Ingela Rådestad

Few women wish to be delivered by caesarean section

Objective To investigate how many women wish to have a caesarean section when asked in early pregnancy, and to identify background variables associated with such a wish.

Parental grief and relationships after the loss of a stillborn baby

OBJECTIVES to describe the grief of mothers and fathers and its influence on their relationships after the loss of a stillborn baby. DESIGN a postal questionnaire at three months, one year and two years after stillbirth. SETTING a study of mothers and fathers of babies stillborn during a one-year period in the Stockholm region of Sweden. PARTICIPANTS 55 parents, 33 mothers and 22 fathers. FINDINGS mothers and fathers stated that they became closer after the loss, and that the feeling deepened over the course of the following year. The parents said that they began grieving immediately as a gradual process, both as individuals, and together as a couple. During this grieving process their expectations, expressions and personal and joint needs might have threatened their relationship as a couple, in that they individually felt alone at this time of withdrawal. While some mothers and fathers had similar grieving styles, the intensity and expression of grief varied, and the effects were profound and unique for each individual. KEY CONCLUSIONS experiences following a loss are complex, with each partner attempting to come to terms with the loss and the resultant effect on the relationship with their partner. IMPLICATIONS FOR PRACTICE anticipating and being able to acknowledge the different aspects of grief will enable professionals to implement more effective intervention in helping couples grieve both individually and together.

Characteristics of primiparous women who are not reached by parental education classes after childbirth in Sweden

Background: Parental education classes are part of the national child health promotion programme of the Swedish Child Health Clinics (CHC). Aim: To investigate attendance at parental education classes during the infants first year, and to identify factors associated with non‐attendance in primiparous women. Methods: Swedish‐speaking women were recruited from 97% of all antenatal clinics in Sweden during 3 wk, evenly spread over 1 y from 1999 to 2000. Questionnaires were mailed in early pregnancy, and at 2 mo and 1 y after the birth. Two thousand, four hundred and forty women answered the main outcome question about class attendance asked in the third questionnaire, and 1076 of these were first‐time mothers. Results: Seventy‐eight per cent of the primiparas attended classes and 31% of the multiparas. Factors associated with non‐attendance in primiparas were: native language other than Swedish, a low level of education, smoking during pregnancy, inconvenient timing of pregnancy, feelings of loneliness and isolation, maternal hospital admission, and infant health problems. Three per cent of the primiparas did not attend classes either during pregnancy or after the birth, and this group seemed to constitute an even less privileged group.

Support After Stillbirth and Its Effect on Parental Grief Over Time

In this study the authors describe parents’ experiences of support over a 2-year period after a stillbirth and its effect on parental grief. Data was collected by questionnaire from 33 mothers and 22 fathers at 3 months, 1 year, and 2 years after a stillbirth. Midwives, physicians, counselors, and priests—at the hospital where the stillbirth occurred—are those on the front line providing professional support. The support from family and friends was seen to be important 2 years after the stillbirth. The need for professional support after stillbirth can differ, depending on the support provided by family, friends, and social networks. They may not fully realize the value of their support and how to be supportive. Printed educational materials given to individuals in the social network or family might therefore be helpful.

Women's premonitions prior to the death of their baby in utero and how they deal with the feeling that their baby may be unwell

Objective. To identify whether mothers of stillborn babies had had a premonition that their unborn child might not be well and how they dealt with that premonition. Design. A mixed method approach. Setting. One thousand and thirty‐four women answered a web questionnaire. Sample. Six hundred and fourteen women fulfilled the inclusion criteria of having a stillbirth after the 22nd gestational week and answered questions about premonition. Methods. Qualitative content analysis was used for the open questions and descriptive statistics for questions with fixed alternatives. Main Outcome Measure. The premonition of an unwell unborn baby. Results. In all, 392 of 614 (64%) of the women had had a premonition that their unborn baby might be unwell; 274 of 614 (70%) contacted their clinic and were invited to come in for a check‐up, but by then it was too late because the baby was already dead. A further 88 of 614 (22%) decided to wait until their next routine check‐up, believing that the symptoms were part of the normal cycle of pregnancy, and that the fetus would move less towards the end of pregnancy. Thirty women (8%) contacted their clinic, but were told that everything appeared normal without an examination of the baby. Conclusions. Women need to know that a decrease in fetal movements is an important indicator of their unborn babys health. Healthcare professionals should not delay an examination if a mother‐to‐be is worried about her unborn babys wellbeing.

Fetal movements in the third trimester – Important information about wellbeing of the fetus

It can be quite natural for pregnant women to believe that a decrease in the frequency of fetal movements at the end of pregnancy is normal if they have been so informed. There is also probably scope for interpretation concerning what is to be regarded as a decrease in the number of movements. Non-evidence-based information that a decrease in fetal movements is normal during the third trimester poses a threat to the unborn babys life. If the mother does not react to a decrease in frequency and if she waits too long before contacting healthcare professionals, the window of opportunity to save the babys life may be closed.

Stillbirth and maternal well-being

Background. Stillbirth imposes severe strains on the mother. Little is known about the long‐term well‐being after such an experience.

Transfer in planned home births in Sweden--effects on the experience of birth: a nationwide population-based study.

OBJECTIVE More than 10% of all planned home births in high-income countries are completed in the hospital. The aim of this study was to compare the birth experiences among women who planned to give birth at home and completed the birth at home and women who were transferred to hospital during or immediately after the birth. METHODS All women in Sweden who had a planned home birth between 1998 and 2005 (n=671) were invited to participate in the study. The women who agreed to participate received one questionnaire for each planned home birth. Mixed methods were used for the analysis. RESULTS Women who had been transferred during or immediately after the planned home birth had a more negative birth experience in general. In comparison with women who completed the birth at home, the odds ratio for being less satisfied was 13.5, CI 8.1-22.3. Reasons for being dissatisfied related to organizational factors, the way the women were treated or personal ability. CONCLUSION Being transferred during a planned home birth negatively affects the birth experience. Treatments as well as organizational factors are considered to be obstacles for a positive birth experience when transfer is needed. Established links between the home birth setting and the hospital might enhance the opportunity for a positive birth experience irrespective of where the birth is completed.

Mothers’ attitudes towards perinatal autopsy after stillbirth

We investigated mothers’ attitudes to autopsy of their stillborn baby and their experiences concerning information and treatment in relation to their loss in an observational study. Data were collected by postal questionnaires and telephone calls. Fifty‐four of 72 mothers (76%) replied. Fifty‐one (94%) received information from a physician about the possibility of having an autopsy; three (6%) did not get any information. The autopsy rate was 83% (n= 45). Thirty‐six of 45 (80%) received adequate information about results. Twenty‐five (56%) were pleased with how results were presented. Eleven (24%) were positive about individual contact with the pathologist who performed the autopsy. Fifty‐one (94%) stated that their decision concerning autopsy was right. Mothers do not regret their decision concerning perinatal autopsy but they do not always receive thorough and timely information concerning autopsy and its results. Personal contact with the perinatal pathologist might help with specific questions both before and after autopsy.

Mothers' experiences of the time after the diagnosis of an intrauterine death until the induction of the delivery: A qualitative Internet‐based study

Aim:  This study aims to describe how mothers spend the period of time between being diagnosed with a dead baby in utero and the induction of the delivery.