Background: Using Patient Reported Experience Measures (PREM) is one way of assessing children's perspectives in identifying areas for improvement in paediatric care. The generic questionnaire Children and Young People-Patient Reported Experience Measure (CYP-PREM) has been adapted to the Swedish paediatric healthcare context to enable children to evaluate their care on issues important to them. Aim: The aim of the study was to pilot the Swedish versions of the CYP-PREM questionnaire in paediatric care. Methods: This pilot study used a descriptive cross-sectional design. Children aged 8-16 years were included when discharged from an inpatient ward or after an outpatient visit. The participating children were asked to complete two questionnaires: Swedish CYP-PREM (Swe-CYP-PREM) appropriate for their inpatient or outpatient visit and the age of the child, and a study-specific questionnaire to evaluate the children's opinions of the Swe-CYP-PREM. Findings: Out of the 319 invited children, 296 agreed to participate, of whom 189 children submitted the questionnaires, resulting in a response rate of 59.5 %. The Swe-CYP-PREM was well accepted by the target population and considered to provide good data completeness and few response errors. The Swe-CYP-PREM captured a range of experiences from children's healthcare visits, with predominantly positive responses. In the openended question about what was good or bad about the visit, 66 children had provided comments, which added value to the closed questions in the questionnaire. Conclusion: The Swe-CYP-PREM can be used in clinical practice to enable children to voice their experiences after a healthcare visit. 

INTRODUCTION Early labor is critical in shaping birth experiences, and women seek midwifery care to manage challenges during this stage. A salutogenic attitude, focusing on positive experiences and health promotion, is needed instead of the current pathogenic maternity model. This study aimed to understand how midwives support women's positive early labor experience and to identify key elements contributing to salutogenic midwifery care practices during early labor. METHODS We employed a qualitative study design, conducting nine focus group discussions (FGDs) with 39 women in Denmark, Sweden, and Switzerland. First, data were analyzed thematically using an inductive approach to capture codes. Second, a salutogenic best-fit framework guided the analysis, structuring the data into three domains: comprehensibility, manageability, and meaningfulness. Within domains, subthemes were identified to elucidate how midwifery care might contribute to positive early RESULTS Comprehensibility was achieved when women trusted midwives to provide accessible, high-quality care tailored to individual needs to help them comprehend the maternity system. Manageability was experienced when midwives guided women through the uncertainties of early labor and provided plans when needed. Meaningfulness was created through availability, accessibility, and emotional support. Continuity of care was an underlying foundation for a positive experience of all three domains. CONCLUSIONS A salutogenic midwifery approach, centering on flexibility and individualization, was essential to women's positive experiences cross-nationally. Salutogenic midwifery care during early labor reduced anxiety and enhanced emotional resilience. Our findings underscore the importance of salutogenic midwifery care for women in early labor, which should be recognized and implemented in maternity care settings.

Background: Early labor is often managed at home without professional support. The Birth App (Birth by Heart) is an app designed to support women during early labor. A pilot study revealed that women found the app’s exercises simple, understandable, and practical. The app was perceived as useful and appreciated by women, although areas for improvement were identified, primarily related to technical issues. After the development and test period, the updated app was tested in a randomized controlled trial.

Objective: This study aims to investigate whether women using the Birth App during pregnancy and childbirth experience less distress during early labor compared to those receiving standard antenatal care.

Methods: We used online recruiting in a nonblinded 3-part blended care model with 1:1:1 randomization: group 1 (Birth App intervention); group 2 (Birth App Plus, combining the app with in-person additional midwifery contacts); and group 3 (control group receiving standard antenatal care). Pregnant nulliparous women were invited via social media. Eligibility criteria were nulliparity, planning a vaginal birth, from gestational week 25+0 to 35+6 weeks, proficiency in understanding Swedish, and having access to a smartphone or tablet. Data were analyzed with descriptive statistics, chi-square tests, and ANOVA.

Results: A total of 391 women completed the baseline questionnaire and were included in the study (group 1, n=118; group 2, n=114; group 3, n=118). Of these, 335 women responded to the questionnaire 1 month postpartum, yielding a response rate of 85.6%. Most participants experienced a spontaneous onset of labor (group 1: 67/103, 65%; group 2: 81/114, 71%; and group 3: control group, 86/118, 73%), with no statistically significant differences between groups. During early labor, women in group 1 remained at home for a mean of 16.76 (SD 20.45) hours, group 2 for a mean of 14.47 (SD 16.82) hours, and the control group for a mean of 12.90 (SD 15.99) hours (P=.32). For the primary and secondary outcomes, only women with spontaneous onset of labor (n=234) were included in the analysis. The primary outcome, emotional distress, showed similar mean values across all groups. No statistically significant differences were identified in the secondary outcomes: childbirth experience, pain relief, and support from the partner. However, for the secondary outcome fear of future birth, a pairwise testing from baseline to follow-up revealed a statistically significant mean difference for the intervention groups (group 1: mean 13.53, 95% CI 5.12‐21.92, P=.002; group 2: mean 14.59, 95% CI 7.75‐21.42, P<.001) with a medium effect size (Cohen d=.40 vs d=.47). For group 3, the mean was 6.78 (95% CI −.95 to 14.53; P=.08).

Conclusions: The Birth App, in conjunction with additional midwifery support, can be a valuable tool for pregnant women and their partners during pregnancy and childbirth. The observed reduction in fear of forthcoming childbirth associated with the Birth App warrants further investigation.

