Ulla Waldenström

Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth

Objective  To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth.

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.

Randomised controlled trial of midwife led debriefing to reduce maternal depression after operative childbirth

Abstract Objective: To assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among women giving birth by caesarean section, forceps, or vacuum extraction. Design: Randomised controlled trial. Setting: Large maternity teaching hospital in Melbourne, Australia. Participants: 1041 women who had given birth by caesarean section (n= 624) or with the use of forceps (n= 353) or vacuum extraction (n= 64). Main outcome measures: Maternal depression (score ≥13 on the Edinburgh postnatal depression scale) and overall health status (comparison of mean scores on SF-36 subscales) measured by postal questionnaire at six months postpartum. Results: 917 (88%) of the women recruited responded to the outcome questionnaire. More women allocated to debriefing scored as depressed six months after birth than women allocated to usual postpartum care (81 (17%) v 65 (14%)), although this difference was not significant (odds ratio=1.24, 95% confidence interval 0.87 to 1.77). They were also more likely to report that depression had been a problem for them since the birth, but the difference was not significant (123 (28%) v 94 (22%); odds ratio=1.37, 1.00 to 1.86). Women allocated to debriefing had poorer health status on seven of the eight SF-36 subscales, although the difference was significant only for role functioning (emotional): mean scores 73.32 v 78.98, t= −2.31, 95% confidence interval −10.48 to −0.84). Conclusions: Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at six months postpartum. The possibility that debriefing contributed to emotional health problems for some women cannot be excluded.

Does a traumatic birth experience have an impact on future reproduction

Objective To investigate whether womens experiences of their first birth affects future reproduction.

Intrapartum and postpartum care in Sweden: Women's opinions and risk factors for not being satisfied

Background. The aim of this study was to investigate satisfaction with intrapartum and postpartum care, and the risk of not being satisfied in relation to 1) a womans sociodemographic background, 2) physical and emotional well‐being in early pregnancy, 3) labor outcomes, 4) care organization, and 5) a womans subjective assessment of aspects of care.

A systematic review comparing continuity of midwifery care with standard maternity services

Objective To review randomised controlled trials of alternative maternity services characterised by continuity of midwifery care.

Depressive mood in early pregnancy: Prevalence and women at risk in a national Swedish sample.

The aim of the present study was to estimate the prevalence of depressive mood in early pregnancy in a national Swedish sample, and to study associations between depressive mood defined as scores >14 on the Edinburgh Postnatal Depression Scale (EPDS) and sociodemographic background, social support, stressful life events, and obstetrical and pregnancy data. A postal questionnaire was completed by 3011 women in gestational week 15 (median). Depressive mood was identified in 8% of the women. Three risk factors were the same for primiparous and multiparous women: lack of support from partner during pregnancy, more than two stressful life events the year prior to this pregnancy and native language other than Swedish. In addition, risk factors were identified in primiparas (unfortunate timing of pregnancy, previous miscarriage and age less than 25 years) and in multiparas (lack of support from person other than partner when coming home with the newborn, single status, negative experience of previous birth, a wish to have a caesarean section, and unemployment). These findings may improve the identification of women with antenatal depressive mood already in early pregnancy.

Physical symptoms after childbirth: prevalence and associations with self‐rated health

Objective  The aims of the present study were to describe the prevalence of a number of physical symptoms, as described by women themselves, two months and one year after childbirth in a national Swedish sample and to investigate the association between specific symptoms and womens self‐rated health.

Women's expectations on antenatal care as assessed in early pregnancy: number of visits, continuity of caregiver and general content

Background. Antenatal care has undergone continuous development over the past decades, but little is known about womens views and expectations. The objective of this study was to explore womens expectations on antenatal care, preferences regarding number of visits and attitudes to continuity of midwife caregiver in a national sample of Swedish‐speaking women.

The Stockholm Birth Centre Trial : maternal and infant outcome

Objective To compare an in‐hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome.