"It was a good good, bad situation.": Cameroonian fathers' experiences of childbirth in Sweden.

INTRODUCTION: In Sweden, partner's presence during childbirth is generally recommended. However, cultural values and norms in some immigrant societies can be an obstacle to this. OBJECTIVE: To examine the experiences of Cameroonian fathers during their women's labour and childbirth in Sweden. DESIGN: An exploratory qualitative study with semi-structured interviews were used for data collection and analysed with thematic content analysis. SETTING: Scania County, South of Sweden. PARTICIPANTS: Twelve fathers accessed through sociocultural associations. FINDINGS: Conflicting feelings was identified as the main category, which was further divided into three subcategories; (a) Ambivalent feelings, (b) Cooperation and finding one's place in a foreign area and (c) Knowledge, insight and transition. KEY CONCLUSION: Pre-knowledge about childbirth, cooperation between fathers and medical staff are key factors which impacted the labour/childbirth experiences of Cameroonian fathers living in Southern Sweden. CLINICAL IMPLICATIONS: This study emphasises the importance to individualise information and support given to fathers during labour and childbirth.

Experiences of Using a Continuous Glucose Monitoring System in Children-A Descriptive Study with Parents in the Republic of Georgia.

The benefits of medical devices are often multifaceted and may have an important impact on patients' and relatives' physical, mental and/or social well-being. Diabetes is a metabolic disorder and a continuous subcutaneous glucose monitoring sensor can suggest increasing treatment satisfaction. The purpose of this study was to describe parents' experiences during their daily lives and support needs when a child uses a Flash Glucose Monitoring system (FGM). Twenty parents (n = 3 men vs. n = 17 women) to children (age ranged between 22 months and 16 years) with diabetes disease type 1, treated with an FGM unit (used for an average of 7 months (range 1-72)) at home, participated in this study. A qualitative questionnaire survey with open questions including follow-up dialogues was distributed to the parents, and collected data were analysed using qualitative content analysis. Overall satisfaction with the Libre device was Md 10 (IQR 9.25-10). One main theme "Advances in technology significantly improved everyday life" emerged from 2 categories: Improvements in quality of life and Elements of challenges. In conclusion, this qualitative study determined that parents of children with DMT1 experience a great improvement in daily life when given the opportunity to use the Libre device.

From passive passenger to participating co-pilot - Pregnant women's expectations of being able to access their online journal from antenatal care.

OBJECTIVE: The aim of the study was to describe pregnant women's expectations of being able to access their electronic health records from antenatal care. METHODS: Nine pregnant women passing 25 full gestational weeks were interviewed individually. Collected data were analysed with an inductive approach using content analysis. The study was performed in antenatal care units in southern Sweden. RESULTS: The following five categories emerged from the analysis: Being able to achieve increased participation, being able to have more control, being more knowledgeable about the pregnancy, identification of possible risks, and perceptions of one's own well-being can predict usage. The five categories led to one main category: 'Shift in power - from passive passenger to participating co-pilot'. CONCLUSION: The pregnant women expected that having access to electronic health records would give them more control, make them more knowledgeable and increase their participation. Access to electronic health records may empower pregnant women and contribute to a more person-centred approach. This could provide greater knowledge for the woman and her partner about her health, thus, allowing them to make evidence-based choices in relation to the newborn baby and the woman's health.

Nordic fathers' willingness to participate during pregnancy.

OBJECTIVE: This study aims to illuminate expectant first-time fathers' experiences of participation during pregnancy in three Nordic countries.  Background: Fathers' participation in pregnancy is associated with improved health for the family as a whole. Research so far has primarily explored fathers' participation in pregnancy within health care settings. It is important to know more about how fathers today engage in all aspects of pregnancy.  Methods: Content analysis was used to analyse semi-structured interviews with 31 first time fathers from Denmark, Finland and Sweden. Interviews were undertaken when their partner was pregnant 30 weeks or more.  Results: Data analysis resulted in the main category 'Willingness to participate' and the two generic categories: 'Being beside the "bump"' and 'Cementing the partnership'. 'Being beside the "bump"' was supported by the subcategories: 'Visualising the unborn child', 'Being included in the rites of motherhood,' 'Lacking full control', 'Compensating for lack of embodiment' and 'Adopting an active father role'. 'Cementing the partnership' encompassed the subcategories: 'Strengthening the partner relationship', 'Meeting the professionals, 'Sharing experiences with peers' and 'Protecting their child and their partner'. CONCLUSION: Fathers wanted to participate and be responsible from the beginning of pregnancy. Fathers' participation in pregnancy involves a wide range of activities and strategies both within the domestic and the professional care-giving sphere. Health care professional's approaches to the father-to-be can enhance or reduce experiences of inclusion in antenatal care.

