Parents who have received 'psycho-prophylaxis training' during pregnancy and their experience of childbirth - An interview study highlighting the experiences of both parents.

Background: The form of parental support during pregnancy is constantly changing due to developments in society. 'Psycho-prophylaxis training' is a form of parental support used in preparation for childbirth. Only a few studies describe the childbirth experience of both the parents.The aim was to interview parents receiving 'psycho-prophylaxis training' during pregnancy and to elucidate their experience of childbirth.Method: A total of 22 open interviews were conducted with 11 expectant mothers and their 11 partners. Analysis of the interviews was performed using the content analysis method.Results: Three categories emerged in the manifest phase. 'To gain security from knowledge and focus on breathing and relaxation', 'The couple's sense of proximity and the team collaboration with the maternity staff' and 'Meeting pain'. Two themes emerged during the latent analysis of which one was," Participation gave a sense of security" and the other was 'Manageability'.Conclusion: Knowledge about childbirth and the ability, by the mother, to use various breathing techniques seemed to help both parents, as it made both of them feel that they were themselves involved in the process.

Pain assessment from Swedish nurses' perspective.

METHODS: This study is a qualitative interview study. The authors used the stimulated recall interview (SRI) with nurses working at a children's hospital in southern Sweden for the data collection. In total twelve nurses were interviewed and qualitative content analysis was used for the data analysis. RESULTS: The results are presented as one theme: Need for higher competencies and evidence, and three categories: Routines can enable pain assessment, Trusting one's own assessment of the whole picture, and Pain assessment scales as an extra workload. The interviewed nurses acknowledged that pain assessment tools are a vital part of the field of pain treatment. They also had trust issues with measuring and estimating pain by means of a tool such as pain scale. Furthermore, their opinion was that too many different tools and methods add up towards a more blurry and stress-related environment and due to a lack of consistent routines, pain assessment is seen as a work-related burden in the daily routines. CONCLUSION: Results from the present study indicated that nurses need clear routines in combination with continued education regarding pain assessment with pain scales, which might be the key to successful pediatric pain assessment and thus to better pain management within pediatrics.

Increasing prevalence and incidence of domestic violence during the pregnancy and one and a half year postpartum, as well as risk factors: -a longitudinal cohort study in Southern Sweden.

BACKGROUND: Domestic violence is a global health problem as well as a violation against human rights. The aim of this study was to explore prevalence and incidence of domestic violence during pregnancy and 1 to 1.5 years postpartum as well as to explore the history of violence among new mothers in the southwestern region of Sweden. In addition, the aim was to explore the association between domestic violence postpartum and possible risk factors. METHODS: This is a longitudinal cohort-study including pregnant women ≥ 18 years of age. Total 1939 pregnant women were recruited to the study and requested to answer three questionnaires (QI-III) during pregnancy and postpartum. Statistical analysis were descriptive statistics, logistic regression and multiple regression with Odds ratios (OR) and 95 % confidence intervals (95 % CI). RESULTS: The response rate for those who received the Q-III (n = 755) at a Child Welfare Center was almost 97 % (n = 731). When all three questionnaires were answered the prevalence of domestic violence during pregnancy irrespective of type or severity was reported by 2.5 % (n = 40/1573). At 1 to 1.5 years postpartum the prevalence of domestic violence had increased to 3.3 % (n = 23/697). The incidence was 14 per 1000 women during pregnancy and 17.2 per 1000 women postpartum. The strongest risk factor for domestic violence reported at1-1.5 years postpartum was a history of violence whereby all of the women (n = 23) who had revealed their exposure to domestic violence postpartum also reported a history of violence (p < 0.001). Being single/living apart gave a 12.9 times higher risk for domestic violence postpartum (AOR 12.9; 95 % CI: 4.5-37.1). Having several symptoms of depression and a low score on the SOC-scale gave a 3.5 and 3.0 times higher risk respectively (AOR 3.5; 95 % CI: 1.2-10.4) and (AOR 3.0; 95 % CI 1.1-8.3). CONCLUSION: Domestic violence increases as the pregnancy develops and postpartum. A history of violence and being single/living apart may be strong indicators for domestic violence during pregnancy as well as postpartum. Also, having symptoms of depression are associated with domestic violence both during pregnancy and postpartum. Collaboration between health care providers at Antenatal and Welfare centres is essential.

