Midwives' experiences of postpartum haemorrhage: A web-based survey in Sweden.

OBJECTIVE: The objective was to describe midwives' experiences of postpartum haemorrhage (PPH) >1000 ml in connection with childbirth. DESIGN: A qualitative web-based survey with open-ended questions was used and the results were analysed with content analysis. SETTING: Participants were recruited through convenience sampling from a national Facebook group for midwives. PARTICIPANTS: The study sample included 24 midwives with varying work experience at different maternity units in Sweden, all of whom had experience of postpartum haemorrhage >1000 ml. FINDINGS: The midwives described that the treatment of PPH is limited by a lack of cooperation, knowledge, and assistance, as well as by staff inexperience. They also described how a high-pressure work environment contributed to feelings of inadequacy. Good cooperation, team training, having colleagues present, embodied knowledge, and good working conditions, led to successful handling of such situations, which contributed to feeling at ease with what had happened. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Good working conditions related to external contextual factors such as total load and support, as well as internal factors such as self-efficacy, can help midwives manage PPH while providing patient-safe care and feeling confident in their ability and at ease with the events. Therefore, midwives need to be given opportunities for emotional support, education, and team-based training to maintain the quality of midwifery care and avoid negative long-term effects for both midwives and patients.

The advancement of a gender ethics protocol to uncover gender ethical dilemmas in midwifery: a preliminary theory model.

OBJECTIVES: Ethical dilemmas at both the individual and structural level are part of the daily work of midwives and gender inequality and injustice can affect women's sexual and reproductive health. Mainstream bioethical theory has been criticized for neglecting women's issues. To ensure women's experiences are addressed, a gender lens on ethics is crucial. AIM: This study develops a theory model by exploring ethical dilemmas related to gender in the context of maternity care from the perspective of midwifery science and feminist ethics. METHODS: The research strategy followed a coherent stepwise approach: literature search, thematic analysis, elaboration of a gender ethics protocol, and the integration of various components into a preliminary gender ethics model for midwifery. FINDINGS: A literature search was performed using Scopus and Web of Science to identify ethical dilemmas in maternity care linked to gender and power. The search of articles published between 1996 and 2019 returned 61 abstracts. These abstracts were screened and assigned one of the following themes: The Midwifery Profession, The Rights of the Woman, Fetal Rights Dominate, and Medicalization of Pregnancy and Childbirth. A tentative gender ethics frame was developed and tested on two articles on abortion, one from Denmark and one from Japan. The protocol facilitated the gender analysis of ethical dilemmas related to abortion, which were related to the imbalance of power relations in health care. In the final step, we synthesized the dimensions of gender and power in a gender ethics model for midwifery. DISCUSSION: The gender ethics protocol developed revealed gendered dimensions of ethical dilemmas in midwifery. This gender analysis adds to the understanding of the "do no harm" principle by revealing assumptions and stereotypes that promote unequal power relations. The gender ethics model is an innovative approach that envisions and exposes power imbalance at the micro, meso, and macro levels. CONCLUSIONS: The protocol could improve gender competence among researchers, midwives/professionals, and midwifery students throughout the world.

As gender inequity, gender inequality, and oppression infuse dimensions in all human cultures and societies, not the least in midwifery practice where the layers of injustice affect women during pregnancy and birth in high-, middle-, and low-income countries, the time has come to renew the perspectives of normative ethics. In this study, we explore gender ethical dilemmas unique to maternity care from the perspective of midwifery science and feminist ethics. A literature search uncovered ethical dilemmas in midwifery, and four broad themes were identified: Midwifery Profession, Rights of the Woman, Fetal Rights Dominate, and Medicalization of Pregnancy and Childbirth. Next, we developed a gender ethics protocol suitable for providing gender ethical interpretations of results. The protocol was tested and refined using two articles (one from the Denmark and one from Japan) that address ethical dilemmas of abortion care. The pilot analysis indicates that the autonomy of midwives and their scope of practice might be constrained and that the obstetric medicalized/authoritative knowledge still plays a dominate role in maternity practice. Here, we present an elaborate model, gender ethics model for midwifery (GEMM), developed for midwifery science that can be further refined. The model challenges the views of maternity care and contributes to a deeper understanding of how fluid concepts such as gender and power circulate and influence women's and birthing person's sexual and reproductive health.

Newborn infants who received skin-to-skin contact with fathers after Caesarean sections showed stable physiological patterns.

