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  • 1.
    Ahldén, Ingegerd
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Dahlgren, Lars Owe
    Linköping University, Department of Behavioural Sciences and Learning, Studies in Adult, Popular and Higher Education. Linköping University, Faculty of Educational Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Parents' Expectations About Participating in Antenatal Parenthood Education Classes2012In: The Journal of Perinatal Education, ISSN 1058-1243, Vol. 21, no 1, p. 11-17Article in journal (Refereed)
    Abstract [en]

    Our objective was to assess parents' expectations about participating in antenatal parenthood education classes and to determine whether their expectations might be related to gender, age, and educational level. Data from 1,117 women and 1,019 partners residing in three cities in Sweden were collected with a questionnaire in a cross-sectional study. Participants believed that antenatal education classes would help them to feel more secure as parents and to be better oriented toward childbirth. Men had more positive expectations about the childbirth than the women. The participants mostly wanted help in preparing for parenthood and in learning infant care skills, followed by help in preparing for childbirth. The participants' expectations were affected by gender, age, and educational level. The expectant parents appeared to want more focus on preparation for parenthood than on childbirth.

  • 2.
    Ahldén, Ingegerd
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Göransson, Anne
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Alehagen, Siw
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Parenthood education in Swedish antenatal care: perceptions of midwives and obstetricians in charge.2008In: The Journal of perinatal education : an ASPO/Lamaze publication, ISSN 1058-1243, Vol. 17, no 2, p. 21-27Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe perceptions of parenthood education among midwives and obstetricians in charge of antenatal care in Sweden. Focus group interviews of 25 obstetricians and midwives were conducted. Data were analyzed with a phenomenographic approach. Five main categories emerged: aim of the parenthood education, content and expectations, implementation, support to group leaders, and strategies for the future. There is a strong belief in parenthood education, and the overall aim was considered to be support in the transition to parenthood. Contents should focus on awareness of the expected child, confidence in the biological processes, and the changes of roles. Pedagogies training, cost effectiveness, development, and the need to reach target groups were emphasized.

  • 3.
    Alehagen, Siw
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Fear pain stress hormones during labor2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of the thesis were to develop a measure of fear during labor and to investigate women's experiences of fear and pain during labor and delivery as well as their levels of stress hormones. We also wanted to explore the associations between fear, pain, stress hormones and the duration of labor. Finally, we aimed to examine the relationships between pre-and postpartum fear, and fear and pain during labor.

    The measurement of fear was developed in two substudies. First we composed a list of 60 fear-related items and their contrasts and tested it in a group of 92 women in labor. After psychometrical analyses, 10 items were selected for the final scale. The scale was then tested in another group of 57 women in labor. Via semi-structured interviews the content of the items was documented and analyzed.

    Fifty-five nulliparous women participated in the investigation of women's experiences of fear, pain, levels of stress hormones and duration of labor. During gestation weeks 37-39, we measured levels of fear of childbirth, urinary catecholamines and salivary cortisol. During labor, hourly measurements were performed of fear, pain and levels of stress hormones. Finally, at two hours, two days and five weeks postpartum, fear of childbirth and stress hormones were measured.

    The questionnaire that measures fear during labor was called the Delivery Fear Scale (DFS). The DFS has an alpha coefficient of .8 and has good psychometric qualities in both nulliparous and parous women. It takes women in labor between 30 and 90 seconds to listen to and answer all the statements. We found that nulliparous women had higher fear during phase 1 of labor (cervix dilatation 3-Scm) than parous women. Fear during phase 1 of labor predicted the total amount of pain relief received during labor, but not the duration of remaining part of labor, nor the occurrence of instrumental vaginal delivery or emergency cesarean section.

    The results from the subsequently studies showed that there was an increase of the levels in stress hormones from pregnancy to labor. Epinephrine and cortisol increased more than 500% and norepinephrine approximately 50%. In women without EDA fear and cortisol increased throughout labor. In women with EDA cortisol did not increase, fear, pain and catecholamine levels first decreased after the administration of EDA but at the end of labor fear and pain increased. In phase 1, fear, but not pain, was more intensive in women who later subsequently received EDA than in those who did not. Fear and pain correlated positively during labor. A high level of epinephrine was associated with a shorter duration of phase 1 of labor. Postpartum fear of childbirth was higher in women who had received EDA during labor than in those who had not. Pre- and postpartum fear of childbirth correlated positively with fear but not with pain during phase 1 of labor.

    In conclusion, DFS is a new measure of fear during labor with good psychometric qualities. Childbirth is a stressful event associated with exceptionally high levels of stress hormones. In this study women's experiences of fear and pain were associated throughout labor. The administration of EDA heavily influenced the course of fear, pain and stress hormones. Women who later received EDA had higher scores of fear but not of pain early during labor than those who did not receive EDA. Late pregnant women who fear childbirth are prone to have a fearful delivery, as reported during the actual labor and postpartwn.

    List of papers
    1. Development of the delivery fear scale
    Open this publication in new window or tab >>Development of the delivery fear scale
    2002 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 23, no 2, p. 97-107Article in journal (Refereed) Published
    Abstract [en]

    This article reviews the development of the Delivery Fear Scale (DFS) to measure fear during labor and delivery.

