Reproduction, Childbirth and Parenting

The parenting research focuses on trying out new models of care during pregnancy, effective care during childbirth, effects of skin-to-skin contact between mother and child immediately following birth, breastfeeding, and interaction within the new family. The results from previous studies are being followed up in different contexts in order to identify evidence-based models of care with a high level of satisfaction among parents. The research on the physiological process of childbirth includes studies regarding place of birth and the midwives management during labor. The group has a large network of national and international researchers from different professions.

Significant results from previous studies

Pregnancy

IVF parents are more anxious during pregnancy than parents who have conceived without the help of assisted reproduction. It seems that the inability to conceive naturally continues to affect the emotions of a proportion of IVF parents even if a pregnancy is achieved and a child is born.

In terms of attachment to the unborn infant and the child, the results showed that IVF parents are not different from parents who have conceived without the help of assisted reproduction in this regard.

Childbirth

Acupressure reduces labour pain in nulliparous women giving birth in a context in which social support and epidural analgesia are not available. Advantages of acupressure are that this form of non-pharmacological pain relieving method is not associated with risks of infections since the skin is not penetrated by needles as is the case with acupuncture, and there are no costs for equipment. Furthermore, acupressure is easy to administer and extensive training of the person who administers the treatment is not needed.

Results from a population based study indicate that women who give birth in alternative birth settings suffer less from severe perineal trauma compared with women who give birth in the hospital. This is now being further investigated in an intervention study on two delivery wards. Women who plan for a home birth more frequently have a spontaneous vaginal delivery with fewer serious perineal or vaginal tears after the birth compared to women who give birth in the hospital. Twelve percent of the planned homebirths in the Nordic countries are transferred to hospital and the risk for a transfer is higher among primiparas. Transfer rates are higher in countries where national guidelines and financial support for homebirths are available.

Skin-to-skin studies -care of the newborn baby and his mother

Among the more important results is the description of infant prefeeding behavior and its different stages. Babies in skin-to-skin contact with their mothers become calm and relaxed which facilitates the use of all its senses to reach the nipple and start sucking the breast. In this process the baby becomes aware of its body and co-ordinates its body movements with sense of sight, hearing, smell and taste. Skin-to-skin contact thus helps the baby to reach self-regulation.

Further, effects of different interventions during labour including administration of pethidine, epidural analgesia and oxytocin infusion on both mother and infant have been studied. Routines such as gastric suction and swaddling of the newborn and its consequences on infant and mother in relation to early interaction, breastfeeding and maternal adaptations during the early postpartum period is also being investigated.

Breastfeeding

Women having had a Caesarean section release less prolactin and do not show a pulsative pattern of oxytocin when breast feeding two days after birth, which may in part explain the initial breastfeeding difficulties known from this group of mothers

When a mother encountered a situation that did not correspond to her expectations of- or her fantasies about- breastfeeding, a feeling of inadequacy and a constant questioning of oneself, both internally and externally occurred. If breastfeeding did not turn out as expected, the situation could also develop into a personal crisis. Mothers expressed a wish to be more involved and responsible than they usually are in consultative meetings with the midwife. The results have contributed to the development of the breastfeeding observation program, centring on mother’s experiences.

Mother-infant dyads with severe breastfeeding problems can be helped to a well functioning breastfeeding by repeated skin-to-skin contact. A short process oriented training of midwives and postnatal nurses improves mothers’ experience of counseling, the duration of breastfeeding and improves maternal feelings for the baby.

Care models

Parents who experience group based antenatal care (GBAC) appreciate the group model. Both group care and standard care have areas that are inconsistent and need to be improved. Similar overall satisfaction in both models of antenatal care suggests that GBAC can be introduced without altering women´s satisfaction with antenatal care.

A large proportion of postpartum mothers seek help at emergency departments in relation to breastfeeding her child or other obstetric complications. Parental support needs to be increased to the nearest postpartum period, improved continuity provides better perception of support. Postpartum care needs to be strengthened after discharge from the maternity hospital including e follow-up activities of maternal health.

Ongoing research programs within the 3B group

• Best possible start of life; Skin-to-skin care, breastfeeding and attachment (Eva Nissen)
• Fathers´ taking-on of the newborn (Wibke Jonas)
• MIMA – Midwive’s management in second stage of labor (Helena Lindgren)
• Nordic Homebirths - medical outcome and experiences from planned homebirths (Helena Lindgren)
• Mindfulness Based Childbirth and Parenting– effects on parental and child health outcomes (Eva Nissen)
• Evaluation of a clinical project with psychodynamic supervision and treatment at Child Health Centers: A quantitative and qualitative study (Björn Salomonsson)
• Implementing uninterrupted skin-to-skin contact between mothers and newborns immediately after birth in Uganda (Anna Hjelmstedt)
• Antisecretory factor as treatment for mastitis in lactating women – a randomized controlled trial (in collaboration with the Department of Clinical Sciences, Intervention and Technology) (Anna Hjelmstedt)
• Parental education groups for expectant and new parents (Mia Barimani)
• Evaluation of a treatment, Mother-Infant Psychoanalysis (MIP), for mothers and infants with “baby worries”: a qualitative study focusing on experiences from the perspectives of mothers and analysts (Björn Salomonsson)