Objective: City Birth Trauma Scale (City BiTS) is an instrument designed to evaluate and diagnose postpartum posttraumatic stress disorder (PTSD) according to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). No validated Swedish instrument exists to measure postpartum PTSD according to DSM-5. Therefore, the primary aim of this study was to assess the psychometric properties of the Swedish version of the City BiTS (City BiTS-Swe) and to examine the latent factor structure of postpartum PTSD. The secondary aim was to report the Swedish prevalence of PTSD following childbirth. Method: A total of 619 women, who had given birth at five clinics in the past 6-16 weeks, completed an online version of City BiTS-Swe and the Edinburgh Postnatal Depression Scale (EPDS). Additionally, sociodemographic and medical data were collected. A second questionnaire was answered by 110 women to examine reliability over time. Results: The confirmatory factor analysis using the two-factor model gave best fit to the data. We found a high internal consistency (a = .89-.87) and good test-retest reliability (ICC = 0.53-0.90). Divergent reliability with EPDS showed significant correlations with satisfying results for the subscale birth-related symptoms (r = .41). We also found discriminant validity concerning mode of birth, parity, gestational age, mental illness, history of traumatic childbirth, and history of traumatic event as expected. The prevalence of PTSD was 3.8%. Conclusions: The City BiTS-Swe is a valid and reliable instrument to assess and diagnose PTSD following childbirth.

Introduction This study analyses the division of parental leave and the income development in gay father families through surrogacy in Sweden, seen as one of the most family-friendly and egalitarian countries in the world. Methods Based on longitudinal population register data, descriptive and bivariate regression models are estimated to analyse the parental leave uptake and income development of married partners becoming (first-time) parents in 2006-2015 (in total 53 couples). Retrospective in-depth interviews with 23 gay men in 12 couples, conducted in 2010 and 2018 are analysed thematically to study how fathers discussed and decided how to divide the leave. Results The process of establishing legal parenthood delays the fathers access to reimbursed parental leave. Despite this, the fathers earnings were not considerably affected by the addition of a child to the family. Once the fathers had access to reimbursed leave, they generally shared this equally, with a tendency for the genetic father to take leave first and for a slightly longer period. Conclusions The fathers becoming parents via surrogacy arrangements are a well-off group, able to counter the negative financial consequences of becoming parents. Swedish family policies enable parents to share the leave equally. Less impacted by gender and parenthood norms creating difference between parents, gay father families are in a better position to realise ideals of shared care and sameness. Policy Implications The delayed access to reimbursed parental leave structures the ability of gay couples to become parents and contributes to class inequalities in the transition to parenthood.

The primary aim of this study was to determine the prevalence of previous trauma exposure among expectant birth-giving parents and their partners within a LBTQ population. The secondary aims were to compare fear of childbirth (FOC) and quality of life (QoL) in relation to previous trauma exposure in pregnant LBTQ people and their partners. A further aim was to analyze associations between severe FOC and clinical and demographic factors in this population. Data was collected from a Swedish LGBTQ competent antenatal clinic. Trauma-exposed pregnant (n = 32) and non-pregnant (n = 21) individuals and pregnant (n = 48) and non-pregnant (n = 30) individuals without previous trauma experiences responded to instruments measuring FOC (Wijma Delivery Expectancy Questionnaire) and QoL (EuroQol 5 D-index/-visual analogue scale, VAS). Differences between groups were assessed using non-parametric tests. The proportion of trauma exposure was similar among pregnant responders and their partners (40.0% vs. 41.2%). Trauma-exposed pregnant respondents had a significantly higher prevalence of severe FOC compared to the pregnant respondents without previous trauma. Pregnant trauma-exposed respondents scored lower on EQ5D-VAS than pregnant respondents without trauma, as did non-pregnant trauma exposed respondents compared with non-pregnant -respondents without trauma. Furthermore, trauma-exposed non-pregnant respondents scored lower on the EQ5D-index compared to non-pregnant respondents without trauma. Previous trauma was the only clinical and demographic factor that had any significant association withto severe FOC in the regression analysis. In conclusion, our results suggest that previous trauma exposure may contribute to the risk of suffering from severe FOC and lower QoL among LBTQ-identifying prospective parents.

Background: Optimizing womens childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised ( BSS-R ) can be used to measure birth satisfaction. Aim: The current investigation sought to translate and validate a Swedish version of the BSS-R. Method: Following translation, a comprehensive psychometric validation of the Swedish - BSS-R ( SW-BSS-R ) was carried out using a multi-model, cross-sectional, between- and within-subjects design. Participants: A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis. Data analysis: Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated. Results: The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R . Important insights into relationships between mode of birth, posttraumatic stress disorder (PTSD), and postnatal depression (PND) were observed. Conclusions and implications for practice: The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.

