Risk for partners' depression and anxiety during pregnancy and up to one year postpartum: A longitudinal cohort study.

INTRODUCTION: Families may benefit from increased focus on partner emotional well-being during pregnancy and the perinatal period. Our aim was to explore the risk for depression and anxiety during pregnancy and one year postpartum in relation to partners' self-reported health, sense of coherence, social support, and lifestyle factors. METHODS: This is a longitudinal cohort study using three questionnaires that were answered twice during pregnancy and at one year postpartum. Participants (n=532) were recruited between April 2012 and September 2013, and follow-up was between April 2012 and March 2015, in Sweden. RESULTS: In late pregnancy, 8.9% of the prospective partners were at high risk for depression and 8.3% one year postpartum. An increased risk for depression was found amongst those reporting 'fair or very poor' sexual satisfaction and those reporting 'fair or very poor' health during pregnancy and postpartum. High anxiety was reported by 10.8% during late pregnancy and 12.4% one year postpartum. Partners who were unemployed, had financial difficulties, and who scored low on a Sense of Coherence scale, showed significantly higher anxiety in late pregnancy and postpartum. Social support has a significant and positive impact concerning signs of depression and anxiety, both during pregnancy and postpartum. CONCLUSIONS: More than 10% of partners in this study showed depressive symptoms and anxiety, indicating a problem in need of attention by stakeholders. Strengthening social support is of greatest importance. It is time for the introduction of family-focused care aimed at prevention of depression and anxiety, and maintenance of family well-being.

The Spanish version of the Mothers' Postnatal Sense of Security Scale: Psychometric properties and predictive utility.

Postnatal sense of security is a relevant construct related to several variables of motherhood. However, it has not yet been studied in the Spanish context. The aims were: (a) To analyze the psychometric properties of a Spanish version of the Mothers' Postnatal Sense of Security Scale (PPSS-S); (b) analyze the factors related to mothers' sense of security during the first 2 weeks following childbirth (sociodemographic variables and factors related to maternity); and (c) examine the predictive utility that mothers' sense of security has on symptoms of postpartum depression 6-11 months after childbirth. This was a prospective longitudinal study performed in the first 6-11 months post-partum in four regions of Spain. A total of 928 mothers whose mean age was 33.67 years (standard deviation = 4.54) participated. The confirmatory factor analysis showed adequate adjustment to the original structure (χ2 = 17,272.79, df = 153, p < .001; Tucker-Lewis index = 0.98; comparative fit index = 0.98; root mean square error of approximation = 0.058 [0.053-0.063])and the overall internal consistency was 0.89. Direct relationships were shown between women' sense of security and already having had a child, the absence of postpartum health complications (either in the mother or the newborn) and receiving consistent information from healthcare professionals. Our results showed adequate evidence for the reliability and validity of the Spanish version of the PPSS-S. Understanding mothers' sense of security during the early months of motherhood, as well as related factors in the postpartum period, will allow health professionals to implement preventive measures to promote mental health and could help reduce symptoms of postpartum depression.

Management of oxytocin for labour augmentation in relation to mode of birth in Robson group 1.

OBJECTIVE: To compare mode of birth in Robson group 1 according to administration of oxytocin for labour augmentation. DESIGN AND PARTICIPANTS: A retrospective review of 724 medical records from women in Robson group 1 was performed. The outcome measurements were: mode of birth in relation to presence of labour dystocia when initiating augmentation with oxytocin, duration of augmentation with oxytocin, increase of the oxytocin infusion according to recommendations and cervical dilation when initiating augmentation with oxytocin. SETTING: The review was based on medical records from a medium-sized tertiary level obstetric unit in southern Sweden, with approximately 3700 births per year. Data was collected between January 2017 and October 2017. MEASUREMENTS AND FINDINGS: Oxytocin for labour augmentation was used in 64.1% of the births. Oxytocin administered according to the national recommendations was related to a greater likelihood of vaginal birth than when these recommendations were not followed. Only 47.8% of the women who underwent a caesarean section was treated according to recommendations. Receiving augmentation with oxytocin at a later stage of labour was related to a greater likelihood of a vaginal birth. The total time treated with oxytocin was significantly longer in women who had an assisted vaginal birth or a caesarean section than those who had a vaginal birth with augmentation. KEY CONCLUSIONS: Oxytocin for labour augmentation was over-used in Robson group 1. Oxytocin early in labour, a long duration of stimulation with oxytocin and a slower increase of the infusion than recommended had a relationship with caesarean section. IMPLICATION FOR PRACTICE: Due to risks for adverse maternal and neonatal outcomes when using oxytocin for labour augmentation, caregivers should implement strict protocols for its use. According to a high use of oxytocin there is a need to describe women's experiences of labour augmentation in labour dystocia but also when received despite normal labour progress.

