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Bakgrund: Flera studier visar att sjuksköterskor inte tillgodoser patientgruppers behov av att tala om sexualitet och sexuell hälsa. Barnmorskors samtal om sexualitet är ett nästan helt outforskat område. Syfte: Syftet är att undersöka barnmorskors syn på och erfarenhet av samtal om sexualitet på barnmorskemottagningen. Metod: Semistrukturerade intervjuer utfördes med nio barnmorskor på sju olika mottagningar i Skåne. Intervjuerna analyserades med en kvalitativ innehållsanalys genom identifiering av kodord, kategorier och teman. Resultat och analys: Skriptteorin har använts för att analysera och förstå hur barnmorskorna agerar och samtalar i relation till sexualitet. Analysen utmynnade i ett övergripande tema: Sexualitet är betydelsefullt men lätt att tappa bort. Barnmorskorna ser sexualitet som ett angeläget ämne men svårt att adressera i möten. Svårigheter att kommunicera sexualitet beror på tids- och kunskapsbrist samt brist på uppmuntran från ledningen och/eller avsaknad av samtalsverktyg samt ytterligare osäkerhet då patienten avviker från heteronormen eller har en annan kulturell bakgrund. Konklusion: Utbildning i sexologi efterfrågas av barnmorskorna för att kommunicera sexualitet och kunna ge den holistiska vård patienter har rätt till oavsett sexuell orientering eller kulturell bakgrund. Men resultatet antyder att tydliga förväntningar och riktlinjer kring att och hur samtal tas upp är viktigare än fördjupad kunskap. Så länge det finns ett kulturellt och interpersonellt skript på arbetsplatsen i vilket sexualitet inte förväntas adresseras kommer inte utbildning förändra förhållningssättet. Stöd från ledningen och/eller organisationen och möjligheter till handledning/reflektion som rör sexuella frågor kan stötta och uppmuntra barnmorskor att initiera frågor om sexualitet och förändra skripten. Vidare studier behöver göras för att till fullo förstå vilka mekanismer som ligger bakom svårigheten att adressera sexualitet på barnmorskemottagningen. / Background: Several studies show that nurses don’t meet the need from groups of patients to talk about sexuality and sexual health. There are almost no studies on midwives’ view on sexuality counselling. Aim: The aim of this study is to explore midwives’ views and experiences on sexuality counselling at the antenatal care. Method: Semi-structured interviews were conducted with nine midwives’ at seven different antenatal care centers in Skåne. The interviews were then analyzed with a qualitative content analysis through identification of codes, categories and themes. Results and analysis: The study utilizes scripting theory to analyze and understand how midwives act and counsel patients in relation to sexuality. One main theme emerged: Sexuality is important but easy to lose. The midwives’ consider sexuality as important but sometimes hard to address. The reasons for this is said to be lack of time, lack of knowledge, lack of encouragement from the managerial level and/or lack of counseling tools, and, added to that, even more uncertainty when the patient deviates from the heterosexual norm or has another cultural background. Conclusion: Midwives’ ask for education to communicate around sexuality and to be able to provide the holistic care that the patients are entitled to. The result, however, suggest that clear expectations and guidelines about when and how to address sexuality is more important than deepened knowledge. As long as there is cultural and interpersonal scripts in the workplace in which sexuality is not expected to be addressed, additional education won’t help to change addressing patients’ sexuality. Organizational and managerial support along with opportunities for reflection concerning dialogue regarding sexual issues might evoke the interest and intent of midwives’ to approach sexuality and change the cultural and interpersonal scripts. Further studies are needed to understand fully what mechanisms underline the barriers that prevent midwives’ from addressing patients’ sexuality.

