Lena Henriksen

Sexual violence and pregnancy-related physical symptoms

BackgroundFew studies have investigated the impact of sexual violence on health during pregnancy. We examined the association between sexual violence and the reporting of physical symptoms during pregnancy.MethodsA population-based national cohort study conducted by The Norwegian Mother and Child Cohort study (MoBa) collected data from pregnant women through postal questionnaires at 17 and 32 weeks gestation. Three levels of sexual violence were measured: 1) mild (pressured into sexual relations), 2) moderate (forced with violence into sexual relation) and 3) severe (rape). Differences between women reporting and not reporting sexual violence were assessed using Pearson’s X2 test and multiple logistic regression analyses.ResultsOf 78 660 women, 12.0% (9 444) reported mild, 2.8% (2 219) moderate and 3.6% (2 805) severe sexual violence. Sexual violence was significantly associated with increased reporting of pregnancy-related physical symptoms, both measured in number of symptoms and duration/degree of suffering. Compared to women not reporting sexual violence, the probability of suffering from ≥8 pregnancy-related symptoms estimated by Adjusted Odds Ratio (AOR) was 1.49 (1.41–1.58) for mild sexual violence, 1.66(1.50–1.84) for moderate and 1.78 (1.62–1.95) for severe. Severe sexual violence both previously and recently had the strongest association with suffering from ≥8 pregnancy-related symptoms, AOR 6.70 (2.34–19.14).ConclusionA history of sexual violence is associated with increased reporting of pregnancy-related physical symptoms. Clinicians should consider the possible role of a history of sexual violence when treating women who suffer extensively from pregnancy-related symptoms.

Sexual violence and mode of delivery: a population‐based cohort study

This study aimed to explore the association between sexual violence and mode of delivery.

Burnout among Norwegian midwives and the contribution of personal and work-related factors: A cross-sectional study

INTRODUCTION Burnout can be the result of long-term exposure to personal and/or work-related stressors and affect midwives performance of care. AIM To assess burnout levels among Norwegian midwives and identify personal and work-related factors associated with burnout. METHODS A cross-sectional study. A total of 1500 Norwegian midwives were sent a questionnaire which included the Copenhagen Burnout Inventory (CBI) that measured personal, work- and client-related burnout. Of 1458 eligible midwives, 598 completed the CBI. Descriptive and comparative analyses were done in addition to logistic regression modelling. RESULTS Approximately 20% reported personal or work-related burnout. Less than 5% reported client-related burnout. Midwives with sick leave within the last three months reported higher levels of burnout. The prevalence of work-related burnout was higher among younger and single midwives. Working in outpatient care and experience of a recent reorganisation increased the likelihood of reporting personal and work-related burnout. CONCLUSION One in five midwives had high levels of personal and work-related burnout in this study and the different sub-groups of burnout were all associated with absence from work within the last three months. Work-related factors such as shift work and number of working hours did not seem to influence burnout in this population.

Sexual violence and neonatal outcomes: a Norwegian population-based cohort study

Objective The objective of this study was to explore the association between sexual violence and neonatal outcomes. Design National cohort study. Setting Women were recruited to the Norwegian Mother and Child Cohort Study (MoBa) while attending routine ultrasound examinations from 1999 to 2008. Population A total of 76 870 pregnant women. Methods Sexual violence and maternal characteristics were self-reported in postal questionnaires during pregnancy. Neonatal outcomes were retrieved from the Medical Birth Registry of Norway (MBRN). Risk estimations were performed with linear and logistic regression analysis. Outcome measures: gestational age at birth, birth weight, preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA). Results Of 76 870 women, 18.4% reported a history of sexual violence. A total of 4.7% delivered prematurely, 2.7% had children with a birth weight <2500 g and 8.1% children were small for their gestational age. Women reporting moderate or severe sexual violence (rape) had a significantly reduced gestational length (2 days) when the birth was provider-initiated in an analysis adjusted for age, parity, education, smoking, body mass index and mental distress. Those exposed to severe sexual violence had a significantly reduced gestational length of 0.51 days with a spontaneous start of birth. Crude estimates showed that severe sexual violence was associated with PTB, LBW and SGA. When controlling for the aforementioned sociodemographic and behavioural factors, the association was no longer significant. Conclusions Sexual violence was not associated with adverse neonatal outcomes. Moderate and severe violence had a small but significant effect on gestational age; however, the clinical influence of this finding is most likely limited. Women exposed to sexual violence in this study reported more of the sociodemographic and behavioural factors associated with PTB, LBW and SGA compared with non-abused women.

