Katri Vehviläinen-Julkunen

Fathers' experiences of childbirth

OBJECTIVE To describe how fathers who are present during childbirth experience the event, what they feel during childbirth and how they understand the meaning of childbirth. DESIGN Survey using questionnaire. SETTING Maternity unit in Finland. PARTICIPANTS A non-random sample of fathers (n = 137) who were present at the birth of their baby at one university hospital in Finland. The response rate was 81% (n = 107). MEASUREMENTS AND FINDINGS Young fathers and those expecting their first baby reported feeling uncomfortable during delivery more frequently than others. Almost all said that they had plenty of good experiences, younger fathers more so than older fathers. The fathers expressed their confidence in the staff and described the environment at the hospital as pleasant. They said their presence at delivery was important for their growth into fatherhood. The best experience was the moment that the baby entered the world. The hardest things were the pain experienced by their partner and being unable to help. Most of the fathers were very pleased with current midwifery practices followed in childbirth, however, it was felt that more attention ought to be paid to pain relief and to supporting and providing guidance to the father during delivery. IMPLICATIONS FOR PRACTICE The work of midwives should be planned so that fathers can feel secure and comfortable. Further studies are needed into the ability of midwives to support fathers in their fatherhood.

The pain of childbirth: perceptions of culturally diverse women.

The pain experiences of culturally diverse childbearing women are described based on a secondary analysis of narrative data from phenomenologic studies of the meaning of childbirth. Study participants were interviewed in the hospital after giving birth or in their homes within the first weeks after having a baby. Transcripts of interviews with childbearing women who lived in North and Central America, Scandinavia, the Middle East, the Peoples Republic of China, and Tonga were analyzed. Participants described their attitudes toward, perceptions of, and the meaning of childbirth pain. Culturally bound behavior in response to childbirth pain was also articulated. A variety of coping mechanisms were used by women to deal with the pain. Understanding the meaning of pain, womens perceptions of pain, and culturally bound pain behaviors is fundamental in order for nurses to facilitate satisfying birth experiences for culturally diverse women.

Hospitalized children's descriptions of their experiences with postsurgical pain relieving methods

The purpose of this study was to describe childrens (aged 8-12 yr) experiences with postsurgical pain relieving methods, and their suggestions to nurses and parents concerning the implementation of pain relief measures in the hospital. The data were collected by interviewing children (N = 52) who were inpatients on a pediatric surgical ward in the university hospital of Finland. Content analysis was used to analyze the data. The children rated the intensity of pain on a visual analogue scale. The results indicated that all of the children used at least one self-initiated pain relieving method (e.g. distraction, resting/sleeping), in addition to receiving assistance in pain relief from nurses (e.g. giving pain killers, helping with daily activities) and parents (e.g. distraction, presence). The children also provided suggestions, especially as it relates to nurses (e.g. creating a more comfortable environment), regarding the implementation of effective surgical pain relief. However, some cognitive-behavioral and physical methods were identified that should be implemented more frequently in clinical practice. Furthermore, most children reported their worst pain to be severe or moderate, which indicates that pain management in hospitalized children should be more aggressive.

Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997-2008.

