Göteborgs Universitet.
    Healy, Patricia
    Carroll, Margaret
    Begley, Cecily
    Matterne, Andrea
    Gross, Mechthild M
    Grylka-Baeschlin, Susanne
    Nicoletti, Jane
    Morano, Sandra
    Nilsson, Christina
    Göteborgs Universitet.
    Lalor, Joan
    Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a study from countries with low VBAC rates.2016In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 16, no 1, article id 350Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.

    METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.

    RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship.

    CONCLUSIONS: The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.

  • 4.
    Lundgren, Ingela
    et al.
    University of Gothenburg.
    Smith, Valerie
    Trinity College Dublin.
    Nilsson, Christina
    University of Gothenburg.
    Vehvilainen-Julkunen, Katri
    University of Eastern Finland.
    Nicoletti, Jane
    Universita Degli Studi di Genova.
    Devane, Declan
    NUI Galway/West North West Hospital Group.
    Bernloehr, Annette
    Hannover Medical School.
    van Limbeek, Evelien
    Zuyd University.
    Lalor, Joan
    Trinity College Dublin.
    Begley, Cecily
    Trinity College Dublin.
    Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review.2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, no 16Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.

    METHODS: The bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, 'Effective Public Health Practice Project'. The primary outcome measure was VBAC rates.

    RESULTS: 238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.

    CONCLUSIONS: This systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.

  • 5. Lundgren, Ingela
    et al.
    van Limbeek, Evelien
    Vehvilainen-Julkunen, Katri
    Nilsson, Christina
    Göteborgs Universitet.
    Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates.2015In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 15, article id 196Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of 'OptiBIRTH', an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates.

    METHODS: Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012-2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.

    RESULTS: The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women's trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open.

    CONCLUSIONS: This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians' perspectives is needed from countries with low, as well as high, VBAC rates.

  • 6.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Hogg, Beatrice (Editor)
    Hildingsson, Ingegerd (Editor)
    Lundgren, Ingela (Editor)
    University of Borås, School of Health Science.
    Att möta och vårda kvinnan med förlossningsrädsla2009In: Lärobok för barnmorskor, 3:e upplagan / [ed] Annette Kaplan, Beatrice Hogg, Ingegerd Hildingsson, Ingela Lundgren, Lund: Studentlitteratur AB , 2009, p. 64-68Chapter in book (Other academic)
  • 7.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Att möta och vårda kvinnor med svår förlossningsrädsla2010In: Att stödja och stärka. Vårdande vid barnafödande / [ed] Marie Berg, Ingela Lundgren, Studentlitteratur , 2010, p. 169-191Chapter in book (Other academic)
  • 8.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Föreläsning om förlossningsrädsla2007Conference paper (Other academic)
  • 9.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Förlossningsrädsla med fokus på kvinnors förlossningsupplevelser2012Conference paper (Other academic)
  • 10.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Förlossningsrädsla: med fokus på kvinnors upplevelser av att föda barn2012Doctoral thesis, monograph (Other academic)
  • 11.
    Nilsson, Christina
    University of Borås, School of Health Science.
    Presentation av forskningsområde.2007Conference paper (Other academic)
  • 12.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Bondas, Terese
    University of Borås, School of Health Science.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    Previous birth experience in women with intense fear of childbirth2011Conference paper (Refereed)
  • 13.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Bondas, Terese
    Lundgren, Ingela
    Previous birth experience in women with intense fear of childbirth2010In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 39, no 3, p. 298-309Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives.

    Design: A descriptive phenomenological study. Setting: A maternity clinic for women with fear of childbirth in the western part of Sweden. Participants: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative.

    Methods: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach.

    Results: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women’s minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense.

    Conclusions: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/ midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.