Norwegian midwives’ opinion of their midwifery education – a mixed methods study

BackgroundMidwifery education in Norway has undergone radical reforms in the past few decades. In 2004, the compulsory year of paid internship was removed from the requirement to become an authorised midwife. Since then, authorisation as a midwife depends on the successful completion of a two-year full-time academic course, consisting of 50% clinical practice and 50% theoretical education. Our objective was to examine midwives’ opinion of their Norwegian midwifery education in relation to their midwifery practice, comparing those educated with internship to those without.MethodsWe performed a mixed-methods study based on data from a nationwide cross-sectional survey. A sample of 547 midwives completed a postal questionnaire, autumn 2014. Midwives were asked how they were educated, how their education prepared them for practice (multiple choice) and to freely comment on their midwifery education. Thematic analysis and descriptive and comparative analysis was used. Data sets were analysed independently and jointly interpreted.ResultsOf our sample, 154 (28.2%) were educated through a two-year midwifery education without internship, while 393 (71.8%) had a one-year midwifery education with internship. Compared to midwives who had internship, midwives without were four times more likely to report that their education did not, or only partially prepare them for their work as a midwife. The association lost its significance when adjusted for experience as a midwife. According to the qualitative data, the primary reason for the association was insufficient clinical practice during education. Relevant clinical placement, ample practice time with good preceptorship and internship were proposed as methods to prepare for practice as a midwife. The theory–practice gap was highlighted as another hindrance to being prepared for practice.ConclusionsAcademisation of the midwifery education has resulted in newly qualified midwives feeling less prepared for practice. Midwives would have liked more time for clinical practice and simulation training of core midwifery clinical skills included in the education. Midwifery educations need to explore ways to achieve a good balance between practice and theory. Workplaces need to explore alternative ways to internship to assist new graduates to become confident midwives with a strong midwifery identity.

Women’s preference for caesarean section and the actual mode of delivery – Comparing five sites in Norway

OBJECTIVES The caesarean (CS) section rate varies among hospitals in Norway, and little is known about whether this is influenced by womens preferences. The aim of this study was to investigate the differences in womens preferred mode of delivery during pregnancy between five hospitals in Norway, and to relate this to the actual mode of delivery. STUDY DESIGN A prospective cohort study of 2,177 unselected pregnant women in five hospitals in Norway. Women were recruited at their standard ultrasound examinations, and data was collected through questionnaires and electronic patient charts. The exposure was a CS preference and the main outcome measure was the actual mode of delivery. RESULTS In total, 3.5% of the primiparous women and 9.6% of the multiparous women reported a preference for CS. This was associated with fear of childbirth and education between 10 and 13 years in both groups, symptoms of depression and an age over 35 years old among the primiparous women, and a previous CS and/or negative birth experience among the multiparous. The multiparous women in Drammen and Tromsø were less likely to prefer a CS, and none of the primiparous women in Tromsø preferred a CS. A total of 67.8% of those who preferred a CS gave birth with this mode of delivery. CONCLUSION There were significant differences between the hospitals according to the CS preference. This preference was associated with the previous obstetric history and psychological factors. Therefore, creating good birth experiences and offering women counselling may reduce the CS preference rate.

‘It is a difficult topic’ – a qualitative study of midwives´ experiences with routine antenatal enquiry for intimate partner violence

BackgroundIntimate partner violence (IPV) during pregnancy may jeopardize maternal and fetal health (IJFWM 49:159-164, 2004; IJGO 133:269-276, 2016). In recognition of the significant public health impact of IPV, the Norwegian Directorate of Health issued new guidelines in 2014, which recommend that health professionals routinely ask all women in antenatal care about their exposure to violence. The objective of this study was to gain an in-depth understanding of midwives’ experiences with routine enquiry for intimate partner violence during the antenatal period.MethodsThe study had a qualitative design. Individual semi-structured interviews with eight midwives providing antenatal care at eight Mother and Child Health Centres (MCHC) in Norway were conducted. Graneheim and Lundmans method of content analysis inspired the analysis.ResultsThree main themes emerged: Midwives do ask about violence; It can be a challenge; and Factors that make it easier to ask. All midwives enquired, but not on a regular basis, about violence. The midwives’ personal interest in the topic was an important factor that made it easier for them to ask about violence. Lack of time, fear of not knowing how to deal with a positive answer and lack of organizational support were barriers to asking pregnant women about their experiences of violence.ConclusionMidwives were aware of the guidelines and made some efforts to implement them. However, further education and organisational support is needed to enable midwives to routinely ask all pregnant women about IVP.

