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  • 51.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences.
    Axelsson, Ove
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences.
    Intrapartal care in a Swedish maternity unit after a quality-improvement programme2007In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 23, no 2, p. 113-122Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to study the effects of a quality-improvement programme (QIP) on documented intrapartal midwifery care in the context of a conventional maternity unit. The aim of the QIP was to improve intrapartal midwifery care in accordance with the World Health Organization (WHO)'s recommendations for care in normal birth, without decreasing the number of spontaneous vaginal births. DESIGN: an audit instrument, developed from WHO recommendations for care in normal birth, was used to compare birth records from before and after the implementation of a QIP. Two hundred and twelve consecutive birth records were examined in the pre-test and 240 in the post-test period. SETTING: a conventional maternity unit in Western Sweden. FINDINGS: an overall documented improvement towards the recommendations by WHO was observed, especially in items for which guidelines were developed; more women were in active labour, intermittent auscultation increased in first and second stage, and oxytocin augmentation decreased in the first stage. The improved care did not influence the number of spontaneous vaginal deliveries or the duration of active labour and second stage. CONCLUSION AND IMPLICATIONS FOR PRACTICE: a QIP facilitated implementation of WHO's recommendations for care in normal birth. Most of the documented care changed in favour of the WHO recommendations. The findings highlight the importance of professional discussions and use of guidelines to implement changes and to show how midwifery care can change in a conventional ward. However, the findings must be interpreted with some caution because of the sample size and because the findings are based on documented, not observed, care.

  • 52.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Retrospektiv granskning av dokumenterad vård i samband med förlossning med utgångspunkt från WHO riktlinjer för normal förlossning2003Conference paper (Refereed)
  • 53.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, ML
    Wilde Larsson, B
    Evidensbaserad vård stöder både barnmorskan och kvinnan2004In: Jordemodern, nr 7-8Article in journal (Other (popular science, discussion, etc.))
  • 54.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, ML.
    Wilde Larsson, B.
    Moving midwifery forward: Documented Care in Childbirth in Relation to WHO Recommendations2003Conference paper (Refereed)
  • 55.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, ML.
    Wilde Larsson, B.
    Professionell utveckling2005Other (Other (popular science, discussion, etc.))
  • 56.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hashimoto, Mayumi
    International Medical Research Center of Japan.
    Kanal, Koum
    International Mother and Child Health Center in Phnom Pehn.
    Sugiura, Yousha
    Intrapartum care at a tertiary hospital in Cambodia: A survey using the Bologna Score2011In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 6, p. e880-e885Article in journal (Refereed)
    Abstract [en]

    Background: developing countries strive to reduce maternal- and child mortality, partly through establishing health centres/hospitals with skilled birth attendants. The aim of this study was to describe childbirth care, by the use of the BolognaScore at atertiaryhospital in Cambodia with approximately 8,500 births per year.

    Methods: a prospective cross-sectional study. The BolognaScore instrument, which reflects the adaption of evidence-based care and attitudes of caregivers, was used for data collection and three study specific questions. The midwives collected data from 177 consecutive childbirths.

    Results: all women were assisted by a skilled birth attendant, the majority by a midwife (63%) and the remaining women by a physician (35%) or midwife student under supervision. A spontaneous vaginal birth was planned for 82% of the women. All women seeking care at the hospital survived the childbirth. A full 5-point BolognaScore, suggesting evidence-based management for women with spontaneous vaginal birth, was not achieved for any of the women. The use of supine position and lack of an accompanying person in the birth room, were items responsible for loss of points. Partogram and skin-to-skin contact between baby and mother were items noted for three quarters of the planned vaginal births, and the item ‘Absence of labour augmentation’, was affirmed to a great extent. Little more than half of the women had an episiotomy and almost 16% of the children had an Apgar score <7 at 5 mins.

    Conclusion: the BolognaScore was easy to use and pointed at items that could be improved. It was satisfying that all women survived, but alarming that 16% of the children had a low Apgar score. The findings suggest that childbirth care can be improved at the hospital.

