Thoughts and experiences of well-educated fathers about their role when breastfeeding difficulties arose.

OBJECTIVE: To investigate how fathers or partners perceive their roles as new parents when confronted with early breastfeeding challenges, how they navigate these difficulties, and the specific type of support they seek from the Child Health Care Centre (CHCC). METHOD: In-depth, individual interviews conducted with 12 partners of women for whom breastfeeding was difficult. Reflexive thematic analysis was applied on the interview data. RESULTS: Interviews resulted in three themes: 1) 'It is a revolutionary time to be a new father' represented a tumultuous time when fathers wanted to be involved in all decisions and part of a strong team with their partners. 2) 'When a breastfeeding problem arose'; fathers questioned the sovereignty of breast milk and began to seek more knowledge. They experienced a strong social norm about breastfeeding that led to feelings of guilt for their partners. They felt helpless when their partners suffered and lacked support. 3) 'Child Health Care Centre's duty'; was instrumental, as knowledge and competence were found to be important for trust. The fathers wanted concrete solutions to breastfeeding problems and more conversations of support with the CHCC nurse. CONCLUSION: Well-educated fathers desire to protect their partners as they experience suffering due to a robust social norm telling them that breastfeeding is best. This can result in them starting to question the sovereignty of breast milk. Fathers need support to help their partners successfully during breastfeeding. They want counselling to strengthen their role as parents and help them build trusting teams with their partners.

"The ignored pain" - experiences of encounters with healthcare from the perspective of women with pain persisting after childbirth - a qualitative study.

INTRODUCTION: Although the prevalence of pain persisting after pregnancy or labour decreases with time, up to 35 % of women report pain 8 months to 12 years after childbirth. To prevent the development and reduce the impact of chronic pain, researchers and clinicians emphasize the importance of early diagnosis as well as timely and appropriate treatment. Previous studies have shown that when women with post-childbirth morbidities consult healthcare professionals during the first year following birth, their problems are often neglected, and they do not receive adequate treatment. OBJECTIVE: To explore how women with pain persisting for eight months after childbirth experienced encounters with healthcare. METHODS: A descriptive qualitative design with 20 face-to-face, semi-structured interviews. Data were analysed using inductive qualitative content analysis. RESULTS: "Pain ignored by healthcare" was identified as an essential theme and included four categories: "Questioned pain experience," "Inadequate pain management," "Lost in healthcare," and "Insufficient postpartum care " CONCLUSION: The women experienced that their pain was often not recognized or adequately treated, but instead ignored or trivialized. Recurring were descriptions of experienced knowledge gaps among the healthcare providers regarding pain and its management. There was an overall desire among women for a well-defined and well-functioning chain of care with better accessibility and scope.

Disempowering women-a mixed methods study exploring informational support about pain persisting after childbirth and its consequences.

BACKGROUND: Access to information is essential to achieving individual empowerment; meaning the ability to exercise control, manage one's own condition and make informed decisions. However, studies have shown that information provided to women regarding physiological changes during the postpartum period and postpartum health was inadequate, incorrect, or inconsistent. METHODS: The aim of this study was to explore informational support about pain persisting after childbirth and its consequences. A sequential explanatory mixed methods design was used. In the first, quantitative phase, 1,171 women, who gave birth eight months earlier, completed a self-administered questionnaire. In the second, qualitative phase, 20 women who experienced chronic pain were interviewed. Descriptive statistics and qualitative content analysis were used to analyse the data. RESULTS: The majority of the women did not receive information about pain persisting after childbirth, or the information was insufficient or incorrect. They did not know when and where to seek help and did not consult health care professionals. In addition, the lack of information had a negative impact on women's psychological well-being. All women expressed the need to be informed by health care professionals, irrespective of the individual risk of developing chronic pain. CONCLUSIONS: Health services should ensure availability of information to give the women opportunity to achieve empowerment to make good health decisions, increase control over their health and well-being as well as to enhance their self-efficacy. We propose that a booklet or leaflet with relevant information about the risk of developing chronic pain, symptoms and treatment, along with advice about appropriate health care settings should be provided as part of antenatal or postnatal care.

Open dialogue - A grounded theory study on peer learning at birthing units.

