"Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden".

OBJECTIVE: This study aimed to investigate new mothers' self-rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers' experiences of received support from the midwifery clinic. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers. MEASUREMENT AND FINDINGS: Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self-rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility. CONCLUSION AND IMPLICATION FOR PRACTICE: It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.

Intimate partner violence and negative health consequences: A cross-sectional study among women in a regional sample in Sweden.

BACKGROUND: Intimate partner violence (IPV) is a global health problem of enormous proportions. However, little is known about the prevalence or health consequences of IPV among women in Stockholm, Sweden, a city characterised by high levels of gender equality that hosts a large population of people born outside Europe. AIMS: This study aimed to assess the prevalence of exposure to physical, psychological and sexual IPV and its associated background factors and health outcomes. METHODS: This was a cross-sectional study employing a survey containing questions about the previous year's exposure to IPV that was distributed to 35 midwifery clinics in Stockholm during the autumn of 2020. Any woman who visited any of these midwifery clinics during these two months was eligible to participate. RESULTS: A total of 2239 women answered the questionnaire, of whom 25.1% reported having been subjected to IPV at some point during their life and 8.7% during the previous year. The most common ongoing exposure was psychological violence, which was reported by 6.6% of the women. Women living with IPV reported poorer self-rated general health and more recurring health symptoms and depression than unexposed women. CONCLUSIONS: Exposure to IPV is common and is associated with depression, lower general well-being and somatic health problems.

Support during the postnatal period: Evaluating new mothers' and midwives' experiences of a new, coordinated postnatal care model in a midwifery clinic in Sweden.

OBJECTIVE: Continuity of care as provided by midwives promoting the health and well-being of new mothers during the postnatal period is critical; thus, access to midwifery services needs to be facilitated. The aim of this study was to describe new mothers' and midwives' experiences and perceptions of a new coordinated postnatal care intervention in a midwifery clinic. DESIGN: New mothers responded to open-ended questions in a survey, and midwives were interviewed individually about the intervention. A deductive content analysis research related to continuity of care concepts was used. SETTING AND PARTICIPANTS: The study was carried out at a midwifery clinic in a larger city in Sweden, for an eight-month period in 2019 and 2020. Two hundred and sixteen answers from new mothers and nine interviews with midwives were analysed. INTERVENTION: All registered pregnant women at the midwifery clinic received enhanced postnatal support based on a new coordinated postnatal care model. The focus was on continuity of care, from pregnancy to the postnatal period and included planning for the first weeks after childbirth at the end of pregnancy, early postnatal contact and several visits to the midwifery clinic. FINDINGS: New mothers describing the coordinated postnatal care model highlighted continuity and accessibility as empowering factors that made them feel assured and confident. Midwives emphasised the pregnancy to postnatal continuity as crucial to providing care based on individual needs. KEY CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Using a structured and coordinated care model as a midwife that includes planning for the postnatal period together with the pregnant woman at the end of pregnancy may be a good and relatively easy way to create continuity and thus ensure satisfaction and confidence in expectant and new mothers.

Open dialogue - A grounded theory study on peer learning at birthing units.

BACKGROUND: Peer learning in clinical settings is supported in nursing research but has rarely been studied in the context of student midwives at birthing units. AIM: To create a theoretical model of peer learning in the context of birthing units. SETTINGS: Four hospitals and maternity units in Stockholm, Sweden. METHODS: A Straussian approach to grounded theory was applied. Data consisted of interviews with fifteen final-term student midwives and 21 preceptors. Further, six peer learning seminars were held with approximately 200 midwives. At these, data was collected from fourteen preceptors presenting their experiences of working with peer learning. FINDINGS: The core of the action emerging was the Open dialogue describing the communication between the pair of students, between students-preceptor and students-becoming parents, that developed skills in communication, participation and reduced prestige and hierarchy. It facilitated social interaction and reinforced a dynamic way of learning and teaching midwifery. CONCLUSIONS: With preparation and a clear framework, peer learning can be used with midwifery students at birthing units. The open dialogue includes the becoming family in decision making and fits in a woman centered care providing support, safety, and participation. The pedagogical benefits are consistent with previous studies on nursing students.

Experiences from leading parental education groups: Perceived difficulties and rewards as an indication of skill acquisition.

