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Introduction: The aim of this study was to compare childbirth experiences and experience of labor pain in primiparous women who had received high‐ vs low‐dose oxytocin for augmentation of delayed labor. Material and methods: A multicenter, parallel, double‐blind randomized controlled trial took place in six Swedish labor wards. Inclusion criteria were healthy primiparous women at term with uncomplicated singleton pregnancies, cephalic fetal presentation, spontaneous onset of labor, confirmed delayed labor progress and ruptured membranes. The randomized controlled trial compared high‐ vs low‐dose oxytocin used for augmentation of a delayed labor progress. The Childbirth Experience Questionnaire version 2 (CEQ2) was sent to the women 1 month after birth. The CEQ2 consists of 22 items in four domains: Own capacity, Perceived safety, Professional support and Participation. In addition, labor pain was reported with a visual analog scale (VAS) 2 hours postpartum and 1 month after birth. The main outcome was the childbirth experience measured with the four domains of the CEQ2. The clinical trial number is NCT01587625. Results: The CEQ2 was sent to 1203 women, and a total of 1008 women (83.8%) answered the questionnaire. The four domains of childbirth experience were scored similarly in the high‐ and low‐dose oxytocin groups of women: Own capacity (P =.36), Perceived safety (P =.44), Professional support (P =.84), Participation (P =.49). VAS scores of labor pain were reported as similar in both oxytocin dosage groups. Labor pain was scored higher 1 month after birth compared with 2 hours postpartum. There was an association between childbirth experiences and mode of birth in both the high‐ and low‐dose oxytocin groups. Conclusions: Different dosage of oxytocin for augmentation of delayed labor did not affect women's childbirth experiences assessed through CEQ2 1 month after birth, or pain assessment 2 hours or 1 month after birth. [ABSTRACT FROM AUTHOR]

Objectives To assess changes in the number of functioning teeth (filled and sound teeth, FS- T index) from 1989/1992 to 2005 in West and East Germany and to evaluate survey- and region-specific associations between sociodemographic and behavioral risk factors and the FS- T index. Methods Within the German Oral Health Studies, random samples from 35-44-year-olds were drawn in 1989, 1992, 1997 and 2005. The FS- T index and a questionnaire with socioeconomic and behavioral items were assessed. Negative binomial regression models were evaluated, including all sociodemographic and behavioral factors simultaneously as independent variables. Results For West Germany, median FS- T index increased by 3 teeth between 1989 and 2005 ( Ptrend < 0.001). In East Germans, FS- T index was similar in 1992 and 1997 (median, 24), but increased by one tooth until 2005 ( Ptrend < 0.001). For West and East Germany, middle and high school education were significantly associated with higher FS- T indices in all surveys, although effects were most pronounced in 2005. Being married, reporting regular dental visits and good oral hygiene were significantly related to a higher number of functioning teeth in at least one survey year. Conclusions Dental health assessed as the number of functioning teeth improved between 1989/92 and 2005 in both German parts and across all educational levels. However, considering the educational level, dental health was less equally distributed in 2005 compared with previous surveys. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the feasibility of an atmospheric pressure plasma jet (PJ) for endodontic treatment and to compare the antimicrobial efficiency with conventional irrigation solutions (chlorhexidine digluconate (CHX), sodium hypochlorite (NaOCl)) against intracanal bacteria (E. faecalis) using a standardized simulated root canal model. The disinfection efficiency was determined by number of colony forming units. Scanning electron microscopy was used to investigate the effect of the treatment procedures on bacteria inside the root canal. The PJ achieved a significantly higher microbial reduction than chemical CHX irrigation and a comparable one with NaOCl. The application of PJ for endodontic treatment could provide a new possibility of controlling endodontic infection. [ABSTRACT FROM AUTHOR]

