Sexual & Reproductive HealthCare

Midwives at youth clinics attitude to HPV vaccination and their role in cervical cancer prevention

Marie G. Oscarsson, Annica Dahlberg, Tanja Tydén — 2011-11-01

Abstract: Objective: To explore youth clinic midwives role in cervical cancer prevention and their attitude to HPV vaccination.Study design: Individual interviews with 13 midwives working at youth clinics in Sweden. The interviews were recorded, transcribed, and analysed by qualitative content analysis.Results: Three themes were identified in the qualitative content analysis: “Cervical cancer prevention not a prioritised area”, “Ambivalence to the HPV vaccine”, and “Gender and socioeconomic controversies”. Few midwives talked spontaneously about cervical cancer prevention. The responsibility for providing information about HPV vaccination was considered as primarily that of school health nurses and parents. Midwives were positive about the HPV vaccination, but recognised certain risks, such as its potential negative impact on cervical cancer screening and increased sexual risk taking. The midwives expressed concerns with medical risks, such as side effects and unknown long-term effects of the HPV vaccine. The midwives in the study had ethical concerns that boys were not included in the program and not all families had the financial resources to vaccinate their children. Thus, weak socioeconomic groups might be excluded.Conclusion: The midwives considered cervical cancer prevention as important, but did not integrate information on the HPV vaccine into their routine work, mainly because young people visiting youth clinics had had their sexual debut and they were concerned about the medical risks and that the vaccine was too expensive.

Perceived family perceptions of breastfeeding and Chinese new mothers’ breastfeeding behaviors

Hong Lu, Hongyan Li, Shuqin Ma, Lijuan Xia, Kyllike Christensson — 2011-11-01

Abstract: Objective: To provide an understanding of Chinese new mothers’ breastfeeding behaviors and especially to explore the relationship between the mothers perceived family perception about breastfeeding and the new mothers’ breastfeeding behaviors.Study design: A cross-sectional questionnaire survey was conducted in Beijing and Yinchuan, the capital of Ning Xia Province, China. 214 new mothers with a baby at the age of 4months were recruited to the study. The family perception of breastfeeding scale and the new mothers’ breastfeeding behavior record were used.Results: The response rate was n=200, 94%. Most of the new mothers perceived positive family perceptions about breastfeeding with an average score of 23.13 using the family perception of breastfeeding scale. Nearly half of the respondents reported that they exclusively breastfed their infants (n=94, 47%). The main reason for breastfeeding difficulty was inadequate lactation (n=56, 69%). The new mothers who breastfed their infants mentioned significantly stronger family perceptions/support compared to those who used mixed feeding or artificial feeding (p<0.001). There were no significant differences (p>0.05) in the types of mothers’ feeding behaviors across the different age group, occupation, ethnicity, educational level, mode of delivery, the time of the baby’s first suck, bottle feeding before the baby’s first suck and the time of having colostrums.Conclusion: It is suggested to develop some strategies, such as family-centered antenatal and postnatal education programmes, to increase the rate of exclusive breastfeeding by influencing new mothers’ families about breastfeeding. Further research is needed to explore socio-demographic variables associated with new-mothers’ breastfeeding behaviors.

Oxytocin augmentation during labor: How to implement medical guidelines into clinical practise

Stina Holmgren, Kristina Ågren Silfver, Cecilia Lind, Lennart Nordström — 2011-11-01

Abstract: Objective: To describe an extensive process to implement guidelines for oxytocin use during labor and to report its effects on compliance to clinical practice guidelines after 1year.Study design: A multifaceted strategy was developed to involve all obstetric staff and identify possible local barriers to change in advance. The process lasted for more than 1year.Main outcome measures: To describe the implementation of oxytocin use according to the new guidelines, and to compare management in clinical practice with guideline recommendations from audits performed before and after the project.Results: Identification of possible barriers to change, academic detailing, audits with feedback, and local opinion leaders were important factors for a successful process. Documentation of the indication for oxytocin use increased from 54% before, to 86% after the completion of the project (P<0.01). The percentage of incidents in which oxytocin augmentation was started before the diagnosis of labor dystocia was reduced from 40% to 11% (P<0.01). Improvement was found in the documentation of cardiotocography (from 5% to 58%, P<0.01) and contraction frequency at the start of the infusion (from 23% to 63%, P<0.01).Conclusions: Our multifaceted strategy involved all obstetric staff, lasted for more than a year, and improved management of oxytocin use according to clinical guidelines. Established rules for documentation were used as a check list to monitor oxytocin use. However, audits with feedback need to continue for medical safety, and have been planned to take place every 6 months.