Talking about intimate partner violence in multi-cultural antenatal care: a qualitative study of pregnant women’s advice for better communication in South-East Norway

BackgroundIntimate partner violence (IPV) against women constitutes a major public health problem. Antenatal care is considered a window of opportunity to disclose and to communicate about IPV. However, little is known about how women from different ethnic backgrounds wish to communicate about their experiences with IPV during pregnancy in antenatal care. The aim of the present study was to explore how women from different ethnic backgrounds experienced IPV and what their recommendations were about how midwives should communicate about IPV in antenatal care.MethodsQualitative individual interviews with eight women who had experienced IPV during pregnancy were conducted and analysed using thematic analysis. The participants were purposively recruited from three crisis shelters in South-East Norway.ResultsThe participants either had immigrant backgrounds (n = 5) or were ethnic Norwegians (n = 3). All participants received antenatal care by a midwife. Although none of the participants were asked about IPV during antenatal care, they wished to talk about their experiences. Most participants felt that it would be important for the midwife to make them aware that they were victims of violence. Participants offered different suggestions on how and when midwives should talk about IPV. Facilitators to talk about IPV with the midwife were a good relationship with and the trustworthiness of the midwife, information about possible negative health outcomes for the newborn owing to IPV and knowing that the midwife could help them. The main barriers to talk about IPV with the midwife were that the participants were accompanied by their husbands during antenatal care, fear that the Child Welfare Service would take away their children after disclosure and cultural acceptance of violence. Participants with immigrant backgrounds also experienced difficulties in talking about IPV owing to their limited language skills. They thought that professionally trained interpreters with experience of IPV could overcome this barrier.ConclusionEven though none of the participants were asked about IPV in antenatal care, they offered different suggestions on how and when midwives should talk about IPV. Participants irrespective of their ethnical backgrounds perceived antenatal care as a key area to facilitate disclosure of IPV. Midwives’ communication and strategic skills to address IPV are crucial for help-seeking women. Training midwives’ skills in culture-sensitive communication might help to overcome cultural barriers to talk about violence.

Lifetime sexual violence and childbirth expectations - a Norwegian population based cohort study

OBJECTIVE this study aimed to explore the association between lifetime sexual violence and expectations about childbirth. DESIGN Norwegian population-based cohort study. SETTING women presenting for routine ultrasound examinations were recruited to the Norwegian Mother and Child Cohort Study between 1999 and 2008. POPULATION 78,660 pregnant women. METHODS sexual violence and expectations about childbirth were self-reported during pregnancy using postal questionnaires. Risk estimations were performed using multivariable logistic regression analysis and stratified by parity. MAIN OUTCOME MEASURES fear of childbirth, the thoughts about pain relief, worries about the infants health and looking forward to the arrival of the infant. FINDINGS of 78,660 women, 18.4% reported a history of sexual violence and 0.9% were exposed to sexual violence within the last 12 months, including during the current pregnancy. We found that nulliparous women who reported previous or recent sexual violence had a decrease in the odds of looking forward to the arrival of the infant with an AOR of 0.8 (95% CI 0.7-0.9) and 0.4 (95% CI 0.3-0.6), respectively, compared to non-abused women. The same pattern was observed among multiparous women and they were more likely to report worries about the infants health. Severe sexual violence (rape) was associated with concerns about childbirth, especially for nulliparous women that were more likely to express fear of birth, a hope for a pain-free birth, a desire for caesarean section and worries about the infants health than non-exposed women. CONCLUSIONS women with a lifetime exposure to sexual violence, both past experiences and within the last 12 months, were less likely to look forward to the arrival of the infant than non-exposed women, and they were more likely to worry about the infants health. Women with experiences of severe sexual violence (rape) had more concerns about childbirth than women without this experience. This finding shows that exploring womens attitudes toward childbirth may work as an approach when examining exposure to violence.