Objective. This study compares quality of life among couples who had adopted a child 4-5.5 years previously with couples whose conception was spontaneous, as well as with couples who had successful or unsuccessful in vitro fertilization (IVF) treatment. Design. Cross-sectional study. Setting. Tertiary level university hospital. Sample. From the following groups, 979 responses were obtained: adoption; successful IVF; unsuccessful IVF-living with children; unsuccessful IVF-living without children; and childbirth after spontaneous conception (controls). Methods. Quality of life was studied with the Psychological General Well Being (PGWB) and Sense of Coherence (SOC) instruments. Demographic, socio-economic and health data were obtained with additional questionnaires. Multiple variance analysis was applied. Main outcome measures. The PGWB and SOC scores. Results. After adjustment for seven confounders, the adoption group had higher PGWB scores than the unsuccessful IVF-living without children and the controls and higher SOC scores than all other groups. The unsuccessful IVF-living without children had lower PGWB and SOC scores than all other groups. The PGWB and SOC scores among controls did not differ from those with successful IVF or unsuccessful IVF-living with children. Conclusions. Adjusted PGWB and SOC scores revealed a high quality of life in the adoption group. However, the group unsuccessful IVF-living without children had low quality of life scores. Quality of life appears to be independent of the outcome of IVF treatment as long as there are children in the family. [ABSTRACT FROM AUTHOR]

Aim To assess the suitability of different definitions of caries and periodontitis for inclusion in tooth loss prediction models. Materials and Methods The Study of Health in Pomerania ( SHIP) is a population-based cohort study conducted in 1997-2001 ( SHIP-0) and 2002-2006 ( SHIP-1). This sample comprised 2,780 subjects aged 20-81 years with complete information on dental and periodontal status [ DMFS status, clinical attachment loss ( CAL) and probing depth ( PD)]. Analyses on five-year tooth loss were limited to half-mouth data. Results The predictive value of tested definitions was markedly age- and gender-dependent: in 20-39-aged men, the number of decayed or filled surfaces best predicted the number of lost teeth, whereas in young women CAL≥4 mm performed best. In older subjects, periodontal definitions were superior to caries definitions: mean CAL performed best in 40-59-year olds, whereas AL- or PD-related definitions predicted best in 60-81-year olds. On tooth level, mean CAL was the superior definition to assess 5-year incident tooth loss in all strata except for young men. Conclusions Caries parameters best predicted incident tooth loss in men aged 20-39 years; in the intermediate and oldest age group and in young women, mean AL was most informative. Therefore, prediction models need to be developed for different age and gender groups. [ABSTRACT FROM AUTHOR]

Background: Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women's experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains. Methods: A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women ( n = 1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth. Results: At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women ( p = 0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management ( p < 0.001). Conclusions: Active management of the third stage of labor does not provoke more intense afterpains than expectant management. (BIRTH 38:4 December 2011) [ABSTRACT FROM AUTHOR]

Objective. The aim of this prospective study was to identify latent phase predictors of active labor duration. Design. Prospective clinical study. Setting. Two delivery units in Sweden. Sample. Healthy nulliparous women with a normal pregnancy, spontaneous onset of active labor at term, and a cervical dilatation of 4 cm or more on admission to the delivery ward ( n = 2,072). Methods. The women were asked to answer questions concerning their food and fluid intake, amount of rest and sleep during the preceding 24 hours and to assess their labor pain, sense of security and expectations of the childbirth on a visual analog scale (VAS). Duration and intervals of contractions, cervical dilatation, and position of the fetal head were noted by the midwife. A multiple regression analysis was performed with active labor duration as the outcome variable. Main outcome measure. Predictive factors of active labor duration. Results. Normal food intake during the preceding 24 hours was associated with short labor duration. A long latent phase, low levels of assessed labor pain and few hours of rest and sleep during the preceding 24 hours were significant independent predictors of extended active labor duration, when high birth weight, long contraction intervals, slight cervical dilatation, intact membranes within 2 hours of admission, high maternal age and malposition of the fetal head were controlled for. Conclusion. New findings are that latent phase duration as well as food intake and the amount of rest and sleep during the preceding 24 hours are independent predictors of labor duration. [ABSTRACT FROM AUTHOR]

