Papers by Ingela Lundgren
Sexual & Reproductive Healthcare, 2012
Background: Theoretical models for health care practice are important both as tools for guiding d... more Background: Theoretical models for health care practice are important both as tools for guiding daily practice and for explaining the philosophical basis for care. Aim: The aim of this study was to define and develop an evidence-based midwifery model of womancentred care in Sweden and Iceland. Method: Using a hermeneutic approach we developed a model based on a synthesis of findings from 12 of our own published qualitative studies about women's and/or midwives' experiences of childbirth. For validity testing, the model was assessed in six focus group interviews with 30 practising midwives in Iceland and Sweden. Findings: The model includes five main themes. Three central intertwined themes are: a reciprocal relationship; a birthing atmosphere; and grounded knowledge. The remaining two themes, which likewise influence care, are the cultural context (with hindering and promoting norms); and the balancing act involved in facilitating woman-centred care. Conclusion: The model shows that midwifery care in this era of modern medical technology entails a balancing act for enhancing the culture of care based on midwifery philosophies. The next step will be to implement the model in midwifery programmes and in clinical practice, and to evaluate its applicability.
An effort to make all the pieces come together : women's long-term experience of intense fear... more An effort to make all the pieces come together : women's long-term experience of intense fear of childbirth
Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 2020
OBJECTIVE To develop a scale that measures attitudes towards vaginal birth after caesarean (VBAC)... more OBJECTIVE To develop a scale that measures attitudes towards vaginal birth after caesarean (VBAC) among clinicians. METHODS A cross sectional survey among midwives (n = 58) and obstetricians (n = 51). A 23-item "Hannover Clinicians' Attitudes towards VBAC scale" (HCAV-scale) was developed. Indicators of reliability and validity were assessed, including item-to-total correlation, Cronbach alpha coefficient and factor analysis. RESULTS The response rate was 35.3% (n = 109). The HCAV-scale showed high construct validity and high internal consistency. The Cronbach alpha coefficient of the 23 items was 0.87 (n = 89), indicating good internal consistency of the items. Exploratory factor analysis resulted in factor loadings between 0.34 and 0.70; all 23 items loaded above 0.3 on one factor, providing evidence that the scale can be conceptualized as one-dimensional. CONCLUSIONS The HCAV-scale is a reliable and valid tool to assess clinicians' favourable attitudes towards V...
International Journal of Qualitative Studies on Health and Well-being
ABSTRACT Purpose: To explore and analyse the experience of work situation and professional role f... more ABSTRACT Purpose: To explore and analyse the experience of work situation and professional role for midwives at a labour ward pre and post the implementation of a midwifery model of care (MiMo). Methods: A simultaneous mixed method was used. The qualitative core component departed from three focus group interviews (n = 16 midwives). Secondary inductive and deductive content analysis was performed using an unconstrained matrix to make a corresponding comparison of the different time points. The supplemental component was a quantitative survey about the work situation (n = 58). Results: The qualitative results pre the implementation showed three categories: Balance between Women and Organization, Midwives—Diverse as both Profession and Person, and Strained Work Situation. Post the intervention they transformed to Balance between Midwifery and Organization, Midwives—An Adaptable Profession, Strained Work Situation, and a new category Ability to concretize midwifery was found. There were no significant differences in the measures of work situation in the quantitative analyses. Conclusions: The synthesized findings based on the qualitative part show that MiMo has a potential to strengthen the professional role and midwifery practice. As such, MiMo has the capability to offer benefits to the labour wards with additional considerations.
BACKGROUND Late-term pregnancy is related to increased risk of serious complications for babies a... more BACKGROUND Late-term pregnancy is related to increased risk of serious complications for babies and women, as pregnancies proceed. Pregnancy is an individual, complex and existential situation for women, who may experience late-term pregnancy as a mentally strenuous period, characterised by worries and anxiety. However, there is a lack of studies in this area. AIM To describe women's experiences of late-term pregnancy ≥41 gestational weeks. METHODS A lifeworld hermeneutic approach was used. Qualitative interviews were performed with ten women, two to seven months after the birth. FINDINGS Six themes emerged from the analysis Doubting the body's ability to cope with the transition from pregnancy to giving birth, The importance of their partner's support during the sea voyage, Lacking clear guidelines for the voyage, Worrying about the cargo at the end of the voyage, How the voyage turned out and Thoughts related to a future voyage. CONCLUSION The women did not feel suffic...