A survey of contemporary antenatal parental education in Sweden: What is offered to expectant parents and midwives' experiences.

OBJECTIVE: To explore how antenatal parental education is provided in southern Sweden and midwives' experiences of it. METHODS: A cross-sectional survey with data collection from 66 antenatal clinics and 189 midwives during 2016. Descriptive and comparative statistics, chi-square and t-tests, were used to present the findings. RESULTS: Antenatal parental education was most commonly offered in small parental groups and the number of hours provided varied between two and ten (mean 5.8) hours. A common and structured program for the sessions was used at 37.3% of the clinics. Normal birth, pain relief, partner role during birth, breastfeeding advantages and breastfeeding initiation were the topics most extensively covered. Topic coverage was in 12 topics, mostly related to the time after birth, lower than midwives' rated importance of the topic: p-values between 0.05 and <0.01. Only 14.2% of the midwives often provided guidance to websites. Although midwives enjoyed working with antenatal parental education, they expressed lack of organizational support and lack of personal skills in group leadership and teaching. Years of experience did not significantly affect their self-rated skills in group leadership or teaching. CONCLUSION: These results contribute to knowledge about contemporary antenatal parental education in Sweden. Our results showed that antenatal parental education is not always in accordance with parents' expectations, especially concerning early parenthood and guidance on the internet. To provide antenatal parental education tailored to the needs of expectant parents it is vital to develop evidence-based guidelines and to address midwives' needs for improved skills in group leadership and teaching.

Lifestyle factors, self-reported health and sense of coherence among fathers/partners in relation to risk for depression and anxiety in early pregnancy.

BACKGROUND: Father's health is important for mothers and unborn/newborn children and knowledge about expectant fathers' health in relation to lifestyle and psychosocial aspects is essential. AIMS: To determine sociodemographic and lifestyle factors, self-reported health and sense of coherence among fathers and partners in relation to their risk for depression and anxiety in early pregnancy. METHODS: A cross-sectional design, descriptive statistics, chi-squared analysis, T-test, binary logistic regression, multiple logistic regression with OR and 95% CI were used. RESULTS: A total of 532 prospective fathers/partners constituted the cohort (mean age 31.55, SD 5.47 years). Nearly, one in ten (9.8%) had a statistically high risk for depression; mainly those who were unemployed (p = 0.043), had financial distress (0.001), reported 'very or fairly bad' health (p = 0.002), had a 'very or fairly bad' sexual satisfaction (p = 0.006) and scored low on the SOC scale (p < 0.001). They smoked more often (p = 0.003) were hazardous users of alcohol (p = 0.001) and slept with difficulties (p = 0.001). Those with sleeping difficulties were 5.7 times more likely to have several symptoms of depression (p = 0.001). Hazardous users of alcohol and smokers had 3.1 respectively 3.0 times higher risk for depression (p = 0.001 respectively 0.003). The single strongest risk factor was a low score on the SOC-scale which gave 10.6 (AOR 10.6; 95% CI 5.4-20.6) higher risk for depression. High-anxiety 'just now' was reported by 8.9% and 'in general' by 7.9%, and those who had sleeping difficulties reported 'very or fairly bad' health (p < 0.001). CONCLUSIONS: Allocating more resources and introducing more family-focused care with depression and anxiety screening in early pregnancy for both expecting parents at antenatal care should be strongly considered by actors and policymakers, as this is a step in maintaining a family's well-being.

"I Didn't Know What to Ask About": First-Time Mothers' Conceptions of Prenatal Preparation for the Early Parenthood Period.

The aim of this phenomenographic study was to describe first-time mothers' conceptions of prenatal preparation for the early parenthood period in relation to their experiences of early parenthood. Eighteen first-time mothers were interviewed approximately 1 month after giving birth. The categories identified in the analysis were: accessing appropriate sources of support, gaining knowledge to form realistic expectations, and mobilizing and strengthening personal resources. First-time mothers want health professionals to actively address postnatal issues as they have difficulties in knowing prenatally what knowledge will prepare them for early parenthood. Both professional and peer support during pregnancy were conceived as important for gaining knowledge. Professionals can support by guidance to reliable sources of information and encouraging personal reflections and partner communication.

Midwifery students' experiences of learning through the use of written reflections - An interview study.

In an effort to strengthen midwifery students' learning process, written reflections during the students' clinical practice at birth units have been applied. The aim of this study was to examine how students of midwifery experienced the writing of daily reflections on their practice at birthing units. An interview study was carried out using an inductive method with descriptive design. During 2013 (n = 12) and 2014 (n = 7), respondents were recruited from two cohorts of midwifery students (n = 19) at a university in southern Sweden. Narrative interviews were carried out. The interviews were analysed with thematic content analysis. One theme including four categories emerged from the analysis. The theme was "An educational strategy for the present and the future". The four categories were "Towards personal and professional development", "Reflection requires effort", "Supervisors' commitment" and "Clarification of the rationale". Daily written reflections are useful for students' personal and professional development during clinical practice/placement. In order for the reflections to be used optimally, students must be given clear instructions on the purpose of their use and be given enough time to write them. Furthermore, supervisors must provide constructive feedback on the students' written reflections.

Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study.

BACKGROUND: Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method. METHODS: In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed. RESULTS: The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone. CONCLUSIONS: Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.

First-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period: Implications for early parenthood preparation.

OBJECTIVE: to describe first-time fathers experiences of their prenatal preparation in relation to challenges met in the early parenthood period. DESIGN: a qualitative study was conducted and data was analysed with a phenomenographical approach. SETTING AND PARTICIPANTS: 15 first-time fathers were recruited from three postnatal units in southern Sweden and interviewed approximately one month after their baby was born. MEASUREMENTS AND FINDINGS: three categories and 14 conceptions about fathers' experiences of their preparation emerged from the data. 'Acquiring knowledge and forming realistic expectations' was essential for 'Developing strategies' and 'Being facilitated and supported' enhanced these processes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: supporting fathers to develop strategies for life with a new baby and providing expert guidance to fruitful and accurate information may help the construction of a fatherhood identity and strengthen the fatherhood role. The findings can be used to develop a parental preparation for early parenthood that will correspond to fathers' needs.

Nordic fathers' willingness to participate during pregnancy.

OBJECTIVE: This study aims to illuminate expectant first-time fathers' experiences of participation during pregnancy in three Nordic countries.  Background: Fathers' participation in pregnancy is associated with improved health for the family as a whole. Research so far has primarily explored fathers' participation in pregnancy within health care settings. It is important to know more about how fathers today engage in all aspects of pregnancy.  Methods: Content analysis was used to analyse semi-structured interviews with 31 first time fathers from Denmark, Finland and Sweden. Interviews were undertaken when their partner was pregnant 30 weeks or more.  Results: Data analysis resulted in the main category 'Willingness to participate' and the two generic categories: 'Being beside the "bump"' and 'Cementing the partnership'. 'Being beside the "bump"' was supported by the subcategories: 'Visualising the unborn child', 'Being included in the rites of motherhood,' 'Lacking full control', 'Compensating for lack of embodiment' and 'Adopting an active father role'. 'Cementing the partnership' encompassed the subcategories: 'Strengthening the partner relationship', 'Meeting the professionals, 'Sharing experiences with peers' and 'Protecting their child and their partner'. CONCLUSION: Fathers wanted to participate and be responsible from the beginning of pregnancy. Fathers' participation in pregnancy involves a wide range of activities and strategies both within the domestic and the professional care-giving sphere. Health care professional's approaches to the father-to-be can enhance or reduce experiences of inclusion in antenatal care.