  • 14.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Bondas, Terese
    University of Borås, School of Health Science.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    Previous birth experience in women with intense fear of childbirth2010Conference paper (Refereed)
    Abstract [en]

    OBJECTIVE: To describe the meaning of previous experiences of childbirth in pregnant women who have exhibited intense fear of childbirth such that it has an impact on their daily lives. DESIGN: A descriptive phenomenological study. SETTING: A maternity clinic for women with fear of childbirth in the western part of Sweden. PARTICIPANTS: Nine women with intense fear of childbirth who were pregnant with their second child and considered their previous birth experiences negative. METHODS: Interviews that were transcribed verbatim and analyzed with a reflective life-world approach. RESULTS: The essential meanings that emerged were a sense of not being present in the delivery room and an incomplete childbirth experience. The women felt as if they had no place there, that they were unable to take their place, and that even if the midwife was present, she did not provide support. The experience remained etched in the women's minds and gave rise to feelings of fear, loneliness, and lack of faith in their ability to give birth and diminished trust in maternity care. These experiences contrasted with brief moments that made sense. CONCLUSIONS: Previous childbirth experiences for pregnant women with intense fear of childbirth have a deep influence and can be related to suffering and birth trauma. The implication is to provide maternity care where the nurse/midwife is present and supports women during birth in a way that enables them to be present and take their place during birth.

  • 15.
    Nilsson, Christina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Dencker, Anna
    Göteborgs Universitet.
    Begley, Cecily
    Trinity University.
    Jangsten, Elisabeth
    Göteborgs Universitet.
    Mollberg, Margareta
    Göteborgs Universitet.
    Patel, Harshida
    Göteborgs Universitet.
    Wigert, Helena
    Göteborgs Universitet.
    Hessman, Eva
    Göteborgs Universitet.
    Sjöblom, Helen
    Göteborgs Universitet.
    Sparud-Lundin, Carina
    Göteborgs Universitet.
    Causes and outcomes in studies of fear of childbirth: A systematic review2018In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799Article, review/survey (Refereed)
    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.

  • 16.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Eriksson, Carola
    Ingegerd, Hildingsson (Editor)
    Hogg, Beatrice (Editor)
    Kaplan, Annette (Editor)
    Förlossningsrädsla2009In: Lärobok för barnmorskor, 3:e upplagan / [ed] Annette Kaplan, Beatrice Hogg, Ingegerd Hildingsson, Ingela Lundgren, Lund: Studentlitteratur AB , 2009, p. 62-64Chapter in book (Other academic)
  • 17.
    Nilsson, Christina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. University of Gothenburg.
    Hessman, Eva
    University of Gothenburg.
    Sjöblom, Helen
    University of Gothenburg.
    Dencker, Anna
    University of Gothenburg.
    Jangsten, Elisabeth
    University of Gothenburg.
    Mollberg, Margareta
    University of Gothenburg.
    Patel, Harshida
    University of Gothenburg.
    Sparud-Lundin, Carina
    University of Gothenburg.
    Wigert, Helena
    University of Gothenburg.
    Begley, Cecily
    Trinity College Dublin.
    Definitions, measurements and prevalence of fear of childbirth: a systematic review2018In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 18, no 1, article id 29329526Article in journal (Refereed)
    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.

  • 18.
    Nilsson, Christina
    et al.
    University of Gothenburg.
    Lalor, Joan
    Trinity College Dublin.
    Begley, Cecily
    Trinity College Dublin.
    Carroll, Margaret
    Trinity College Dublin.
    Gross, Mechthild M
    Hannover Medical School.
    Grylka-Baeschlin, Susanne
    Hannover Medical School.
    Lundgren, Ingela
    University of Gothenburg.
    Matterne, Andrea
    Hannover Medical School.
    Morano, Sandra
    University of Genoa.
    Nicoletti, Jane
    University of Genoa.
    Healy, Patricia
    National University of Ireland.
    Vaginal birth after caesarean: Views of women from countries with low VBAC rates2017In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 6, p. 481-490, article id 28545775Article in journal (Refereed)
    Abstract [en]

    PROBLEM AND BACKGROUND:Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women's views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low.AIM:To investigate women's views on important factors to improve the rate of vaginal birth after caesareanin countries where vaginal birth rates after previous caesarean are low.

    METHODS:A qualitative study using content analysis. Data were gathered through focus groups and individual interviews with 51 women, in their native languages, in Germany, Ireland and Italy. The women were asked five questions about vaginal birth after caesarean. Data were translated to English, analysed together and finally validated in each country.