    In an initial study, 92 women in labor answered a list of 60 items, expressing fear-related appraisals and their contrasts that were characteristic of women in labor. Ten items were then selected by means of an item-total analysis. In a second study, the final list of ten items was tested psychometrically and a semi-structured interview was performed on 45 women in labor, to explore the women s descriptions of the content of each of the ten items. According to the content analysis of the interviews, the dominating connotation of the ten items is fear based on the appraisal of being captured. The studies show that the DFS is a questionnaire that almost effortlessly can be completed within 60-90 seconds during any moment of labor and delivery. The scale has a good reliability: Cronbach‘s alpha was 0.88 in both studies.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-26351 (URN)10.3109/01674820209042791 (DOI)10884 (Local ID)10884 (Archive number)10884 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2018-11-15Bibliographically approved
    2. Fear during labor
    Open this publication in new window or tab >>Fear during labor
    2001 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 80, no 4, p. 315-320Article in journal (Refereed) Published
    Abstract [en]

    Background. The aims of the present study were to compare primiparous and multiparous women’s experiences of fear of delivery during an early stage of active labor (cervix dilatation 3–5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm – partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section.

    Method. Thirty-five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief.

    Results. Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor.

    Conclusion. The clinical implications of the study are that the delivery staff should consider women’s fear during labor and pay attention especially to primiparous women’s increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women’s. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman’s need of pain relief.

    Keywords
    Delivery, Fear, Labor, Primiparous women
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25745 (URN)10.1034/j.1600-0412.2001.080004315.x (DOI)10177 (Local ID)10177 (Archive number)10177 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2018-11-15Bibliographically approved
    3. Catecholamine and cortisol reaction to childbirth
    Open this publication in new window or tab >>Catecholamine and cortisol reaction to childbirth
    Show others...
    2001 (English)In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 8, no 1, p. 50-65Article in journal (Refereed) Published
    Abstract [en]

    One way to study the stressfulness of childbirth is to examine the output of stress hormones. In this study, urinary catecholamines and salivary cortisol from 50 primiparous women were collected for 1 day during gestational weeks 37 to 39, hourly during labor and delivery, and 2 hr and 2 days postpartum. All three stress hormones increased statistically significantly from pregnancy to labor. The increase in adrenaline and cortisol was more than 500%, and the increase in noradrenaline was about 50%. After labor, the output decreased but not statistically significantly below the levels during late pregnancy. Hormone levels during late pregnancy, during labor and delivery, and during the period postpartum mostly did not correlate systematically. However, noradrenaline and adrenaline, as well as adrenaline and cortisol, were positively correlated during labor. After administration of epidural analgesia, there was a moderate but significant decrease in noradrenaline and adrenaline, whereas cortisol did not change. In conclusion, the results of this study support the assumption that childbirth is a very stressful event and that the stress responses vary considerably among women. The substantial increase of adrenaline and cortisol compared with noradrenaline indicates that mental stress is more dominant than physical stress during labor.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-25744 (URN)10.1207/S15327558IJBM0801_04 (DOI)10176 (Local ID)10176 (Archive number)10176 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2018-11-15Bibliographically approved
    4. Fear, pain and stress hormones during childbirth
    Open this publication in new window or tab >>Fear, pain and stress hormones during childbirth
    2005 (English)In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 26, no 3, p. 153-165Article in journal (Refereed) Published
    Abstract [en]

    Aims. To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA).

    Method.  One day during gestation weeks 37–39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones.

    Results. The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated.

    Conclusion.  The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.

    Keywords
    childbirth, fear, pain, catecholamines, cortisol, epidural analgesia
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-29305 (URN)10.1080/01443610400023072 (DOI)14594 (Local ID)14594 (Archive number)14594 (OAI)
    Note

    On the day of the defence day the status of this article was submitted.

    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2018-11-15Bibliographically approved
    5. Pre- and postpartum fear of childbirth and fear and pain during labor
    Open this publication in new window or tab >>Pre- and postpartum fear of childbirth and fear and pain during labor
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aims of the present study were 1) to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during labor (phase 1: cervix dilatation 3-5 cm), and 2) to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia (EDA) during labor.

    Method. During gestation weeks 37-39, in 47 nulliparous women fear of childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A. Early during labor (labor phase I = cervix dilatation 3-5cm) the women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale) were measured hourly. Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery.

    Results. Fear of childbirth during pregnancy and in the three postpartum measures was positively related to fear during labor, phase I. Pain during phase 1 of labor was neither associated with fear of childbirth measured during late pregnancy, nor with postpartum fear. There were no differences in fear of childbirth during late pregnancy between those women who received EDA and those who did not. Postpartum fear was higher in those women who had received EDA.

    Conclusion. Late pregnant women who fear childbirth are prone to have a fearful delivery, as reported during the actual labor and postpartum.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-81399 (URN)
    Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2018-11-15Bibliographically approved
  • 4.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Chamberlain Wilmoth, Margaret
    School of Nursing, College of Health and Human Services, UNC Charlotte, Charlotte, North Carolina, USA.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Defining and Clarifying Sexual Health: A Simultaneous Concept analysis2012In: Advances in Medicine and Biology vol 28 / [ed] Leon V. Berhardt, Nova Science Publishers, Inc., 2012, p. 177-198Chapter in book (Refereed)
    Abstract [en]

    Purpose: The concepts of health and sexuality are complex and the discussion of how to clarify them seems to be ongoing. This continuing work is essential also according to the joined concept sexual health as it is central in national and international public health programs. Hence, the aim of this paper was to clarify the concept of sexual health by making a simultaneous concept analysis of sexuality and health.

    Methods: A qualitative content analysis defined the meanings, the major concepts and the components of the superior concepts Sexuality and Health, respectively. The data for this analysis were dictionaries, definitions, reports, guidelines, books and articles. Next, a simultaneous concept analysis (SCA) was chosen in order to answer the research questions and develop a process model of sexual health.