AIM: Separating infants and their parents after a Caesarean section is still the routine care worldwide. This study investigated three caregiving models on the wakefulness and physiological parameters of full-term infants after an elective Caesarean section. METHODS: Newborn infants born in a Chilean public hospital in 2009-12 were randomised to three groups: cot, fathers' arms or skin-to-skin contact with their father. They were assessed at 15-minute intervals, from 45 to 120 minutes after the Caesarean section. Their physiological parameters were measured, and their wakefulness was assessed using the Neonatal Behavioural Assessment Scale. RESULTS: We studied 95 infant (53% girls) born at a mean gestational age of 38.9 ± 0.9 weeks. Heart rates were significantly higher in the skin-to-skin than cot or fathers' arms groups and showed greater stability over time. Wakefulness was initially higher in the skin-to-skin group, but there were no significant differences by the end of the observation. There were no differences between the groups in peripheral oxygen saturation. Skin-to-skin contact had no negative impact on the infants. CONCLUSION: The skin-to-skin group showed some advantages over the cot and fathers' arms groups when it came to establishing stable physiological parameters and wakefulness. This approach should be supported during mother-infant separation.

Young people's health and risk behaviours in relation to their sexual orientation: A cross-sectional study of Thailand and Sweden.

OBJECTIVES: This study examined the associations between sexual orientation of young people and their health and risk behaviours in Thailand and Sweden, and to explore similarities and differences between the countries. STUDY DESIGN: A cross-sectional study using data from the Life and Health - Young surveys in Thailand and Sweden. Three different statistical analyses were used to examine the associations of the variables. RESULTS: In total, 3869 students aged 16-18 years old were included: 1488 Thai students and 2381 Swedish students. Significantly more Thai (20%) than Swedish (9%) students identified themselves as bisexual, homosexual or unsure (p < .001). Bivariate analysis showed that, in Thailand, self-harm was more often reported by the homosexual, unsure, and bisexual groups than by the heterosexual group (p = .005). In Sweden, early sexual debut was more often reported by the unsure, bisexual, and homosexual groups than by the heterosexual group (p = .033). Multiple logistic regression analysis showed that homosexual and unsure sexual orientations were significantly associated with self-harm (p < .05) among Thai students. Unsure sexual orientation was significantly associated with early sexual debut (p = .04) among Swedish students. Multiple correspondence analysis indicated that sexual orientation was associated with health and risk behaviours, and varied by different subcategories of students' backgrounds such as country, sexual orientation, family structure and adult support. CONCLUSIONS: Sexual minority young people reported more risk behaviours and poorer health than their heterosexual counterparts. The findings are useful for policy programmes on sexual and reproductive health and rights of young people.

Methodological Challenges in Developing a Youth Questionnaire, Life & Health Young People, for Comparative Studies in Thailand and Sweden: About Bridging the Language Gap Between Two Non-English-Speaking Countries.

PURPOSE: To develop a Thai questionnaire ชีวิตและสุขภาพของวัยรุ่นในประเทศไทย (TYQ) to explore girls' and boys' living conditions, lifestyles, and self-reported health with special focus on sexuality, based on a Swedish questionnaire, Liv & Hälsa ung (SYQ). Challenges in developing a youth questionnaire for comparative studies are described. DESIGN: A multistep translation, sociocultural adaptation procedure, and a mixed-method validation test were performed using English as a common language within the research group. Three versions of SYQ were used as a pool of questions to develop the questionnaire. FINDINGS: From a field test, unclear questions were identified and minor adjustments made. Life & Health Young People in a Thai version was successfully developed. The English version was used to bridge the language gap. CONCLUSION: This unique multistep methodology, including mixed-method validation procedure, can be used by researchers in countries where English is not the main language.

Fathers' care of the newborn infant after caesarean section in Chile: A qualitative study.

BACKGROUND: In Chilean hospitals the current model of care after caesarean section is to separate newborn infants from both parents. The care of newborn infants and the parents' experience immediately after caesarean section requires further exploration. AIM: To describe fathers' experiences and perceptions of being the primary caregiver to their newborn infant during the first 90 minutes after caesarean section in a public general maternity hospital setting in Santiago de Chile. METHOD: The questionnaire was one part of a larger research programme named: "Caregiving Models after Elective Caesarean Section - Parents' perceptions and effects on infants' wellbeing". Four open ended questions were used to gather written text on the experiences and perceptions of 95 fathers who were the primary caregiver to their newborn infant. Ethical approval was obtained from the Ethics Committee, Scientific Assessment Metropolitan Health Service South East. Systematic text condensation according to Malterud's description was used for analysis of the written text. FINDINGS: Two themes were identified: "understanding the first moment of life" and "shared responsibility for future family life" with each theme divided into six categories. CONCLUSION: This study concludes by arguing that in situations where the mother is unavailable or unable to provide basic care, the father should be supported to care for the newborn infant. CLINICAL IMPLICATIONS: Parents should be made aware of the benefits of this caring model especially when mother and baby have been separated after birth.

Effects of mother-infant skin-to-skin contact on severe latch-on problems in older infants: a randomized trial.