BackgroundPreeclampsia is a frequent syndrome and its cause has been linked to multiple factors, making prevention of the syndrome a continuous challenge. One of the suggested risk factors for preeclampsia is advanced maternal age. In the Western countries, maternal age at first delivery has been steadily increasing, yet few studies have examined women of advanced maternal age with preeclampsia. The purpose of this registry-based study was to compare the obstetric outcomes in primiparous and preeclamptic women younger and older than 35 years.MethodsThe registry-based study used data from three Finnish health registries: Finnish Medical Birth Register, Finnish Hospital Discharge Register and Register of Congenital Malformations. The sample contained women under 35 years of age (N = 15,437) compared with those 35 and over (N = 2,387) who were diagnosed with preeclampsia and had their first singleton birth in Finland between 1997 and 2008. In multivariate modeling, the main outcome measures were Preterm delivery (before 34 and 37 weeks), low Apgar score (5 min.), small-for-gestational-age, fetal death, asphyxia, Cesarean delivery, induction, blood transfusion and admission to a Neonatal Intensive Care Unit.ResultsWomen of advanced maternal age (AMA) exhibited more preeclampsia (9.4%) than younger women (6.4%). They had more prior terminations (<0.001), were more likely to have a body mass index (BMI) >25 (<0.001), had more in vitro fertilization (IVF) (<0.001) and other fertility treatments (<0.001) and a higher incidence of maternal diabetes (<0.001) and chronic hypertension (<0.001). Multivariate logistic regression indicated that women of AMA had higher rates of: preterm delivery before 37 weeks 19.2% (OR 1.39 CI 1.24 to 1.56) and before 34 weeks 8.7% (OR 1.68 CI 1.43 to 2.00) low Apgar scores at 5 min. 7.1% (OR 1.37 CI 1.00 to 1.88), Small-for-Gestational Age (SGA) 26.5% (OR 1.42 CI 1.28 to 1.57), Asphyxia 12.1% (OR 1.54 CI 1.34 to 1.77), Caesarean delivery 50% (OR 2.02 CI 1.84 to 2.20) and admission to a Neonatal Intensive Care Unit (NICU) 31.6% (OR 1.45 CI 1.32 to 1.60).ConclusionsPreeclampsia is more common in women with advanced maternal age. Advanced maternal age is an independent risk factor for adverse outcomes in first-time mothers with preeclampsia.

Caregiver depression is associated with a low sense of coherence and health-related quality of life

Objectives: The main objective is to examine the sense of coherence (SOC) of spouse caregivers. The aim was further investigate the association of SOC, health-related quality of life (HRQoL), depressive symptoms, distress and how severity of Alzheimers disease (AD) affects SOC. Method: 17O patient–spouse caregiver dyads in which the patient has recently diagnosed mild AD. Caregivers completed SOC scale (SOC-29), HRQoL (15D), Beck depression and general health questionnaire scale. The assessment of AD-related symptoms was made using mini mental state examination, clinical dementia rating, neuropsychiatric inventory and functional performance using activities of daily living (ADCS-ADL) scale. Results: Male caregivers’ SOC was significantly higher than female caregivers. The main predictor for low SOC was depression, with 37% of spousal caregivers reporting depressive symptoms. Women reported more depressive symptoms and distress. Caregivers’ HRQoL was as high as 0.8714, and a significant correlation was found between SOC and depression, r = −0.632 and distress r = −0.579. Furthermore, significant correlations were found between HRQoL and depression (r = −0.572) and distress (r = −0.568). The main predictors for high HRQoL were female gender and low distress. Conclusion: Spouse caregivers with low SOC seem to be a vulnerable group of caregivers. The many negative effects of perceived health accumulate in these caregivers during the very early phases of the caregiving process. Vulnerable caregivers need to be recognized at the time of AD diagnosis so that they can receive psychological support and counselling in addition to prevent morbidity in these caregivers.

Lateral episiotomy protects primiparous but not multiparous women from obstetric anal sphincter rupture.

Objective. To identify the risk factors for obstetric anal sphincter rupture (OASR). Design and setting. Retrospective population‐based register study. Population. A total of 514,741 women with singleton pregnancy and vaginal delivery between 1997 and 2007 in Finland. Methods. Primiparous (n = 2,315) and multiparous women (n = 534) with OASR were compared with primiparous and multiparous women without OASR by using stepwise logistic regression analysis. Main outcome measure. The OASR risk. Results. Episiotomy decreased the likelihood of OASR for the primiparous [odds ratio (OR) 0.83, 95% CI (confidence interval) 0.75–0.92], but not the multiparous women (OR 2.01, 95% CI 1.67–2.44). The strongest risk factors for OASR among the primiparous women were forceps delivery (OR 10.20, 95% CI 3.60–28.90), birth weight over 4,000 g (OR 4.66, 95% CI 3.86–5.63), vacuum assisted delivery (OR 3.88, 95% CI 3.25–4.63), occiput posterior presentation (OR 3.17, 95% CI 1.64–6.15), and prolonged active second stage of birth (OR 2.06, 95% CI 1.65–2.58). Episiotomy was associated with decreased risks for OASR in vacuum assisted deliveries (OR 0.70, 95% CI 0.57–0.85). Risk factors for OASR among the multiparous women included forceps delivery (OR 10.13, 95% CI 2.46–41.81), prolonged active second stage of the birth (OR 7.18, 95% CI 4.32–11.91), birth weight over 4,000 g (OR 5.84, 95% CI 3.40–10.02), and vacuum assisted delivery (OR 4.17, 95% CI 3.17–5.48). Conclusions. The results support the restrictive use of episiotomy, since 909 episiotomies appear to be needed to prevent one OASR among primiparous women. Equivalent estimate in vacuum assisted deliveries among primiparous women was 66, favoring routine use of episiotomy in such cases.