BACKGROUND: Peer learning in clinical settings is supported in nursing research but has rarely been studied in the context of student midwives at birthing units. AIM: To create a theoretical model of peer learning in the context of birthing units. SETTINGS: Four hospitals and maternity units in Stockholm, Sweden. METHODS: A Straussian approach to grounded theory was applied. Data consisted of interviews with fifteen final-term student midwives and 21 preceptors. Further, six peer learning seminars were held with approximately 200 midwives. At these, data was collected from fourteen preceptors presenting their experiences of working with peer learning. FINDINGS: The core of the action emerging was the Open dialogue describing the communication between the pair of students, between students-preceptor and students-becoming parents, that developed skills in communication, participation and reduced prestige and hierarchy. It facilitated social interaction and reinforced a dynamic way of learning and teaching midwifery. CONCLUSIONS: With preparation and a clear framework, peer learning can be used with midwifery students at birthing units. The open dialogue includes the becoming family in decision making and fits in a woman centered care providing support, safety, and participation. The pedagogical benefits are consistent with previous studies on nursing students.

Parents' Experiences of Immediate Skin-to-Skin Contact After the Birth of Their Very Preterm Neonates.

OBJECTIVE: To explore parents' experiences of immediate skin-to-skin contact after the birth of their very preterm neonates and their perceptions regarding care and support from staff. DESIGN: A descriptive qualitative study. SETTING: Birth and neonatal units within a university hospital in Sweden. PARTICIPANTS: Six parent couples who co-cared for their very preterm neonates with skin-to-skin contact throughout the first 6 hours after birth. METHODS: We analyzed individual interviews using reflexive thematic analysis as described by Braun and Clarke. RESULTS: The parents' experiences of immediate skin-to-skin contact with their very preterm neonates were represented by the following three themes: A Pathway to Connectedness, Just Being in a Vulnerable State, and Creating a Safe Haven in an Unknown Terrain. Skin-to-skin contact helped the parents attain their roles as essential caregivers and provided a calming physical sensation that promoted parents' feelings of connectedness with their newborns. When parents provide skin-to-skin contact at birth, staff members need to recognize and address their vulnerability. A good relationship with nursing staff, which was mediated through staff behaviors and availability, facilitated skin-to-skin contact. CONCLUSION: Skin-to-skin contact initiated at birth with very preterm neonates was a valuable and empowering experience for parents and enhanced early bonding between parents and their newborns. Staff members should recognize that skin-to-skin contact between parents and neonates is an interactive process that has challenges and requires adequate support. Future research is warranted to understand the needs of nursing staff who provide initial care in the postpartum period. Furthermore, we recommend the implementation of maternal-neonatal couplet care.

When student midwives are present during labour and childbirth in a peer-learning model: An interview study of parents in Sweden.

OBJECTIVE: For peer learning to be useful in clinical practice, we need to know how parents experience peer learning during labour and childbirth. This study explored how parents experienced having two students present during labour and childbirth in a peer-learning model. DESIGN: A qualitative approach using individual interviews followed by thematic inductive analysis. SETTING: Three hospitals and obstetric units in Stockholm, Sweden. PARTICIPANTS: Eleven women and nine partners. FINDINGS: The overarching theme was that of a fruitful model of health care, in which there were gains for both parents and students. Parents described feeling seen and cared for, being made aware of what was going on, and never being left alone (subtheme 1, Trustful relationship). Parents appreciated being able to observe student midwives' attendance to the tasks at hand and that they, the two students, learned from each other (subtheme 2, Advantages for students). CONCLUSIONS: The parent couple was able to build a trustful relationship with both students. Furthermore, could parents only see advantages for students in a peer-learning model. Parents reported generous support and were willing to contribute to student education. Parents took advantage of the learning taking place between the two students. The model deserves to be incorporated in the midwifery-student internships to complement more individually assisted births.

Grieving over the past and struggling forward - a qualitative study of women's experiences of chronic pain one year after childbirth.

OBJECTIVE: To describe women's experiences of chronic pain related to childbirth approximately one year after labour. DESIGN: A qualitative design with face-to-face interviews analysed using inductive qualitative content analysis. PARTICIPANTS: Twenty women who reported chronic pain, with onset during pregnancy and/or following labour, approximately one year after childbirth. FINDINGS: The analysis revealed an essential theme, "Grieving over the past and struggling forward", and three categories "Mourning the losses", "Struggling with the present" and "Managing the future". CONCLUSIONS: This study provides new knowledge about women's experiences of chronic pain one year after childbirth. The pain severely reduced women´s previous ability to perform physical and social activities, negatively impacted psychological well-being and altered their self-image. Most of the women adopted a positive attitude and hoped for improved health in the future, although constantly struggling with the pain and its consequences. IMPLICATIONS FOR PRACTICE: This knowledge is particularly important as chronic pain may not diminish with time in predisposed individuals who may need help and support from health professionals in their endeavour to manage their pain. Healthcare providers, i.e. midwives, gynaecologists and general practitioners need to understand women´s experiences of chronic pain from their own perspective to improve identification and treatment of pain following childbirth, thus preventing women's suffering and potential long-term health problems. Future studies are warranted to further explore and discuss women's coping strategies, health seeking behaviour and experiences of health care.

Student midwives' perception of peer learning during their clinical practice in an obstetric unit: A qualitative study.

BACKGROUND: Evidence supports peer learning in clinical settings, but it has not been studied in obstetric units. In Sweden, obstetric units are a challenging learning area for student midwives because of the lack of attention to student needs and the stress of attaining the final number of 50 assisted births. OBJECTIVES: To explore how student midwives experienced peer learning during clinical placement in an obstetric unit. DESIGN: Qualitative approach. SETTINGS: Three hospitals and obstetric units in Stockholm, Sweden. PARTICIPANTS: Fifteen student midwives in a peer-learning model during clinical placement. METHODS: Individual interviews followed by deductive content analysis using Boud's (2001) theoretical descriptions of peer learning. RESULTS: The students shared skills, experience, and knowledge as equals and took responsibility for their peers' learning while supporting women in labor and childbirth. Students shared ideas, thoughts, and knowledge and gained perspective while learning as peers on an equal level. Students used each other to work independently without much involvement from the preceptor. Feedback was welcomed as encouragement. CONCLUSIONS: Peer learning had positive consequences as an educational model in the clinical context in obstetric units.

Exploring the internship experiences of Swedish final term student midwives: A cross-sectional survey.

Today, student midwives in Sweden spend half of their midwifery education at various internships. Practice reality demonstrates that there is an insufficient number of preceptors for the students, and the workload is demanding. Therefore, the present study aimed to explore the experiences of final term Swedish students during their midwifery internship and whether other paedagogical learning experiences beyond the apprenticeship model were included. A cross-sectional survey was distributed to 288 final year midwifery students at all universities offering the midwifery programme in Sweden. This paper focuses on open-ended questions, which were answered by 108 students, and analysed inductively via thematic analysis. Students described an intensive period with pressure during their internship. They expressed a desire for fewer parallel tasks and a better-structured internship. Students revealed that it was both a challenge and stressful to be under constant high performance while practising clinically. Furthermore, students described feelings of competition towards fellow peers in regard to attaining the final number of 50 assisted births. As to the paedagogical methods, the classical preceptorship model with a one-to-one student-preceptor relationship was predominately used. Preceptors were perceived as crucial role models. However, this learning experience was considered suboptimal for learning in the event where preceptors were not engaged or felt insecure regarding their knowledge, or if the preceptor was changed. For the students, the most optimal setting would be if preceptors were selected, trained, and supported in their role to supervise students, instead of being assigned any available preceptor, who was, at times, not a midwife.

Urinary incontinence after uncomplicated spontaneous vaginal birth in primiparous women during the first year after birth.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is associated with pregnancy and parity and can cause health problems for women. Our objective was to explore risk factors for UI and its effect on women's daily activities, psychological health and wellbeing 9-12 months postpartum in a low-risk primiparous population. METHODS: In this prospective cohort study, first-time mothers in a low-risk population with a spontaneous vaginal birth reported the occurrence of UI and its effect on daily activities and on their psychological health and wellbeing in a questionnaire completed 1 year after birth. Descriptive and comparative statistics were employed for the analysis. RESULTS: A total of 410 women (75.7%) completed the questionnaire. The self-reported rates of stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence were 45.4%, 38.0% and 27.0% respectively. Neither the duration of the second stage of labour, the baby's head circumference or its birth weight were associated with the incidence of UI. There was an association between reported negative impact on daily activities and more negative psychological wellbeing (p < 0.001). CONCLUSIONS: Urinary incontinence was common among primiparous women at 9-12 months postpartum. Women whose symptoms had a negative impact on their daily activities reported more psychological suffering.

A hermeneutic study of integrating psychotherapist competence in postnatal Child Health Care: Parents' perspectives.

A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.

El desarrollo emocional y social del niño depende de que los padres le brinden un apoyo óptimo. Muchos progenitores con aflicciones perinatales experimentan dificultades al aprender a dominar la crianza y buscan ayuda de profesionales dentro del cuidado de salud de primera instancia. En Estocolmo, se inició un proyecto clínico en el que sicoterapeutas sicodinámicos ofrecieron consultas a corto plazo en los Centros de Salud Infantil. Este estudio exploró cualitativamente las experiencias de aflicciones perinatales de los padres y las de recibir ayuda del cuerpo de enfermería y terapeutas del proyecto. Método: Se entrevistaron trece progenitores y sus respuestas se analizaron con un método hermenéutico. Resultados: Se concretaron tres temas principales: la accesibilidad a ayuda sicológica con detección de problemas emocionales, las experiencias de terapia en los Centros de Salud Infantil, así como las técnicas de los terapeutas. A los progenitores se les agrupó también en tres designados Tipos Ideales: el inseguro, el progenitor en crisis, el progenitor con problemas sicológicos a lo largo de la vida. Conclusión: los progenitores se enfrentaron con obstáculos al tratar de encontrar ayuda sicológica dentro del cuidado de salud de primera instancia; los sicoterapeutas con una perspectiva familiar integral y aquellos que podían oscilar entre fomentar la percepción y las intervenciones de apoyo fueron especialmente apreciados; se identificaron categorías de pacientes que se beneficiaron del fomento de la percepción y del apoyo, respectivamente.

Le développement émotionnel et social d'un enfant dépend du soutien optimal qu'offrent les parents. Beaucoup de parents avec une détresse périnatale font l'expérience de difficultés quant à la gestion du parentage et cherchent l'aide de professionnels au sein des soins de santé primaires. Un projet clinique a été lancé à Stockholm, en Suède, au sein duquel des psychothérapeutes psychodynamiques ont offert des consultations à court terme dans les Centres de Santé de l'Enfant. Cette étude a exploré de manière qualitative les expériences de détresse périnatale des parents et l'aide qu'ils ont reçue de la part des infirmières/infirmiers et des thérapeutes dans ce projet. Méthode: Treize parents ont passé un entretien, et leurs réponses ont été analysées au moyen d'une méthode herméneutique. Résultats : Trois thèmes principaux ont émergé, l'accès à l'aide psychologique et la détection de problèmes émotionnels, les expériences de thérapie au Centre de Santé de l'Enfant, et la technique des thérapeutes. Les parents ont aussi été regroupés en trois soi-disant Types Parfaits: les insécures, les parents en crise et les parents avec des problèmes psychologiques de longue haleine. Conclusion: Les parents ont fait l'expérience d'obstacles dans l'accès au soin psychologique au sein des soins de santé primaires. Les psychothérapeutes ayant une perspective familiale holistique et ceux qui sont arrivés à osciller entre une promotion de perspicacité et des interventions de soutien ont été généralement appréciés. Les catégories de patients qui ont respectivement bénéficié de perspicacité et de soutien ont été identifiées.

Perineal pain the first year after childbirth and uptake of post-partum check-up- A Swedish cohort study.

OBJECTIVE: The aim of this prospective cohort study was to investigate the prevalence of perineal pain related to the perineal injury within the first year after childbirth. The study further explored the rates of postpartum check-up attendance, and whether they had undergone a vaginal examination, pelvic floor assessment and exercise advice. RESEARCH DESIGN: The primary outcome was women's self-perceived and selfreported occurrence of pain related to perineal injuries (within three, six and 12 months) after birth. Secondary outcomes were uptake of postpartum check-up six to 12 weeks after birth and care received at the check-up. A postal questionnaire was completed one year after birth. Descriptive data was used to present data. FINDINGS: A total of 461 Swedish women (77%) were included in the study. The majority of women with severe perineal injuries (75.0%), and 61.8% of those with moderate injuries II suffered from perineal pain three months postpartum, while 60% with severe injuries and 38.7 with moderate injuries II still had perineal pain six months after birth. The postpartum check-up was attended by 90.6%. However, one out of four had not been given a pelvic examination or advised about pelvic floor exercises. KEY CONCLUSION: Many primiparas suffer from pain related to perineal injuries during the first year after birth. One out of ten women has problems with perineal pain one year postpartum. It is essential to investigate and recognize the impact of perineal pain on women's daily life and psychological and emotional wellbeing at the postpartum checkup.