    Findings: The definitions of the processed concepts and the developing outcome from sexual health were: Prime mover, Interconnectedness, Interdependence, Norms, Completeness, Functional physiology, Insight, Relatedness, Adaptiveness and Contentedness. These outcomes are presented in a process model.

    Conclusions: This study adds a theoretical perspective clarifying the concept sexual health. The clarifications of this study contribute with knowledge, which can be used in practise, enabling health care professionals promoting sexual health and develop sexual health issues in further research.

  • 5.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Somasunduram, Konduri
    Centre for Social Medicine, Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Bangal, Vidyadhar
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Patil, Ashok
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Chandekar, Pratibha
    Pravara Institute of Medical Sciences-Deemed University, Loni, Maharashtra, India.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration2012In: Rural and remote health, ISSN 1445-6354, Vol. 12, no 3Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality.

    METHODS:

    The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed.

    RESULTS:

    Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%.

    CONCLUSION:

    These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.

  • 6.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Hägg, Monica
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Kalén-Enterlöv, Maria
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Experiences of community health nurses regarding father participation in child health care2011In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 3, p. 153-162Article in journal (Refereed)
    Abstract [en]

    Traditionally child health care (CHC) has been an arena where mothers and nurses meet, but in recent years fathers are entering CHC with increasing frequency. The aim of this study was to describe nurses’ experiences of fathers’ participation in CHC. Nine Swedish nurses working in CHC were interviewed and asked to give a description of their experiences from meetings with fathers in CHC. Phenomenology according to Giorgi was used for the analysis and the essence of the findings was that father participation was seen from the perspective of mother participation and was constantly compared to mother participation in CHC. The essence is explicated in the following themes: participation through activities; equal participation although diverse; influence of structures in society; and strengthening participation. Clinical implications include the need for creating a separate identity in CHC for fathers and more communication directed at fathers.

  • 7.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wambui, Theresah
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ek, Anna Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Perceptions of family planning among low-income men in Western Kenya: Original Article2009In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 56, no 3, p. 340-345Article in journal (Refereed)
    Abstract [en]

    Background: Men have rarely been involved in either receiving or providing information on sexuality, reproductive health or birth spacing. They have also been ignored or excluded in one way or the other from participating in many family planning programmes as family planning is viewed as a womans affair.

    Aim: To describe the perceptions of family planning among low-income men in Western Kenya. Methods: A qualitative study using focus group interviews and content analysis was conducted, with 64 men aged 15-54 years participating actively.

    Findings: Perceptions of family planning were manifold. For example, some perceived it as meaning having the number of children one is able to provide for. Most men knew about traditional and modern methods of birth control, although their knowledge was poor and misconceived. Modern methods were thought to give side effects, discouraging family planning. Low instances of family planning were also because of the fact that culturally, children are considered wealth. A law advocating family size limitation was regarded as necessary for the future.

    Conclusion: Mens perceptions of family planning are manifold. Their knowledge about contraception is poor and sometimes misconceived. Preferences regarding a childs gender are strong, thus attitudes and cultural beliefs that might hinder family planning have to be considered. A policy on male contraception and contraceptive services is seen as necessary.

  • 8.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Linköping University, Faculty of Health Sciences.
    Lundberg, Ulf
    Division of Biological Psychology, Department of Psychology, Stockholm University, Stockholm, Sweden.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Fear, pain and stress hormones during childbirth2005In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 26, no 3, p. 153-165Article in journal (Refereed)
    Abstract [en]

    Aims. To investigate the course of fear, pain and stress hormones during labor, and the associations between fear, pain, stress hormones and duration of labor in nulliparous women with and without epidural analgesia (EDA).

    Method.  One day during gestation weeks 37–39, urinary and salivary samples were collected to measure catecholamines and cortisol. Hourly during labor, the participants answered the Delivery Fear Scale and a pain intensity scale, and urinary and salivary samples were collected to measure stress hormones.

    Results. The course of fear, pain and stress hormones differed throughout labor in women with and without EDA. Pain and cortisol increased throughout labor in women without EDA. Women who received EDA had more fear, but not more pain, before the administration of the EDA than women who did not receive EDA. Pain, fear and catecholamines decreased when women received EDA, but fear and pain increased again later in labor. Fear and pain correlated, as well as levels of fear in the different phases of labor. During phase one of labor epinephrine and duration of the phase were negatively correlated.

    Conclusion.  The course of fear, pain and concentrations of stress hormones differed, highly influenced by the administration of EDA. Fear and pain correlated more pronounced than stress hormones and fear, pain and duration of labor.

  • 9.
    Alehagen, Siw
    et al.
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Fear of childbirth before, during, and after childbirth2006In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 85, no 1, p. 56-62Article in journal (Refereed)
    Abstract [en]

    Background. Only scanty research exists about the relationship between women's expectations during pregnancy and their experiences as reported during the actual process of labor and afterwards. The aims of the present study were: 1. to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during early active labor (phase 1: cervix dilatation 3–5 cm), and 2. to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia during labor.

    Methods. Fear of childbirth was measured in 47 nulliparous women during gestation weeks 37–39 by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ version A). During early active labor we measured women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale). Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery.

    Results. A positive correlation appeared between fear of childbirth during pregnancy, postpartum, and early active labor. There were no differences in fear of childbirth during late pregnancy between women who received epidural analgesia and those who did not. Postpartum fear was higher in the women who had received epidural analgesia.

    Conclusions. Pregnant women who fear childbirth are prone to report fear during the actual labor and postpartum. The administration of epidural analgesia is not a sufficient response to women's fear during the process of labor.