Swedish midwives’ views on severe fear of childbirth

Birgitta Salomonsson, Siw Alehagen, Klaas Wijma — 2011-11-01

Abstract: Objective: To describe the views of Swedish midwives on severe fear of childbirth (SFOC).Study design: In this cross sectional study, a random sample of 1000 midwives, selected from the database of the Swedish Association of Midwives, received a questionnaire. The response rate was 84% (n=834), with 726 questionnaires included in the final analysis.Main outcome measures: The views of midwives on SFOC in different contexts of work: antenatal care clinic (ACC), labour ward (LW) either ACC/LW or Neither-Nor ACC/LW.Results: The majority of respondents thought that the frequency of SFOC has increased during the last 10years (67%), and that pregnant women today are more likely to discuss their fears (70%). Midwives at ACCs thought that special education in SFOC is needed (p<0.001) and that they have more responsibility to identify women with SFOC (p<0.001) than midwives at LWs. The majority of respondents, both at ACCs (60%) and LWs (65%), intuitively sensed when they were meeting a woman with SFOC. Opinions among midwives who alternate between working in ACCs and LWs reflected the views of the midwives working either in an ACC or an LW.Conclusions: The views of midwives on SFOC are partly in concordance and partly contradictory in relation to the different workplaces as well as research data. Knowledge of the views of midwives on SFOC is a necessary pre-requisite to improve care for pregnant women.

How to determine symptom severity in premenstrual syndrome: A combination of daily symptom ratings and interviews

Sigrid Nyberg — 2011-11-01

Abstract: Objective: To investigate how premenstrual symptoms are experienced and affect daily life, and to see if there is an agreement in reported symptom severity based on interviews compared to ratings on a symptom rating scale.Study design: Twenty-two women with different degree of premenstrual symptoms were interviewed about their symptoms. Based on the luteal-phase interviews, they were categorized in four different severity groups: severe (n=5), moderate (n=3), mild (n=8), and no symptoms/cyclicity (n=6). The interviews were then compared with rated symptom scores, number of expressed symptoms per day, number of days with symptoms, and daily life impairment.Main outcome measures: Agreement between rated symptom scores and reported symptoms in the interviews.Results: Comparing seven days in luteal phase scorings with interview data the group with no symptoms/cyclicity showed high agreement between severities reported in the interviews and daily rated scores. Among women who reported severe symptoms, an agreement was seen in three out of five. In the mild/moderate group, the agreement was less conclusive. The day of interview there was a high agreement between data from the reported symptom ratings and symptoms reported in the interview.Conclusion: Rated symptom scores the day of interview reflects well symptoms reported in the interviews. Mean symptom scores for seven luteal phase days showed an agreement between symptom ratings and symptoms expressed in interviews among women with severe symptoms and no symptoms/cyclicity. In the group with mild/moderate symptoms, data was less conclusive.

Cognizance of sexually transmitted infections among low-income men in western Kenya

Theresah Wambui, Anna-Christina Ek, Siw Alehagen — 2011-11-01

Abstract: Sexually transmitted infections (STIs) pose a worldwide health problem. To improve the efforts of prevention of STIs it is important to gain insight into the awareness of STIs among people in the society.Objective: To describe the cognizance of STIs among low-income men in western Kenya.Method: Data was collected from eight focus groups consisted of 64 men between15 and 54years of age. The interviews were audio taped and content analysis was used for the analysis.Findings: Three categories were derived: Consciousness of STIs, Risk of and prevention of STIs, and Marital relationship and STIs. The results indicate that men had some limited consciousness of STIs but that there were misunderstandings. The treatments the men mentioned were hospital treatment help, from traditional herbalists and self-administration. Condoms were regarded as an effective prevention method, but there were obstacles to using them as well as to talking about STIs within marriage.Conclusion: The study stresses the need to promote cognizance of STIs, including gender aspects, and to reduce the gap between knowing and practising.