Developing skills in a professional setting is linked to practical experience. The relationship between experience and acquisition of skills can be seen as a transition from novice to expert. In a nursing setting, this has been studied using the Dreyfus model of skill acquisition. The aim was to investigate how experience influences midwives' and child healthcare nurses' views of difficulties and rewards in working with parental education groups. The study has a cross-sectional design with a mixed methods approach. A total of 437 midwives and child healthcare nurses answered a web-based survey. First, a qualitative analysis was carried out, and then patterns of experience were analysed. The results showed that less experience as a leader corresponds to a greater focus on one's own role and on personal benefits from working with parents, but not on the specific context of the group. With experience, leaders had a greater focus on the group itself and rewards of making it function well. Not being able to take the current group and the specific context into account when working as a leader reduces possibilities of achieving a well-functioning group and the goals of the parental education.

When student midwives are present during labour and childbirth in a peer-learning model: An interview study of parents in Sweden.

OBJECTIVE: For peer learning to be useful in clinical practice, we need to know how parents experience peer learning during labour and childbirth. This study explored how parents experienced having two students present during labour and childbirth in a peer-learning model. DESIGN: A qualitative approach using individual interviews followed by thematic inductive analysis. SETTING: Three hospitals and obstetric units in Stockholm, Sweden. PARTICIPANTS: Eleven women and nine partners. FINDINGS: The overarching theme was that of a fruitful model of health care, in which there were gains for both parents and students. Parents described feeling seen and cared for, being made aware of what was going on, and never being left alone (subtheme 1, Trustful relationship). Parents appreciated being able to observe student midwives' attendance to the tasks at hand and that they, the two students, learned from each other (subtheme 2, Advantages for students). CONCLUSIONS: The parent couple was able to build a trustful relationship with both students. Furthermore, could parents only see advantages for students in a peer-learning model. Parents reported generous support and were willing to contribute to student education. Parents took advantage of the learning taking place between the two students. The model deserves to be incorporated in the midwifery-student internships to complement more individually assisted births.

Student midwives' perception of peer learning during their clinical practice in an obstetric unit: A qualitative study.

BACKGROUND: Evidence supports peer learning in clinical settings, but it has not been studied in obstetric units. In Sweden, obstetric units are a challenging learning area for student midwives because of the lack of attention to student needs and the stress of attaining the final number of 50 assisted births. OBJECTIVES: To explore how student midwives experienced peer learning during clinical placement in an obstetric unit. DESIGN: Qualitative approach. SETTINGS: Three hospitals and obstetric units in Stockholm, Sweden. PARTICIPANTS: Fifteen student midwives in a peer-learning model during clinical placement. METHODS: Individual interviews followed by deductive content analysis using Boud's (2001) theoretical descriptions of peer learning. RESULTS: The students shared skills, experience, and knowledge as equals and took responsibility for their peers' learning while supporting women in labor and childbirth. Students shared ideas, thoughts, and knowledge and gained perspective while learning as peers on an equal level. Students used each other to work independently without much involvement from the preceptor. Feedback was welcomed as encouragement. CONCLUSIONS: Peer learning had positive consequences as an educational model in the clinical context in obstetric units.

Maternal depression symptoms during the first 21 months after giving birth.

AIMS: The first year after childbirth involves a major transition for women, which can accentuate inadequacies and feelings of powerlessness, making them vulnerable to depression. The aim of this study was to investigate the prevalence and frequency of maternal postpartum depressive symptoms at different times after giving birth (0-21 months). METHODS: Data were collected cross-sectionally using a web questionnaire containing the Edinburgh Postnatal Depression Scale (EPDS). A total of 888 mothers with children in the age range 0-21 months responded. RESULTS: The results showed different levels of depression over the range of months included in the study. The overall prevalence using EPDS ⩾ 12 was 27.8%. There were higher levels at 9-12 months and 17-21 months. The highest levels of symptoms of depression were found at nine, 12, and 17 months after birth, and the lowest levels at two and 16 months. CONCLUSIONS: Many mothers experience symptoms of depression after giving birth that can continue well beyond the child's first year. We have identified different levels of depression at different points in time after giving birth, with highs and lows throughout the first 21 months. This highlights a need to screen for depression more than once during the first years, as well as a closer cooperation between midwives and child healthcare nurses in supporting mothers in the transition to motherhood. This is an important aspect of public health, which not only involves mothers with symptoms of depression, but also their ability to care for their child and a possible negative impact on the child's development.

Fatherhood group sessions: A descriptive and summative qualitative study.