Group antenatal care: new pedagogic method for antenatal care--a pilot study.

OBJECTIVE: to investigate how women who attended group antenatal care experienced the information they received, compared with women who attended traditional antenatal care, and their satisfaction with the form of care. The aim was also to determine the effect of group antenatal care on women's social networks compared with traditional antenatal care. DESIGN AND SETTING: a pilot study with an intervention group (group antenatal care) and a control group (traditional antenatal care). Both groups were selected through informed choice. A questionnaire and a follow-up telephone call, using a structured questionnaire, were used to evaluate both groups. PARTICIPANTS: for each woman who had chosen to be in the intervention group, two women who had chosen traditional antenatal care were selected from the same antenatal clinic and given the same questionnaire. FINDINGS: 35/45 (77%) women in the intervention group returned a completed questionnaire, compared with 40/85 (48%) women in the control group. There was little difference in satisfaction with information between the two groups, and overall satisfaction was high. KEY CONCLUSIONS: at six months post partum, the women who attended group antenatal care still met others from the group more regularly than the women who attended traditional antenatal care. IMPLICATIONS FOR PRACTICE: group antenatal care is well accepted by women, and can better utilise midwives' time.

Information for better or for worse: interviews with parents when their foetus was found to have choroid plexus cysts at a routine second trimester ultrasound.

The aim of the study was to gain a theoretical understanding of parents' experiences and handling of the situation, when their foetus was diagnosed as having choroid plexus cysts, at a routine second trimester ultrasound examination. Nine couples and one mother were interviewed using one open question. Analysis method was Grounded Theory. The main concern was anxiety and the core category became need for knowledge. The other categories were frightening and confusing, judging risk and making a choice and comforting. The parents felt information during the ultrasound examination was insufficient. The time delay between the diagnosis and the doctor's appointment was also often criticized. Most of the parents in this study wanted to know what can be diagnosed by ultrasound, even if there is a small risk that the child will have a malformation or chromosome abnormality. However, when the diagnosis is made, they need adequate information, otherwise unnecessary anxiety arises. By giving sufficient information without days of delay, anxiety can hopefully be minimized. Some written information was also requested. It is of utmost importance that the staff use the same terminology and the correct name of the soft marker to the parents.

Diabetes and pregnancy: women's opinions about the care provided during the childbearing year.

BACKGROUND: The extended programmes for pregnant women with diabetes, needed to improve pregnancy outcome, might negatively influence the experience of expecting a baby. AIM: To investigate opinions about care during pregnancy, childbirth and the postnatal period among women with diabetes mellitus (DM) and gestational DM (GDM). METHOD: A four-part questionnaire was constructed, covering the childbearing year, with a focus on treatment and information. A total of 156 women were asked to participate (53 DM, 103 GDM), three refused. The questionnaire was anonymous. RESULTS: The reply frequency was 94%. Of all answers, 95% fell in neutral-satisfied range (Lickert scale 2-5). Three answering patterns deviated positively (care on Specialist Antenatal Clinic, accessibility, and participation-responsibility-respect). Four patterns deviated negatively (information flow, preparation, postpartum care and postpartum check-up). Increased supervision caused problems with time for the family and at work. Comments showed focus on diabetes, forcing the healthy pregnancy aspects into the background. The answers concerning treatment indicated satisfaction (4 + 5 Lickert scale). Women with GDM felt badly prepared before the glucose tolerance test. It was doubtful whether they had been able to make an informed choice about participating. Lack of knowledge among staff was pointed out. Need for more written material was expressed. CONCLUSION: Satisfaction with care was shown. A discussion about the implication of informed choice with both staff and mothers are needed. Sharper implementation of the diabetes-care-chain was also an area for improvement.

Parents' experiences, reactions and needs regarding a nonviable fetus diagnosed at a second trimester routine ultrasound.