Prevalence and incidence of domestic violence during pregnancy and associated risk factors: a longitudinal cohort study in the south of Sweden.

BACKGROUND: Domestic violence during pregnancy is not only a severe public health issue that jeopardizes maternal and foetal health but also violates human rights. The aim was to explore the prevalence and incidence of domestic violence among pregnant women, in the southwestern region of Scania in Sweden, and their experience of a history of violence. In addition, to explore the association between domestic violence during pregnancy and possible risk factors. METHODS: This is a longitudinal cohort-study including pregnant women ≥18 years of age, registered at antenatal care when pregnant. A cohort of 1939 pregnant women answered Questionnaire I (QI) in gestational week 13 (mean 12.8 week, SD 5.11). Response rate of Questionnaire II (QII) in gestation week 34 (mean 33.9 week, SD 2.2) was 78.8 % (n = 1527). Statistical analysis was descriptive statistics, logistic regression and multiple regression with Odds ratios (OR) and 95 % confidence intervals (95 % CI). RESULTS: Both QI and QII were completed by 77.8 % (n = 1509) of the women and 44.3 % (n = 668) reported a lifetime experience of abuse irrespective of type, severity or perpetrator. Also, 5.1 % (n = 77) reported some experience of abuse past year. Prevalence of domestic violence during pregnancy was 2.0 % (n = 29) and the incidence was 7.3 new cases per 1000 women. The strongest risk factor for domestic violence, during early and late pregnancy, was history of violence whereby all women who disclosed exposure had also reported history of violence (p < 0.001). To be single/living apart gave 8.4 times more risk associated with domestic violence during pregnancy (AOR 8.4; 95 % CI: 2.2-32.6). Having several symptoms of depression and lack of sleep gave 3.8 times more risk respectively (AOR 3.8; 95 % CI: 1.1-13.6) and (AOR 3.8; 95 % CI 1.1-12.9). CONCLUSIONS: Pregnant women with a history of violence as well as being single/living apart and/or having several symptoms of depression during pregnancy should be alerts for clinical working midwives and obstetricians. Further, this is important knowledge for health care providers to develop or upgrade guidelines and plans of action for pregnant women exposed to violence.

Mothers' awareness towards child injuries and injury prevention at home: an intervention study.

BACKGROUND: Most injuries to young children happen in the home. Therefore, this study aimed to investigate if extended individual information to mothers' related to injury to children in the home and possible preventative actions has any effect on their awareness of the problem and if Sense of Coherence has an influence. METHODS: This was a quasi-experimental designed intervention study with a comparison group. Extended individual information with empowerment as the approach was used. RESULTS: Ninety-nine mothers of children under the age of 7 months participate. A questionnaire with sociodemographic data and questions regarding awareness towards prevention was used. Mothers who took part in the intervention significantly increased their awareness of the fact that child injuries take place at home when compared with the mothers in the comparison group, [OR 2.3, CI 1.3-4.3]. However, no significant improvement of awareness towards prevention was noted, neither any association to the mothers' SOC-scores. CONCLUSION: This study showed that the intervention had a positive effect on mothers' awareness towards the fact that child injuries are taking place at home, but it did not increase the mothers' awareness towards prevention of child injury.

Struggling to survive for the sake of the unborn baby: a grounded theory model of exposure to intimate partner violence during pregnancy.

BACKGROUND: Intimate partner violence (IPV) during pregnancy is a serious matter which threatens maternal and fetal health. The aim of this study was to develop a grounded theoretical model of women's experience of IPV during pregnancy and how they handle their situation. METHOD: Ten interviews with women who had experience of being exposed to IPV during pregnancy were analyzed using the grounded theory approach. RESULTS: The core category 'Struggling to survive for the sake of the unborn baby' emerged as the main concern of women who are exposed to IPV during pregnancy. The core category also demonstrates how the survivors handle their situation. Also, three sub-core categories emerged, 'Trapped in the situation' demonstrates how the pregnant women feel when trapped in the relationship and cannot find their way out. 'Exposed to mastery' demonstrates the destructive togetherness whereby the perpetrator's behavior jeopardizes the safety of the woman and the unborn child. 'Degradation process' demonstrates the survivor's experience of gradual degradation as a result of the relationship with the perpetrator. All are properties of the core category and part of the theoretical model. CONCLUSION: The theoretical model "Struggling to survive for the sake of the unborn baby" highlights survival as the pregnant women's main concern and explains their strategies for dealing with experiences of violence during pregnancy. The findings may provide a deeper understanding of this complex matter for midwives and other health care providers. Further, the theoretical model can provide a basis for the development and implementation of prevention and intervention programs that meet the individual woman's needs.