Children′s experiences of attitudes and rules for going to the toilet in school Introduction: School children often base their toilet habits on behavioural and social reasons. Bladder emptying problems, urinary tract infections and constipation are common health problems which are also associated with irregular toilet habits. School rules for going to the toilet have been shown to create difficulties for school children with bladder dysfunction. Aim of this study was to describe children’s experiences of school rules for going to the toilet and their significance for the children. Methods: Individual open-ended questions with 19 schoolchildren aged 9–16 in elementary schools. Results: To manage the children’s toilet needs, teachers used rules designed for maintaining order in the classroom. The children saw their toilets needs as a private matter and experienced it complicated to go to the toilet during recess as time was short and the risk for violation of their integrity was at its highest. The most frustrating when to comply with rules during lessons was to be forced to, in front of all their classmates, make public the need to go to the toilet: i.e the most private was exposed to the disclosure. Conclusion: The rules for going to the toilet came from the teachers’ need for maintaining order in the classroom and were not adapted to the children’s physical and developmental needs. To violate the integrity of children can affect their willingness to go to the school toilet which in turn affects their wellbeing during school time. [ABSTRACT FROM AUTHOR]

Objective. To describe and compare quality of life in men and women who had in vitro fertilization (IVF) within the Swedish public health system 4–5.5 years previously, either unsuccessfully and were subsequently living without children, or successfully, having children aged 4–5.5 years. These groups were compared to a control group of men and women with children born at the same time as in the successful group. Design. Cross-sectional study. Setting. Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Twenty-six men and 37 women in the unsuccessful group, 135 men and 154 women in the successful group and 93 men and 118 women in the control group. Methods. Questionnaire study. The respective gender differences were studied in the control and study groups. Main outcome measures. Psychological general well-being (PGWB), sense of coherence (SOC), experience of infertility, demographic-socio-economic, and health characteristics. Results. Men in the unsuccessful IVF group scored lower in total PGWB and SOC indices than the successful group men. They reported more depression, lower PGWB and lower SOC than the control group men. Women in the unsuccessful IVF group reported more anxiety, depression, and lower SOC than the successful group women and more depression and lower SOC indices than control group women. Men and women in the unsuccessful IVF group did not differ in any of the parameters. Men in the successful IVF group had higher PGWB, less signs of depression and more self-confidence than women in that group. C onclusion. Quality of life in men seems more negatively affected by involuntary infertility than reported in earlier studies. [ABSTRACT FROM AUTHOR]

Background and aims: Childhood overweight is presented as a complex problem to solve. To elaborate efforts required in striving for normal weight in overweight children healthy signs of life from the child’s point of view should be identified and promoted. The aim of the present study is to describe everyday experiences of life, body and well-being in children with overweight. Method: A qualitative descriptive design based on lifeworld perspective was used in 16 open-ended interviews with overweight children aged 10–12 years. Child overweight was defined by body mass index (kg/m2) for each age. Drawings and body pictograms were used to supplement the interviews. Text was analysed using qualitative content analysis. Findings: The primary finding was the respondents’ search for a sense of community in daily life. The respondents yearned to be part of a community but spent a lot of time alone. Parents and other family members were an important source of community but were not present enough in the respondents’ daily life. The respondents had a sound body image, were concerned about their bodies and were aware of a healthy lifestyle. Nevertheless, they did not manage to implement this awareness in practice. Unhealthy sleeping, eating and exercise habits along with a sense of victimization were revealed in the interviews. Well-being meant self-esteem, trust and satisfaction and was preserved and improved through exciting relationships and activities. Feeling well was equal to feeling capable, feeling happy and feeling a sense of community. Discussion and conclusions: Findings emphasize the problem of loneliness in the children studied. Their healthy signs of life were not promoted in an acceptable way. They spent too much time alone doing sedentary activities with easy access to junk food. Findings indicate they should be provided with company at all meals and during activities on a daily basis. [ABSTRACT FROM AUTHOR]