Midwifery competence: Content in midwifery students' daily written reflections on clinical practice.

OBJECTIVE: to examine the content in midwifery students' written daily reflections and in their supervisors' written feedback during clinical practice at birth units. METHOD: a total of 388 reflections written by a cohort of 18 midwifery students and written feedback provided by their supervisors have been analysed using content analysis. FINDINGS: one main category, transition to midwifery competence emerged and was interpreted as a process of development in midwifery skills over time. This main category encompasses five categories: evaluations, own actions, communication, own emotions and insights comprising fourteen subcategories. As the education programme progressed there was evidence of development from fragmented reflections about care and learning to holistic reflections on learning. Comments from the clinical supervisors contained acknowledgement of the students' reflections or comments with a didactic content. CONCLUSIONS: daily written reflections on practice may be a useful pedagogical tool as reflective writing helps students to be active in transition to midwifery competence. Professional development may be facilitated by insights generated by reflection. Amount and content of feedback varied between supervisors which can result in a discrepancy in pedagogical value for individual students.

Analysis of midwifery students' written reflections to evaluate progression in learning during clinical practice at birthing units.

Written daily reflections during clinical practice on birthing units have been used during several years in midwifery education at Lund University, Sweden. However, the usefulness of these reflections for evaluation of progression in learning and professional development of students has to date not been evaluated. In order to analyse written reflections, two taxonomies developed by Bloom and Pettersen have been applied to the texts. Progression in the professional development of midwifery students can be seen through levels of complexity in cognitive and psycho-motor learning areas and also in the description of learning situations. Progression can be seen from a basic description of facts in simple situations at the beginning of the students' practice to a complex description of complicated situations towards the end of the practice. Written daily reflections appear to be a suitable method to help students to reflect in a structured way, thereby helping their professional development. Reflections can help clinical supervisors to understand the needs of the individual student and to support their knowledge accruement. Daily written reflections on clinical practice can be of use in other health education programs.

Fathers' sense of security during the first postnatal week--a qualitative interview study in Sweden.

BACKGROUND: father's sense of security in the early postnatal period is important for the whole family. An instrument, which measures Parents' Postnatal Sense of Security (the PPSS instrument), is under development. OBJECTIVE: to explore and describe factors, which influence fathers' sense of security during the first postnatal week. METHODS: an explorative design with a qualitative approach was used. Thirteen fathers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews. Analysis was carried out using qualitative content analysis. FINDINGS: participation in the processes of pregnancy birth and early parenthood emerged as the main category for fathers' postnatal sense of security. The emergent categories were; 'willingness to participate and take responsibility', 'being given the opportunity to take responsibility', 'being assured about mother's and baby's well-being', 'having someone to turn to-knowing who to ask', 'being met as an individual' and 'being met by competent and supporting staff'. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: new and specific items of importance when investigating fathers' sense of security during the early postnatal period have been pinpointed. Fathers' sense of early postnatal security may be enhanced by giving them a genuine opportunity to participate in the whole process and by giving them the opportunity to stay overnight at the hospital after the birth. Midwives and care organisations need to give clear information about where competent help and advice can be obtained at all hours. Midwives should strengthen the fathering role by acknowledging and listening to the father as an individual person.

Mothers' sense of security in the first postnatal week: interview study.

AIM: This paper is a report of a study of factors which influence mothers' sense of security during the first postnatal week. BACKGROUND: Mothers' sense of security the first postnatal week is not thoroughly elucidated in the literature. METHODS: An interview study with a qualitative descriptive design was carried out, using thematic content analysis. Fourteen mothers from three hospital uptake areas in Southern Sweden were interviewed using focus group discussions and individual interviews between May 2008 and March 2009. FINDINGS: Postnatal sense of security was dependent on support from staff, support from family and the capacity and health of the woman and the baby, and these themes had categories and sub-categories, including: Being met as an individual, being given relevant information, being prepared for the time after birth and having someone to turn to--knowing who to ask, having partner and/or significant others close at hand, mother's and the baby's own resources, being assured that her own physical health was good, and having planned follow-up regarding the baby's health after discharge. CONCLUSION: Staff attitudes should be continually discussed at all units providing maternity care. These discussions should include attitudes towards the father and the significance of his presence for the wellbeing of the family. Continued postbasic staff education in, for example, counselling and communication is necessary if services are to be improved so that parents' individual needs can be met. Preparation for the early postpartum period is important and all information given must be consistent, in particular information about breastfeeding.