Prevalence of domestic violence during pregnancy and related risk factors: a cross-sectional study in southern Sweden.

BACKGROUND: Domestic violence during pregnancy is a serious public health issue which threatens maternal and foetal health outcomes. The aim of the study was to explore prevalence of domestic violence among pregnant women in southern Sweden (Scania) and to explore associations with background factors, as symptoms of depression and sense of coherence. METHODS: This study has a cross-sectional design and is the first part of a longitudinal, cohort study. Inclusion criteria were women ≥ 18 years, registered at antenatal care when pregnant and who understand and write Swedish or English. Questionnaires were collected prospectively at seventeen antenatal care receptions situated in the two cities and six smaller municipalities in Scania. Statistical analyses were done using descriptive statistics, chi-square tests, bivariate logistic regression and multiple regression with Odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: Study sample included 1939 women. History of violence was reported by 39.5% (n =761) women. Significant differences were obtained between the groups with or without history of violence regarding being single/living apart, unemployment, financial distress, smoking/snuffing, unintended pregnancy as well as history of miscarriage/legalised abortion (p < 0.001). Experience of domestic violence during pregnancy regardless of type or level of abuse was 1.0% (n = 18); history of physical abuse by actual intimate partner was 2.2% (n = 42). History of violence was the strongest risk factor associated with domestic violence during pregnancy, where all women (n = 18) exposed reported history of violence (p < 0.001). Several symptoms of depression (adjusted for low socio-economic status, miscarriage/abortion, single/living apart, lack of sleep, unemployment, age and parity) were associated with a 7.0 fold risk of domestic violence during pregnancy (OR 7.0; 95% CI: 1.9-26.3). CONCLUSIONS: The reported prevalence of domestic violence during pregnancy in southwest Sweden is low. However, a considerable proportion of women reported history of living in a violent relationship. Both history of violence and the presence of several depressive symptoms detected in early pregnancy may indicate that the woman also is exposed to domestic violence during pregnancy. Increased attention to this vulnerable group of women is needed to improve maternal and child health.

Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden.

BACKGROUND: Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. METHOD: A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach. RESULTS: Two categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses' work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses' personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation. CONCLUSION: Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.

Living with uncertainty: a Swedish qualitative interview study of women at home on sick leave due to premature labour.

OBJECTIVE: to highlight the experiences of pregnant women, experiencing preterm labour, being on sick leave at home and how they handled their daily life. DESIGN: qualitative, descriptive using open interviews. SETTING: 10 antenatal clinics in the south of Sweden. PARTICIPANTS: 15 pregnant women who were on sick leave for premature labour. FINDINGS: four categories were identified: how to interpret unpredictable contractions in the uterus? Having concern regarding premature labour of their child, handling the new situation and finding a balance, and from work to sick leave. KEY CONCLUSIONS: to be on sick leave for premature contractions can be compared with enduring a situation of inactivity. The woman finds herself in a stressful situation which she must learn to handle this and find a balance. IMPLICATIONS FOR PRACTICE: it appears that supportive information offers the women in premature labour the opportunity of increased participation and responsibility which thereby positively affects her well-being.

Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study.

BACKGROUND: Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. METHOD: A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. RESULTS: Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent's lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. CONCLUSION: CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse's conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse's, as well as the parent's efforts to influence the children's weight. It is suggested that CHC- nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight.

Fathers' sense of security during the first postnatal week--a qualitative interview study in Sweden.