  • 10.
    Alehagen, Siw
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Lundberg, Ulf
    Department of Psychology, Stockholm University.
    Melin, Bo
    Department of Psychology, Stockholm University.
    Wijma, Barbro
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Catecholamine and cortisol reaction to childbirth2001In: International Journal of Behavioral Medicine, ISSN 1070-5503, E-ISSN 1532-7558, Vol. 8, no 1, p. 50-65Article in journal (Refereed)
    Abstract [en]

    One way to study the stressfulness of childbirth is to examine the output of stress hormones. In this study, urinary catecholamines and salivary cortisol from 50 primiparous women were collected for 1 day during gestational weeks 37 to 39, hourly during labor and delivery, and 2 hr and 2 days postpartum. All three stress hormones increased statistically significantly from pregnancy to labor. The increase in adrenaline and cortisol was more than 500%, and the increase in noradrenaline was about 50%. After labor, the output decreased but not statistically significantly below the levels during late pregnancy. Hormone levels during late pregnancy, during labor and delivery, and during the period postpartum mostly did not correlate systematically. However, noradrenaline and adrenaline, as well as adrenaline and cortisol, were positively correlated during labor. After administration of epidural analgesia, there was a moderate but significant decrease in noradrenaline and adrenaline, whereas cortisol did not change. In conclusion, the results of this study support the assumption that childbirth is a very stressful event and that the stress responses vary considerably among women. The substantial increase of adrenaline and cortisol compared with noradrenaline indicates that mental stress is more dominant than physical stress during labor.

  • 11.
    Alehagen, Siw
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Can women's cognitive appraisals be registered throughout childbirth?2000In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 49, no 1, p. 31-35Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were: (a) to examine whether it was possible to measure women’s cognitive appraisals hourly during the whole process of labor and delivery, and (b) to explore how the appraisals varied during labor. Measurements from 12 nulliparous women are presented. The findings indicate that it is possible to study psychological appraisals directly, in detail and continuously during the process of labor and delivery. The women’s cognitive appraisals varied throughout labor both per individual woman and between the participating women.

  • 12.
    Alehagen, Siw
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Fear during labor2001In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 80, no 4, p. 315-320Article in journal (Refereed)
    Abstract [en]

    Background. The aims of the present study were to compare primiparous and multiparous women’s experiences of fear of delivery during an early stage of active labor (cervix dilatation 3–5 centimeters) and to study whether fear of delivery, measured during the early stage of active labor, was a predictor of the amount of pain relief received during the remaining part of labor (cervix dilatation 5 cm – partus), of the duration of the remaining part of labor, and of the occurrence of instrumental vaginal delivery and emergency cesarean section.

    Method. Thirty-five primiparous and 39 multiparous women answered the Delivery Fear Scale (DFS) once during the early stage of labor and before they had received any pain relief.

    Results. Primiparous women reported higher levels of fear than multiparous women did. Fear during the first phase of labor predicted only the total amount of pain relief received during labor.

    Conclusion. The clinical implications of the study are that the delivery staff should consider women’s fear during labor and pay attention especially to primiparous women’s increased risk of higher levels of fear during an early stage of active labor, as compared with multiparous women’s. The challenge for staff of a delivery ward is to support the woman in labor in a way that decreases fear, which in turn might reduce the woman’s need of pain relief.

  • 13.
    Alehagen, Siw
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Pre- and postpartum fear of childbirth and fear and pain during laborManuscript (preprint) (Other academic)
    Abstract [en]

    Aims: The aims of the present study were 1) to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during labor (phase 1: cervix dilatation 3-5 cm), and 2) to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia (EDA) during labor.

    Method. During gestation weeks 37-39, in 47 nulliparous women fear of childbirth was measured by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A. Early during labor (labor phase I = cervix dilatation 3-5cm) the women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale) were measured hourly. Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery.

    Results. Fear of childbirth during pregnancy and in the three postpartum measures was positively related to fear during labor, phase I. Pain during phase 1 of labor was neither associated with fear of childbirth measured during late pregnancy, nor with postpartum fear. There were no differences in fear of childbirth during late pregnancy between those women who received EDA and those who did not. Postpartum fear was higher in those women who had received EDA.

    Conclusion. Late pregnant women who fear childbirth are prone to have a fearful delivery, as reported during the actual labor and postpartum.

  • 14.
    Brantelid, Ida Emilie
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilver, Helena
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Menstruation during a lifespan: A qualitative study of women's experiences2014In: Health Care for Women International, ISSN 0739-9332, E-ISSN 1096-4665, Vol. 35, no 6, p. 600-616Article in journal (Refereed)
    Abstract [en]

    Menstruation is a natural phenomenon for women during their reproductive years. Our aim was to describe womens experiences of menstruation across the lifespan. Qualitative interviews with a narrative approach were conducted with 12 women between 18 and 48 years of age in Sweden. Using thematic analysis, we found menstruation to be a complex phenomenon that binds women together. It is perceived as an intimate and private matter, which makes women want to conceal the occurrence of menstrual bleeding. Over time, menstruation becomes a natural part of womens lives and gender identity. Health professionals play a central role supporting women to deal with menstruation.

  • 15.
    Carlsson, Noomi
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Andersson Gäre, Boel
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Johansson, AnnaKarin
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    "Smoking in children's environment test": a qualitative study of experiences of a new instrument applied in preventive work in child health care2011In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 11, no 113Article in journal (Refereed)
    Abstract [en]

    Background

    Despite knowledge of the adverse health effects of passive smoking, children are still   being exposed. Children's nurses play an important role in tobacco preventive work   through dialogue with parents aimed at identifying how children can be protected from   environmental tobacco smoke (ETS) exposure. The study describes the experiences of   Child Health Care (CHC) nurses when using the validated instrument SiCET (Smoking   in Children's Environment Test) in dialogue with parents.