The aim of this qualitative study of fatherhood group sessions offered as part of child health care services for new parents was to examine the activities, roles, and topics initiated by the leader and describe fathers' participation. Eight new fathers took part in three audio- and video-recorded sessions led by a male leader. Three qualitative content analysis approaches were used to analyze the data. The analysis showed that the group leader took on four leadership roles, mainly that of discussion leader, but also expert, friend, and organizer. When the group leader acted as discussion leader, fathers participated by discussing challenges and changes in their new situation. Challenges were related to raising the child, partner relationships, everyday life, and gender equality. Fathers also discussed changes in their partner relationships and an increased focus on practicalities in daily life. Fatherhood groups can help new fathers form social networks and can create space for fathers to work through challenging topics, such as gender equality in parenting. The discussion leader's choice of role is crucial to creating the space for such discussions.

Exploring the internship experiences of Swedish final term student midwives: A cross-sectional survey.

Today, student midwives in Sweden spend half of their midwifery education at various internships. Practice reality demonstrates that there is an insufficient number of preceptors for the students, and the workload is demanding. Therefore, the present study aimed to explore the experiences of final term Swedish students during their midwifery internship and whether other paedagogical learning experiences beyond the apprenticeship model were included. A cross-sectional survey was distributed to 288 final year midwifery students at all universities offering the midwifery programme in Sweden. This paper focuses on open-ended questions, which were answered by 108 students, and analysed inductively via thematic analysis. Students described an intensive period with pressure during their internship. They expressed a desire for fewer parallel tasks and a better-structured internship. Students revealed that it was both a challenge and stressful to be under constant high performance while practising clinically. Furthermore, students described feelings of competition towards fellow peers in regard to attaining the final number of 50 assisted births. As to the paedagogical methods, the classical preceptorship model with a one-to-one student-preceptor relationship was predominately used. Preceptors were perceived as crucial role models. However, this learning experience was considered suboptimal for learning in the event where preceptors were not engaged or felt insecure regarding their knowledge, or if the preceptor was changed. For the students, the most optimal setting would be if preceptors were selected, trained, and supported in their role to supervise students, instead of being assigned any available preceptor, who was, at times, not a midwife.

Child health care nurses' use of teaching practices and forms of knowledge episteme, techne and phronesis when leading parent education groups.

This study explores child health care nurses' pedagogical knowledge when supporting parents in their parenthood using various teaching practices, that is how to organise and process the content during parent education groups in primary health care. The aim is to identify teaching practices used by child health care nurses and to analyse such practices with regard to Aristotle's three forms of knowledge to comprehensively examine child health care nurses' use of knowledge in practice. A qualitative methodological design alongside the analysis of video-recordings was used. The results showed that child health care nurses used four teaching practices: lecturing, demonstration, conversation and supervision. Their use of episteme was prominent, but they also seemed to master techne in combination with episteme during the first three teaching practices. During the conversation teaching practice, the child health nurses rarely succeeded. Consequently, they missed opportunities to identify mothers' expressed concerns and to act in the best interests of both the mothers and their infants by the use of phronesis. In health care, however, theoretical episteme is superordinate to productive knowledge or phronesis, which also became evident in this study. Nevertheless, more interactive pedagogical practices are needed if more use of phronesis is to become a reality in parent education groups.

Parents' reasons for not attending parental education groups in antenatal and child health care: A qualitative study.

AIMS AND OBJECTIVES: To explore expectant and new parents' reasons not to participate in parental education (PE) groups in antenatal care or child health care. BACKGROUND: In Sweden, expectant and new parents are offered PE groups in antenatal care and in child health care. Although many parents feel unprepared for parenthood, an urgent task is to attract parents to attend the PE groups. DESIGN: A total of 915 parents with children aged 0 to 21 months answered a web questionnaire with open questions about (a) reasons not to participate; (b) anything that could change their mind; and (c) parenting support instead of PE groups. This was analysed using content analysis. The study follows the SRQR guidelines. RESULTS: Parents expressed private reasons for not attending PE groups. Some parents also asked for more heterogeneity regarding content and methods, as well as accommodation of parents' different interests. Other parents asked for like-minded individuals who were in similar situation to themselves. Lack of information or invitations from antenatal care or child health care, or that PE groups were unavailable, were additional reasons for not participating in groups. CONCLUSIONS: Reasons for not attending PE groups were multifaceted from personal, self-interested and norm-critical reasons, to that the groups were not available or that the parents were not aware of their existence. RELEVANCE TO CLINICAL PRACTICE: Parents of today are a diverse group with different interests and needs. Nevertheless, all parents need to feel included in a way that makes participation in PE groups relevant for them. Thus, it is important for leaders to be aware of structures and norms, and to be able to create a group climate and a pedagogy of acceptance where group members value each other's differences. However, to attract parents to participate in PE groups, it is necessary for clinical practice to work on individual, group and organisational levels.

