Intrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy liver-specific disease. Induction of labor in gestational weeks 37-39 is commonly performed with the perspective to avoid the complication of stillbirth. We aimed to study whether this practice increases the risks of emergency cesarean section (CS) and fetal asphyxia.We assessed the risk of emergency CS and fetal asphyxia in ICP among women with spontaneous and induced onset of labor in comparison to women without ICP. We performed a hospital based retrospective cohort study with 25,870 singleton pregnancies, 333 with ICP (1.3%), of which 231 gave birth in weeks 37-39. Obstetric outcome was assessed through linkage of the Swedish Medical Birth Registry and a local obstetrical database based on the patient's medical files.Risk for emergency CS; fetal asphyxia and postpartum hemorrhage.The risk of emergency CS in ICP with spontaneous onset of labor (12.5%) did not differ from non ICP women with spontaneous onset of labor (9.3%; aOR, 1.33; 95% CI 0.60-2.96). When labor was induced, risk of emergency CS was significantly lower among women with ICP than among without ICP (aOR, 0.47; 95% CI 0.26-0.86). Exclusion of women with preeclampsia, gestational hypertension or diabetes mellitus did not alter the result. The risk for fetal asphyxia was not significantly associated with ICP status.Induction of labor in women with ICP gestational weeks 37-39 did not increase the risks of emergency CS or fetal asphyxia.

To investigate the relationship between breastfeeding self-efficacy and postpartum depression symptoms in a sample of Portuguese-speaking mothers in southern Brazil.There remains equivocal evidence regarding a putative association between breastfeeding self-efficacy and postpartum depression.This is a cross-sectional study in which eligible research participants completed screening questionnaires and other assessment tools. Mothers were interviewed once only in their homes between the 2nd and 12th week of the postpartum period. Research participants completed the Portuguese version of the Postpartum Depression Screening Scale (PDSS) and Edinburgh Postnatal Depression Scale (EPDS). Breastfeeding self-efficacy was evaluated through the Breastfeeding Self-Efficacy Scale (BSES-SF).A total number of 89 mothers completed the investigation: 69 (77%) were exclusively breastfeeding, whereas 20 mothers (22.7%) were partially breastfeeding at the time of the interview. Mothers who combined breastfeeding and bottle-feeding presented higher PDSS and EPDS scores. The breastfeeding self-efficacy scores were higher in mothers who exclusively breastfed and were negatively associated (p<0.001) with both EPDS and PDSS (postpartum depression) scores.These findings suggest that mothers who suffer from depressive symptoms may experience less confidence in their ability to breastfeed. This association may be particularly relevant for the purpose of screening procedures for depression and unsatisfactory breastfeeding during the postpartum period.

An instrumental vaginal birth is known to affect women's birth experience, few studies have explored the fathers' experiences of attending such a birth. The aim of this study is to compare birth outcome and parents' feelings in parents with instrumental vaginal birth or a spontaneous vaginal birth.A regional survey was conducted of 936 mothers and 827 fathers recruited in mid-pregnancy and followed up 2 months after birth. Data was collected by questionnaires. Crude and adjusted odds ratios with a 95% confidence interval were used in the analysis.The prevalence for instrumental vaginal birth was 9%. Prolonged labour (OR 8.3; 95% CI 5.0-13.9), augmentation with synthetic oxytocin (OR 5.1; 2.9-8.9), and birth complications (OR 2.5; 1.5-2.6) were more common in the instrumental vaginal group. An instrumental vaginal birth was associated with a negative birth experience for mothers (OR 3.2; 1.3-8.1) and fathers (OR 5.2; 1.2-21.5). Mothers who had an instrumental vaginal birth were more likely to report feelings that the baby would be damaged during birth (OR 3.0; 1.7-5.5) and that the birth experience made them decide not to have any more children (OR 3.4; 1.1-10.7). Fathers reported a near-panic feeling when attending an instrumental vaginal birth (OR 5.2; 1.7-15.5).An instrumental vaginal birth was correlated with longer and more complicated births, epidurals and oxytocin augmentation. It affected the birth outcome and parents' feelings and was associated with future reproductive thoughts and a negative birth experience.

This article reports on newly qualified midwives' experiences of the core elements of their transition support program; clinical rotations, supernumerary time, study days and midwife-to-midwife support.There is limited knowledge and understanding of how midwives transition from student to registered midwife and how best to support them during this time.A qualitative descriptive approach. Thirty-eight newly qualified midwives from 14 hospitals in the state of New South Wales, Australia participated. Telephone interviews and focus groups were used to collect the data. Content analysis was used to analyse the data set.Despite being employed by different hospitals, most participants were offered transition support programs that shared common core elements: rotations to a variety of clinical areas, additional study days, supernumerary time and support from colleagues. Participants stressed the importance of planned clinical rotations and supernumerary time that allowed them to ease into the new clinical area. Study days provided an opportunity for graduates to focus on new skills and to connect with their peers. Support from colleagues, managers and educators was essential, though workloads often impacted on its availability.The evidence from the project contributes to our understanding of newly graduated midwives' support needs. As such the findings can be used to inform the development, implementation and evaluation of future transition support programs that better meet the needs of graduates, the women they care for and the facilities in which they work.