Evaluation of changes in postnatal care using the "Parents' Postnatal Sense of Security" instrument and an assessment of the instrument's reliability and validity.

BACKGROUND: A sense of security is important for experiences of parenthood in the early postpartum period. The objectives of this study were to evaluate two models of postnatal care using a questionnaire incorporating the Parents' Postpartum Sense of Security (PPSS) instrument and to test the validity of the PPSS instrument. METHODS: Postal surveys were sent to 234 mothers who had experienced two different forms of postnatal care (study group and control group) and returned by 86.8%. These two groups of mothers were compared for total scores on the PPSS instrument. Demographic variables and mothers' opinions about care interventions were also compared and these variables were tested for correlations with the total PPSS score. A regression analysis was carried out to assess areas of midwifery care which might affect a sense of security. The internal consistency and concurrent validity of the instrument were tested for the total population. RESULTS: there were no significant differences between the groups for scores on the PPSS instrument. A total of three variables predicted 26% of the variability on the PPSS scores for the study group and five variables predicted 37% of the variability in the control group. One variable was common to both: "The midwives on the postnatal ward paid attention to the mother as an individual". There were significant correlations between the total PPSS scores and scores for postpartum talks and visits to the breastfeeding clinic. There was also a significant correlation between the single question: "I felt secure during the first postpartum week" and the total PPSS score. Tests for internal consistency and concurrent validity were satisfactory. CONCLUSION: The proposed new model of care neither improved nor impaired mothers' feelings of security the week following birth. Being seen as an individual by the midwife who provides postnatal care may be an important variable for mothers' sense of postnatal security. It is possible that postpartum talks may encourage the processing of childbirth experiences in a positive direction. Availability of breastfeeding support may also add to a sense of security postpartum. The PPSS instrument has shown acceptable reliability and validity.

Important variables for parents' postnatal sense of security: evaluating a new Swedish instrument (the PPSS instrument).

OBJECTIVE: to evaluate dimensions of both parents' postnatal sense of security the first week after childbirth, and to determine associations between the PPSS instrument and different sociodemographic and situational background variables. DESIGN: evaluative, cross-sectional design. PARTICIPANTS AND SETTINGS: 113 mothers and 99 fathers with children live born at term, from five hospitals in southern Sweden. MEASUREMENTS AND FINDINGS: mothers and fathers had similar feelings concerning postnatal sense of security. Of the dimensions in the PPSS instrument, a sense of midwives'/nurses' empowering behaviour, a sense of one's own general well-being and a sense of the mother's well-being as experienced by the father were the most important dimensions for parents' experienced security. A sense of affinity within the family (for both parents) and a sense of manageable breast feeding (for mothers) were not significantly associated with their experienced security. A sense of participation during pregnancy and general anxiety were significantly associated background variables for postnatal sense of security for both parents. For the mothers, parity and a sense that the father was participating during pregnancy were also significantly associated. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: more focus on parents' participation during pregnancy as well as midwives'/nurses' empowering behaviour during the postnatal period will be beneficial for both parents' postnatal sense of security.

Parents' postnatal sense of security (PPSS): development of the PPSS instrument.