Leaders' limitations and approaches to creating conditions for interaction and communication in parental groups: A qualitative study.

The aim of this study was to describe and understand parental group (PG) leaders' experiences of creating conditions for interaction and communication. The data consisted of 10 interviews with 14 leaders. The transcribed interviews were analysed using thematic analysis. The results showed that the leaders' ambition was to create a parent-centred learning environment by establishing conditions for interaction and communication between the parents in the PGs. However, the leaders' experience was that their professional competencies were insufficient and that they lacked pedagogical tools to create constructive group discussions. Nevertheless, they found other ways to facilitate interactive processes. Based on their experience in the PG, the leaders constructed informal socio-emotional roles for themselves (e.g. caring role and personal role) and let their more formal task roles (e.g. professional role, group leader and consulting role) recede into the background, so as to remove the imbalance of power between the leaders and the parents. They believed this would make the parents feel more confident and make it easier for them to start communicating and interacting. This personal approach places them in a vulnerable position in the PG, in which it is easy for them to feel offended by parents' criticism, questioning or silence.

Walk the talk: Leader behavior in parental education groups.

Expectant and new parents are offered parental education groups as a way to support their transition to parenthood. Group leadership in these groups has been found to be challenging. Using a qualitative and summative design, the aim of the present study was to investigate how health professionals describe their role in parental education groups compared to their actual behavior. Thirteen health professional leaders in antenatal and child health services were interviewed. These descriptions were compared with the leaders' actual behavior in video and audio-recordings of 16 different group sessions. The results revealed that regardless of how the leaders described their role, they acted as experts and left little time to parents for discussions and active participation. In particular, leaders who described themselves as discussion leaders did not "walk the talk"; that is, they did not do what they said they do when leading groups. That could be explained by lack of professional awareness, group leadership, and pedagogical skills. In order to provide high-quality parental support, leaders need training in group leadership and pedagogy combined with supervision and support on a regular basis.

Postnatal ER visits within 30 days-Pattern, risk factors and implications for care.

AIMS AND OBJECTIVES: To (i) reveal care-seeking patterns of emergency room visits within 30 days following childbirth (i.e., identify risk factors that trigger contact with emergency room, visit rate and diagnoses) and (ii) suggest clinical implications for postnatal follow-up. DESIGN: The study had a longitudinal design; it used anonymised data from a county council database on all women in Stockholm County, Sweden, who gave birth in 2013. METHODS: Descriptive and inferential data analysis methods were used. Cox regression was applied to these variables: age when giving birth, diagnostic codes at birth, care encounters and types (e.g., visits or hospital admissions), day of discharge and care organisation and type. The data covered the period from childbirth through a 30-day period following discharge from hospital. RESULTS: The database contained 28,963 births and 59,202 healthcare or medical care encounters. Of these encounters, 50.3% (n = 29,774) were planned visits to hospital postnatal care units within 7 days following discharge and 1.2% (n = 681) were admissions to hospitals. Of all women who gave birth, 12.2% (n = 3,533) visited the emergency room at least once. The number of visits peaked at day 6 following discharge. These factors significantly increased risk for emergency room visits: caesarean, assisted birth and sphincter injury. CONCLUSIONS: Emergency room visits occurred most commonly immediately following discharge when there were no routine check-ups. Greater risk of emergency room visits - following caesareans, assisted childbirths or sphincter injuries - indicated that early support for women with childbirth complications should be improved upon discharge from hospital. Other multiple risk factors for emergency room visits might exist. RELEVANCE TO CLINICAL PRACTICE: Many emergency room visits could be prevented through early, more qualified, appropriate follow-up via maternity care systems and effective midwifery interventions. These initiatives could enhance care continuity and facilitate postpartum recovery.

THERAPISTS' EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT: A QUALITATIVE STUDY.