BACKGROUND: Infants with latch-on problems cause stress for parents and staff, often resulting in early termination of breastfeeding. Healthy newborns experiencing skin-to-skin contact at birth are pre-programmed to find the mother's breast. This study investigates if skin-to-skin contact between mothers with older infants having severe latching on problems would resolve the problem. METHODS: Mother-infant pairs with severe latch-on problems, that were not resolved during screening procedures at two maternity hospitals in Stockholm 1998-2004, were randomly assigned to skin-to-skin contact (experimental group) or not (control group) during breastfeeding. Breastfeeding counseling was given to both groups according to a standard model. Participants were unaware of their treatment group. Objectives were to compare treatment groups concerning the proportion of infants regularly latching on, the time from intervention to regular latching on and maternal emotions and pain before and during breastfeeding. RESULTS: On hundred and three mother-infant pairs with severe latch-on problems 1-16 weeks postpartum were randomly assigned and analyzed. There was no significant difference between the groups in the proportion of infants starting regular latching-on (75% experimental group, vs. 86% control group). Experimental group infants, who latched on, had a significantly shorter median time from start of intervention to regular latching on than control infants, 2.0 weeks (Q1 = 1.0, Q3 = 3.7) vs. 4.7 weeks (Q1 = 2.0, Q3 = 8.0), (p-value = 0.020). However, more infants in the experimental group (94%), with a history of "strong reaction" during "hands-on latch intervention", latched-on within 3 weeks compared to 33% in the control infants (Fisher Exact test p-value = 0.0001). Mothers in the experimental group (n = 53) had a more positive breastfeeding experience according to the Breastfeeding Emotional Scale during the intervention than mothers in the control group (n = 50) (p-value = 0.022). CONCLUSIONS: Skin-to-skin contact during breastfeeding seems to immediately enhance maternal positive feelings and shorten the time it takes to resolve severe latch-on problems in the infants who started to latch. An underlying mechanism may be that skin-to-skin contact with the mother during breastfeeding may calm infants with earlier strong reaction to "hands on latch intervention" and relieve the stress which may have blocked the infant's inborn biological program to find the breast and latch on. TRIAL REGISTRATION: Karolinska Clinical Trial Registration number CT20100055.

Sex differences in newborn interaction with mother or father during skin-to-skin contact after Caesarean section.

AIM: To investigate differences between the breast-seeking and crying behaviour of girls and boys in skin-to-skin contact (SSC) with their mother or their father after Caesarean section as well as the point-in-time for the first breastfeeding and to compare mothers' and fathers' interactive behaviour with their newborn girl or boy. METHODS: Twenty girls and 17 boys were randomized to 25 min of SSC with one or the other parent immediately after birth. The interaction was videotaped. RESULTS: Girls started rooting movements earlier than boys in SSC with either parent (p = 0.027). Infants started to breastfeed significantly earlier if having been in SSC with mothers compared with SSC with fathers during the first 5-30 min (p = 0.018). Girls cried more than boys in SSC with either parent (p = 0.02). Mothers used more touching behaviour towards their newborn infant than fathers (p = 0.001). Mothers touched girls less than boys (p = 0.038). Fathers directed less speech towards girls compared with boys (p = 0.042). CONCLUSION: Early mother-infant SSC immediately after Caesarean section should be promoted until the occurrence of the first breastfeed. If the mother is unable to provide SSC immediately after birth, the father-infant SSC is a valuable alternative because it enhances paternal interaction.

Onset of vocal interaction between parents and newborns in skin-to-skin contact immediately after elective cesarean section.

BACKGROUND: Cesarean section is associated with delayed mother-infant interaction because neither the mother nor the father routinely maintains skin-to-skin contact with the infant after birth. The aim of the study was to explore and compare parent-newborn vocal interaction when the infant is placed in skin-to-skin contact either with the mother or the father immediately after a planned cesarean section. METHODS: A total of 37 healthy infants born to primiparas were randomized to 30 minutes of skin-to-skin contact either with fathers or mothers after an initial 5 minutes of skin-to-skin contact with the mothers after birth. The newborns' and parents' vocal interaction were recorded on a videotape and audiotape. The following variables were explored: newborns' and parents' soliciting, newborns' crying and whining, and parental speech directed to the other parent and to the newborn. RESULTS: Newborns' soliciting increased over time (p=0.032). Both fathers and mothers in skin-to-skin contact communicated more vocally with the newborn than did fathers (p=0.003) and mothers (p=0.009) without skin-to-skin contact. Fathers in skin-to-skin contact also communicated more with the mother (p=0.046) and performed more soliciting responses than the control fathers (p=0.010). Infants in skin-to-skin contact with their fathers cried significantly less than those in skin-to-skin contact with their mothers (p=0.002) and shifted to a relaxed state earlier than in skin-to-skin contact with mothers (p=0.029). CONCLUSIONS: Skin-to-skin contact between infants and parents immediately after planned cesarean section promotes vocal interaction. When placed in skin-to-skin contact and exposed to the parents' speech, the infants initiated communication with soliciting calls with the parents within approximately 15 minutes after birth. These findings give reason to encourage parents to keep the newborn in skin-to-skin contact after cesarean section, to support the early onset of the first vocal communication.