Background and aim: When a newborn baby needs care in a neonatal intensive care unit (NICU), the parents are welcome to stay with their child whenever they wish. The aim of the present study was to investigate the time per day parents are present together with their child at the NICU and to identify factors that facilitated and obstructed their presence. Methods: In a descriptive study 67 parents of 42 children from two NICUs registered all time they spent at the NICU and then took part in a structured interview. Findings: Parental presence at NICUs varied depending on types of accommodation offered. Those who stayed in parent rooms at the units showed a significantly higher presence with their children than parents who stayed at family hotel, at home or on a maternity ward. Factors that motivated parental presence were primarily the willingness to take parental responsibility, the child’s condition requiring it, and the want to have control. Good treatment by the staff, a family-friendly environment and high quality care were main facilitating factors for parents to be present at the NICU. Obstructing factors were primarily ill health by parents, a non-family-friendly environment, care of the home and of children at home. Conclusions: The result shows that there is a need to develop a family-friendly environment that provides optimal conditions for parents to be with their child in a NICU and to consider the parent’s own reason for being or not being present. [ABSTRACT FROM AUTHOR]

Objective. To investigate the use of oxytocin for augmentation of labor and its relation to labor progress and delivery outcome. Design and setting. A retrospective observational study undertaken in a Swedish hospital during 2000–2001. Sample. Singleton pregnancies at ≥ 37 weeks of gestation with cephalic presentation and spontaneous onset of labor. Methods. Data were collected from 1,263 clinical records. The partogram was used to diagnose labor dystocia (LD). Main outcome measures. Prevalence of oxytocin administration, LD and operative delivery. Results. Oxytocin was administered to 55% of the women (75% of primiparas and 38.1% of multiparas); a majority did not meet LD criteria. LD frequency was 19.8% (32.7% in primiparas and 7.4% in multiparas). Oxytocin was started both ‘too early’ and ‘too late’ in relation to the diagnosis of LD. Cesarean section (CS) was performed on 17.1% of primiparous and 2.4% of multiparous oxytocin recipients with LD, compared to 2.3 and 1.5%, respectively, of oxytocin recipients without diagnosed LD. Conclusions. Oxytocin augmentation was undertaken in an unstructured manner; some women were inadequately treated and others were treated unnecessarily. Oxytocin recipients with LD underwent operative delivery to a higher extent than oxytocin recipients without LD, suggesting that the main reason for CS was the underlying problem of LD rather than the oxytocin augmentation itself. [ABSTRACT FROM AUTHOR]

Objective. To describe quality of life in men and women who had terminated in vitro fertilization (IVF) within the public health system 4-5.5 years previously, and for whom treatment did not result in childbirth. Design. Cross-sectional study. Setting. Reproductive Unit, Sahlgrenska University Hospital, Gothenburg, Sweden. Sample. Four hundred pairs were invited to participate, 71% accepted and 68% completed questionnaires. Methods. Questionnaire study. Study subgroups were compared with a control group with children and with each other. Main outcome measure. Psychological General Well-Being (PGWB), Sense of Coherence (SOC), experience of infertility, demographic-socio-economic and health characteristics were measured. Results. Surprisingly, 76.7% had or lived together with children; 39.6% had biological children, 34.8% had adopted and 3.7% were parents to both biological and adopted children. No differences were found between the study and the control groups, except in SOC which scored lower in the study group. The study group with children had a higher PGWB index than the 23.3% without children and the controls. SOC scored higher in the subgroup with than those without children. Infertility was still a central issue in the subgroup without children. Conclusion. Despite having undergone unsuccessful IVF within the public health system, more than 75% lived with children 4-5.5 years later. This subgroup had a better quality of life, compared to those without children. Additional IVF treatment may result in increased quality of life. [ABSTRACT FROM AUTHOR]