The safety of planned home births remains controversial in Western countries. The aim of the present study was to compare outcomes in women who planned, and were selected to, home birth at the onset of labor with women who planned for a hospital birth.Data from 1631 planned home births between 1990 and 2007 were compared with a random sample of 16,310 low-risk women with planned hospital births. The primary outcomes were intrapartum intervention rates and complications. Secondary outcomes were perinatal and neonatal death rates.Primiparas who planned home births had reduced risks for assisted vaginal delivery (OR 0.32; 95% CI 0.20-0.48), epidural analgesia (OR 0.21; CI 0.14-0.33) and dystocia (OR 0.40; CI 0.27-0.59). Multiparas who planned home births had reduced risks for operative vaginal delivery (OR 0.26; CI 0.12-0.56), epidural analgesia (OR 0.08; CI 0.04-0.16), episiotomy (OR 0.48; CI 0.31-0.75), anal sphincter tears (OR 0.29; CI 0.12-0.70), dystocia (OR 0.10; CI 0.06-0.17) and postpartum hemorrhage (OR 0.27; CI 0.17-0.41). We found no differences in cesarean section rate. Perinatal mortality rate was 0.6/1000 (CI 0-3.4) and neonatal mortality rate 0.6/1000 (CI 0-3.4) in the home birth cohort. In the hospital birth cohort, the rates were 0.6/1000 (CI 0.3-1.1) and 0.9/1000 (CI 0.5-1.5) respectively.Planning for home births was associated with reduced risk of interventions and complications. The study is too small to make statistical comparisons of perinatal and neonatal mortality.

To explore young women's decision-making process for HPV vaccination and to identify their beliefs about HPV vaccination.This study employs a qualitative design. Data was collected by audio-taped interviews with 16 HPV vaccinated Swedish women, 17-26 years old. The data was analysed using latent content analysis.Three themes emerged from the data: "Fear of cancer", "Reliance on vaccination" and "Mother--the main motivational factor". One of the major reasons for taking the decision to be HPV vaccinated was fear of cancer: vaccination was seen as a way to protect oneself against this. The young women's decision-making surrounding HPV vaccination was based on reliance on vaccination and trust in health care. Support from the mothers of the young women and mothers' sponsorship of costs initiated HPV vaccination. Other motivational factors were advertisements and friends. Despite having been vaccinated, the young women were unaware of the relation between cervical cancer, sexual behaviour and HPV.These HPV vaccinated young women had limited knowledge about HPV. Therefore it is important that health professionals provide comprehensible information about HPV vaccination in attaining informed consent. In order to avoid misunderstandings, health care professionals in youth clinics and schools need to initiate discussion with young women, clarifying the relation between cervical cancer, HPV and sexual transmission.

In Nepal, the change of the abortion law in 2002 extended the staff duties at family planning clinics to include performing induced abortions. This study investigated the experiences, opinions and attitudes of the staff about their work at safe abortion service centres in the Kathmandu Valley and identified areas in which the health care staff stated the need for improvement.Fifteen qualitative semi-structured interviews were conducted with doctors and nurses working with induced abortion at one hospital and five clinics in the Kathmandu Valley. The interviews were transcribed verbatim and analysed using the constant comparative method.The core category 'Proud, not yet satisfied' comprised a strong perception of providing an important service that is beneficial for women's health and a feeling of pride in providing quality service. Four related categories were identified: 'Beneficial legal framework', 'A will to reach out to all women', 'Frustration about misuse' and 'Dilemma of sex-selective abortion'. The respondents emphasised that improvements are necessary to (1) ensure that all women have access to safe abortion services; (2) prevent abortions from being used instead of contraceptives; (3) stop illegal medical abortions; and (4) deal with the dilemma of sex-selective abortions.Respondents were proud of and had positive experiences from their work. They stated they have the opportunity to secure women's rights and health; however, changes are needed to bring the quality of abortion care to a satisfactory level.

The aim of this study was to describe the distribution of indications for vacuum extraction (VE) and emergency cesarean section (EMCS) from 1999 to 2010. Furthermore, we investigated the association of induction of labor and epidural analgesia (EA) on the risk of operative delivery.Population based register study with data from the Swedish Medical Birth Register during 1999-2010 including all 415230 primiparous women giving birth in gestational week 37+0 to 41+6.Indication for operative delivery as well as VE and EMCS.Among the VE deliveries the indication "signs of fetal distress" increased while "multiple indications" decreased. For EMCS, "prolonged labor" increased steadily while "multiple indications" decreased. The total rate of induction of labor increased from 8.2% in 1999 to 11.9% in 2010, and was associated with an increased risk of both EMCS (OR 3.37) and VE (OR 1.5). The total rate of EA increased from 43.7% in 1999 to 49.8% in 2010, and was associated with a double risk for VE (OR=2.23) and with an increased risk of EMCS (OR=1.64).There have been changes in the distribution of indications for VE and EMCS during the study period. A growing number of mothers are being induced and more mothers receive EA. These factors seem to have influenced the rate of operative deliveries. Our findings underline the importance of carefully considering the advantages, disadvantages and risks with EA and induction of labor.

To gain a deeper understanding of how undergraduate male medical students experience a pelvic examination learning concept and performing the first pelvic examination (PE) on a professional patient.A qualitative study. In-depth interviews with 12 male medical students' after their involvement in a learning session about the PE, with professional patients and a supervising gynecologist as instructors. The interviews were analyzed according to the constant comparative method, a variety of content analysis, to acquire a deeper understanding of the students' experiences and the ongoing social processes.The essence of the entire analysis was "Unexpected enlightening of a 'female world'" and was identified from the three categories; "Not just any exam", "Professional supportive interaction" and "Humble awareness". The male students' most prominent concern was how to establish a professional rapport with the patient in the PE situation. Beneficial active support from the professional patient and the gynecologist assisted the students to overcome inherent barriers and facilitated the examination procedure. The informants gained "inside information" from the patients' perspective of being examined leading to a new awareness about an earlier unknown "female world" that is what women might go through before and during a PE and an humble understanding of how vulnerable it is to be placed in the examination position.The beneficial PE learning concept promoted an unexpected insight in what a woman might experience during a PE, creating a humble awareness of this vulnerable intimate situation and ideas for how to establish professional rapport.