Haemorrhoids - A neglected problem faced by women after birth.

OBJECTIVE: To investigate the prevalence and severity of haemorrhoids after birth among first-time mothers in relation to management during the second stage of labour and to describe the women's experiences with haemorrhoids. METHOD: A mixed method explanatory sequential design was used. Nulliparous women were allocated to an intervention group for whom the second-stage of labour practice followed the MIMA model (Midwives management during second stage of labour) or to a control group for whom standard-care practice was followed. Data were collected three weeks and 1.5 years after birth. RESULT: A total of 496 (82.1%) women responded to the questionnaire three weeks after birth, 120 (70%) responded to the questionnaire 1.5 years after the birth. The women in the intervention group had fewer symptoms from haemorrhoids three weeks after birth compared to the women in the control group (adj. OR 0.6 95% CI 0.4-0.9). Half of the women in the intervention and control group (50.8%) who reported problems with haemorrhoids three weeks after birth still experienced problems after 1.5 years. The majority of all women did not seek medical care due to their symptoms. The women who described that they experienced haemorrhoids as a problem after birth felt neglected by the healthcare system. CONCLUSION: A substantial percentage of women had symptoms from haemorrhoids after birth. Many of these women felt that their problems were neglected. Women who experienced a slow birth of the baby's head and spontaneous pushing suffered less from haemorrhoids 3 weeks after birth.

A hermeneutic study of integrating psychotherapist competence in postnatal child health care: nurses' perspectives.

BACKGROUND: There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses' conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm. METHODS: In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach. RESULTS: Four main themes crystallized; The nurses' conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses' conceptions of the psychotherapist's function. In a second step, an analysis that clustered the nurses' attitudes towards handling mental health problems yielded one last theme with three "Ideal types"; nurses who expressed "I don't want to", "I want to but I cannot", and "I want to and I can" (take care of families' emotional problems at the CHC). CONCLUSION: The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.

Pediatricians' experiences of working with breastfeeding: An interview study.

OBJECTIVE: The aim of the study was to investigate pediatricians' experiences of working with breastfeeding. METHOD: Semi-structured interviews were conducted with 12 pediatricians working at hospitals in Stockholm County. The interviews were recorded, transcribed and analyzed using content analysis and an inductive approach. RESULTS: All pediatricians saw their role in working with breastfeeding as an important one, but their primary role as pediatricians was to ensure that infants received good nutrition. They delegated the practical aspects of breastfeeding to midwives, who were seen as experts, although the pediatricians believed they had a greater understanding of the necessity for supplemental feeding than did midwives. They also expressed the need for a common strategy regarding supplemental feeding and better teamwork with the midwives. Some respondents noted that it was difficult to advocate for breastfeeding without seeming critical of mothers who experienced problems with it or who did not want to do it. The results comprised a general theme, that breastfeeding is a genuine and difficult task, and five categories: factors decreasing breastfeeding, competence, roles of the professionals, supplemental feeding, the health-care system's responsibility. CONCLUSIONS: Pediatricians have an interest in breastfeeding. However, they perceive inadequate communication with midwives and a need for better collaboration with them regarding breastfeeding. The study also identified a need for a national breastfeeding strategy and for improved conditions that create a breastfeeding-friendly environment.

A qualitative study showing women's participation and empowerment in instrumental vaginal births.