Aim. The aim of this research was to systematically review computer-based, behaviour change (BC) ... more Aim. The aim of this research was to systematically review computer-based, behaviour change (BC) interventions during pregnancy and their design components in order to determine their best application within the context of the OptiBIRTH intervention. Design. A systematic literature review was undertaken using the Cochrane collaboration guidelines for systematic reviews of health promotion and public health interventions. Literature searches were conducted in: Ovid MEDLINE, PubMed, Cochrane Library, Embase, PsycINFO, from database inception to June 2015. Cochrane Risk of Bias criteria was applied to assess the methodological quality and a taxonomy of BC techniques was used to appraise the interventions. PICO. Participants included healthy pregnant women who were ≥18 years old. The types of intervention used were computer-based interventions designed to facilitate a BC approach in a sample of pregnant women. The comparison was routine antenatal care. The primary outcome included impro...
Sexual & Reproductive Healthcare
Sexual & Reproductive Healthcare
International Journal of Qualitative Studies on Health and Well-being
Purpose: There is a need to gain deeper knowledge about women's experience of vaginal birth after... more Purpose: There is a need to gain deeper knowledge about women's experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women's experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate. Method: This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth. Results: The essential meaning of the studied phenomenon is "to challenge oneself as a childbearing woman", which is further described by its four constituents: "striving for support from professionals", "desiring the experience", "contrasting and comparing memories of two different births" and "being part of the birthing culture". Conclusions: The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS.
Women and Birth
BACKGROUND Caesarean section (CS) rates are increasing worldwide, an increase that is multifactor... more BACKGROUND Caesarean section (CS) rates are increasing worldwide, an increase that is multifactorial and not well understood. There is considerable variation in the rates of vaginal birth after previous Caesarean section (VBAC). Cultural differences could be one explanation of the varying rates. OBJECTIVE To interpret cultural perspectives on VBAC. METHODS A hermeneutic approach for analysing findings from four published qualitative studies that were part of the OptiBIRTH study, focusing on clinicians and women's views of important factors for improving the rate of VBAC. 115 clinicians and 73 women participated in individual interviews and focus group interviews in countries with low rates (Germany, Italy and Ireland) and countries with high rates (Sweden, Finland and the Netherlands), in the original studies. RESULTS Three themes demonstrated how the culture differs between the high and low VBAC rate countries; from being an obvious first alternative to an issue dependent on many factors; from something included in the ordinary care to something special; and from obstetrician making the final decision to a choice by the woman. The fourth theme, preparing for a new birth by early follow-up and leaving the last birth behind, reflects coherence between the cultures. DISCUSSION The findings deepen our understanding of why the VBAC rates vary across countries and healthcare settings, and can be used for improving the care for women. CONCLUSION In order to improve VBAC rates both maternity care settings and individual professionals need to reflect on their VBAC culture, and make make changes to develop a 'pro-VBAC culture'.
Women and Birth
BACKGROUND Theoretical models as a basis for midwives' care have been developed over recent d... more BACKGROUND Theoretical models as a basis for midwives' care have been developed over recent decades. Although there are similarities between these models, their usefulness in practice needs to be researched in specific cultural contexts. AIM To explore whether, when adopted by midwives on labour wards, a midwifery model of woman-centred care (MiMo) was useful in practice from the viewpoint of a variety of health professionals. METHODS Data were collected from a variety of health professionals before and after an intervention of implementating MiMo at a hospital-based labour ward in Sweden, using nine focus group interviews with a total of 43 participants: midwives (n=16), obstetricians (n=8), assistant nurses (n=11) and managers (n=8). The text from interviews was analysed using content analysis. FINDINGS From expressing no explicit need of a midwifery model of woman-centred care before the intervention, there was a shift in midwives, obstetricians and managers perceptions towards identifying advantages of using the MiMo as it gives words to woman-centred midwifery care. Such shift in perception was not found among the assistant nurses. DISCUSSION Clarification of the various roles of health professionals is needed to develop the model. Heavy workloads and stress were barriers to implementing the model. Thus, more support is needed from organisational management. CONCLUSIONS The model was useful for all professional groups, except for assistant nurses. Further studies are needed in order to clarify the various professional roles and interdisciplinary collaborations in making the MiMo more useful in daily maternity care.
