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1.  Parents' experiences of an abnormal ultrasound examination - vacillating between emotional confusion and sense of reality 
Reproductive Health  2010;7:10.
Background
An ultrasound examination is an important confirmation of the pregnancy and is accepted without reflection to any prenatal diagnostic aspects. An abnormal finding often comes unexpectedly and is a shock for the parents. The aim was to generate a theoretical understanding of parents' experiences of the situation when their fetus is found to have an abnormality at a routine ultrasound examination.
Methods
Sixteen parents, mothers and fathers, whose fetus had been diagnosed with an abnormality during an ultrasound scan in the second or third trimester, were interviewed. The study employed a grounded theory approach.
Results
The core category vacillating between the emotional confusion and sense of reality is related to the main concern assessment of the diagnosis impact on the well-being of the fetus. Two other categories Entering uncertainty and Involved in an ongoing change and adaptation have each five sub-categories.
Conclusions
Parents are aware of that ultrasound examination is a tool for identifying abnormalities prenatally. The information about the abnormality initially results in broken expectations and anxiety. Parents become involved in ongoing change and adaptation. They need information about the ultrasound findings and the treatment without prolonged delay and in a suitable environment. The examiner who performs the ultrasound examination must be aware of how anxiety can be intensified by environmental factors. All parents should to be offered a professional person to give them support as a part of the routine management of this situation.
doi:10.1186/1742-4755-7-10
PMCID: PMC2904723  PMID: 20546610
2.  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.
doi:10.1186/1471-2393-14-293
PMCID: PMC4162910  PMID: 25169740
Intimate partner violence; Pregnancy; Experience
3.  Prevalence of domestic violence during pregnancy and related risk factors: a cross-sectional study in southern Sweden 
BMC Women's Health  2014;14:63.
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.
doi:10.1186/1472-6874-14-63
PMCID: PMC4030020  PMID: 24885532
Domestic violence; Pregnancy; Prevalence; Risk factors; Depression
4.  Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden 
BMC Family Practice  2013;14:143.
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.
doi:10.1186/1471-2296-14-143
PMCID: PMC3852529  PMID: 24079391
Child; Nurses; Obesity; Overweight; Perceptions; Preventive work; Primary care; Qualitative research
5.  Swedish Child Health Care nurses conceptions of overweight in children: a qualitative study 
BMC Family Practice  2012;13:57.
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.
doi:10.1186/1471-2296-13-57
PMCID: PMC3426496  PMID: 22697580
Child; Conceptions; Nurses; Overweight; Perceptions; Primary health care; Qualitative research
6.  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.
doi:10.1186/1471-2393-11-14
PMCID: PMC3052209  PMID: 21338523
7.  Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy. A qualitative study 
Background
National guidelines recommend that healthy pregnant women take 30 minutes or more of moderate exercise a day. Most women reduce the level of physical activity during pregnancy but only a few studies of women's experiences of physical activity during pregnancy exist. The aim of the present study was to elucidate experiences and views of leisure time physical activity during pregnancy in nulliparous women who were physically active prior to their pregnancy.
Methods
A qualitative study was conducted by means of personal interviews. Nineteen women, all with a moderate pre-pregnancy level of physical activity but with different levels of physical activity during pregnancy, participated in the study. Content analysis was applied.
Results
In the analyses of experiences and views of physical activities during pregnancy, four categories and nine sub-categories were developed: Physical activity as a lifestyle (Habit and Desire to continue), Body awareness (Pregnancy-related discomfort, Having a complicated pregnancy and A growing body), Carefulness (Feelings of worry and Balancing worry and sense of security) and Sense of benefit (Feelings of happiness and Physical well-being).
Conclusion
As other studies have also shown, women find that the discomfort and complications associated with pregnancy, the growing body, and a sense of insecurity with physical activity are barriers to maintaining former levels of physical activity. This study adds a new perspective by describing women's perceptions of these barriers and of overcoming them - thus, when pregnant, the majority of the women do not cease to be physically active but continue to be so. Barriers are overcome by applying one's own experience, looking to role models, mirroring the activities of other pregnant women and following the advice of experts (midwives/physiotherapists). Women then continue to be physically active during pregnancy, most often to a lesser extent or in alternative activities, and derive considerable enjoyment and physical well-being from this.
doi:10.1186/1471-2393-10-33
PMCID: PMC2913936  PMID: 20584333
8.  Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study 
Background
In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria.
Methods
A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR) and 95% confidence intervals (CI) are given.
Results
The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix < 4 cm (1.63, 1.38–1.92), tense cervix (1.31, 1.04–1.65), thick lower segment (1.32, 1.09–1.61), fetal head above the inter-spinal diameter (2.29, 1.80–2.92) and poor fetal head-to-cervix contact (1.83, 1.31–2.56). The use of epidural analgesia (5.65, 4.33–7.38) was also associated with dystocia.
Conclusion
Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.
doi:10.1186/1471-2393-8-45
PMCID: PMC2569907  PMID: 18837972
9.  Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partner's involvement 
Background
Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner.
Methods
Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis.
Results
The four main categories that developed were:
• Access to the professional midwife
• Useful counselling
• Stable motherhood in transition
• Being a family living in a different culture
Conclusion
According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted.
Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost.
Clinical implications
There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.
doi:10.1186/1742-4755-4-9
PMCID: PMC2173883  PMID: 17958884
10.  Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach 
Background
Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received.
Methods
A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery.
Results
The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control.
Conclusion
A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible.
doi:10.1186/1471-2393-7-15
PMCID: PMC1971051  PMID: 17662152

Results 1-10 (10)