BACKGROUND: An instrumental birth with a ventouse or forceps is a complicated birth, possibly resulting in fear of childbirth which could influence the entire birth experience negatively. Patients who are actively involved in their care have a stronger sense of satisfaction and a sense of participation can contribute to shorter hospital stays. AIM: To describe the experience of participation for women involved in an instrumental delivery with ventouse or forceps. METHOD: Qualitative semi-structured interviews with 16 women who gave birth aided by a ventouse or forceps. Their answers were analyzed through qualitative content analysis. In addition the women were asked to evaluate their experience during the delivery. Using a numerical scale (NRS) the birth experience was graded by choosing a number between 0 (worst possible experience) and 10 (best conceivable experience). FINDINGS: Two themes were extracted from the data: To be part of a team and To feel empowered. Five categories were identified from the women's descriptions of the experience of involvement during the instrumental delivery: to cooperate; to understand; to have contact; to participate, and to not be involved. Those women who rated their experience as low grade, described a lack of involvement in their childbirth compared to those women who rated their experience as high. CONCLUSION: This study shows how cooperation and empowerment of the woman are two key factors in order for the women to have a positive experience of their instrumental vaginal births. The study also shows that empowerment is created when the woman is actively engaged and participates in the birth process which gives her the feeling of being part of the team, creating an environment based on mutual understanding.

Midwives experiences of participating in a midwifery research project: A qualitative study.

PROBLEM AND BACKGROUND: In an earlier research project midwives were asked to perform women-centered care focusing on the assumption that the physiological process in the second stage of labour could be trusted and that the midwives role should be encouraging and supportive rather than instructing. There is no knowledge about how midwives participating in such a research project, uses their skills and experience from the study in their daily work. AIM: The aim in this study was to investigate how midwives experienced implementing woman-centered care during second stage of labour. METHODS: A qualitative study was designed. Three focus groups and two interviews were conducted. The material was analysed using content analysis. FINDINGS: The participating midwives' experiences were understood as increased awareness of their role as midwives. The overarching theme covers three categories 1) establishing a new way of working, 2) developing as midwife, 3) being affected by the prevailing culture. The intervention was experienced as an opportunity to reflect and strengthen their professional role, and made the midwives see the women and the birth in a new perspective. CONCLUSIONS: Implementing woman-centered care during second stage of labour gave the midwives an opportunity to develop in their professional role, and to enhance their confidence in the birthing women and her ability to have a physiological birth. To promote participation in, as well as conduct midwifery research, can enhance the development of the midwives professional role as well as contribute new knowledge to the field.

Intensive care nurses' experiences of infants and partners' presence on the postoperative ward after an emergency caesarean section; An interview study.

It is evident that immediate skin-to-skin care after birth has the potential to improve breastfeeding outcomes and maternal satisfaction after a caesarean section; hence partners and infants should be present on the postoperative ward. OBJECTIVE: To investigate the intensive care nurses' experiences of having the infant and partner present on the postoperative ward after emergency caesarean sections. DESIGN: Interviews with semi-structured interviews were conducted and analysed using qualitative content analysis. SETTING: The interviews were conducted at a hospital in Stockholm, Sweden; where close to 10,000 births occur each year. After a caesarean section the mother is treated on a postoperative ward for at least two hours. Eight intensive care nurses participated in the study. RESULT: The analysis yields the theme 'The challenges of caring for infants on a postoperative unit' covering the following categories; collision between the intensive care nurse and midwife, responsibility versus knowledge and organisational issues. The study concluded that improved routines and increased continuity between involved clinics could improve care. There is also a need for education for staff involved in caesarean section regarding the benefits of early skin-to-skin care between the mother and her infant.

Fathers' experiences of a vacuum extraction delivery - a qualitative study.

OBJECTIVE: To explore fathers' experiences of a birth by vacuum extraction (VE). METHOD: A qualitative interview study with 10 fathers analysed with qualitative content analysis. FINDINGS: The theme 'affected but helpless' refers to the father's role changing when childbirth terminates with a VE. From initially being involved in the delivery, his role switches to being merely an observer at the mercy of the professionals' knowledge and guidance. The VE procedure evoked concerns over the mother's and the child's safety and wellbeing, even if the fathers wanted the birth process to be over. The fathers considered the choice of conducting a VE as an adequate alternative, but they expressed concerns about consequences on future decisions. The theme encompasses all the main categories: wish to be involved, anxious observer, turbulent feelings and thoughts about consequences. CONCLUSIONS: VE delivery has a strong emotional impact on fathers and the procedure is often experienced as a dramatic way to end a birth and an ultimate way to terminate a long birth process. The results indicate that a lack of support and of a genuine opportunity to participate, as well as the mother's pain impair their experience, not the VE delivery, per se.