    Method

    In an intervention in CHC centres in south-eastern Sweden nurses were invited to use   the SiCET. Eighteen nurses participated in focus group interviews. Transcripts were   reviewed and their contents were coded into categories by three investigators using   the method described for focus groups interviews.

    Results

    The SiCET was used in dialogue with parents in tobacco preventive work and resulted   in focused discussions on smoking and support for behavioural changes among parents.   The instrument had both strengths and limitations. The nurses experienced that the   SiCET facilitated dialogue with parents and gave a comprehensive view of the child's   ETS exposure. This gave nurses the possibility of taking on a supportive role by offering   parents long-term help in protecting their child from ETS exposure and in considering   smoking cessation.

    Conclusion

    Our findings indicate that the SiCET supports nurses in their dialogue with parents   on children's ETS exposure at CHC. There is a need for more clinical use and evaluation   of the SiCET to determine its usefulness in clinical practice under varying circumstances.

  • 16.
    Grundström, Hanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Arendt-Nielsen, Lars
    Center for Sensory‐Motor Interactions, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
    Kjölhede, Preben
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reduced pain thresholds and signs of sensitization in women with persistent pelvic pain and suspected endometriosis2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 3, p. 327-336Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Endometriosis is a gynecological disorder that may cause considerable pelvic pain in women of fertile age. Determining pain mechanisms is necessary in order to optimize the treatment of the disease. The objective of the study was to evaluate pain thresholds in women with persistent pelvic pain with and without confirmed endometriosis, and healthy, unaffected controls, and analyze how pain thresholds in these cohorts related to duration of pelvic pain, quality of life, and symptoms of anxiety and depression.

    MATERIAL AND METHODS: Pain thresholds for heat, cold and pressure were assessed with quantitative sensory testing on six locations on a reference group of 55 healthy women and on 37 women with persistent pelvic pain who had been admitted for diagnostic laparoscopy on the suspicion of endometriosis. Validated instruments were applied to assess quality of life and symptoms of anxiety and depression. Data were analyzed by means of uni- and multivariate analysis of variance and Spearman's rank-order correlation.

    RESULTS: The women with persistent pelvic pain had significantly lower pain thresholds compared with the reference women. In the women with pain, no differences were observed in pain thresholds between women with (n = 13) and women without (n = 24) biopsy-proven endometriosis. The duration of pelvic pain correlated significantly positively with reduced pain thresholds, ie, the longer the duration, the more sensitization. In the persistent pelvic pain group, pain thresholds for heat correlated significantly with the Short Form Health Survey 36 dimension of bodily pain, and thresholds for cold correlated with Short Form Health Survey 36 bodily pain and with symptoms of depression.

    CONCLUSIONS: Our results showed widespread alterations in pain thresholds in women with persistent pelvic pain that are indicative of central sensitization and a time-dependent correlation. Women with pelvic pain and suspicion of endometriosis should probably be treated more thoroughly to prevent or at least minimize the concomitant development of central sensitization.

    The full text will be freely available from 2019-11-25 12:48
  • 17.
    Grundström, Hanna
    et al.
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Kjølhede, Preben
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    “A challenge” – healthcare professionals' experiences when meeting women with symptoms that might indicate endometriosis2016In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 7, p. 65-69Article in journal (Refereed)
    Abstract [en]

    Objective

    The aim of the study was to identify and describe the experiences of healthcare professionals when meeting women with symptoms that might indicate endometriosis.

    Methods

    Semi-structured interviews were conducted with 10 gynecologists, six general practitioners and nine midwives working at one university hospital, one central hospital, one private gynecology clinic and five healthcare centers in south-east Sweden. The interviews were recorded and transcribed verbatim and analyzed using qualitative conventional content analysis.

    Results

    Three clusters were identified: the corroborating encounter, the normal variation of menstruation cycles, and the suspicion of endometriosis. The healthcare professionals tried to make a corroborating encounter by acknowledging the woman, taking time to listen, and giving an explanation for the problems. Healthcare professionals had different ways to determine what was normal as regards menstrual pain, ovulation pain and dyspareunia. They also needed to have the competence to act and react when the symptoms indicated endometriosis.

    Conclusions

    Meeting women with symptoms that might indicate endometriosis is challenging and demands a certain level of competence from healthcare professionals. Sometimes the symptoms are camouflaged as “normal” menstruation pain, making it hard to satisfy the needs of this patient group.

  • 18.
    Johansson, AnnaKarin
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Carlsson, Noomi
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Department of Public Health and Medical Care, Jönköping County Council, Sweden.
    Almfors, Helena
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Rosén, Monica
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Parents' experiences of participating in an intervention on tobacco prevention in Child Health Care2014In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 14, no 69Article in journal (Refereed)
    Abstract [en]

    Background

    Child health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents’ experiences from participating in a nursebased tobacco prevention intervention.     

    Methods

    Eleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process.     

    Results

    The analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents’ smoking.     

    Conclusion

    The clinical implication is that CHC is an important arena for preventive work aiming to minimize children’s tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.