Title: Women experiencing the second stage of labour for the first time: a qualitative free-text analysis within the Oneplus trial. Background: The second stage of labour is the time from full cervical dilation to the birth of the baby. The risks to the woman and the baby are increased during this stage, leading to intensified midwifery care. A positive birth experience is a significant goal of intrapartum care and it is important to investigate how women experience the second stage of labour in particular. Aim: The aim was to explore women's experiences of the second stage of labour in their first vaginal birth. Methods: This qualitative study analysed data from the Oneplus trial's one-month postpartum follow-up questionnaire. The questionnaire included an open-ended question about the second stage of labour and the free-text answers were analysed using inductive and manifest qualitative content analysis. Results: The open-ended question was answered by 865 women and three categories emerged. In the first category, women described their physical and emotional sensations during this stage. The other two categories concerned women's relationship with midwives. The relationship was a major contributor to a positive experience but also had the opposite potential. Midwives' use of instructions mostly regarded pushing technique. When women were given instructions, it could lead to feelings of blame instead of accomplishment. Conclusions: The result showed the essentiality of midwifery care during the second stage of labour, as it contained both emotional support and guidance which affected the women's experiences positively. The experience of being instructed by the midwife during the second stage of labour is more complex and needs further research.

Background

In order to evaluate interventions aimed at reducing cesarean births, care practitioners’ attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners.

Methods

A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS.

Results

A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians.

Conclusions

The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.

Background

There is no national, validated, generic patient-reported experience measure (PREM) for children under 15 years of age in Sweden. A recent cross-sectional study found no consensus in how children's voices are heard in paediatric health care, as well as a lack of validated questionnaires.

Aim

The aim of this study is to translate, adapt and validate the six versions of the Children's and Young People's PREM for use in a Swedish health care context.

Design

An exploratory sequential mixed-method design including cognitive interviews and content validity index (CVI) was used. The interviews focused on evaluating children's understanding of the questionnaire, and the CVI was used to further adjust the relevance of the questionnaire.ParticipantsA convenience sample of 62 children participated in the cognitive interviews and an additional convenience sample of 42 children was included in the CVI testing. The children, aged 8–16 years, were attending routine visits at paediatric departments in a county hospital and a children's hospital in the mid-Sweden region between October 2020 and June 2022.

Results

The translation, adaptation and validation process identified several issues regarding the understanding of the questionnaire in a Swedish context. Adaptations were made based on issues related to context, wording and the structure of the questions. CVI testing resulted in the removal of 3–10 questions in each of the different versions of the questionnaire.

Conclusion

The study has resulted in six face- and content-validated Swedish versions of the questionnaire ready for pilot testing. Although the versions of the original questionnaire were developed in collaboration with children in the United Kingdom, this did not mean that they could automatically be used in a Swedish health care context. This study confirms the importance of a rigorous process of adaptation and validation to ensure quality and applicability to children accessing health care in different countries.

Patient or Public Contribution

Children's views have guided the development of the original instrument and its adaptation to the Swedish health care context. Due to the strong patient involvement in the process of developing the Swedish versions of the questionnaire, the research group made a pragmatic decision to have no other patient contribution in the study.

Introduction:Positive birth experiences can be a decisive factor in the well-being and future health of both women and their newborns. The quality of care is a multidimensional concept influenced by the external structure of the organization, the administrative qualities of the environment, and the individual patient’s preferences about care. The aim was to describe women’s preferences and experiences concerning support and treatment, and their perception of quality of care during all phases of labor and the postnatal period.

Methods:Free-text comments of 635 women from four different open comment questions were analyzed. A qualitative content analysis was conducted in two steps: an inductive phase followed by a deductive phase using the Quality of care from a Patient’s Perspective framework (QPP).

Results:A total of 1148 free-text comments were coded; and 10 sub-categories were created and inserted under the QPP framework covering the latent meaning of the subcategory. Five of the sub-categories were sorted under the identity-oriented approach, four under physical-technical conditions, and one under the sociocultural atmosphere and reflected the women’s experiences and needs regarding support and treatment during early labor, the active phase of labor, and the postnatal period.

Conclusions:High-quality care and support are important aspects for women during childbirth, irrespective of the phase of labor or postnatal period. The need for individualized care, active participation in one’s own birth and using a family centered approach were also emphasized. Organizational factors influenced the quality of care and were particularly noticeable during birth.

Background: Use of mobile applications (apps) are increasing during pregnancy but few of these are evidence-based or evaluated in research.

Aim: To examine the feasibility, including perceived usefulness and usability, and the preliminary effects of an app based on the Confident birth method.

Methods: A mixed-method approach, including 48 women, was used to evaluate acceptability, usability and to test study design and procedures. iPhone-users (n = 24) tested the app during pregnancy while the remaining (n = 24) formed a control group. Background characteristics and outcome measurements were collected from all women at baseline. Women in the app group received two follow-up phone calls from a midwife concerning usefulness and ease of use of the app. A follow-up questionnaire after birth were used to measure preliminary effects of the intervention as well as system usability of the app.

Results: Women using the app found the app exercises simple, understandable, and useful. System usability score showed a mean score of 85.3 indicating excellent system usability. Notes from phone calls resulted in four categories: positive feedback about the app, negative feedback about the app, partners involvement, and knowledge. Preliminary effects of labour experience showed no significant differences between the two groups, in terms of early labour or childbirth experience.

Conclusion: The app tested in this feasibility study, was perceived as useful and appreciated by women. Areas for improvement of the app were identified. The result shows promise for further efficacy testing in a forthcoming randomised controlled trial.