  • 57.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hashimoto, Mayumi
    National Center for Global Health, Tokyo, Japan.
    Kanal, Kuhm
    National Maternal and Child Health Center, Phnom Pehn , Cambodia.
    Sugiura,, Youshio
    National Center for Global Health, Tokyo, Japan.
    Childbirth care in a Cambodian hospital2013Conference paper (Refereed)
  • 58.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kvist, J L
    Hur gör vi?: En nationell kartläggning av förlossningsvård2008Conference paper (Other (popular science, discussion, etc.))
  • 59.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kvist, JL
    Berg, M
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    What is, could be better: Swedish womens perceptions of their intrapartal care during planned vaginal birth2011In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 24, no 1, p. 81-95Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to describe Swedish womens perceptions of the qualityof intrapartal care that they received and the subjective importance they ascribe to their care.Design: The study was nested within a Swedish national survey of intrapartal care. Thewomen whose care was investigated were invited to participate in the current study by themidwife who attended the birth. A total of 1173 women agreed to answer a questionnaireabout quality of general care and quality of specific intrapartal care two months postpartum. The questions were posed in two ways, perceived reality (PR) and subjectiveimportance (SI).Findings: 739 women (63%) returned their questionnaires. PR and SI for quality of generalcare were generally high (PR range 2.98 -3.81; SI range 2.85-3.85 , out of a possible 4) andfor quality of specific intrapartal care (PR range 3.15-3.86; SI range 3.23-3.86, out of apossible 4). Twelve items had statistically significantly higher scores for SI compared to PR.Eighty-one percent of the women fully or mostly agreed that the birth of their child was apositive experience.Orginality: The way in which questions about intrapartal care are posed is reflected in theway they are answered answers. In this study we have therefore asked not only how care wasperceived but also what importance individual women ascribed to different areas of their care.The questionnaire in this study allow identification of areas where what is, could be better.

  • 60.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kvist, L
    Care in labor: a Swedish survey using the Bologna Score2008In: Birth 35(4) p 321-328Article in journal (Refereed)
    Abstract [en]

    Background: An important part of midwives area of responsibility is to strive to keep birth normal. Interventions during childbirth are costly and may disrupt the course of normal labor. The aim of this study was to describe, by use of the Bologna score, how birth is managed in Sweden.

    Methods: A prospective cross-sectional study in a national sample was performed. All (n = 51) Swedish maternity units were invited to participate, and 36 (70.6 %) agreed. Midwives collected data, in accordance with the Bologna score, for all deliveries occurring during a 2-week period in 2007.

    Results: Qualified health personnel assisted at almost all deliveries (99.9 %), and a vaginal birth was planed for 84 percent of the women. A Bologna score of 5 signifies that birth has been managed using recommended evidence-based practice, which was achieved for 22.7 percent of the planned vaginal births. Use of the supine position and some interventions were responsible for loss of points. The percentage of 5-point scores varied greatly between units (0 % to 53.1 %).

    Conclusions: The findings suggest that in Sweden, birth is managed according to scientific evidence to a limited degree. Large differences among units also suggest that care in childbirth is based on attitudes rather than on scientific evidence. The Bologna score was easy to use and gave a good picture of how care was given at the participating maternity units. We suggest that the instrument is useful as a quality indicator for intrapartum care

  • 61.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Kvist, Linda
    A national survey of Swedish midwifery care2008Conference paper (Refereed)
    Abstract [en]

    Background: In Sweden approximately 100.000 childbirths occur every year. Almost all of them take place in a delivery unit. According to World Health Organization 70-80% of all births could be normal. Normal childbirth is defined as spontaneous in onset, low risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37-42 completed weeks of pregnancy. After birth mother and infant are in good condition. Midwives area of expertise is normal pregnancy and childbirth and according to ICM they should promote normal childbirth. The goals of maternity care are a healthy mother and child and a positive birth experience. These goals should be reached with as few interventions as possible in the birth process. However, studies show that interventions are common in both normal and complicated childbirth and the numbers of normal childbirths as defined above are unknown. The aim of this study was to describe the amount of normal versus complicated childbirths in Swedish maternity care.



    Method: All maternity units in Sweden are invited to partcipate. At the participating maternity units midwives will fill in a questionnaire for each childbirth during a two- week period (3800 deliveries). The questionaire consits of 1) an instrument, the Bologna Score, based on WHO recommendations for normal birth that assess whether childbirth is managed as normal versus complicated (7 items), 2) study specific questions (3 items) and 3) background variables (8 items). For items in the Bologna Score, the data will be analyzed using descriptive and analytic statistics. Subgroup analysis will be performed for different age groups, parity, smoking and different levels of care.





    Results: Data will be collected in late spring 2007 and processed during the autumn 2007. The results will be presented at the congress.

  • 62.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sundin, A
    Informerat samtycke vid obstetriskt ultraljud eller...?1996In: Vård i Norden 3Article in journal (Refereed)
  • 63.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Women’s perception of intrapartal care  in relation to WHO’s recommendations2008In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Journal of Clinical Nursing, Vol. 17, no 22, p. 2993-3003Article in journal (Refereed)
    Abstract [en]

    Background. The aim of intrapartal care in normal birth is to achieve a healthy mother and child using the least possible number of interventions that is compatible with safety. Aim. The aims of this study were to elucidate women’s perception of intrapartal care and women’s perceptions of normal birth. Methods. A questionnaire developed from the WHO’s recommendations for care in normal birth was answered by 138 (response rate 66·0% Swedish women. The women were asked to evaluate items in two ways: their perceived reality of care received and the subjective importance of each item. Results. Most women reported receiving care in the category (A) practices that are good and should be encouraged. However, women to a minor degree reported assessment for physical health, enquiring about support needs and pain assessment on admission. Many women received electronic foetal monitoring, repeated vaginal examinations, oxytocin augmentation and suturing after birth which fall under the category (B) practices that are harmful, (C) insufficient evidence exists and (D) practices frequently used inappropriately. The women who reported ‘Yes’ for perceived reality also reported high subjective importance for those items regardless of category A–D. Eighty-four per cent of the women perceived that they had a normal delivery. Conclusion. The result suggests that women have great trust that the care midwives give them is the best care. Midwives, therefore, have an ethical responsibility to keep themselves informed about the best evidence-based care and to implement critical reviewing of their practice as part of continuing professional development. The women’s perceptions of a normal birth allows for a wide range of interventions. Relevance for clinical practice. The result emphasises the importance of midwives’ knowledge of evidence-based care and how to implement this into practice. Further research should include elucidation of the meaning of normal childbirth to childbearing women.

  • 64.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Berg, Marie
    Sahlgrenska universitetssjukhuset.
    Kvist, Linda
    Lunds universitet.
    What is could be better: Swedish women´s perception of intrapartal care during planned vaginal birth2010Conference paper (Refereed)
  • 65.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Some Swedish women´s perception of childbirth2008Conference paper (Refereed)
    Abstract [en]

    Background: The aim of intrapartal care in normal birth is to achieve a healthy mother and child using the least possible number of interventions that is compatible with safety.

    Aim: The aims of this study were to elucidate womens perceptions of intrapartal care and womens perceptions of normal birth.

    Methods: A questionnaire developed from the WHOs recommendations for care in normal birth were answered by 138 (response rate 66.0%) Swedish women. The women were asked to evaluate items in two ways; their perceived reality (PR) of care received and the subjective importance (SI) of each item.

    Results: Most women reported received care in the category (A) Practices that are good and should be encouraged. However, women to a minor degree reported assessment for physical health, enquiring about support needs and pain assessment on admission. Many women received electronic fetal monitoring, repeated vaginal examinations, oxytocin augmentation and suturing after birth which fall under the categories (B) practices that are harmful, (C) insufficient evidence exists and (D) practices frequently used inappropriately. The women who reported Yes for perceived reality also reported high subjective importance for those items regardless of category A-D. Eighty-four percent of the women perceived that they had a normal delivery.

    Conclusion: The result suggests that women have great trust that the care that midwives give them is the best care. Midwives have therefore an ethical responsibility to keep themselves informed about the best evidence-based care and to implement critical reviewing of their practice as part of ongoing professional development. The womens perceptions of a normal birth allows for a wide range of interventions.