Background and aims: The importance of fathers’ participation for development of the child and the well-being of the family is recognized from earlier research. In Sweden, legislation allows fathers to share the parental leave equally with the mother even so fathers only use a small of their paid leave. The aim of the study was to explore experiences of the first year as a father. Method: A phenomenological life world approach was used. Ethical approval was obtained. Ten men, recruited by a purposive sample, were interviewed 12–14 months after the delivery of their first child. The data collection was performed during June and August 2004 in the south-west area of Sweden. Findings: The essence of the experiences of the first year as father was to place the baby in the centre without giving up one’s own person. The child provided warmth and happiness in the family and men experienced a deeper relationship to their partner. The contact between father and child was facilitated by engagement and time spent alone with the child. The major constituents identified from the findings were ‘To be overwhelmed’, ‘To master the new situation’ and ‘To get a new completeness in life’. Discussion and conclusion: To master fatherhood maintenance of integrity and possibility to develop an independent relationship with the child is important. Fathers are invited to participate in postnatal childbirth education but the activities address women’s needs and it is doubtful if the fathers benefit from participation. Though fathers entered the delivery room some decades ago, as a support to the woman, health personnel of today must be aware of fathers’ own needs and the impact gender aspects have on their professional support. [ABSTRACT FROM AUTHOR]

Background. Labour dystocia (LD) is associated with adverse maternal and child outcomes. This study investigated obstetric risk factors, frequency of interventions and delivery outcomes for LD. Methods. A retrospective, observational, study of 1,480 deliveries was undertaken in a Swedish district hospital during 2000 and 2001. Results. LD was identified in 21% of deliveries, 16.7% of which ended in caesarean section (CS) compared to 1.7% of deliveries without LD. Multiparity with no previous vaginal delivery (OR=6.0), epidural analgesia (EDA) at cervical dilation ≤5 cm (OR=4.6), primiparity (OR=4.5), gestational age ≥42 weeks (OR=3.1), birth weight >4,000 g (OR=2.7) and EDA at cervical dilation >5 cm (OR=2.0) were major independent risk factors for LD. Conclusions. In delivery management, special attention should be directed to primiparous women and multiparous women with no previous vaginal delivery. Women given EDA, especially at cervical dilation ≤5 cm are also of particular interest. Furthermore, rigorous routines for LD diagnosis and oxytocin augmentation are important. [ABSTRACT FROM AUTHOR]

Present-day society has produced changes in family living patterns and conditions and this has resulted in new stressors and health problems. Most children and adolescents with chronic diseases and disabilities, who were previously cared for at hospitals and institutions for long periods, are now integrated in society and they are expected to live a normal life in the conditions that currently prevail. The number of young people with long-term illnesses/disability has increased worldwide during the last decades. There is lack of studies relating to the way young people regard their daily lives and factors that are important for their well-being. The aim of this study was to describe the meaning of feeling good in daily life in adolescents living with a long-term illness or disability. Eight boys and seven girls, aged between 12 and 19 years, with different conditions of long-term illness or disability, participated in the study. Tape-recorded interviews were conducted between the years 2003–2004 and the data were analysed using content analysis. The results revealed that the adolescents with long-term illness generally experienced well-being like everybody else. Three themes were found to be important in order to feel good: ‘a feeling of acceptance of illness/disability as a natural part of life’, ‘a feeling of support’ and ‘a feeling of personal growth’. This study concludes that adolescents with long-tem illness or disabilities experience well-being when they are allowed to prepare for living a normal life integrated in society. [ABSTRACT FROM AUTHOR]