Objective: To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people dur-ing births where complications have arisen.Design: Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications.Setting: Interviews were conducted in Sweden. Participants: A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent.Findings: Most participants had felt invalidated as an LBTQ family. Separation of the family due to com-plications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help.Conclusions: Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences. Implications for practice: To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive effort s to transfer LBTQ related information between wards.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Transgender people report significantly poorer mental health than cisgender people. In psychological research, these health disparities are explained by theories of minority stress and microaggressions, while other disciplines use theories on normativity, livability, affective work, world making and utopias. Such theories are seldom picked up by psychologists even though they could serve to help psychological research and practice improve mental health in transgender people.The aim of this interview study was twofold. Empirically, it was to explore how 29 transgender people in Sweden (aged 17-63 years), experience and cope with vulnerability to make life survivable/livable. Analytically, psychological theories of minority stress, microaggressions and coping were put in conversation with theories of livability and emotional labor. Queer phenomenology was used to orient our analysis of the empirical material, as well as orient us theoretically, to find new ways of understanding transgender people’s vulnerability psychologically.While participants’ negative experiences are interpreted as covered by theories on minority stress and microaggressions, these theories do not explain all nuances of the exposure. In addition, theories on coping do not fully capture the constantly ongoing work participants need to do to manage everyday situations. The analysis resulted in three themes. One theme describes the ontic work that participants do in response to existential challenges of not being recognized as a subject. Another theme visualizes the relational work that participants do to deal with subtle exposure in their everyday life, trying to relate to oneself and others simultaneously. The final theme shows that participants utilize reactive and agentic reflexivity to try to achieve minority peace and a livable life. We hope that this dialogue between psychology and gender studies can continue in a Swedish context to better serve transgender people’s livability.

Objectives: Heatwaves are having a disproportionate impact on the elderly population, as demonstrated by pronounced mortality and morbidity. The present study aimed to explore elders subjective experiences of heat impacts and adaptive strategies. Methods: Semi-structured interviews with 19 elderly Swedes were conducted, focusing on their experiences of the extremely hot summer of 2018. Results: Most informants suffered during the heatwave, although some found it pleasant. The readiness to implement adaptive measures was generally high among the healthiest, who were able to avoid excessive heat and adjust their daily routines. In contrast, those highly dependent on care from others had limited options for avoiding the heat, and little capacity to take up adaptive measures. Discussion: With heat becoming an increasing problem, it is important to adjust elderly care so that the most vulnerable elderly people can avoid excessive heat exposure.

Background: Most studies of fear of childbirth (FOC) are conducted on heterosexual cisgender pregnant populations of birth-giving parents. Among lesbian and bisexual women, as well as transgender and queer people (LBTQ), minority stress can add an extra layer to FOC. Gender binary and cisnormative assumptions leave it to the patient to educate and navigate healthcare providers, which can increase mental health problems. Objective: The aim of this study is to compare FOC and mental illness among expecting birth-giving parents and their partners in an LBTQ population. Materials and methods: This cross-sectional study recruited 80 self-identified pregnant LBTQ persons and their 54 non-pregnant partners at a LBTQ specialized antenatal clinic in a large Swedish city of over one million inhabitants. The survey included socio-demographic characteristics, sexual and gender orientation, obstetric history, previous mental health, previous trauma exposure and measures of FOC and mental health. Results: Levels of FOC were significantly higher for the pregnant participants (median W-DEQ 67.5) than for partners (median W-DEQ 60.0). The proportion of severe FOC was higher for pregnant participants (20.3%) than for partners (9.4%), although this difference was not statistically significant. Mental illness was significantly associated with FOC. Conclusion: The results add valuable information to our understanding of the specific needs of pregnant LBTQ people and their partners and may help us to develop healthcare in the future.

The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged >= 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage >= 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann-Whitney U-test, chi-square test or Fishers exact test, and Spearmans rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.

Prospective parents in Sweden are offered antenatal education led by midwives. The composition of some classes is based on the family situation, and some LGBTQ prospective parents are offered separate classes. People who attend such separate classes are generally highly satisfied with the programme. They emphasize that they feel comfortable and find the discussed topics relevant to them. On the contrary, LGBTQ people who attend regular antenatal education reflect on hetero- and cis-normativity in the education, where midwives focus on stereotypic gender roles. In particular, non-pregnant mothers and pregnant transmasculine people feel excluded. Using Sweden as a case study, this chapter explores the heteronormative obstacles in regular antenatal education and the benefits of LGBTQ-certified options.

För ett manligt samkönat par finns det flera möjliga vägar till föräldraskap. Men trots det står praktiska, rättsliga, ekonomiska och etiska hinder ofta i vägen. Därför kan det ta många år av överväganden, planering och drömmar innan paret blir föräldrar...