  • 66.
    Sandin-Bojö, Ann-Kristin
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Hall-Lord, Marie-Louise
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Axelsson, O
    Undèn, G
    Validity of an instrument developed to measure quality of midwifery care based on the WHO classification of care in normal birth2003Conference paper (Refereed)
  • 67.
    Skoogh, Annika
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Bååth, Carina
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Östfold University College, Norway.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Hall-Lord, Marie Louise
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Norwegian University of Science and Technology, Norway.
    Healthcare professionals' perceptions of patient safety for the woman in childbirth in Sweden - An interview study2020In: Nursing Open, E-ISSN 2054-1058, no 2, p. 642-649Article in journal (Refereed)
    Abstract [en]

    Aim:To describe healthcare professionals' perceptions of patient safety with a focus on the woman in connection to childbirth.Design: A descriptive and qualitative design with a phenomenographic approach.Methods: Individual qualitative face-to-face interviews with 19 healthcare professionals (midwives, nursing assistants and physicians) were conducted in three labour wards in Sweden. The data were analysed according to Dahlgren and Fallsberg's seven steps.Results: The informants' perceptions of patient safety for the women were identified in four qualitative different descriptive categories: Safeguarding the woman, Safeguarding the birth process, Respecting the individual and the team and Managing workforce and learning. Supportive care and listening to the woman were important for patient safety. It was crucial to follow labour stages and to avoid unnecessary interventions. An open and tolerant atmosphere between the healthcare professionals improved decision-making, and a reasonable workload was essential for ensuring safe care.

  • 68.
    Thies-Lagergren, Li
    et al.
    Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet.
    Kvist, Linda
    Department of Health Sciences, Lund University.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Christensson, Kyllike
    Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet.
    Hildingsson, Ingegerd
    Department of Women's and Children's Health, Division of Reproductive Health, Karolinska Institutet.
    Labour augmentation and featal outcomes in relation to birth positions: A secondary analysis of an RCT evaluating birth seat births2013In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 29, no 4, p. 344-350Article in journal (Refereed)
    Abstract [en]

    Objective

    the aim of this study was to compare the use of synthetic oxytocin for augmentation, duration of labour and birth and infant outcomes in nulliparous women randomised to birth on a birth seat or any other position.

    Study design

    a randomised controlled trial in Sweden where 1002 women were randomised to birth on a birth seat (experimental group) or birth in any other position (control group). Data were collected between November 2006 and July 2009. The outcome measurements included synthetic oxytocin augmentation, duration of the second stage of labour and fetal outcome. Analysis was by intention to treat.

    Setting

    southern Sweden.

    Findings

    the main findings of this study were that women randomised to the experimental group had a statistically significant shorter second stage of labour than women randomised to the control group. There were no differences between the groups for use of synthetic oxytocin augmentation or for neonatal outcomes.

    Conclusions

    women allocated to the birth seat had a significantly shorter second stage of labour despite similar numbers of women subjected to synthetic oxytocin augmentation in the study groups. The adverse neonatal outcomes did not differ between groups. The birth seat can be suggested as non-medical intervention used to reduce duration of second stage labour and birth. The birth seat can be suggested as a non-medical intervention that may facilitate reduced duration of the second stage of labour. Furthermore it is recommended that caregivers, both midwives and midwifery students, should learn skills to assist women in using a variety of birth positions.

  • 69.
    Thies-Lagergren, Li
    et al.
    Karolinska Institutet.
    Kvist, Linda
    Lunds universitet.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Christensson, Kyllike
    Karolinska Institutet.
    Hildingsson, Ingegerd
    Mittuniversitetet.
    The Swedish birth seat trial. Augmentation of labour and fetal outcomes in relation to birth positions:: a secondary analys of an RCT evaluating birth seat births2012In: The Swedish birth seat trial. Augmentation of labour and fetal outcomes in relation to birth positions:: a secondary analys of an RCT evaluating birth seat births, 2012Conference paper (Refereed)
  • 70.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Larsson, G
    Kvist, L
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Womens' opinions on intrapartal care: development of a theory-based questionnaire2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 11/12, p. 1748-1760Article in journal (Refereed)
    Abstract [en]