  • 19.
    Kilander, Helena
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Department of Obstetrics and Gynecology in Eksjö, County Council of Jönköping.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Svedlund, Linnea
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Westlund, Karin
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Norrköping.
    Thor, Johan
    Jonköping University, Sweden.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Likelihood of repeat abortion in a Swedish cohort according to the choice of post-abortion contraception: a longitudinal study2016In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 95, no 5, p. 565-571Article in journal (Refereed)
    Abstract [en]

    IntroductionDespite high access to contraceptive services, 42% of the women who seek an abortion in Sweden have a history of previous abortion(s). The reasons for this high repeat abortion rate remain obscure. The objective of this study was to study the choice of contraceptive method after abortion and related odds of repeat abortions within 3-4 years. Material and methodsThis is a retrospective cohort study based on a medical record review at three hospitals in Sweden. We included 987 women who had an abortion during 2009. We reviewed medical records from the date of the index abortion until the end of 2012 to establish the choice of contraception following the index abortion and the occurrence of repeat abortions. We calculated odds ratios (OR) with 95% CI. ResultsWhile 46% of the women chose oral contraceptives, 34% chose long-acting reversible contraceptives (LARC). LARC was chosen more commonly by women with a previous pregnancy, childbirth and/or abortion. During the follow-up period, 24% of the study population requested one or more repeat abortion(s). Choosing LARC at the time of the index abortion was associated with fewer repeat abortions compared with choosing oral contraceptives (13% vs. 26%, OR 0.36; 95% CI 0.24-0.52). Subdermal implant was as effective as intrauterine device in preventing repeat abortions beyond 3 years. ConclusionsChoosing LARC was associated with fewer repeat abortions over more than 3 years of follow up.

  • 20.
    Kjærgaard, Hanne
    et al.
    Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital, Copenhagen, Denmark.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine. Linköping University, Faculty of Health Sciences.
    Dykes, Anna-Karin
    The Unit of Caring Sciences, Lund University, Sweden.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Fear of childbirth in obstetrically low‐risk nulliparous women in Sweden and Denmark2008In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 26, no 4, p. 340-350Article in journal (Refereed)
    Abstract [en]

    The prevalence of troublesome fear of childbirth (FOC) in Western countries is about 20%, of which approximately 6–10% suffer from severe FOC that impacts daily life. The countries of Sweden and Denmark are quite alike as far as childbirth culture is concerned. However, to some extent they differ in the organisation of midwifery care during the antenatal and labour period, respectively, and this may influence women's FOC. The aims of this study were to compare FOC among Danish and Swedish nulliparous women and to investigate a possible difference in FOC between women who, during pregnancy, had met the midwife who they were subsequently coincidentally allocated to receive labour care from and women who had not previously met the midwife. In total 165 women participated, comprising 55 Swedes and 110 Danes, of whom 55 among the latter group had met the midwife during pregnancy. Severe FOC was found in 10%. There were no differences between the Swedish women and the Danish women who had or had not met the midwife. Fear of childbirth measured in gestational week 37 correlated positively with fear at admission to the labour ward.

  • 21.
    Kånåhols, Anna Frida
    et al.
    Kvinnohälsovården, Värnamo Sjukhus.
    Magnusson, Hanna
    Kvinnokliniken, Länssjukhuset Ryhov, Jönköping.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Swedish adolescents' experiences of educational sessions at Youth Clinics2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 3, p. 119-123Article in journal (Refereed)
    Abstract [en]

    Abstract 

    Planning sex and relationship health education suitable for adolescents is a pedagogical challenge.

    Objective

    To describe how secondary school pupils in Sweden experience health educational sessions at Youth Clinics.

    Methods

    Data were collected from six focus groups within 2 weeks of an educational session. The groups consisted of pupils aged 14–16 years from three cities. The participants were 29 adolescents divided into groups of girls (n=15) and boys (n=14) and the interviews were audio taped. Data were analysed using qualitative content analysis.

    Findings

    Five categories were identified: Impact of the educational session, The desirable educator, Didactic setup, Gender inequalities and Suitable age for the educational session. The adolescents were satisfied with the content of the education and the session was evaluated as a complement to school education. The educators were seen as competent with an ability to create a comfortable atmosphere which made it easier for participants to discuss the subject and ask questions. The session was experienced as secure which was appropriate for the intimate and personal subject and gender aspects were seen as influencing the conversation.

    Conclusion

    This study can give an understanding of the needs and demands of adolescents which can be useful when planning and conducting sex and relationship health education.

  • 22.
    Molander, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Routine ultrasound examination during pregnancy: a world of possibilities.2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, p. 18-26Article in journal (Refereed)
    Abstract [en]

    Objective

    to identify and describe the meaning of the routine ultrasound scan to pregnant women.

    Design

    a qualitative descriptive study using a grounded theory approach, with individual interviews to collect data.

    Setting

    three antenatal clinics in a Swedish county of approximately 400,000 inhabitants.

    Participants

    voluntary samples of 10 pregnant Swedish women, 26–38 years of age, were interviewed prior to their first routine ultrasound.

    Findings

    ‘making it possible’ was the core category that explained and illustrated the meaning of the scan. The core category showed that the women considered the examination to be filled with possibilities to reach different goals during pregnancy. It also explained the categories: ultrasound as an event; ultrasound as a situation; ultrasound as a test; and the effects of ultrasound; as well as how they related to each other. The findings are considered the beginning of a theory concerning the meaning of the first ultrasound to pregnant women.

    Key conclusions and implications for practice

    pregnant women can see their first ultrasound as a tool that enables them to reach different goals during their pregnancy. Many of the goals concern meeting and connecting with the baby, suggesting that pregnant women consider the examination an important step towards parenthood. An ultrasound examination offered for medical reasons, which has other meanings than the intended for pregnant women, is important knowledge. It can be useful when giving information about the scan, addressing the woman during the examination, and for understanding and handling possible reactions.