As part of a larger research project in Sweden, a qualitative study investigated psychotherapists' experiences of mother-infant psychoanalysis (MIP). A randomized controlled trial compared two groups of mother-infant dyads with psychological problems. One had received Child Health Center care, and the other received MIP. Previous articles on long-term effects have found that mothers who had received MIP were less depressed throughout a posttreatment period of 3½ years, and their children showed better global functioning and psychological well-being. The present study's objectives were to describe the therapist's experiences of MIP and deepen the understanding of the MIP process. Six months after treatment began, all therapists were interviewed. Transcribed interviews with therapists from 10 (of 33 total) MIP treatments were randomly selected and analyzed in detail by thematic analysis. Therapists worked successfully with mother and infant together and found different ways of cooperation during MIP sessions. Therapists reported overall positive experiences; however, in cases where mothers needed more personal attention, it would be important to adapt the method to them.

MOTHERS' EXPERIENCES OF MOTHER-INFANT PSYCHOANALYTIC TREATMENT-A QUALITATIVE STUDY.

As part of a larger research project in Sweden, a qualitative study investigated mother-infant psychoanalysis (MIP). Earlier, a randomized controlled trial compared two mother-infant groups. One received MIP, and the other received standard child health center care. Previous articles have reported long-term effects: MIP-group mothers were less depressed throughout a 3-year posttreatment period, and their children demonstrated better global functioning and psychological well-being (Winberg Salomonsson, Sorjonen, & Salomonsson, ). The present study's objectives were to describe the mothers' experiences of MIP and deepen the understanding of the MIP process. Six months after treatment started, all mothers were interviewed. Transcribed interviews of 10 (of 33) MIP-group participants were randomly selected and analyzed in detail. Thematic analysis was used on the interview data. Two main themes emerged: (a) transition to motherhood and (b) relationships with the infant and family. MIP facilitated mother-infant relationship development and familial relationship development and clarified mothers' views of how their personal histories were connected with their motherhood experiences. Mothers reported that the analysts had succeeded in balancing the mothers' own needs and those of the infant. Their accounts of therapy matched the published descriptions of MIP.

Facilitating and inhibiting factors in transition to parenthood - ways in which health professionals can support parents.

BACKGROUND: The transition to parenthood is an overwhelming life event. From a theoretical perspective, transition to parenthood is a developmental transition that contains certain phases and patterns. AIM: This study aim was twofold (i) discover, describe and comprehend transitional conditions that parents perceive as facilitating and inhibiting during transition to parenthood and to (ii) use that knowledge to develop recommendations for professional interventions that support and facilitate transition to parenthood. DESIGN: Meleis transition theory framed the study's deductive qualitative approach - from planning to analysis. METHODS: In a secondary analysis, data were analysed (as per Meleis transition theory) from two studies that implemented interviews with 60 parents in Sweden between 2013 and 2014. Interview questions dealt with parents' experiences of the transition to parenthood - in relation to experiences with parent-education groups, professional support and continuity after childbirth. ETHICAL ISSUES: A university research ethics board has approved the research. RESULTS: These factors facilitated transition to parenthood: perceiving parenthood as a normal part of life; enjoying the child's growth; being prepared and having knowledge; experiencing social support; receiving professional support, receiving information about resources within the health care; participating in well-functioning parent-education groups; and hearing professionals comment on gender differences as being complementary. These factors inhibited transition to parenthood: having unrealistic expectations; feeling stress and loss of control; experiencing breastfeeding demands and lack of sleep; facing a judgmental attitude about breastfeeding; being unprepared for reality; lacking information about reality; lacking professional support and information; lacking healthcare resources; participating in parent-education groups that did not function optimally; and hearing professionals accentuate gender differences in a problematic way. CONCLUSION: Transition theory is appropriate for helping professionals understand and identify practices that might support parents during transition to parenthood. The study led to certain recommendations that are important for professionals to consider.

Content and Presentation of Content in Parental Education Groups in Sweden.

This study investigated parents' experiences of parental education groups at antenatal and child health care centers, including content, presentation of content, the leader's role, and the importance of other participating parents. Twenty-one interviews with 26 parents from 6 cities across Sweden were analyzed with 3 content analysis approaches. Parents expressed both satisfaction and dissatisfaction with the content, presentation of content, and the leader's role. They reported that social contact with other parents was important, that parenthood topics were covered less frequently than child and childbirth-related topics, and that group activities were less frequent than lectures. When designing future parental education groups, it is important to consider expanding parenthood topics and group activities because this structure is considered to provide support to parents.