Childbirth care

Care during childbirth is essential throughout labour and delivery, regardless of the place of birth, with long-lasting outcomes for the mother and child. It is essential to understand the best practices and supportive interactions between the mother and skilled healthcare workers assisting the birth. Post-delivery care, lasting from the first hours after birth up to 42 days, is also crucial for successful birth outcomes, including the role of different healthcare workers in postnatal care, support and education.

Continuity of care during childbirth

The overall aim of the research project is to describe women's, midwives' and midwifery students' attitudes and experiences of a midwife-led continuity model during pregnancy, childbirth and aftercare.

Offering women a midwife-led continuity model during pregnancy, childbirth and aftercare has been shown to achieve very good outcomes in terms of fewer interventions and more spontaneous births. Continuity models also generate higher levels of patient satisfaction, as demonstrated in several randomized controlled trials. A systematic review of the literature found that what women valued most in a continuity of care model was person-centered care, where trust was built based on the relationship between the midwife and the birthing woman. Continuity models are therefore recommended by the World Health Organization. The Swedish government and the Swedish Association of Local Authorities and Regions have invested financial resources to improve maternity care and are calling for continuity of care models. To be prepared to offer women coherent care during pregnancy, birth and the postnatal period, this project is important to provide evidence-based care.

Collaborations

Professor Ingegerd Hildingsson, Uppsala universitet
Med dr Birgitta Larsson, Sophiahemmet högskola
Doktorand Hanna Fahlbeck, Uppsala universitet
Med dr Sophia Holmlund, Umeå universitet
Med dr Maria Lindqvist, Umeå universitet

Responsible

Margareta Johansson, Uppsala universitet, Kvinnors och barns hälsa, Akademiska sjukhuset, 751 85 Uppsala. E-postadress: margareta.johansson@uu.se

Publications

Hildingsson I, Fahlbeck H, Larsson B, Johansson M. Swedish midwives’ attitudes towards continuity models-a cross-sectional survey. Sexual & Reproductive Healthcare, 2024:40 (2024) 100957. https://doi.org/10.1016/j.srhc.2024.100957

Hildingsson IM, Fahlbeck H, Larsson B, Johansson M. Increasing levels of burnouts in Swedish midwives – A ten-year comparative study. Journal of Sexual & Reproductive Healthcare, 2023. https://doi.org/10.1016/j.wombi.2023.10.010

Hildingsson I, Fahlbeck H, Larsson B, Johansson M. How midwives’ perceptions of work empowerment have changed over time: A Swedish comparative study. Midwifery, 2023. https://doi.org/10.1016/j.midw.2023.103599

Fahlbeck H, Hildingsson I, Johansson M, Larsson B. ‘A longing for a sense of security’ – women’s experiences of continuity of midwifery care in rural Sweden: a qualitative study. Sexual & Reproductive Healthcare, 2022 Sep;33:100759. https://doi.org/10.1016/j.srhc.2022.100759

Hildingsson I, Fahlbeck H, Larsson B, Johansson M. ‘A perfect fit’ – Swedish midwives’ interest in continuity models of midwifery care. Women and Birth, 2022:Apr 30;S1871-5192(22)00080-4. https://doi.org/10.1016/j.wombi.2022.04.014

Financing

FoU Region Uppsala

Kampradstiftelsen

Sophiahemmets högskola

Support program for fear of childbirth

The aim of the research project is to increase access to evidence-based psychological support tailored to parents with childbirth anxiety by developing a parenting intervention and testing its feasibility and acceptability.

Despite the fact that 20% of pregnant women and 14% of expectant co-parents experience fear of childbirth, access to evidence-based psychological support is limited. Fear of childbirth can result in serious consequences for the baby in the form of growth retardation, premature birth and the need for neonatal care. Expectant parents with fear of childbirth are associated with depression during the first period after the birth of the child, which causes suffering. Parents with depression can have a negative impact on the child's emotional and cognitive development.

As evidence-based psychological support for couples with postpartum anxiety is limited, this research project will contribute knowledge on how health care providers can support expectant parents with postpartum anxiety a healthy transition into parenthood.

Collaborations

Dr. Michael B. Wells, Karolinska Institutet
Karin Lindelöf, PhD, Uppsala University
PhD student Carita Nordin-Remberger, Uppsala University
Joanne Woodford, PhD, Uppsala University
Professor Ingegerd Hildingsson, Uppsala University

Responsible researcher

Docent Margareta Johansson, Uppsala universitet, Kvinnors och barns hälsa, Akademiska sjukhuset, 751 85 Uppsala margareta.johansson@uu.se

Publications

Hildingsson I, Nordin-Remberger C, Wells MB, Johansson M. Factors associated with fear of childbirth, mental health and self-efficacy-A cluster analysis. Journal of Obstetric, Gynecologic & Neonatal Nursing. Accepted April 22nd 2024

Hildingsson I, Johansson M. A cluster analysis of reasons for fear of birth among women in Sweden. Journal of Psychosomatic Obstetrics & Gynecology, 2024:45:1, 2319291. https://doi.org/10.1080/0167482X.2024.2319291

Financial

FoU Region Uppsala

Centrum för kvinnors psykiska hälsa- Women’s Mental Health during the Reproductive lifespan (WOMHER) Uppsala universitet

Midwife continuity

In recent years, international research has shown significant benefits for women and children when care is provided in the form of midwife continuity through the care chain from pregnancy, during childbirth and the first period after the child's birth. Various models of midwifery continuity have been developed internationally and recommended by the World Health Organization (WHO) for most pregnant and laboring women. In Sweden, continuity with the same midwife is relatively good for women during pregnancy, but maternity care and aftercare is usually fragmented with different care providers, and many different staff categories involved. A large Cochrane review article shows that care continuity leads to fewer interventions during childbirth, more spontaneous births, a high degree of continuity by a known midwife, happier women and cheaper care. In Sweden, individual projects with continuity are beginning to develop. We have implemented such a project at the Hjärtat Midwifery Clinic in Uppsala in collaboration with the delivery department at the Academic Hospital, to address women afraid of childbirth. We have carried out a further project with continuity for women afraid of childbirth at three hospitals in the country, where the responsible midwife supporting the woman afraid of childbirth also assisted her in giving birth, whenever possible. Having a known midwife meant that the fear of childbirth disappeared for some of the women, decreased for the majority and gave an overall better assessment of the maternity care and the experience of childbirth. Continuity projects are often run in metropolitan regions, but it is less common in sparsely populated areas. In connection with the planned reorganization of maternity care in Sollefteå, the opportunity was given to try a new way of working by increasing continuity and offering a cohesive care chain. The projects will provide new knowledge about the importance of the form of care for the outcome of childbirth as well as the experiences of women, partners and midwives.