The COVID-19 pandemic led to major restrictions of everyday life activities. This worsened the social situation of many people, and marginalized groups have been especially affected. This article explores how LGBTQ+ young adults in Sweden have been affected by the COVID-19 pandemic and the subsequent recommendations and restrictions. Fifteen participants between 20-29 years, who self-identified as lesbian, gay, bisexual, transgender, and queer (LGBTQ+), were interviewed about their experiences. A thematic analysis of the data showed that the participants perceived their psychological wellbeing to have been greatly affected by the pandemic. Several reported symptoms of clinical depression, as well as anxiety, worry, rumination, and a heightened sensitivity to stress. Stressors included fear of the disease itself, and fear of spreading the virus, as well as the negative consequences of adhering to the recommendations of social distancing, which constantly interplayed with the marginalized position of being a young LGBTQ+ person. Most participants experienced a decrease in minority stress in face-to-face interaction with social distancing measures in place, but an increase in minority stress online. Those who faced minority stress at home experienced the isolation as particularly stressful. Limited access to the LGBTQ+ community was a common stressor. For transgender participants, the effects on transgender healthcare, such as prolonged waiting times for gender dysphoria assessment and hormone treatment, were a major challenge. Our results have added valuable knowledge to research indicating how vulnerable young adults were highly affected by the COVID-19 pandemic restrictions.

Objective: To conduct an empirical validation of the theoretical model of midwifery care suggested by Peters et al. (2020). Design: A qualitative deductive methodology was used to validate the theoretical model of aims and objectives of midwifery care. The existing model was validated for midwifery care before, during and after childbirth by interviewing women who had reported high satisfaction with childbirth and low fear of childbirth postpartum. Setting: Data were collected via interviews with women who had given birth from January to March 2018 at a middle-sized hospital in south-east Sweden. Participants: Swedish-speaking women aged > 18 years, were invited by midwives to participate at a postpartum maternal healthcare ward, and they received oral and written information. They filled in a demographic questionnaire, a grading of their birth experience on a 0-10 numeric rating scale (NRS) and the Wijma Delivery Experience Questionnaire Version B (W-DEQ B). We used >7 as the cut-off for high satisfaction with childbirth (NRS), and a sum score <= 60 for low fear of childbirth (W-DEQ B). Of 172 women, 28 were eligible, of whom 20 were interviewed 8-13 months postpartum. The interviews were analysed using qualitative content analysis with a directed approach. Findings: All of the models levels and their aspects were found in the interviews. All women had experienced a trusting relationship, including individual and woman-centred care, communication, choice and continuity, prompt attention and an empathic attitude. A majority described midwifery in terms of promoting security, and almost all had experienced aspects of personal control. The objective of midwifery care, described as the facilitation of womens reproductive capabilities, was described as being met by half of the women. The importance of pep talks and coaching was emphasized, and partner support could be added to the model. Key conclusions and implications for practice: Our findings indicate that the theoretical model proposed by Peters et al. (2020) is mainly applicable to midwifery care of women reporting high satisfaction with their birth experience and low postpartum fear of childbirth. Our findings suggest that this model may serve as a clarification of the unique objective of midwifery care, and could be used by midwives in daily clinical work and in midwifery education programs.

This article explores the experiences of transgender men who became parents through childbirth and started families with their cisgender male partners. The study explores the transgender mens experiences of having and raising children in this family constellation, with a specific focus on how they experience gender in their parenting role. Semi-structured interviews were conducted with three participants. The data was transcribed and analyzed with thematic analysis. Results of the analysis showed that the participants had experienced gender dysphoria before and during pregnancy, but also embraced their childbearing capacity. As transgender fathers, they found themselves expected to fulfill gendered expectations for women and mothers but sometimes appreciated access to womens spaces. The participants had employed different strategies to protect their masculine selves, such as concealing their pregnancy and/or defending the right to be respected as transgender pregnant men. When passing as cisgender men, they experienced being praised for taking care of their children. They did not receive such praise when they were assumed to be women or known to be transgender men. The men struggled with inequality in their relationships, reflecting each partners assigned gender at birth. Still, they emphasized that same-gender relationships facilitated attempts to achieve equality.

Objective: Several studies have shown that the quality of the working alliance predicts symptomatic improvement sessionby-session, including in cognitive-behavioral therapy (CBT). We wanted to explore what characterizes CBT sessions with high and low alliances further using qualitative analysis. Method: Ten CBT-sessions were selected from eight patients therapies in a larger research project on psychotherapy for patients with major depression. Five sessions were chosen from high- and five from low-alliance sessions, based on therapist- and patient-reported Working Alliance Inventory scores. Transcripts of these sessions were analyzed using thematic analysis. Results: The analysis yielded four themes, each structured into two sub-themes: Therapist style, Person in focus, Content focus, and Therapeutic direction. In contrast to low-alliance sessions, high-alliance sessions were characterized by a more exploring as opposed to expert therapist style; a focus on the patients thoughts, feelings, and behavior, rather than a diffuse focus or a focus on other peoples actions/external events; and a sense of moving forward rather than stagnation. Conclusion: Our qualitative analysis showed theoretically and clinically meaningful processes in CBT sessions of high- vs low working alliance. This method is a useful complement to quantitative within-patient analyses, to expand on the meaning of quantitative findings.