  • 23.
    Salomonsson, Birgitta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Swedish midwives’ views on severe fear of childbirth2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 4, p. 153-159Article in journal (Refereed)
    Abstract [en]

    Objective

    To describe the views of Swedish midwives on severe fear of childbirth (SFOC).

    Study design

    In this cross sectional study, a random sample of 1000 midwives, selected from the database of the Swedish Association of Midwives, received a questionnaire. The response rate was 84% (n = 834), with 726 questionnaires included in the final analysis.

    Main outcome measures

    The views of midwives on SFOC in different contexts of work: antenatal care clinic (ACC), labour ward (LW) either ACC/LW or Neither-Nor ACC/LW.

    Results

    The majority of respondents thought that the frequency of SFOC has increased during the last 10 years (67%), and that pregnant women today are more likely to discuss their fears (70%). Midwives at ACCs thought that special education in SFOC is needed (p < 0.001) and that they have more responsibility to identify women with SFOC (p < 0.001) than midwives at LWs. The majority of respondents, both at ACCs (60%) and LWs (65%), intuitively sensed when they were meeting a woman with SFOC. Opinions among midwives who alternate between working in ACCs and LWs reflected the views of the midwives working either in an ACC or an LW.

    Conclusions

    The views of midwives on SFOC are partly in concordance and partly contradictory in relation to the different workplaces as well as research data. Knowledge of the views of midwives on SFOC is a necessary pre-requisite to improve care for pregnant women.

  • 24.
    Salomonsson, Birgitta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Self-efficacy in pregnant women with severe fear of childbirth2013In: Journal of Obstetric, Gynecologic and Neonatal Nursing, ISSN 0884-2175, E-ISSN 1552-6909, Vol. 42, no 2, p. 191-202Article in journal (Other academic)
    Abstract [en]

    Objective: To apply and test the concept of childbirth self-efficacy to expectations of the upcoming birth in the context of severe fear of childbirth (SFOC).

    Design: Qualitative study using semi-structured interviews.

    Setting: A region in the southeast of Sweden

    Participants: Nulliparous pregnant women (n=17) with SFOC.

    Method: The interviews were analysed according to content analysis, using deductive and inductive approaches. The seven domains of the childbirth self-efficacy inventory (CBSEI) made up the matrix for the deductive analysis.

    Results: Behaviours for coping with labour and childbirth were related to six domains of childbirth self-efficacy; “concentration”, “support”, “control”, “ motor/relaxation”, “selfencouragement” and “breathing”. Most of these behaviours referred to capabilities to carry out (self-efficacy expectancy) rather than to beliefs in effectiveness (outcome expectancy). Five additional sub-domains representing defined childbirth self-efficacy were identified; “guidance”, “the body controls”, “the professionals´ control”, “reliance” and ‘fatalism’.

    Conclusion: The domains of childbirth self-efficacy have been deepened and expanded in relation to SFOC. It is imperative to identify pregnant women with SFOC and their efficacy beliefs in order to help them find appropriate coping behaviours prior to the onset of labour, and furthermore these behaviours must be supported by healthcare professionals during labour and childbirth. Support in the form of verbal persuasion emanating from the subdomains of childbirth self-efficacy ought to be added.

  • 25.
    Salomonsson, Birgitta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Gullberg, Mats T
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Medical Psychology. Linköping University, Faculty of Health Sciences.
    Self-efficacy beliefs and fear of childbirth in nulliparous women2013In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 34, no 3, p. 116-121Article in journal (Refereed)
    Abstract [en]

    Objective: To explore how childbirth self-efficacy, i.e. outcome expectancy and efficacy expectancy, was associated with fear of childbirth (FOC) and how efficacy expectancy and FOC, respectively were related to socio-demographic characteristics, mental problems and preference for a caesarean section.

    Methods: In this cross-sectional study, a consecutive sample of 1000 pregnant nulliparous women was sent the Wijma Delivery Expectancy Questionnaire and Childbirth Self-Efficacy Inventory. Statistical analyses were performed on data from 423 women.

    Results: Outcome expectancy and efficacy expectancy correlated significantly and positively, FOC correlated significantly and negatively with both outcome expectancy and efficacy expectancy. Women with severe FOC (20.8%) had a significantly lower level of education (p = 0.001), and had more often sought help because of mental problems (p = 0.004). They were more likely to have low-efficacy expectancy (p < 0.001) and to prefer a caesarean section instead of a vaginal birth (p < 0.001).

    Conclusions: Lower efficacy expectancy was associated with higher FOC while preference for a caesarean section was not. Improvement of self-efficacy could be a part of care for women with FOC during pregnancy; however, it would not be enough for fearful women who wish to have a caesarean section.

  • 26.
    Salomonsson, Birgitta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Clinical and Experimental Medicine, Gender and medicine . Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Swedish midwives' perceptions of fear of childbirth2010In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 3, p. 327-337Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to describe midwives' experiences with, and perceptions of, women with fear of childbirth. DESIGN: a qualitative study with a phenomenographic approach. Data were collected by means of interviews in focus groups. SETTING: four focus groups at four types of hospital in Southern Sweden over a period of 18 months, 2004-2006. PARTICIPANTS: 21 experienced midwives. FINDINGS: four description categories emerged, i.e. appearance of fear of childbirth, origins of fear of childbirth, consequences of fear of childbirth, and fear of childbirth and midwifery care. KEY CONCLUSION: fear of childbirth is seen as a continuum from normal to irrational, severe fear. It has various origins which are more or less difficult to operationalise. Fear of childbirth influences the experience of pregnancy, the labour process and the transition to parenthood. Midwifery care of women with fear of childbirth is emotionally demanding and time consuming. Aspects of care required early identification of women with fear of childbirth, individual care, preparation for giving birth, support of a companion during labour, and postpartum follow-up.  