Objective: Animal literature has suggested that the impact of antenatal corticosteroids (ACS) may vary by infant sex. Our objective was to assess the impact of infant sex on the use of multiple courses versus a single course of ACS and perinatal outcomes. Study Design: We conducted a secondary analysis of the Multiple Courses of Antenatal Corticosteroids (MACS) for Preterm Birth trial. Our primary outcome was a composite of perinatal mortality or clinically significant neonatal morbidity (including neonatal death, stillbirth, severe respiratory distress syndrome, intraventricular hemorrhage [grade III or IV], cystic periventricular leukomalacia, and necrotising enterocolitis [stage II or III]). Secondary outcomes included individual components of the primary outcome as well as anthropometric measures. Baseline characteristics were compared between participants who received multiple courses versus a single course of ACS. Multivariable regression analyses were conducted with adjustment for pre-defined covariates including an interaction between exposure to ACS and infant sex. Results: Data on 2304 infants were analyzed. The interaction term between treatment status (multiple courses versus a single course of ACS) and infant sex was not significant in the adjusted model for the primary outcome (p=0.86), nor for any of the secondary outcomes. Exposure to multiple courses versus a single course of ACS was not associated with the primary outcome either before or after adjustment (aOR 0.99, 95% CI 0.67 to 1.45, n=2292 infants). However, exposure to multiple courses versus a single course of ACS resulted in significantly lower birth length (p=0.02) and head circumference at birth (p=0.04) although not birthweight (p=0.06). Conclusions: Infant sex did not modify the association between exposure to ACS and perinatal outcomes including perinatal mortality or neonatal morbidity or anthropometric outcomes. However, animal literature indicates that sex specific differences after exposure to ACS may emerge over time and thus investigating long-term sex-specific outcomes warrants further attention. / Thesis / Master of Science (MSc) / Antenatal corticosteroids (ACS) are given in pregnancies at risk of early birth. ACS help the lungs and other organs, such as the brain and kidneys to mature. ACS help improve babies’ survival and reduce the risk of other health complications. Several animal studies suggest that infant sex can affect long-term outcomes after receiving a higher dose of ACS. The goal of our study was to look at the effect of infant sex on the relationship between the use of multiple courses (i.e., a higher dose) versus a single course of ACS and short-term outcomes. These outcomes include challenges with breathing, bleeding in the brain, problems in the bowel, and infant death. Our study found that infant sex did not significantly change the relationship between ACS and short-term infant outcomes, but further study is required on long-term outcomes as sex specific differences may emerge over time as reported in animal literature.

Healthcare professionals and expecting mothers frequently voice concerns that massages during pregnancy might cause complications or premature labor. This PRISMA review outlines current results on effects, side effects and contraindications of relaxation massage during pregnancy. Inclusion criteria: all randomized controlled trials (RCT) comparing relaxation massage during pregnancy with standard care or standard care plus another intervention (i.e., progressive muscle relaxation). Restrictions were full text availability and English language. Results: 12 RCT were included. Trials had good methodological quality but unknown risk of bias. All women were at least 12 weeks gestation at the start of the study. The main benefits of massage during pregnancy were: reduced stress, back and leg pain, depression and anxiety; increased immune response; increased serotonin and dopamine levels; higher fetal birth weight and reduced risk of preterm delivery. Only 2 RCT reported potential side effects of massage, which were minor and transient. Seven RCT excluded women with difficult pregnancies or preexisting complications, five studies did not report preexisting conditions. Those obstetric or postnatal complications that occurred were most likely unrelated to massage treatments. In healthy pregnant women without complications, relaxation massage has positive effects throughout pregnancy. Precautions for massage during pregnancy (i.e., to prevent pulmonary embolism) are discussed.