    Aim. To develop a patient questionnaire specific to intrapartal care, based on the theoretical foundation of the generalinstrument Quality from the Patients Perspective (QPP).Background. Existing general patient questionnaires do not take intrapartal care aspects fully into account, and availableintrapartal-specific patient questionnaires tend to have a weak theoretical foundation.Design. A cross-sectional, nationwide study carried out during a two-week period in 2007 at Swedish maternity units.Method. An intrapartal-specific QPP-questionnaire (QPP-I) was developed by combining a selection of 22 items from the shortand long versions of the QPP with 10 newly constructed items. Responses were obtained from 739 women (63% response rate).The dimensionality of the QPP-I was assessed using structural equation modelling (a nested factor model). Non-parametricstatistics were used for subgroup comparisons.Results. A nested model with a general factor including all 32 items and 10 subordinate factors was developed. Most scales hadacceptable reliability coefficients (0Æ730Æ93), and a meaningful pattern of subgroup differences was obtained.Conclusions. The QPP-I is theory based and has its roots in a patient perspective. It was developed using a nationwide sample ofSwedish women receiving intrapartal care, and an advanced statistical method was used. The outcome of this initial empiricaltrial was promising but needs to be tested in different countries and cultures.Relevance to clinical practice. By combining womens responses on perceived reality and subjective importance ascribed to thevarious aspects of care measured, the QPP-I offers the care provider better guidelines on which elements to focus qualityimprovement work on, than would be the case if only a rank order of perceived reality ratings was available

  • 71.
    Wilde-Larsson, Bodil
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Starrin, Bengt
    Karlstad University, Faculty of Social and Life Sciences, Department of Social Studies.
    Larsson, G
    Birthgiving Women´s feelings and perceptions of quality of intrapartal care: a nationwide Swedish cross-sectional study2011In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 7-8, p. 1168-1177Article in journal (Refereed)
    Abstract [en]

    Aim. The aim was to explore the relationships between the feelings of women who give birth and several birth-related care conditions, the womens' socio-demographic background, personality and perceptions of the quality of intrapartum care. Background. Childbirth is a highly significant emotional event for women and it is an explicit goal that each woman should have a positive childbirth experience. Design. The nationwide study is cross-sectional and was conducted at Swedish maternity units over two months in 2007. Methods. The study group consisted of 739 women (63% response rate). A dimensionality analysis of six emotion items was performed using structural equation modelling (SEM). Non-parametric tests and generalised linear mixed effects model analyses were used to study relationships and to make subgroup comparisons. Results. In the SEM analysis, a positive and a negative feeling factor were identified. Strong associations between the feeling factors and the womens' perceptions of the quality of care were found, particularly in regard to the so-called identity-oriented approach of the midwives and other health professionals. In addition, a higher intensity of negative feelings was associated with a personality pattern characterised by extraversion, emotional instability and lower degree of conscientiousness, a lower level of education and having had delivery through Caesarean section. Conclusions. The positive and negative feelings of women who give birth strongly covary with the women's perception of the quality of their intrapartum care. This pertains in particular to information issues, the midwives showing commitment, empathy and respect, being present during labour and allowing the women to actively participate as much as they want to. Relevance to clinical practice. Subgroup differences indicate that midwives should pay increased attention to childbearing women who have primary school education only, a lower emotional stability and/or deliver through Caesarean section.

  • 72.
    Ängeby, Karin
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences. Kvinnokliniken, Centralsjukhuset, Karlstad.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hildingsson, Ingegerd
    Mittuniversitetet Sundsvall.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Social and Life Sciences, Department of Nursing.
    Prolonged latent phase of childbirth: women's voices2013Conference paper (Refereed)
  • 73.
    Ängeby, Karin
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Persenius Wentzel, Mona
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Early labour experience questionnaire: Psychometric testing and women's experiences in a Swedish setting2018In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 64, p. 77-84Article in journal (Refereed)
    Abstract [en]