This article concerns childless bisexual and gay mens expectations of potential future fatherhood. Social context, biological prerequisites and legal restrictions have in previous research proven to be complicating factors in the process of starting a family. This article investigates the experience of 14 bisexual and gay men in Sweden who are contemplating parenthood. Semi-structured interviews were conducted. The interviews were analyzed using grounded theory methodology, resulting in a model that identified obstructing and enabling factors in realizing future parenthood. The path to parenthood was seen as a process containing both the decision to pursue parenthood and the belief that parenthood was a possibility. The process toward parthood was not linear, but a pendular movement, affected by obstructing factors and enabling factors. One of the main findings was the experience of invisibility in relation to involuntary childlessness amongst bisexual and gay men. Simultaneously, the possibility to break this invisibility, to become a parental role model for other bisexual and gay men, and to revise images of the nuclear family were strong motivating factors. The findings are discussed in relation to Swedish gay men and fathers social situation.

Norms regarding childhood and parenthood differ between social contexts. The present study focuses on Swedish middle-class parents of young children. Based on semi-structured interviews, the study aims to explore norms and ideals regarding children’s emotions and how parents should respond to them. Analysis is informed by discursive psychology, with a focus on ideological dilemmas. Most parents acknowledged an ideal where children are seen as entitled to their own emotions and having the full right to express them. Related to this, two different parenting ideals were identified. The first stipulates that parents should allow and validate the child’s emotional expressions. The second stipulates that parents should be in control of their own emotions, in order to enable children to express theirs. Both ideals were negotiated by the parents as they contradict other ideals and everyday realities.

Objective

To explore and describe norms concerning maternity, femininity and cisgender in lesbian and bisexual women and transgender people (LBT) assigned female at birth, with an expressed fear of childbirth (FOC).

Design

Semi-structured interviews were conducted with self-identified LBT people with an expressed FOC.

Participants

17 self-identified LBT people participated. 15 had an expressed FOC, and two were non-afraid partners.

Findings

Participants described how their FOC was related to ideals of “the primal woman”, including ideals of a natural birth. They also described stress in relation to expectations of gaining a feminine-coded body during pregnancy and of being related to as feminine women.

Key conclusions

Maternity ideals, and the ideal of the “natural” birth, can be particularly stressful on those who fear childbirth. Norms concerning femininity and cisgender can contribute to FOC among those who do not comfortably conform with feminine body ideals or feminine gender expressions.

Implication for practice

Treatments of FOC must be designed to acknowledge whether and how norms concerning maternity, femininity and cisgender affect the individual's FOC.

The strapline "life finds a way," from the classic movie Jurassic Park, referred to how the all-female dinosaurs in a theme park had been able to reproduce, despite the laws of nature. Similarly, the participants in the present study described how their lesbian mothers had shown that "life finds a way," when having children and forming a family, prior to the legal recognition of same-sex parents in Sweden. The study draws on interviews with eight young Swedish adults, aged 17-30 (average age 25). They had been raised by lesbian couples but were born prior to the legal recognition of same-sex parenthood. Prior to a legal change in 2003, a same-sex couple could not share legal parenthood. Further, female couples were excluded from Swedish assisted reproduction programs until 2005. The interviews have been analyzed thematically, and the article presents the results in four themes. The first theme, circumvent, oppose, or adapt to legal obstacles, shows the participants' reflections on how their parents navigated legal obstacles in order to have children and to live together as a family. The second theme, legal obstacles do not affect everyday life, depicts a common experience of how a lack of legal recognition seldom mattered to the participants during their childhood. Rather, they explained how their parents had been able to form parenthood and close relations without legal recognition. In contrast, the third theme describes occasions when legal parenthood matters. This theme highlights occasions when the lack of legal parenthood was problematic or devastating for the participants, such as when parents divorced, or one parent died. The final theme, the meaning of legal parents in adulthood, explores the participants' reflections on the meaning and impact of legal ties (or lack of legal ties) between themselves as young adults and their parents. The findings are discussed in relation to previous research on children and young adults with same-sex parents.

BACKGROUND: Fear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied.

AIM: The aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC.

METHODS: Seventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis.

RESULTS: FOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care.