Sexual & reproductive healthcare : official journal of the Swedish Association of Midwives, 2018
Abstract Objective The second stage of labor is considered to be the most stressful part of the p... more Abstract Objective The second stage of labor is considered to be the most stressful part of the process of childbirth for the woman and her unborn child, and consequently for the midwife. Midwives use different methods to enhance maternal bearing-down efforts and to ascertain the progress during the second stage. The aim of this study was to describe methods used by midwives during the second stage of labor and to assess potential associations with perineal trauma. Study design and main outcome measures A secondary analysis with data from an experimental study with a cohort design, conducted at two maternity wards. Data from 704 primiparous women were available for the analysis. Outcome variables were second-degree tears, and severe perineal trauma. Descriptive statistics and multivariable logistic regression analysis adjusting for known risk factors were performed to compute incidence and adjusted odds ratios. Results The most common techniques used during the second stage were directed pushing (57.1%), digital stretching of the vagina (levator pressure) (29.8%), and manual stretching of the perineum (21.9%). The birth-seat was the most common birth position (30.3%). 77.3% of the women sustained a second-degree tear and 3.1% had an episiotomy performed. None of the methods used by the midwives were associated with second-degree tears or severe perineal trauma. Conclusions The practices used by the midwives were not associated with second-degree tears, or severe perineal trauma and were used in both upright and supine birth positions, except fundal pressure.
Birth
Introduction: Most women who give birth for the first time experience some form of perineal traum... more Introduction: Most women who give birth for the first time experience some form of perineal trauma. Second-degree tears contribute to long-term consequences for women and are a risk factor for occult anal sphincter injuries. The objective of this study was to evaluate a multifaceted midwifery intervention designed to reduce second-degree tears among primiparous women. Methods: An experimental cohort study where a multifaceted intervention consisting of 1) spontaneous pushing, 2) all birth positions with flexibility in the sacro-iliac joints, and 3) a two-step head-to-body delivery was compared with standard care. Crude and Adjusted OR (95% CI) were calculated between the intervention and the standard care group, for the various explanatory variables. Results: A total of 597 primiparous women participated in the study, 296 in the intervention group and 301 in the standard care group. The prevalence of second-degree tears was lower in the intervention group: [Adj. OR 0.53 (95% CI 0.33-0.84)]. A low prevalence of episiotomy was found in both groups (1.7 and 3.0%). The prevalence of epidural analgesia was 61.1 percent. Despite the high use of epidural analgesia, the midwives in the intervention group managed to use the intervention. Conclusion: It is possible to reduce second-degree tears among primiparous women with the use of a multifaceted midwifery intervention without increasing the prevalence of episiotomy. Furthermore, the intervention is possible to employ in larger maternity wards with midwives caring for women with both low-and high-risk pregnancies.
BMC Pregnancy and Childbirth
Background: Globally, the prevalence of post term pregnancy (PTP) is about 5-10%, but the rate va... more Background: Globally, the prevalence of post term pregnancy (PTP) is about 5-10%, but the rate varies considerably between and within countries. PTP is defined as a pregnancy ≥294 days, but the definition is arbitrary. Many studies focusing on the prevalence, risks and management of PTP include pregnancies ≥41 gestational weeks (GW). However, qualitative interview studies concerning women's experiences of PTP are lacking. Therefore, the aim of this study was to describe women's lived experiences of a pregnancy ≥41 GW. Method: The study has a lifeworld research approach. Individual in-depth interviews were conducted from August 2013 to September 2014 with 10 healthy women with an expected normal pregnancy at GW 41 + 1-6 days in Gothenburg, Sweden. Interviews were conducted at the antenatal clinic or in the woman's home, depending on her preference. Data were analysed with a phenomenological reflective lifeworld approach. Result: The essence of women's experiences of a pregnancy at GW ≥ 41 was described as being in limbo, a void characterised by contradictions related to time, giving birth and the condition. Exceeding the estimated date of childbirth implied a period of up to 2 weeks that was not expected. The contradictory aspect was the notion that time passed both slowly and quickly. Negative feelings dominated and increased over time. The women experienced difficulty due to not being in complete control, while at the same time finding it a beneficial experience. Health care professionals focused solely on the due date, while the women felt neither seen nor acknowledged. Lack of information led to searches in social media. Previously, they had trusted the body's ability to give birth, but this trust diminished after GW 41 + 0. In this state of limbo, the women became more easily influenced by people around them, while in turn influencing others. Conclusions: Being in limbo represents a contradictory state related to time and process of giving birth, when women need to be listened to by healthcare professionals. An understanding of the importance of different information sources, such as family and friends, is necessary. It is vital that women are seen and acknowledged by midwives at the antenatal clinics. In addition, they should be asked how they experience waiting for the birth in order to create a sense of trust and confidence in the process.