    Objective: (a) to psychometrically test the Early Labour Experience Questionnaire (ELEQ) among both primi- and multiparous women giving birth in a Swedish setting, and (b) to describe and compare their experiences during early labour in relation to background characteristics. Design: a cross-sectional study. Setting: a county in Sweden. Participants: primi- and multiparous women with a spontaneous onset of labour after gestational week 37 + 0. In total, n = 1193 women were invited, and n = 754 responded the questionnaire, with a final total of n = 344 primi and n = 410 multiparous women. Methods: the ELEQ was translated with cross-cultural adaptation. The validity was determined using exploratory factor analysis with principal axis factoring analyses. Reliability was estimated from the internal consistency using Cronbach's alpha. The relationship between the questionnaire and the demographic characteristics of the participating women were analysed using ANOVA and t-test. Findings: an explorative factor analysis showed a three-factor solution for primiparas women (SWE-ELEQ-PP) consist of 23 items and a stable factor structure that explained 49.2% of the total variance with sufficient reliability coefficients (0.81–0.86). A four-factor solution for multiparous women (SWE-ELEQ-MP) consist of 22 items, with 52.62% of the total variance explained and with adequate internal consistency reliability coefficients (0.77–0.86) for three factors and relatively low stability (0.62) for the fourth factor with two items. Primiparous women scored significantly higher on items about feeling confused, and significantly lower on some items measuring emotional wellbeing and perceptions of midwifery care compared to multiparous women. Primiparous women with longer early labour (>18 h), scored significantly lower on the perceptions of midwifery care. Primi- and multiparous women who were dissatisfied with their telephone conversation or with not being admitted during early labour, scored significantly lower on emotional wellbeing, higher regarding emotional distress, and significantly lower about perceptions of midwifery care. Key conclusions: the SWE-ELEQ-PP and SWE-ELEQ-MP are considered valid questionnaires for use in a Swedish setting. Differences exist between parity and the factor structure and experiences in early labour vary. Women less content with early labour management decisions rated perceived midwifery care lower regardless of parity. Implication for practice: the questionnaire can be used to evaluate early labour care in a Swedish setting. The result suggests that differences according to parity exist and should be addressed when managing early labour care and a more individualised approach requires considerations.

  • 74.
    Ängeby, Karin
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Persenius Wentzel, Mona
    Karlstad University, Faculty of Health, Science and Technology (starting 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Women's labour experiences and quality of care in relation to a prolonged latent phase of labour2019In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, p. 155-164Article in journal (Other academic)
    Abstract [en]

    im: To describe primiparous and multiparous women's labour experiences and their perception of quality of intrapartum care, in relation to background characteristics and length of latent phase of labour prior to admittance to labour ward. Design: A cross-sectional study. Setting: A middle-sized hospital in a rural county in western part of Sweden. Participants: Primiparous and multiparous women, both low-risk and risk, with a spontaneous onset of labour after gestational week 37+0 were included. In total, n =1193 women were invited, and n = 757 responded the questionnaire, n = 342 primiparous and n = 415 multiparous women. Methods: The Intrapartal-specific Quality from Patient Perspective (QPP-I), with responses on perceived reality and subjective importance, was used for data collection. QPP-I covers ten factors of quality of care. Background characteristics, length of latent phase of labour, global items about labour experience and items regarding feelings during labour and birth were included. Data were analysed with descriptive and analytic statistics. Findings: All factors in QPP-I were rated higher for subjective importance than perceived reality, except for information about selfcare, for both primi- and multiparous women. Labour experience, perceived reality of quality of care, and feelings were related to length of the latent phase of labour. Primiparous women with a prolonged latent phase (>18 h) had significantly lower scores regarding six out of ten QPP-I factors (PR); Information procedures, Information self-care, Commitment (midwives), Commitment (enrolled nurses), Midwives present, and Partner/ significant others. They scored lower on Experience birth as normal and Safe during labour and birth. The felt less proud and felt more ignored by professionals. Multiparous women with a prolonged latent phase of labour scored significantly lower on one QPP-I factor, Commitment (midwives). They also scored lower on Control over the situation and felt less safe during labour and birth. Key Conclusion: Women's perception of quality of intrapartum care, the birth experience and feelings are related to length of the latent phase of labour. Women perceive quality of intrapartum care as being lower than its subjective importance. Implications for Practice: A prolonged latent phase of labour can be regarded as a risk factor for a more negative birthing experience. 

  • 75.
    Ängeby, Karin
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Karlstad Univ, Fac Hlth Sci andTechnol, Dept Hlth Sci, SE-65188 Karlstad, Sweden..
    Hildingsson, Ingegerd
    Uppsala universitet.
    Prevalence of prolonged lathent phase and labour outcome: review of birth records in a Swedish population2016In: NJF congress: Gothenburg May 12-14, 2016 Nordisk Jordmoderförbund (NJF) / [ed] Svenska Barnmorskeförbundet, 2016Conference paper (Refereed)
  • 76.
    Ängeby, Karin
    et al.
    Women’s Department, Central Hospital, Karlstad, Sweden.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Inland Norway Univ Appl Sci, Fac Publ Hlth, Dept Nursing, Elverum, Norway.
    Hildingsson, Ingegerd
    Department of Health Sciences, Mid Sweden University, Sundsvall, .
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Prevalence of Prolonged Latent Phase and Labor Outcome: Review of Birth Records in a Swedish Population2018In: Journal of midwifery & women's health, ISSN 1526-9523, E-ISSN 1542-2011, Vol. 63, no 1, p. 33-44, article id JMWH12704Article in journal (Refereed)
    Abstract [en]