CONCLUSIONS: It is important that healthcare staff address both partners' prenatal expectancies and postnatal experiences.

OBJECTIVE: To describe how women with severe fear of childbirth postpartum recall the professional support they received before, during, and after childbirth. STUDY DESIGN: This is a qualitative study based on telephone interviews with 10 women reporting fear of childbirth postpartum and who had given birth in 2018. They were interviewed using a semi-structured interview guide. The interviews were digitally recorded, transcribed verbatim, and analyzed using thematic analysis according to Braun and Clarke. RESULTS: The results showed that most women expressed satisfaction with the support they received from the healthcare professionals before, during, and after childbirth, and most of them could not identify any lacking support. The experiences were categorized into 3 themes: "validation and trust," "guidance," and "being in control." CONCLUSION: In summary, the womens reported fear of childbirth postpartum did not seem related to any perceived lack of professional support. The supposed association between fear of childbirth, negative childbirth experiences, and perceived support may need further illumination.

Across the world, people have seen their lives interrupted by the COVID-19 pandemic. Using an online survey, we explored how the psychosocial effects of the pandemic affected the mental health of LGBTQ+ young adults who were confined with their parents during the lockdown period (N = 1,934), from six countries: Portugal, UK, Italy, Brazil, Chile, and Sweden. South American participants experienced more negative psychosocial effects of the pandemic. Depression and anxiety were higher among participants who were younger, not working, living in Europe and who reported feeling more emotionally affected by the pandemic, uncomfortable at home, or isolated from non-LGBTQ friends. Not attending higher education predicted depression while not being totally confined at home, residing habitually with parents, and fearing more future infection predicted anxiety. LGBTQ+ community groups, as well as health and educational services should remain particularly attentive to the needs of LGBTQ+ young adults during health crises.

With global warming, heat waves are becoming more frequent and intense, particularly in northern latitudes, where the pace of warming is faster. Due to its northern location, Swedish society has been built primarily to manage a cold climate, and is less prepared to manage heat, which the 2018 heat wave demonstrated. While young children are recognized as vulnerable to heat, and are reliant on preschool care, few studies have examined how the young and vulnerable people are cared for during heat waves in the institutional preschool setting. This exploratory study demonstrates how children in preschool environments are vulnerable to heat, in order to identify management needs by assessing experienced impacts and responses to the 2018 heat wave in Sweden. Empirically, the study builds on a survey completed by 33 unit heads responsible for 77 preschools in the focused municipality, and qualitative interviews with five educators and five parents, as well as temperature measurements in three selected preschools. This study shows that: (i) children and educators are exposed to both high indoor and outdoor temperatures in the preschools; (ii) both children and educators were affected by the heat wave in the preschools, and their sensitivity is deeply intertwined due to their dependency relationship, rendering a form of double sensitivity to heat; and (iii) the preschool heads and educators were unprepared to sufficiently cope with the heat wave, and organizational strategies for managing heat were lacking, indicating weak adaptive capacity. The significant exposure to heat in preschool environments, the dual sensitivity of children and preschool educators, and the low organizational readiness resulting in uncoordinated responses to reduce heat stress suggest a pronounced vulnerability to heat waves in preschools.

The study explored in detail how Swedish gay fathers (through surrogacy) talked about the surrogate mother and the egg donor. Thirteen semi-structured interviews with 22 gay fathers were conducted and analysed using critical discursive analysis. The surrogates were primarily constructed as a close family member, but occasionally in terms of their instrumental function. They were often described as active and independent, but occasionally as vulnerable or exploited. The egg donors were in some interviews constructed as close family members, while others talked about them as distant acquaintances. Further, donors were constructed either as a significant individual (for the fathers), or as an instrumental provider of the oocyte. While some participants constructed the surrogate and/or donor as their childs mother(s), others were more reluctant or ambivalent about the mother construct. In conclusion, the participants engaged in rhetorical work that shed a positive light on surrogacy, and their own decisions were depicted as solid, ethical and genuine. The participants positive framing can be understood as the production of a counter discourse, in relation to an ongoing debate in Sweden, in which surrogacy is constructed as exploitation, dehumanization and prostitution.

Although most European countries offer paid parental leave to both mothers and fathers, mothers continue to take the lion’s share. Previous studies have analysed patterns of parental leaves in heterosexual couples, in order to understand the gendered skewness and its effects on the lives of women and men. This chapter adds new perspectives on parental leave as it focuses on lesbian parents. Swedish lesbian parents generally share parental leave more equally than heterosexual couples, and they highlight the benefits of an equal relationship and close parent-child bonds. Both parents’ parental leave is depicted by the interviewees as desired; however, only the birth mother’s leave is depicted as necessary. Therefore, the non-birth mother’s leave is often shortened to meet practical circumstances, while the birth mother’s leave is not. The chapter concludes that access to a long parental leave promotes equal sharing among couples where both parents desire parental leave, while the issue is far more complex in cases where one parent does not.