Giving birth. Perceptions of Finnish childbearing women.

PURPOSE To describe the lived experience of childbirth with women giving birth in Finland. DESIGN Phenomenology. METHODS Twenty Finnish women who had recently given birth were interviewed within 2 weeks following childbirth, sharing their perceptions of meaning of their childbirth experiences. Culturally appropriate strategies for qualitative data collection were employed. Trustworthiness of the data was ensured. RESULTS The richness and diversity of the childbirth experience emerged from the data. One theme identified was a sense of awe at the creation of a new life within the context of birth as a bittersweet paradox. A strong sense of maternal confidence or self-efficacy was identified, which influenced the womens perception of and management of childbirth pain. Feelings of self-actualization were articulated as Finnish women successfully negotiated a challenging life event. CLINICAL IMPLICATIONS Perinatal nurses should increase their sensitivity to the socio-cultural context of giving birth by acknowledging womens experiences as legitimate sources of knowledge.

Ethical Considerations in a Grounded Theory Study on the Dynamics of Hope in Hiv-Positive Adults and Their Significant

The purpose of this article is to describe and reflect ethical challenges in a grounded theory study on the dynamics of hope in HIV-positive adults and their significant others. It concentrates on the justification of a research problem, sensitive research and the relationship between the researcher and the participants in data collection. The basis of ethically sound nursing research on the dynamics of hope in these two vulnerable groups lies in the relationship between the researcher and the participant. However, it is also obvious that the content, the process, the methods used and the ethics of the study cannot be divorced from this relationship. In conducting grounded theory research on the dynamics of hope in this research population, the researcher has to consider the surrounding world, that is, the reality in which these people live in hope or despair.

A review of pregnancy in women over 35 years of age.

The objective of the present paper is to review how pregnant women over 35 years have been described in previous research, and to review the risks associated with pregnancy in those of advanced maternal age. Computerized searches of the Cinahl, PubMed, Medic and Cochrane Library databases were undertaken. Research articles in scientific journals, relevant to the objective, and published in English between 2000 and 2008, were included. Data were extracted based on the aims, sample, authors, year and results. Results: Advanced maternal age is associated with certain pregnancy-related risks. Being “at risk” causes anxiety and concern, which older pregnant women try to ease by being as well-informed as possible. This may be overwhelming to some women due to the large amount of information available. Conclusions: It is important for healthcare providers to be aware of the different feelings and experiences of older pregnant women in order to meet their individual needs within the maternity services.

Communication and Cultural Issues in Providing Reproductive Health Care to Immigrant Women: Health Care Providers’ Experiences in Meeting Somali Women Living in Finland

Communication problems due to language and cultural differences between health care professionals and patients are widely recognized. Finns are described as more silent whereas one concurrent large immigrant group, the Somalis, are described as more open in their communication. The aim of the study was to explore physicians-nurses/midwives’ communication when providing reproductive and maternity health care to Somali women in Finland. Four individual and three focus group interviews were carried out with 10 gynecologists/obstetricians and 15 nurses/midwives from five selected clinics. The health care providers considered communication (including linguistic difficulties), cultural traditions, and religious beliefs to be problems when working with Somali women. Male and female physicians were generally more similar in communication style, interpersonal contacts, and cultural awareness than the nurses/midwives who were engaged in more partnership-building with the Somali women in the clinics. Despite the communication and cultural problems, there was a tentative mutual understanding between the Finnish reproductive health care professionals and the Somali women in the clinics.