    FINDINGS:Important factors for the women were that all involved in caring for them were of the same opinion about vaginal birth after caesarean, that they experience shared decision-making with clinicians supportive of vaginal birth, receive correct information, are sufficiently prepared for a vaginal birth, and experience a culture that supports vaginal birth after caesarean.DISCUSSION AND

    CONCLUSION:Women's decision-making about vaginal birth after caesarean in these countries involves a complex, multidimensional interplay of medical, psychosocial, cultural, personal and practical considerations. Further research is needed to explore if the information deficit women report negatively affects their ability to make informed choices, and to understand what matters most to women when making decisions about vaginal birth after a previous caesarean as a mode of birth.

  • 19.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Lundgren, I
    Karlström, A
    Hildingsson, I
    Self reported fear of childbirth and its association with women´s birth experience and mode of delivery: a longitudinal population-based study.2012In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 25, no 3, p. 114-121Article in journal (Refereed)
    Abstract [en]

    Objective: To explore fear of childbirth (FOC) during pregnancy and one year after birth and its association to birth experience and mode of delivery. Design: A longitudinal population-based study. Population: Pregnant women who were listed for a routine ultrasound at three hospitals in the middle-north part of Sweden. Method: Differences between women who reported FOC and who did not were calculated using risk ratios with a 95% confidence interval. In order to explain which factors were most strongly associated to suffer from FOC during pregnancy and one year after childbirth, multivariate logistic regression analyses were used. Results: FOC during pregnancy in multiparous women was associated with a previous negative birth experience (RR 5.1, CI 2.5—10.4) and a previous emergency caesarean section (RR 2.5, CI 1.2—5.4). Associated factors for FOC one year after childbirth were: a negative birth experience (RR 10.3, CI 5.1—20.7), fear of childbirth during pregnancy (RR 7.1, CI 4.4—11.7), emergency caesarean section (RR 2.4, CI 1.2—4.5) and primiparity (RR 1.9, CI 1.2—3.1). Conclusion: FOC was associated with negative birth experiences. Women still perceived the birth experience as negative a year after the event. Women’s perception of the overall birth experience as negative seems to be more important for explaining subsequent FOC than mode of delivery. Maternity care should focus on women’s experiences of childbirth. Staff at antenatal clinics should ask multiparous women about their previous experience of childbirth. So that FOC is minimized, research on factors that create a positive birth experience for women is required.

  • 20. Nilsson, Christina
    et al.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    Women's lived experiences of fear of childbirth2009In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 25, no 2, p. 1-9Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to describe women's lived experience of fear of childbirth.

    DESIGN: a qualitative study using a phenomenological approach and a lifeworld perspective. Data were collected via tape-recorded interviews. SETTING: Sahlgrenska University Hospital, Göteborg, Sweden in 2003. PARTICIPANTS: eight pregnant women (24-37 gestational weeks) seeking help within an outpatient clinic for women with severe fear of childbirth. Two of the women were primiparous.

    FINDINGS: four constituents were identified: feeling of danger that threatens and appeals; feeling trapped; feeling like an inferior mother-to-be and on your own. The essential structure was described as 'to lose oneself as a woman into loneliness'.

    KEY CONCLUSIONS: fear of childbirth affects women in such a way that they start to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Previous birth experience was central to the multiparous women. They described their experiences of suffering in relation to the care they received during childbirth. This mainly concerned pain and negative experiences with staff.

    IMPLICATIONS FOR PRACTICE: pregnant women who fear childbirth are an exposed group in need of much support during pregnancy and childbirth. The encounter between the woman and the midwife can be a way of breaking down the feeling of loneliness and restoring the woman's trust in herself as a childbearing woman.

  • 21.
    Nilsson, Christina
    et al.
    University of Gothenburg.
    Lundgren, Ingela
    University of Gothenburg.
    Smith, Valerie
    Trinity College Dublin.
    Vehvilainen-Julkunen, Katri
    Kuopio University Hospital.
    Nicoletti, Jane
    Universita Degli Studi di Genova.
    Devane, Declan
    Saolta University Healthcare Group.
    Bernloehr, Annette
    Hannover Medical School.
    van Limbeek, Evelien
    Zuyd University.
    Lalor, Joan
    University of Gothenburg.
    Begley, Cecily
    Trinity College Dublin.
    Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review.2015In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 31, no 7, p. 657-63, article id S0266-6138(15)00118-7Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: to evaluate the effectiveness of women-centred interventions during pregnancy and birth to increase rates of vaginal birth after caesarean.