Background

The role of explicit learning of treatment content in internet-based cognitive-behavioural treatment (ICBT) is an emerging field of research. The objective of this study was to explore clients experiences of their ICBT treatment for depression with a focus on knowledge gain and usage of knowledge learned during treatment.

Methods

A strategic sample of ten adolescents, aged between 15 and 19 years, who had received ICBT for major depression within a clinical controlled trial were recruited for the study. Semi-structured interviews were conducted 6 months following trial completion. Data were transcribed and analysed using thematic analysis. The participants had a general adherence rate of 6–8 opened modules out of 8 possible.

Results

Two main themes were identified; “Active agents of CBT” and “Passive agents of CBT”, with each theme consisting of three and two sub-themes. Active agents of CBT reflect a tendency to specifically remember and actively apply specific CBT principles in present life situations. Passive agents of CBT reflect a tendency to remember CBT treatment principles vaguely and express a passive or reactive usage of learned therapy content.

Conclusion

The findings suggest that young clients can remember and apply CBT principles 6 months after their treatment. However, while experiencing benefits of treatment, clients recall and application of treatment strategies vary. The study emphasizes the importance of exploring client recall of CBT components and how valuable it is to explicitly remember contents of a treatment in order to improve and maintain improvement. Further studies on the role of knowledge and memory of ICBT for adolescent populations are warranted.

The strapline "life finds a way," from the classic movie Jurassic Park, referred to how the all-female dinosaurs in a theme park had been able to reproduce, despite the laws of nature. Similarly, the participants in the present study described how their lesbian mothers had shown that "life finds a way," when having children and forming a family, prior to the legal recognition of same-sex parents in Sweden. The study draws on interviews with eight young Swedish adults, aged 17-30 (average age 25). They had been raised by lesbian couples but were born prior to the legal recognition of same-sex parenthood. Prior to a legal change in 2003, a same-sex couple could not share legal parenthood. Further, female couples were excluded from Swedish assisted reproduction programs until 2005. The interviews have been analyzed thematically, and the article presents the results in four themes. The first theme, circumvent, oppose, or adapt to legal obstacles, shows the participants reflections on how their parents navigated legal obstacles in order to have children and to live together as a family. The second theme, legal obstacles do not affect everyday life, depicts a common experience of how a lack of legal recognition seldom mattered to the participants during their childhood. Rather, they explained how their parents had been able to form parenthood and close relations without legal recognition. In contrast, the third theme describes occasions when legal parenthood matters. This theme highlights occasions when the lack of legal parenthood was problematic or devastating for the participants, such as when parents divorced, or one parent died. The final theme, the meaning of legal parents in adulthood, explores the participants reflections on the meaning and impact of legal ties (or lack of legal ties) between themselves as young adults and their parents. The findings are discussed in relation to previous research on children and young adults with same-sex parents.

The aim of the present work is to explore how gay fathers have experienced legal obstacles throughout their process of becoming fathers, and what strategies they have used to cope with the difficulties they have met. The study used semi-structured interviews to capture the fathers’ experiences, and a constructivist grounded theory to analyse the data. Interviews with thirty gay fathers in Sweden were included in the study. The participants had become fathers through surrogacy, shared parenthood with women, or foster care. Legal obstacles had played a prominent role in all three family forms, as well as in adoption – which some participants had unsuccessfully pursued. Obstacles marked both their pursuit of fatherhood and their establishment of legal custody. Some participants had eventually given up their initially preferred path to parenthood and searched for another route. To overcome legal obstacles, the participants had utilised one or more strategies; such as being persistent and well prepared, pretending to be straight, and finding access to assisted reproduction treatment abroad. Regardless of the path to parenthood, the participants stressed the necessity of possessing adequate personal or economic resources to become parents. 

Objective: To explore and describe thoughts about and experiences of pregnancy, childbirth and reproductive healthcare in lesbian and bisexual women and transgender people (LBT) with an expressed fear of childbirth (FOC). Design: Data were collected through semi-structured interviews with self-identified LBTs with an expressed FOC. Participants: 17 self-identified LBTs participated. 15 had an expressed FOC, and two were non-afraid partners. Findings: Participants fears were similar to those previously described in research on FOC, e.g., fear of pain, injury, blood, death of the child or of the parent. However, minority stress, including fear and experiences of prejudicial treatment, in maternity care and at delivery wards add an additional layer to the fear of childbirth. Key conclusions: LBTs with FOC are a particularly vulnerable group of patients, whose needs must be addressed in healthcare. Implication for practice: The findings call attention to the need for LBT-competent treatment prior to, and throughout pregnancy and childbirth. In the most vulnerable patients, caregivers must work extensively to build trust, in order to explore and reduce FOC. (C) 2019 Elsevier Ltd. All rights reserved.