The relationship between the midwife and the woman is essential for a positive experience for woman during childbearing period, i.e. pregnancy, childbirth and the first postpartum phase. Thereby, the aim of this study was to delineate central concepts in the midwife–woman relationship, in normal as well as high-risk situations. A secondary analysis was performed on original texts from eight Swedish qualitative studies, all with a phenomenological or phenomenological–hermeneutic approach. Six pairs of concepts were elucidated; each one describing one aspect from the woman's perspective and one responsive aspect from the midwife. The pairs of concepts are: surrender–availability, trust–mediation of trust, participation–mutuality, loneliness–confirmation, differenceness–support uniqueness and creation of meaning–support meaningfulness. Disciplinary concepts about the midwife–woman relationship have evolved that are essential for care in both normal and high-risk contexts, and we suggest that they should be implemented as a guide for midwifery care. [ABSTRACT FROM AUTHOR]

Background. This study describes maternal and neonatal characteristics and delivery outcome in women with gestational diabetes mellitus [GDM], compared to a control group. Methods. A retrospective observational study of 719 women with GDM was undertaken in a Swedish urban district. All other parturients at the same hospital served as the control group. GDM was diagnosed using random capillary glucose levels at fixed intervals, beginning early in pregnancy. An oral glucose tolerance test was performed at glucose levels ≥7.0 mmol/l (127.8 mg/dl). Data was analysed according to glucose levels at diagnosis, ie, mild or severe GDM. Results. GDM was diagnosed in 2.28% of the women who were older and had higher Body Mass Index [BMI]. A high proportion was of non-Nordic origin (44.5%); they had severe GDM more often (49.1%) than the Nordic group (33.1%). The GDM-mild group had less complications and abnormalities, compared to the GDM-severe group, although both groups differed from the control group in this respect. Delivery was spontaneous in 70.2% of GDM-mild, 65.7% of GDM-severe and 81.0% of the control group. LGA (+2 SD) was found in 4.8, 10.5 and 3.2%, respectively. Conclusion. Early non-fasting random universal screening and multidisciplinary antenatal teamwork intervention seems to be favourable, with low rates of excessive fetal growth, instrumental vaginal delivery and caesarean section. [ABSTRACT FROM AUTHOR]

Nausea and vomiting during pregnancy is a condition with an obscure aetiology. The treatment is symptomatic but there is a lack of alternative treatments. Tactile massage is known to give relaxation and increased well-being in connection with different illnesses, but has never been studied on women with severe nausea and vomiting during pregnancy (SNVP). The aim of this study was to describe hospitalized women's experiences of SNVP and of tactile massage. A phenomenological method was used. Ten hospitalized women with SNVP were included. Each woman was given tactile massage on three separate occasions. After the final massage an open interview was used covering both the experience of severe nausea and vomiting, and of tactile massage. The findings revealed an essential meaning summarizing the experience: to obtain a relieving moment of rest and access to the whole body when nausea rules life. When nausea is experienced as controlling a woman's life, tactile massage is experienced as promoting relaxation and gives her an opportunity to regain access to her body. The findings suggest that tactile massage is a good alternative and complement to traditional treatment of SNVP. [ABSTRACT FROM AUTHOR]