  • 27.
    Salomonsson, Birgitta
    et al.
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Wijma, Klaas
    Linköping University, Department of Molecular and Clinical Medicine, Gender and Medicine. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Swedish midwives perceptions of fear of childbirth in JOURNAL OF PSYCHOSOMATIC OBSTETRICS AND GYNECOLOGY, vol 31, issue , pp 53-532010In: JOURNAL OF PSYCHOSOMATIC OBSTETRICS AND GYNECOLOGY, Informa Healthcare , 2010, Vol. 31, p. 53-53Conference paper (Refereed)
    Abstract [en]

    n/a

  • 28.
    Skagerström, Janna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Häggström-Nordin, Elisabet
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden / School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, article id 1193Article in journal (Refereed)
    Abstract [en]

    Background: Consensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy.

    Methods: Data were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis.

    Results: Three main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life.

    Conclusions: Social expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.

  • 29.
    Skagerström (Malmsten), Janna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Haggstrom-Nordin, Elisabet
    Mälardalen University, Sweden.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, no 780Article in journal (Refereed)
    Abstract [en]

    Background

    There is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach.

    Methods

    The study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support.

    Results

    Questionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives.

    Conclusions

    The prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.

  • 30.
    Wambui, Theresah
    et al.
    Department of Nursing, School of Medicine, Moi University, Kenya.
    Ek, Anna-Christina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Cognizance of sexually transmitted infections among low-income men in western Kenya2011In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 2, no 4, p. 169-173Article in journal (Refereed)
    Abstract [en]

    Sexually transmitted infections (STIs) pose a worldwide health problem. To improve the efforts of prevention of STIs it is important to gain insight into the awareness of STIs among people in the society.

    Objective: To describe the cognizance of STIs among low-income men in western Kenya.

    Method: Data was collected from eight focus groups consisted of 64 men between15 and 54 years of age. The interviews were audio taped and content analysis was used for the analysis.

    Findings: Three categories were derived: Consciousness of STIs, Risk of and prevention of STIs, and Marital relationship and STIs. The results indicate that men had some limited consciousness of STIs but that there were misunderstandings. The treatments the men mentioned were hospital treatment help, from traditional herbalists and self-administration. Condoms were regarded as an effective prevention method, but there were obstacles to using them as well as to talking about STIs within marriage.

    Conclusion: The study stresses the need to promote cognizance of STIs, including gender aspects, and to reduce the gap between knowing and practising.

  • 31.
    Wijma, Klaas
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Alehagen, Siw
    Linköping University, Department of Molecular and Clinical Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences.
    Wijma, Barbro
    Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
    Development of the delivery fear scale2002In: Journal of Psychosomatic Obstetrics and Gynaecology, ISSN 0167-482X, E-ISSN 1743-8942, Vol. 23, no 2, p. 97-107Article in journal (Refereed)
    Abstract [en]

    This article reviews the development of the Delivery Fear Scale (DFS) to measure fear during labor and delivery.

    In an initial study, 92 women in labor answered a list of 60 items, expressing fear-related appraisals and their contrasts that were characteristic of women in labor. Ten items were then selected by means of an item-total analysis. In a second study, the final list of ten items was tested psychometrically and a semi-structured interview was performed on 45 women in labor, to explore the women s descriptions of the content of each of the ten items. According to the content analysis of the interviews, the dominating connotation of the ten items is fear based on the appraisal of being captured. The studies show that the DFS is a questionnaire that almost effortlessly can be completed within 60-90 seconds during any moment of labor and delivery. The scale has a good reliability: Cronbach‘s alpha was 0.88 in both studies.

  • 32.
    Åsenhed, Liselotte
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting.
    Kilstam, Jennie
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Örebro läns landsting.
    Alehagen, Siw
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Baggens, Christina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Becoming a father is an emotional roller coaster - an analysis of first-time fathers' blogs2014In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 9-10, p. 1309-1317Article in journal (Refereed)
    Abstract [en]

    Aims and objectives. To identify and describe the process of fatherhood during the partner’s pregnancy among expectant,first-time fathers.Background. Pregnancy seems to be a demanding period for expectant fathers, and this period is a part of their transition tofatherhood. Blogs can be seen as personal diaries and offer an alternative method of collecting data as they are an arena forsharing experiences and narratives.

    Design. An explorative qualitative design.Methods. Blogs from the Internet by eleven first-time fathers living in Sweden were included in the study. Qualitative contentanalysis was used for the analysis of the blogs.

    Results. A theme emerged expressing the latent content of the text: ‘Becoming a father for the first time is an emotional rollercoaster where the role of the expectant father is not obvious’ and five different categories describing the manifest content: thepregnancy, a new life, to make the child real, preparations for the delivery and the arrival of the child, and a new role in life.

    Conclusions. The metaphor ‘roller coaster’ indicates the tension between different feelings about the men’s future as fathers.They are searching for answers on how to be a good father. They feel excluded when they visit antenatal care centres andhave difficulties finding out how to support their partner. This is an existential period when they understand themselves asadults and also miss relatives who have died. During pregnancy, the men start to communicate with their child, and thisinteraction gives a sense of reality and creates hope and joy about being a father.Relevance to clinical practice. Staff involved in antenatal care can use the knowledge from this study when meeting withexpectant fathers. Perspectives expressed in blogs may enhance the professionals’ understanding that the transition processof fatherhood is complex.

    Key words: blogs, first-time fathers, pregnancy, qualitative content analysis, qualitative study, reproductive health, sexuality,transition

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