BACKGROUND: father's sense of security in the early postnatal period is important for the whole family. An instrument, which measures Parents' Postnatal Sense of Security (the PPSS instrument), is under development. OBJECTIVE: to explore and describe factors, which influence fathers' sense of security during the first postnatal week. METHODS: an explorative design with a qualitative approach was used. Thirteen fathers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews. Analysis was carried out using qualitative content analysis. FINDINGS: participation in the processes of pregnancy birth and early parenthood emerged as the main category for fathers' postnatal sense of security. The emergent categories were; 'willingness to participate and take responsibility', 'being given the opportunity to take responsibility', 'being assured about mother's and baby's well-being', 'having someone to turn to-knowing who to ask', 'being met as an individual' and 'being met by competent and supporting staff'. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: new and specific items of importance when investigating fathers' sense of security during the early postnatal period have been pinpointed. Fathers' sense of early postnatal security may be enhanced by giving them a genuine opportunity to participate in the whole process and by giving them the opportunity to stay overnight at the hospital after the birth. Midwives and care organisations need to give clear information about where competent help and advice can be obtained at all hours. Midwives should strengthen the fathering role by acknowledging and listening to the father as an individual person.

Ultrasound screening during pregnancy in Iran: womens' expectations, experiences and number of scans.

OBJECTIVE: To determine the number of ultrasound scans received by Iranian mothers during pregnancy and the relationship between scanning and background factors, and to describe the mothers' expectations and experiences of ultrasound scanning. DESIGN: Descriptive survey. SETTING: A hospital related to the Social Security Organisation of Urmia City in Iran. PARTICIPANTS: Over a six-month period, all mothers attending postpartum care and who met the inclusion criteria (n=654) were interviewed two to three days post partum, and asked to complete a questionnaire containing defined closed- and open-ended questions. FINDINGS: The mean number of ultrasound scans received by each woman during her latest pregnancy was 5.9. None of the participants received written information about the scanning procedure. For 91.1% (n=596) of the women, the most important reason for undergoing the scan was to be assured of their infant's health. However, the majority of women were not shown the monitor screen during any of their scans. The main reasons given for feeling happy after a scan were discovering the infant's gender and assurance about the infant's health. Most women overestimated the diagnostic power of ultrasound scanning. Few mothers reported negative feelings towards scanning, but more than half of the mothers indicated that they would like to see changes in the scanning procedure. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The quality of the information offered prior to scanning and the communication between staff and mothers should be improved. The number of scans should be decreased to be in accordance with the official Iranian public health-care guidelines. Although most women viewed ultrasound as being beneficial, it is essential to offer women appropriate information about the limitations of ultrasound in order to discourage unreasonable expectations and demands.

Attitudes of Swedish midwives towards management of extremely preterm labour and birth.

OBJECTIVE: the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. DESIGN: this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. PARTICIPANTS: the answers from midwives (n=259) were collected in a prospective SWEMID study. SETTING: the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. FINDINGS: in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. KEY CONCLUSIONS: midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. IMPLICATIONS FOR PRACTICE: based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.

Midwives' awareness and experiences regarding domestic violence among pregnant women in southern Sweden.

OBJECTIVE: to explore midwives' awareness of and clinical experience regarding domestic violence among pregnant women in southern Sweden. DESIGN: an inductive qualitative design, using focus groups interviews. SETTING: midwives with experience of working in antenatal care (ANC) units connected to two university hospitals in southern Sweden. Participants 16 midwives recruited by network sampling and purposive sampling, divided into four focus groups of three to five individuals. FINDINGS: five categories emerged: 'Knowledge about 'the different faces' of violence', perpetrator and survivor behaviour, and violence-related consequences. 'Identified and visible vulnerable groups', 'at risk' groups for exposure to domestic violence during pregnancy, e.g. immigrants and substance users. 'Barriers towards asking the right questions', the midwife herself could be an obstacle, lack of knowledge among midwives as to how to handle disclosure of violence, fear of the perpetrator and presence of the partner at visits to the midwife. 'Handling the delicate situation', e.g. the potential conflict between the midwife's professional obligation to protect the pregnant woman and the unborn baby who is exposed to domestic violence and the survivor's wish to avoid interference. 'The crucial role of the midwife', insufficient or non-existent support for the midwife, lack of guidelines and/or written plans of action in situations when domestic violence is disclosed. The above five categories were subsumed under the overarching category 'Failing both mother and the unborn baby' which highlights the vulnerability of the unborn baby and the need to provide protection for the unborn baby by means of adequate care to the pregnant woman. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: avoidance of questions concerning the experience of violence during pregnancy may be regarded as a failing not only to the pregnant woman but also to the unprotected and unborn baby. Nevertheless, certain hindrances must be overcome before the implementation of routine enquiry concerning violence during pregnancy. It is important to develop guidelines and a plan of action for all health-care personnel at antenatal clinics as well as to provide continuous education and professional support for midwives in southern Sweden.