The article presents findings from interviews with 15 Swedish 6- to 9-year-olds from two family forms: children of single mothers by choice and children of heterosexual couples. The article focuses on the childrens reflections on child conception and other paths to parenthood. The children of single mothers by choice mentioned heterosexual intimacy, assisted reproduction, and adoption. The children of heterosexual couples mentioned heterosexual intimacy and adoption, but not assisted reproduction, in the interviews. Heterosexual intimacy was often, but not always, presented as the obvious or optimal path to parenthood by children in both groups, while assisted reproduction and adoption often were seen as secondary solutions. Some children did, however, present assisted reproduction or adoption as optimal for singles. The findings show that heteronormativity is the predominant discourse, but also that most participants acknowledged other paths to parenthood.

Prospective parents in Sweden are offered antenatal education led by midwives. The composition of some classes is based on the family situation, and in Stockholm an LGBTQ-certified maternity clinic offers separate classes for LGBTQ parents. Women who attend separate antenatal classes for LGBTQ parents are generally highly satisfied with the programme. They emphasize that they feel comfortable with it, and that the discussed topics are relevant to them. On the contrary, women who attend regular antenatal education, in classes with different-sex couples, reflect on hetero-normativity in the education - midwives focus on stereotypic gender roles, and non-birth mothers’ situation is overlooked when the classes are divided into separate sub-groups for (pregnant) mothers and (non-pregnant) fathers.

För lesbiska par har möjligheten till familjebildning förändrats i grunden sedan millennieskiftet. De kan få barn genom assisterad befruktning på fertilitetskliniker, både i Sverige och utomlands, eller genomföra inseminationer på egen hand i hemmet. Två kvinnor kan också ha gemensam vårdnad om sina barn. "Lesbiska småbarnsföräldrar" följer en stor grupp lesbiska par från det att de planerar barn, genom graviditet och förlossning, under spädbarnstiden fram till att barnen är i förskoleålder. Den syftar till att förmedla kunskap om lesbiska familjer till dig som möter familjer i ditt framtida eller nuvarande yrke, exempelvis inom hälso- och sjukvård, familjerätt, skola och förskola. Boken riktas även till en bredare allmänhet med intresse för lesbiska pars familjebildning. "Lesbiska småbarnsföräldrar" tar avstamp i vår samtids möjligheter, men lyfter och diskuterar också de utmaningar som lesbiska par kan ställas inför på vägen mot föräldraskap och som småbarnsfamilj.

When a female same-sex couple has a child together through assisted reproduction, it is important that both partners be granted status as the child's legal parents. Second-parent adoption, where the non-birth mother adopts the child, is currently an option in several Western nations. The article presents findings from interviews with 96 Swedish mothers, all of whom have gone through second-parent adoptions in same-sex relations. The interviewees describe the adoption as crucial for their family. If the parents divorce or if one of them dies, it is deemed important to have legal parenthood established. A second-parent adoption process in Sweden can take several months to finish. In several interviews, the social workers assessing the family for the adoption are depicted as unprofessional and as asking irrelevant or intrusive questions. Others depict social workers as kind and competent. Other methods of granting legal parenthood to non-birth mothers are suggested for Swedish legislation.

ObjectiveTo describe the expectations concerning imminent childbirth before and after 8weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth. DesignQualitative study of nulliparous pregnant womens narratives before and after CBT. SettingThe first ICBT programme for treating severe fear of childbirth. SampleFifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme. MethodsSemi-structured open-ended questions over the internet before and after 8weeks of ICBT. The data were analysed using thematic analysis. Main outcome measuresThe participants narratives pertaining to five different situations during labour and delivery before and after ICBT. ResultsAfter therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth. ConclusionsFollowing the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.

Options and possibilities for lesbian parents have changed fundamentally since the turn of the millennium. A legal change in 2003 enabled a same-sex couple  to share legal parenthood of the same child. An additional legal change, in 2005, gave lesbian couples access to fertility treatment within public healthcare in Sweden. The present thesis focuses on families where two women share legal parenthood of their children. It aims to provide knowledge about lesbian parenting couples and their children, and to focus on the interplay between family members within lesbian families, and between family members and their surroundings. Furthermore, the thesis aims to visualize and analyse notions of heteronormativity and homonormativity in contemporary Sweden. The thesis draws on interviews with 118 parents in 61 families, and 12 children in 11 families. The participants’ stories, descriptions, reflections and discourses have been analysed using discursive psychology and thematic analysis.