BACKGROUND: There is a need to develop an instrument that measures both the parents' experiences and sense of security during the first postnatal week. No instrument measuring positive dimensions which can be influenced and supported by the postnatal health care has been developed. OBJECTIVE: The aim of the study was to develop a specific instrument to assess both mothers' and fathers' postnatal sense of security concerning the first postnatal week. DESIGN: The study has a methodological and developmental design and was carried out in four steps: construction of the items, face validity, data collection and data analysis. SETTINGS AND PARTICIPANTS: One hundred and thirteen mothers who had given birth in hospitals in southern Sweden and 99 fathers comprised the study participants. DATA ANALYSIS: Statistical analysis, testing for construct validity with explorative factor analysis, internal consistency reliability and comparative validity was carried out. RESULTS: The parents' postnatal sense of security (PPSS) instrument, mother's version, was reduced from 37 to 18 items (explained variance 66.8%, Cronbach's coefficient alpha 0.88) comprising the following dimensions: a sense of the midwives'/nurses' empowering behaviour, a sense of general well-being, a sense of affinity within the family and a sense that breast feeding was manageable. The father's version was reduced from 36 to 13 items (explained variance 69%, Cronbach's coefficient alpha 0.77), and comprised the following dimensions: a sense of the midwives'/nurses' empowering behaviour, a sense of the mother's general well-being including breast feeding, a sense of general well-being and a sense of affinity within the family. CONCLUSIONS: The PPSS instrument is valid and reliable and the only specific instrument measuring postnatal sense of security that is useful for both parents. The instrument needs to be further evaluated.

Factors that influence first-time mothers' choice and experience of early discharge.

OBJECTIVE: The aim of this study was to describe factors that influenced first-time mothers' choice of and experiences during the first postnatal week, after early discharge without a domiciliary visit by the midwife. DESIGN: Interviews were analysed using content analysis. SETTINGS AND PARTICIPANTS: The nine participants were recruited from the Maternity Department at a University Hospital in Sweden. The catchment area included both an urban and rural population. MEASUREMENTS AND FINDINGS: One main category and three subcategories emerged from the text. The main category was a feeling of confidence and security and the subcategories were being able to meet the needs of the baby, feeling 'back to normal' and receiving support. KEY CONCLUSION: Factors that influenced first-time mothers' choice and experience of early discharge were their sense of confidence and security, that they had support from their partner and that they could trust the follow-up organization. IMPLICATIONS FOR PRACTICE: A booked telephone call and a follow-up visit to the midwife can be sufficient as a programme for first-time mothers choosing early discharge.

Expectant first-time fathers' experiences of pregnancy.

OBJECTIVE: to describe first-time-expectant fathers' experiences of pregnancy. DESIGN: an inductive method using narrative interview form and qualitative content text analysis. The text of the transcripts was coded and categorised. SETTINGS AND PARTICIPANTS: seven first-time-expectant fathers living in a multicultural industrial town in southern Sweden were interviewed individually when their partner was in the 38th to 39th week of pregnancy. MEASUREMENTS AND FINDINGS: all the fathers-to-be experienced some psychological, social and/or physical change during the pregnancy. The main category, was 'time of transition'. Eight categories were found under this. They were: 'feelings of unreality, 'insufficiency and inadequacy', 'exclusion', 'reality', 'social changes', 'physical changes', 'responsibility, and development'. KEY CONCLUSION: the fathers'-to-be special needs for support and encouragement during pregnancy may be as important as those of the mothers'-to-be. The caregiver needs to be as aware of and sensitive to these needs. However, before any interventions can be recommended more research is needed.

Parents' experience of early discharge from hospital after birth in Sweden.

OBJECTIVE: to investigate the factors that influence the experience of mothers and fathers when they have chosen to return home, earlier than is the normal routine, following the birth of their baby. DESIGN: a qualitative study, using open interviews, was undertaken. The text of the transcripts was coded and categorised according to the grounded theory method using constant comparative analysis. SETTING: interviews were carried out with 12 parents, six mothers and six fathers, individually in their own homes. They had all left a maternity/family ward at the Helsingborg Hospital in southern Sweden within 26 hours of birth whereas the normal discharge time is 72 hours. MEASUREMENTS AND FINDINGS: 'a sense of security' was the core category. Achieving a sense of security linked to informed choice for early discharge appeared to be dependent on the following categories: (l) the midwives' empowering behaviour; (2) affinity within the family; (3) the parents' right to autonomy/control; (4) physical well-being. There appears to be an inner connection between each of these categories. KEY CONCLUSIONS: the midwife's empowering behaviour supports the parents' sense of security and encourages their informed choice of earlier discharge after birth. When the mothers' and babies return home it strengthens the affinity within the family and the father's sense of participation.