Background: From birth the child has an ability to respond to the environment, which influences the interaction between mother and child. If this attachment is interrupted, the child's emotional development is negatively influenced. When the child needs care in a neonatal intensive care unit (NICU) it is difficult to establish contacts between mother and child. Separation from the child is found to be the most difficult aspect for mothers when their newborn child is hospitalized in a NICU. Aim: The aim of this study was to describe mothers’ experiences when their full-term newborn child was cared for in a NICU during the postpartum maternity care period. Method: A phenomenological hermeneutic interview study was performed. Ten mothers were interviewed once, 6 months to 6 years after the experience. Results: The essence of the experience is understood as an alternation between two opposite concepts, exclusion and participation, with emphasis on exclusion. A feeling of exclusion dominates when the new mother feels a lack of interaction and a sense of not belonging to either the maternity care unit or the NICU. This has a negative effect on her maternal feelings. On the contrary, when a feeling of participation dominates, a continuous dialogue exists and the mother is cared for as a unique person with unique needs. This supports her maternal feelings in a positive direction. The implication of the result for nurses is that it is important to decrease mothers’ experience of exclusion and to increase their feeling of participation when their child is cared for in a NICU. A return visit to the responsible nurse to go through the treatment and experiences should be offered to all parents whose child has been cared for in a NICU. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2005; 19; 58–63Women's experiences of childlessness 2 years after the end ofin vitrofertilization treatmentApproximately 15% of all couples in the reproductive age are involuntarily childless. Many of these couples consult medical experts for diagnosis and treatment but not all of them achieve the results. This paper describes a study of women's experiences of childlessness 2 years after the end ofin vitrofertilization (IVF) treatment, which represents the end of infertility treatment in Swedish society. Giorgi's method, based on Husserl's phenomenology with the lifeworld theory, was used. The participants were eight women treated at the Clinic of Reproductive Medicine, Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Göteborg, Sweden. Data were generated from transcriptions of taped interviews. Five constituents emerged from the analysis: (i) childlessness is a central issue in life, (ii) IVF is a positive and important part of life, (iii) contact with other people is not an important issue, (iv) the hope of achieving pregnancy still exists and (v) attempts to identify other central issues in life. The essence of all constituents is‘life-grief’ and expresses the grief of being childless, of not reproducing, and being unable to confirm one's relationship through parenthood. The result is important in professional caring and presents a challenge to all midwives, nurses, physicians and other staff who are involved in the care of involuntarily childless women. [ABSTRACT FROM AUTHOR]

From antenatal clinics in Sweden, 271 women were recruited after week 33 of pregnancy and given a questionnaire designed to assess their attitudes and feelings about the coming childbirth. Thereafter, they formulated a birth plan. The midwife in attendance at the birth was able to refer to this plan. Women who followed this program were compared with women from the same clinics who were asked to complete a questionnaire during the first postpartum week to assess their birth experience. A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women''s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery, with respect to listening and paying attention to needs and desires, support, guiding, and respect. Although a birth plan did not improve the experience of childbirth in the overall group, there may be beneficial effects with regard to fear, pain, and concerns about the newborn for certain subgroups of women. [Copyright &y& Elsevier]

Evaluates the attitudes of birthing women towards labor duration, amniotomy, and epidural analgesia. Preference on quick and painless labor; Efficacy of amniotomy in active labor management; Effects of epidural analgesia on labor induction.

Background:   Management of the third stage of labor, the period following the birth of the infant until delivery of the placenta, is crucial. Active management using synthetic oxytocin has been advocated to decrease blood loss. It has been suggested, but not studied, that oxytocin may increase afterpains. The aim of this study was to compare women's experience of pain intensity when the third stage of labor was managed actively and expectantly and their experience of afterpains., Methods:   A single-blind, randomized, controlled trial was performed at two delivery units in Sweden in a population of healthy women with normal, singleton pregnancies, gestational age of 34 to 43 weeks, cephalic presentation, and expected vaginal delivery. Women (n=1,802) were randomly allocated to either active management or expectant management of the third stage of labor. Afterpains were assessed by Visual Analog Scale (VAS) and the Pain-o-Meter (POM-WDS) 2 hours after delivery of the placenta and the day after childbirth., Results:   At 2 hours after childbirth, women in the actively managed group had lower VAS pain scores than expectantly managed women (p=0.014). Afterpains were scored as more intense the day after, compared with 2 hours after, childbirth in both groups. Multiparas scored more intense afterpains, compared with primiparas, irrespective of management (p<0.001)., Conclusions:   Active management of the third stage of labor does not provoke more intense afterpains than expectant management., (© 2011, Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc.)