OBJECTIVE: To conceptualize women's and their partners' experiences and ways of handling the situation before, during, and after second trimester ultrasound examination with the diagnosis of a nonviable fetus. DESIGN: A grounded theory study. SETTING: A Swedish regional hospital. PARTICIPANTS: Nine women and 6 men (n=15) were interviewed within a year of the event. RESULTS: The core category was Unexpected change in life. Four categories that were encompassed by the core category emerged: (a) Deceived by a false sense of security; (b) Confronting reality; (c) Grieving; and (d) Reorientation. CONCLUSION: These parents were unprepared for the diagnosis of a nonviable fetus. In addition to the crisis reaction, they realized that the sense of security they had experienced was false. As different care givers were involved, the need for a care plan was evident. Support from care givers was a very important factor.

Problem based learning and the case method--medical students change preferences during clerkship.

BACKGROUND: The Case Method (Case) and Problem Based Learning (PBL) are two student active methods, increasingly used in medical education. AIM: The aim of this study was to compare medical student satisfaction with the two different active methods of learning and to see if there was any variation in preference between two stages in medical training. METHODS: A short questionnaire was given out to 254 students during the eighth and eleventh term of medical training. Answers were obtained from 221 students. The results were computer analysed. RESULTS: Students in the eighth term rated both methods high, while students in the eleventh term rated Case even higher while PBL decreased in popularity. Traditional lectures were given constant neutral rating. Case was rated better for problem solving. CONCLUSIONS: It seems that Case is more suitable than PBL for the later stages of medical training when clinical problem-solving skills need to be honed.

Applying the case method for teaching within the health professions--teaching the teachers.

The case method provides training in problem solving and is useful in clinical education within health professions. The method consumes less teaching resources and might be useful in a situation with increasing numbers of students and staff cuts. As it is a relatively new method within the Faculty of Medicine, University of Lund, a training program for teachers has been established with a short, practical, course. This paper describes the application and introduction of the case method and evaluation of the introductory course by 106 teachers. In this course the case method is introduced and demonstrated. The participants construct cases and take an active part as both students and teachers. Almost everyone was planning to incorporate the case method in their teaching practice, at both undergraduate and graduate levels. To have constructed and led cases themselves was considered a great strength. More time was requested as well as a follow-up session after practically using the case method.

A qualitative study of mothers' and fathers' experiences of routine ultrasound examination in Sweden.

OBJECTIVE: to conceptualise mothers' and fathers' thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. DESIGN, SETTING AND PARTICIPANTS: a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. FINDINGS: the basic social process was confirmation of a new life. The four categories, visualising-the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents' process towards confirmation of a new life. The caregivers' way of assisting and supporting the process by information and treatment was very important to parents. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life.

Midwives' attitudes to and knowledge about a newly introduced foetal screening method.

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate.

Expectant first-time fathers' experiences of pregnancy.

OBJECTIVE: to describe first-time-expectant fathers' experiences of pregnancy. DESIGN: an inductive method using narrative interview form and qualitative content text analysis. The text of the transcripts was coded and categorised. SETTINGS AND PARTICIPANTS: seven first-time-expectant fathers living in a multicultural industrial town in southern Sweden were interviewed individually when their partner was in the 38th to 39th week of pregnancy. MEASUREMENTS AND FINDINGS: all the fathers-to-be experienced some psychological, social and/or physical change during the pregnancy. The main category, was 'time of transition'. Eight categories were found under this. They were: 'feelings of unreality, 'insufficiency and inadequacy', 'exclusion', 'reality', 'social changes', 'physical changes', 'responsibility, and development'. KEY CONCLUSION: the fathers'-to-be special needs for support and encouragement during pregnancy may be as important as those of the mothers'-to-be. The caregiver needs to be as aware of and sensitive to these needs. However, before any interventions can be recommended more research is needed.

Maternal serum screening for Down syndrome--opinions on acceptance from Swedish women.

BACKGROUND: Different screening procedures are becoming an important part of health care. Information about screening and its consequences can be difficult to both impart and understand. This study examined women's theoretical acceptance of a new screening procedure, before its introduction. METHODS: A group of women (n = 823), who had made an informed choice about the form of foetal diagnosis they wished for, were also asked, in a questionnaire, about their opinion on the acceptability of serum screening for Down syndrome. The main purpose of the this was to ascertain their feelings when making a choice. RESULTS: Replies were received from 80.4%. The answers indicated that serum screening would be acceptable to 86% of the women who had chosen a second trimester ultrasound examination. Of the women who had chosen amniocentesis, 51% would consider the test acceptable as a first alternative. CONCLUSIONS: The ease with which the women were able to make their choice of prenatal diagnosis had bearing on their degree of acceptance of serum screening for Down syndrome.