    The prevalence of a prolonged latent phase of labor has been described as ranging from 5% to 6.5% in previous research. The aim of this study was to describe the prevalence of the prolonged latent phase of 18 hours or more, based on women's report, in women intending vaginal birth and who had spontaneous onset of labor. An additional aim was to compare the incidence of obstetric interventions, and the labor and neonatal outcomes in women with and without a prolonged latent phase.

    METHODS:

    A descriptive and comparative study was performed in a mid-sized hospital in western Sweden. The sample consisted of 1343 birth records of women who intended vaginal births and who had spontaneous onset of labor at 37 or more weeks' gestation during a one-year period (2013-2014). Background characteristics, obstetric interventions, and labor and neonatal outcomes were compared between women with latent phases lasting less than 18 hours and 18 hours or more, based on women's self-report. Odds ratios with 95% confidence intervals were calculated for the different exposure variables.

    A prolonged latent phase lasting 18 hours or more occurred in 23% of all births analyzed (n = 1343). A prolonged latent phase was more common among nulliparous women (29.2%) but also common for multiparous women (17%). Nulliparous and multiparous women who experienced a prolonged latent phase were more often exposed to amniotomy during latent phase. For nulliparous women, the adjusted odds ratio (aOR) was 11.57 (95% confidence interval [CI], 5.25-25.51) and for multiparous women the aOR was 18.73 (95% CI, 9.06-38.69). Similarly, amniotomy during active phase was more common for both nulliparous and multiparous women who experienced a prolonged latent phase (aOR, 4.05; 95% CI, 2.53-6.47 and aOR, 3.93; 95% CI, 2.43-6.37, respectively). Women with latent phases of 18 hours or more, more often experienced augmentation of labor during all phases, especially during latent phase. For nulliparous women, the aOR was 10.13 (95% CI, 2.82-36.39) and for multiparous women, aOR was11.9 (95% CI, 3.69-38.71). A prolonged latent phase was associated with more instrumental vaginal births for multiparas (aOR, 2.58; 95% CI, 1.27-5.26) and emergency cesarean regardless of parity (nulliparous women: aOR, 3.21; 95% CI, 1.08-9.50 and multiparous women: aOR, 3.93; 95% CI, 1.67-9.26).

    Based on women's self-report, the prevalence of a prolonged latent phase in women at term who planned a vaginal birth and had spontaneous onset of labor was higher than previously reported. Women with a prolonged latent phase were more likely to receive obstetric interventions. Assisted vaginal birth was more common for nulliparous women with prolonged latent phase and emergency cesarean occurred more frequently for both nulliparous women and multiparous women with a prolonged latent phase.

  • 77.
    Ängeby, Karin
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Wilde-Larsson, Bodil
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Hildingsson, Ingegerd
    Mittuniversitetet.
    Sandin-Bojö, Ann-Kristin
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Primiparous women's preferences for care during a prolonged latent phase of labour2015In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 6, no 3, p. 145-150Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate primiparous women's preferences for care during a prolonged latent phase of labour. Methods: A qualitative study based on focus groups and individual interviews and analysed with inductive content analysis.Results: Sixteen primiparous women with a prolonged latent phase of labour >18 hours were interviewed in five focus groups (n = 11) or individually (n = 5). One main category emerged “Beyond normality – a need of individual adapted guidance in order to understand and manage an extended latent phase of labour” which covers the women's preferences during the prolonged latent phase. Five categories were generated from the data: “A welcoming manner and not being rejected”, “Individually adapted care”, “Important information which prepares for reality and coping”, “Participation and need for feedback” and “Staying nearby the labour ward or being admitted for midwifery support”. Women with a prolonged latent phase of labour sought to use their own resources, but their needs for professional support increased as time passed. A welcoming attitude from an available midwife during the latent phase created a feeling of security, and personally adapted care was perceived positively. Conclusions:  Women with a prolonged latent phase of labour preferred woman-centred care. Midwives play an important role in supporting these women. Women's need for midwifery-support increases as the time spent in latent phase increases.

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