Precautions taken by mothers to prevent burn and scald injuries to young children at home: an intervention study.

AIM: The aim of this study was to investigate to what extent individual-based extended information given to mothers from city parts of low education can improve precautions taken by them to prevent burn and scald injuries involving young children in the home and further to compare the results with a group of mothers who had not received extended information. METHODS: This intervention study, with a comparison group, has a quasi-experimental design. Individual-based information, with an empowerment approach, was given to a group of mothers living in two separate areas of a city in southern Sweden with a low level of education. In total, 99 mothers of children under the age of 7 months participated. The mothers were selected through the local child healthcare authorities. Observations were made and bivariate analyses were established. RESULTS: The results showed that the intervention had a significant impact on improving the precautions the participating mothers introduced to protect their children against burn and scald injuries in the home and further, in relation to a comparison group. CONCLUSIONS: Through empowerment, workshops, and home visits aimed to increase their consciousness and knowledge, the participating mothers' precautions taken against child injuries in the home improved. It is of great importance that a framework for considering the problem of burn and scald injuries to children is presented from a preventive perspective which, in combination with evidence-based interventions, may enable the creation of injury prevention programmes for implementation by the community health care.

Attitudes of midwives in Sweden toward a woman's refusal of an emergency cesarean section or a cesarean section on request.

BACKGROUND: A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. METHODS: The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). RESULTS: In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. CONCLUSIONS: The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician.

A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term.

BACKGROUND: Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. METHODS: A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia. RESULTS: Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96). CONCLUSIONS: Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.

Mothers' sense of security in the first postnatal week: interview study.

AIM: This paper is a report of a study of factors which influence mothers' sense of security during the first postnatal week. BACKGROUND: Mothers' sense of security the first postnatal week is not thoroughly elucidated in the literature. METHODS: An interview study with a qualitative descriptive design was carried out, using thematic content analysis. Fourteen mothers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews between May 2008 and March 2009. FINDINGS: Postnatal sense of security was dependent on support from staff, support from family and the capacity and health of the woman and the baby, and these themes had categories and sub-categories, including: Being met as an individual, being given relevant information, being prepared for the time after birth and having someone to turn to--knowing who to ask, having partner and/or significant others close at hand, mother's and the baby's own resources, being assured that her own physical health was good, and having planned follow-up regarding the baby's health after discharge. CONCLUSION: Staff attitudes should be continually discussed at all units providing maternity care. These discussions should include attitudes towards the father and the significance of his presence for the wellbeing of the family. Continued postbasic staff education in, for example, counselling and communication is necessary if services are to be improved so that parents' individual needs can be met. Preparation for the early postpartum period is important and all information given must be consistent, in particular information about breastfeeding.

Sports and leisure time physical activity during pregnancy in nulliparous women.

To describe patterns of leisure time physical activity during pregnancy in relation to pre-pregnancy leisure time physical activity, socio-demographic characteristics, fertility history, and lifestyle factors. 4,718 nulliparous with singleton pregnancy and intended spontaneous vaginal delivery were included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased from 6% to 29%. During the third trimester women performing competitive sports or moderate-to-heavy activities before pregnancy continued to have a higher level of physical activity than women with light activities or sedentary activities before pregnancy. In general the intensity and time spent on exercise decreased during pregnancy. Women with the highest level of exercise prior to pregnancy continued to be the most active during pregnancy. Among women with sedentary activities before pregnancy one-fourth changed to light activity during pregnancy.