    DESIGN: we searched bibliographic databases for randomised trials or cluster randomised trials on women-centred interventions during pregnancy and birth designed to increase VBAC rates in women with at least one previous caesarean section. Comparator groups included standard or usual care or an alternative treatment aimed at increasing VBAC rates. The methodological quality of included studies was assessed independently by two authors using the Effective Public Health Practice Project quality assessment tool. Outcome data were extracted independently from each included study by two review authors.

    FINDINGS: in total, 821 citations were identified and screened by title and abstract; 806 were excluded and full text of 15 assessed. Of these, 12 were excluded leaving three papers included in the review. Two studies evaluated the effectiveness of decision aids for mode of birth and one evaluated the effectiveness of an antenatal education programme. The findings demonstrate that neither the use of decision aids nor information/education of women have a significant effect on VBAC rates. Nevertheless, decision-aids significantly decrease women's decisional conflict about mode of birth, and information programmes significantly increase their knowledge about the risks and benefits of possible modes of birth.

    KEY CONCLUSIONS: few studies evaluated women-centred interventions designed to improve VBAC rates, and all interventions were applied in pregnancy only, none during the birth. There is an urgent need to develop and evaluate the effectiveness of all types of women-centred interventions during pregnancy and birth, designed to improve VBAC rates.

    IMPLICATIONS FOR PRACTICE: decision-aids and information programmes during pregnancy should be provided for women as, even though they do not affect the rate of VBAC, they decrease women's decisional conflict and increase their knowledge about possible modes of birth.

  • 22. Nilsson, Christina
    et al.
    Robertson, Eva
    Lundgren, Ingela
    An Effort to Make All the Pieces Come Together: Women's Long-Term Perspectives on Their Experiences of Intense Fear of Childbirth2012In: International Journal of Childbirth, ISSN 2156-5287, E-ISSN 2156-5295, Vol. 2, no 4, p. 255-268Article in journal (Refereed)
  • 23.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Robertson, Eva
    University of Borås, School of Health Science.
    Lundgren, Ingela
    University of Borås, School of Health Science.
    The meaning of women's long-term experiences of birth and fear of childbirth2012Conference paper (Refereed)
  • 24.
    Nilsson, Christina
    et al.
    University of Borås, School of Health Science.
    Rusner, Marie
    University of Borås, School of Health Science.
    Johansson Sundler, Annelie
    Berglund, Maria
    Meranius, Martina
    Thurang, Anna
    Karlsson, Ann-Christine
    Pettersson, Bengt-Olof
    Bremer, Anders
    University of Borås, School of Health Science.
    Varför vårdvetenskap?2008Report (Other academic)
  • 25.
    Nilsson, Christina
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    van Limbeek, Evelien
    Zuyd University.
    Vehvilainen-Julkunen, Katri
    University of Eastern Finland.
    Lundgren, Ingela
    Vaginal birth after caesarean - Views of women from countries with high VBAC rate2017In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 27, no 3, p. 325-340Article in journal (Refereed)
    Abstract [en]

    Despite the consequences for women’s health, a repeat cesarean section (CS) birth after a previous CS is common in Western countries. Vaginal Birth After Cesarean (VBAC) is recommended for most women, yet VBAC rates are decreasing and vary across maternity organizations and countries. We investigated women’s views on factors of importance for improving the rate of VBAC in countries where VBAC rates are high. We interviewed 22 women who had experienced VBAC in Finland, the Netherlands, and Sweden. We used content analysis, which revealed five categories: receiving information from supportive clinicians, receiving professional support from a calm and confident midwife/obstetrician during childbirth, knowing the advantages of VBAC, letting go of the previous childbirth in preparation for the new birth, and viewing VBAC as the first alternative for all involved when no complications are present. These findings reflect not only women’s needs but also sociocultural factors influencing their views on VBAC.

  • 26.
    Sundler, Annelie Johansson
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindberg, Elisabeth
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Nilsson, Christina
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Palmér, Lina
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Qualitative thematic analysis – based on phenomenology2018Conference paper (Refereed)
  • 27.
    Wulcan, Ann-Charlotte
    et al.
    Northern Älvsborg County Hospital, NU-Hospital Group.
    Nilsson, Christina
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study2019In: Sexual and Reproductive Healthcare, ISSN 1877-5756, Vol. 19, p. 24-30Article in journal (Refereed)
    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.

1 - 27 of 27
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