BMC medical research methodology, Jan 19, 2017
Maternity intrapartum care research and clinical care more often focus on outcomes that minimise ... more Maternity intrapartum care research and clinical care more often focus on outcomes that minimise or prevent adverse health rather than on what constitutes positive health and wellbeing (salutogenesis). This was highlighted recently in a systematic review of reviews of intrapartum reported outcomes where only 8% of 1648 individual outcomes, from 102 systematic reviews, were agreed as being salutogenically-focused. Added to this is variation in the outcomes measured in individual studies rendering it very difficult for researchers to synthesise, fully, the evidence from studies on a particular topic. One of the suggested ways to address this is to develop and apply an agreed standardised set of outcomes, known as a 'core outcome set' (COS). In this paper we present a protocol for the development of a salutogenic intrapartum COS (SIPCOS) for use in maternity care research and a SIPCOS for measuring in daily intrapartum clinical care. The study proposes three phases in developin...
Women and birth : journal of the Australian College of Midwives, Jan 22, 2017
Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women&#... more Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women's views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low. To investigate women's views on important factors to improve the rate of vaginal birth after caesareanin countries where vaginal birth rates after previous caesarean are low. A qualitative study using content analysis. Data were gathered through focus groups and individual interviews with 51 women, in their native languages, in Germany, Ireland and Italy. The women were asked five questions about vaginal birth after caesarean. Data were translated to English, analysed together and finally validated in each country. Important factors for the women were that all involved in caring for them were of the same opinion about vaginal birth after caesarean, that they experience shared decision-making with clinicians supportive of vagin...
Scandinavian Journal of Caring Sciences, 2016
The body of first-time pregnant women is affected in many ways, and the women may not know what t... more The body of first-time pregnant women is affected in many ways, and the women may not know what to expect. Conversations between women and healthcare personnel about women's bodily experience in early pregnancy can contribute to increased body knowledge, which may have a positive impact in later stages of their pregnancy and in relation to delivery. The aim of the study was to describe first-time pregnant women's experiences of their body in early pregnancy (pregnancy weeks 10-14). Twelve women were asked to draw pictures and answer questions freely about their experiences of their first pregnant body. Hermeneutical text interpretation was used to obtain an overall view of the experiences. A main theme emerged: 'the body is connected to the cycle of life'. This theme comprised five subthemes: 'bodily longing and a sense of ambivalence', 'being doubtful', 'welcoming changes in body and mind', 'feeling inner strength and struggle to find strength' and 'accepting a different body and mind'. This main theme and the subthemes were further interpreted and were understood as an experience of 'me and my body'. The body reminded the women to take care of it and gave rise to positive thoughts. When the body exhibited uncomfortable reactions and sensations, these were taken as evidence of pregnancy, which was also seen positive but it also triggered a sense of dissatisfaction with the body and a feeling of it becoming alien.
BMC Pregnancy and Childbirth, 2016
Background: Caesarean section (CS) rates are increasing worldwide and the most common reason is r... more Background: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates. Methods: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision makingrapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship. Conclusions: The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.
Sexual & Reproductive Healthcare, 2017
There are no national guidelines or financial support for planned homebirths in Sweden. Some wome... more There are no national guidelines or financial support for planned homebirths in Sweden. Some women choose to give birth at home without the assistance of a midwife. The objective of this study was to describe eight women's experience of unassisted planned homebirth in Sweden. Women who had the experience of an unassisted planned home birth were interviewed. The material was analysed using a phenomenological approach. The essential meaning of the phenomenon giving birth at home without the assistance of a midwife is understood as a conflict between, on one hand, inner responsibility, power and control and on the other hand insecurity in relation to the outside, to other people and to the social system. A wish to be cared for by a midwife is in conflict with the fear of not maintaining integrity and respect in this precious moment of birth. Some women may be more sensitive to attitudes and activities that are routinely performed during pregnancy and childbirth and therefore choose not to turn to any representatives of the medical system. The challenge should be to provide safe care to all women so that assistance from a midwife becomes a reality in all settings.
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Papers by Ingela Lundgren