The thesis includes five empirical papers. Paper I focuses on encounters with healthcare professionals prior to and during pregnancy, at childbirth and during the early stages of parenthood. Paper II deals with the participants’ experiences of second-parent adoption processes. Paper III focuses on equality in parenting relations. Paper IV focuses on encounters with fertility clinics within public healthcare. Paper V highlights the children’s reflections and shows how the children talk about fathers and donors.

When a lesbian couple conceives through donor insemination, the partners transform their relations to each other. In this article, I explore how women in lesbian relations depict their parental roles in relation to the notion of equality. Drawing on critical discursive psychology, I conducted and analyzed interviews with 96 Swedish lesbian parents. Findings show how the interviewees draw on three different interpretative repertoires when they talk about their parental roles. In one repertoire, parents describe themselves as being spontaneously equal in relation to the child. In a second repertoire, equality is depicted as a potential result of struggling, where some parents claim to have achieved equality, whereas others describe being frustrated about their unequal situation. Finally, in a third repertoire, inequality is depicted as a given starting point, drawing on a biologistic rhetoric. Although most parents present equality as idealized, most also refer to biology as a reality that sets the benchmark. Findings in the present study could be useful for clinicians working with lesbian couples; rather than assuming that a lesbian couple is more or less equal, it is important to consider the specific couple and their descriptions.

The present article discusses how 12 children (five to eight years) in planned lesbian familiestalk about families, parents and specifically ‘daddies’ as such and not having a father themselves.Findings from child interviews demonstrate that the children described daddies as ‘the same’ asmummies, i.e. as having the same functions. This contrasts with previous research showing howchildren of heterosexuals often describe mothers and fathers as different. The children varied interms of how they labelled donors. Some children adopted the denomination ‘daddy’, drawing ona paternity discourse, while others simply referred to him as ‘a man’.

After lesbian couples have decided to become parents, their family-making journeyentails a wide range of encounters with professionals in fertility clinics and/or in maternaland child healthcare services. The article presents the results of an analysis of 96lesbian mothers’ interview talk about such encounters. In their stories and accounts,the interviewees draw on two separate and contradictory interpretative repertoires,the ‘just great’ repertoire and the ‘heteronormative issues’ repertoire. Throughout theinterviews, the ‘just great’ repertoire strongly predominates, while the ‘heteronormativeissues’ repertoire is rhetorically minimized. The recurrent accounts of health servicesas ‘just great’, and the mitigation of problems, are meaningful in relation to abroader discursive context. In a society where different-sex parents are the norm,the credibility of other kinds of parenthood is at stake. The ‘just great’ repertoire hasa normalizing function for lesbian mothers, while the ‘heteronormative issues’ repertoireresists normative demands for adaptation.

The current study is a qualitative follow-up of a study on guided internet-delivered cognitive behavior therapy (ICBT) for social anxiety disorder (SAD), conducted four years after treatment completion. The main aim was to capture participants' description of their experiences of the treatment, their view on treatment effects, memories of the treatment, and whether they continued using the gained knowledge after treatment. Sixty participants were selected from the original study's treatment group. A criterion based sampling approach was used based on the obtained treatment effect, and with a minimum of five completed treatment modules. E-mail invitations were sent, with information about the follow-up and the instruction to respond if interested in participating. Twelve semi-structured interviews were made and the material was analyzed using an approach based on grounded theory. The results showed that all participants found the treatment to have some effect, but they also found it to be demanding, difficult, and hard. Many appreciated to hear of the experiences of other participants in the online forum. Under the theme of memory, most could describe the setup of the treatment in general terms. The exposure module was mentioned by all, cognitive restructuring by most, and some also reported memories of the psychoeducation. A core process was identified which involved how the attained treatment effect was viewed over the time, and how this view changed from treatment completion to current time. The findings outlined in this study describe how treatment effects can be sustained via an active approach to the treatment and the symptoms of SAD.

IVF with ROPA (Reception of Oocytes from Partners) allows lesbian mothers to share biological motherhood. The gestational mother receives an egg from her partner who becomes the genetic mother. This article examines the ethics of IVF with ROPA with a focus on the welfare of the woman and the resulting child, on whether ROPA qualifies as a "legitimate" medical therapy that falls within the goals of medicine, and on the meaning and value attributed to a biologically shared bond between parents and child. We also contrast IVF with ROPA with egg donor IVF for heterosexual couples and intrafamilial live uterus transplantation with IVF, and show how Swedish legislation makes certain ways of sharing biological bonds out of place. In Sweden, IVF with ROPA is illegal, egg donor IVF for heterosexual couples is allowed and practiced as is sperm donor IVF for lesbians, and live uterus transplantation is performed within a research project (though not allowed in regular health care). But is ROPA really ethically more problematic than these other cases? The article argues that IVF with ROPA gives rise to fewer ethical questions than does live uterus transplantation with IVF and, in some cases, egg donor IVF.