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

Background: Prenatal alcohol consumption is one of the leading preventable causes of birth defects, including fetal alcohol syndrome and learning disabilities. Although there is strong evidence of the benefits of screening and alcohol brief interventions (ABIs) in reducing hazardous and harmful drinking among the primary care population, evidence of its effectiveness with the antenatal care population is limited. Nevertheless, the Scottish Government is incorporating an alcohol screening and ABI programme as part of the routine antenatal care provided to women in a bid to protect the health and safety of the unborn child and improve subsequent health and developmental outcomes. This research therefore seeks to increase understanding of the factors that are likely to influence the effectiveness of this recently implemented programme. It also aims to explore the extent to which contemporary issues such as change in guidelines regarding alcohol consumption during pregnancy influences perceptions and attitudes, and the possible implications of these on the screening and ABI delivery. Methods: The study described in this thesis employed a realistic evaluation methodology. Realistic evaluation is a theory-driven approach to investigating social programmes. It is concerned with hypothesising, testing and refining programme theories by exploring the interaction of contexts, mechanisms and outcomes. To identify the relevant screening and ABI programme theories, two separate systematic reviews, a critical review and four face-to-face interviews were undertaken with health policy implementers. The findings were used to construct context, mechanism and outcomes propositions. The propositions were then tested by conducting individual interviews with seventeen pregnant women and fifteen midwives, a further six midwifery team leaders were involved in a focus group discussion. A thematic approach using a hybrid of inductive and deductive coding and theme development informed the qualitative analysis. Results: In the context of uncertainties regarding the threshold of drinking that causes fetal harm, pregnant women reported that screening assessment helped them to reflect on their drinking behaviour and facilitate behaviour change. For women who drank at hazardous and harmful levels before attending the booking appointment, screening and ABI may be helpful in terms of eliciting behaviour change. However, they may not be very beneficial in terms of reducing harm to the fetus as it has been found that drinking during the first trimester poses the most risk to the fetus. Training and resources provided to midwives as part of the screening and ABI programme were found to be facilitating mechanisms that midwives indicated improved their skills and confidence. However, most of the midwives had not subsequently employed the motivational interviewing skills required for the ABI delivery, as many of the pregnant women reported that they reduced or abstained from alcohol consumption once pregnancy was confirmed. The outcome noted was that midwives confidence decreased leading to missed opportunities to appropriately deliver the ABI to eligible women. The small numbers of women being identified for ABI meant midwives rarely delivered the ABI. This negatively influenced midwives attitudes as they then accorded ABI low priority in their workload. Other disenabling mechanisms noted to be hampering the implementation of the screening and ABI initiative included midwives contending with competing priorities at the booking appointments, and the lack of adequate rapport between midwives and pregnant women at the booking appointment to discuss alcohol issues appropriately, leading to women providing socially desirable responses to screening questions. Conclusions: The findings of this study has generated greater explanations of the working of the screening and ABI programme in antenatal care setting and has provided transferable lessons that can be used by others intending to implement similar programmes in other settings.

In Sweden, there is currently no consensus addressing the screening, diagnostics and treatment of gestational diabetes mellitus (GDM). In addition, there is little knowledge on the impact of GDM on the daily life of pregnant women and the experiences of health care professionals providing maternal health care to women with GDM. Using different perspectives, this thesis examines the experiences of GDM and the performance of screening for GDM in a regional context in Sweden. The studies used qualitative and quantitative methods. In the qualitative studies, grounded theory was applied in two studies and qualitative content analysis in one study. In the quantitative study, a combination of questionnaire data and data from medical records of pregnancy and birth were processed. Surprisingly, screening for GDM was reduced despite local clinical guidelines stipulating the risk factors indicating an OGTT. Furthermore, the prevalence of the risk factors for GDM in the population investigated was almost doubled compared to previous Swedish studies. Pregnant women developing risk factors for GDM during pregnancy were found to be at substantially increased risk of giving birth to an infant with macrosomia. The experiences of pregnant women with GDM revealed that being diagnosed with and living with GDM during pregnancy might be understood as a process ‘from stun to gradual balance’. The experience comprised both negative and positive dimensions. Despite the challenges, the inconveniences and the changes involved, gradually adapting to an altered lifestyle and finding their balance in daily life was ‘the prize’ the women ‘were willing to pay’ to secure optimal maternal and foetal health. The experiences of midwives comprised managing conflicting demands providing antenatal care to pregnant women diagnosed with GDM. Most midwives felt the obligation to control and monitor the complicated pregnancy, to initiate and motivate the recommended changes in life style together with providing an empowering and caring relation with the women. These assignments disclosed complex conflicting situations and the midwives appeared to choose strategy for managing the situation depending on their perception of the circumstances. The experiences of the obstetricians were understood as ‘dealing with ambiguity’. The ambiguity permeated all aspects of working as an obstetrician within the maternal health care counselling women with GDM: the role of the obstetrician, the context of the organization, balancing the multifaceted interests of the maternal and foetal conditions and the lack of consensus, recommendations and evidence-based knowledge.   The studies revealed the complexity of the situation for the affected pregnant women as well as for the health care professionals providing antenatal care to women diagnosed with GDM. Furthermore, the performance of screening of GDM in pregnant women with risk factors for GDM was insufficient in the investigated region. The findings in this thesis may be useful to increase knowledge of the experiences of pregnant women living with or managing GDM. The findings may also be useful when planning for improvements of maternal health care directed to pregnant women diagnosed with GDM during pregnancy.