Background

In Sweden, during the school years of 2021/22, 11,900 women and 8,100 men chose to spend a semester abroad; however, there has been little research on how they experience their time abroad and what difficulties they might face. Some studies have shown that Swedish exchange students consume alcohol to a higher degree and indulge in risky sexually behaviour while on exchange studies. Therefore, our aim was to explore Swedish exchange students' experiences from a semester abroad.

Methods

A qualitative design with semi-structured interviews. Eleven students who had spent parts of their education abroad participated in the study. A qualitative content analysis was used to analyse the data.

Results

The exchange students experienced stress due to a high workload and found that cultural differences could be both frustrating and fascinating. Some exchange students experienced minor illnesses and homesickness. The exchange students expressed a responsible view on sex and emphasized using protection against STIs while engaging in casual sex. Some enjoyed drinking alcohol to varying degrees and meeting new friends while abroad. However, they rarely engaged in excessive drinking; instead, they adopted a more spontaneous and social drinking pattern. Some experienced violence, such as robbery and harassment, and most took several safety measures, including being extra careful to lock their doors, not going out alone, and using public transport instead of taxis.

Conclusion

Swedish exchange students described stress and casual alcohol consumption as common experiences. They emphasized the importance of STI protection as well as safety measures to avoid exposure to violence. Reports of alcohol consumption, casual sex, violence, minor illnesses, and homesickness highlight the challenges faced during exchange studies. These findings indicate potential risks associated with being an exchange student.

Background Amniotomy is a commonly used labour intervention with uncertain evidence. In a recent Norwegian study, amniotomy was identified as an unrecognized risk factor for severe perineal trauma (SPT), however, the sample size was small. The aim of the present study was therefore, to investigate whether amniotomy is a risk factor for SPT, and to examine whether the timing of performing amniotomy affects the occurrence of SPT.

Methods This nationwide register-based study included 477 321 women who gave birth in 2014–2020. Data were collected from the Swedish Pregnancy Register. Simple and multiple binary logistic regression analyses was used to investigate the association between amniotomy and SPT, adjusted for other risk factors.

Results A significant association between amniotomy and SPT was found in the simple logistic regression for both nulliparous [OR 1.33; 95% CI, 1.28-1.38] and multiparous women [OR 1.12; 95% CI, 1.03-1.22]. However, this association did not remain in the multiple logistic regression in neither nulliparous [OR 0.96; 95% CI, 0.87-1.07] nor multiparous women [OR 0.83; 95% CI, 0.67-1.03].  An increased duration between amniotomy and birth decreased the odds for SPT in nulliparous women (OR 0.97; 95% CI, 0.96-0.98).

Conclusions Performing amniotomy near the birth in nulliparous women entailed an increased risk for SPT, indicating the importance of a controlled and slow birth of the baby, to prevent SPT.

Potential impact This study adds to the body of knowledge of amniotomy and SPT. Awareness of risk factors for SPT is essential to improve obstetric management for women giving birth.

Ethics and conflicts of interest The study followed the principles of the Declaration of Helsinki (World Medical Association, 2018). Ethical approvals were given by the Swedish Ethical Review Authority (No. 2019–03626, 2020–04657 and 2023-04074-02).

Objective: Amniotomy is a commonly used labour intervention with uncertain evidence. In a recent Norwegian study,amniotomy was identified as an unrecognized risk factor for severe perineal trauma (SPT), however, the sample size wassmall. The objective of the present study was therefore, to investigate whether amniotomy is a risk factor for SPT, and toexamine whether the timing of performing amniotomy affects the occurrence of SPT.

Methods: This nationwide register-based study included 477 321 women who gave birth in 2014–2020. Data werecollected from the Swedish Pregnancy Register. Simple and multiple binary logistic regression analyses were used toinvestigate the association between amniotomy and SPT, adjusted for other risk factors.

Results: A significant association between amniotomy and SPT was found in the simple logistic regression for bothnulliparous [OR 1.33; 95% CI, 1.28-1.38] and multiparous women [OR 1.12; 95% CI, 1.03-1.22]. However, thisassociation did not remain in the multiple logistic regression in neither nulliparous [OR 0.96; 95% CI, 0.87-1.07] normultiparous women [OR 0.83; 95% CI, 0.67-1.03]. An increased duration between amniotomy and birth decreased theodds for SPT in nulliparous women (OR 0.97; 95% CI, 0.96-0.98).

Conclusion: Performing amniotomy near the birth in nulliparous women entailed an increased risk for SPT, indicating theimportance of a controlled and slow birth of the baby, to prevent SPT.

BackgroundSweden has a large population of migrant women, which contributes to communication challenges and, consequently, suboptimal maternity care. Compared with native-born women, migrant women have an increased prevalence of adverse pregnancy outcomes. Miscommunication and language barriers are among the reasons for these results. Thus, language barriers can also lead to providing less information to migrant women. A digital Swedish-Arabic dialog support tool was developed and tested at antenatal care, to facilitate communication between midwives and Arabic-speaking women. This study aimed to describe midwives' perceptions of communication via Swedish-Arabic dialog support (Sadima) in antenatal care.MethodsA qualitative study was conducted with 14 midwives in antenatal care with experience communicating using a Swedish-Arabic dialog support tool. The data were collected via semi structured individual interviews and were analyzed via phenomenographic analysis.ResultsThe analysis resulted in three categories: (1) Dialog support - the skill of constructing bridges, comprised the main finding that dialog support facilitated communication by providing a multimodal way of communication including intercultural evidence-based content;(2) Dialog support - challengingly implementing adaptive efficiency, represented the implementation of dialog support to be time-consuming and, eventually, time-efficient when midwives gained digital skills; and (3) Women and their partners - the ability to be empowered, included the main finding of increased women's empowerment and control over their lives by being less dependent on interpreters.ConclusionsThe findings contribute to the understanding of communication via dialog support based on midwives' experiences. This study highlights that communication via dialog support facilitates communication between midwives and Arabic-speaking women and enhances midwives' working conditions. Within our increasingly heterogeneous societies, health care could provide support for communication via digital dialog support that is women-centered and culturally sensitive to avoid misunderstandings and delayed or incorrect treatment of migrant women.

IntroductionUmbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a spontaneous rupture of the membranes (SROM), it is possible to prevent an amniotomy, which is a commonly used intervention in labor. This study aimed to explore the incidence and risk factors that are associated with UCP in labor when amniotomy is used vs SROM.Material and methodsA retrospective nationwide register study was conducted of all births in Sweden from January 2014 to June 2020 that were included in the Swedish Pregnancy Register (n = 717 336). The main outcome, UCP, was identified in the data by the International Classification of Diseases (ICD-10) diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify the risk factors.ResultsAmniotomy was performed in 230 699 (43.6%) of all pregnancies. A UCP occurred in 293 (0.13%) of these cases. SROM occurred in 298 192 (56.4%) of all cases, of which 352 (0.12%) were complicated by UCP. Risk factors that increased the odds of UCP for both amniotomy and SROM were: higher parity, non-cephalic presentation and an induction of labor. Greater gestational age reduced the odds of UCP. Risk factors associated with only amniotomy were previous cesarean section and the presence of polyhydramnios. Identified risk factors for UCP in labor with SROM were a higher maternal age and maternal origin outside of the EU.ConclusionsUCP is a rare complication in Sweden. Beyond confirming the previously recognized risk factors, this study found induction of labor and previous cesarean section to be risk factors in labor when amniotomy is used. This is the largest study examining the incidence of umbilical cord prolapse (UCP) and its risk factors in labors when an amniotomy is used and those with a spontaneous rupture of membranes. The incidence of UCP was similar for both labors with an amniotomy and those with a spontaneous rupture of membranes. This study confirms previously recognized risk factors for UCP and identifies some differences in risk factors between labors with amniotomy and those with a spontaneous rupture of membranes.image

Introduction

Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women’s experiences of a prolonged passive second stage. 

Objective

To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women.MethodsA qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. 

Results

The analysis resulted in four themes: “An unknown phase” that entailed remaining in a phase that the women lacked an awareness of. “Trust and mistrust in the body’s ability” represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme “Loss of control” included experiences of frustration, fatigue, and having to deny bodily instincts. “Support through presence and involvement” signifies support through the midwife’s presence in the birthing room, although there were also descriptions of emotional or physical absence.

Conclusions

The findings contribute to the understanding of prolonged labour based on women’s lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

Aim

To describe educators' conceptions of the pedagogical challenges involved in teaching practical topics to nursing students at clinical skills centres (CSCs).

Design

A qualitative descriptive design.

Methods

The study used a phenomenographic approach. Data were collected through individual qualitative interviews with 17 educators teaching at CSCs, between November 2020 and March 2021. The checklist called Consolidated Criteria for Reporting Qualitative Research for qualitative research was used.

Results

Three categories of description emerged regarding the educators' conceptions of the pedagogical challenges: teaching with credibility, teaching with confidence and creating a conducive learning environment. These conceptions were interrelated based on the way that the teaching was performed. Further, the results indicate that educators had to manage two different professional areas, that is, nursing and pedagogy, which both needed to be integrated in order to create the right learning environment.

Conclusion

To increase competence and confidence, it is recommended to develop educational course for the educators at the clinical skills centre where pedagogy and nursing are intertwined.

Implications for the Profession

This study indicated the need for educators to be prepared with credibility and confidence when teaching at CSCs to create a conducive learning environment. In order to develop this, it is key to provide support through formal and informal mentoring and entail the need for educators to combine the two roles of nursing and pedagogy.

Reporting Method

Consolidated criteria for reporting qualitative research (COREQ).

Public Contribution

No patient or public contribution.

Aim: Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group. Method: Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study. Results: Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students. Conclusion: The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

Objective: To investigate the mode of delivery and birth outcomes in relation to the duration of the passive second stage of labour in nulliparous women.

Methods and findings: A retrospective cohort study of all nulliparous women (n = 1131) at two delivery units in Sweden. Maternal and obstetric data were obtained from electronic medical records during 2019. The passive second stage was defined as the complete dilation of the cervix until the start of the active second stage. The duration of the passive second stage was categorized into three groups: 0 to 119 min (0 to <2 h), 120–239 min (2- <4h) and ≥240 min (≥4h). Differences between the groups were examined using t-test and Chi2-tests and regression analyses were used to analyse adjusted odds ratio with 95% confidence intervals. The primary outcome was mode of delivery in relation to the duration of the passive second stage and the secondary outcomes covered a series of adverse maternal and neonatal birth outcomes. The rates of instrumental and caesarean deliveries increased as the duration of the passive second stage increased. A ≥4-hour duration of the passive second stage was associated with a nine-times increased risk of caesarean section, and a four-times risk of instrumental delivery compared to a duration of <2 hours in the adjusted analyses. No differences were found in the maternal birth outcomes. The risk of a 5-minute Apgar score <7 was increased in the 2-<4h group. A longer passive second stage was not associated with an increased risk of negative birth experience.

Conclusions: Our study demonstrates an increased risk of operative delivery for a longer duration (>2h) of the passive second stage in nulliparous women, although most of the women gave birth by spontaneous vaginal delivery even after ≥4 hours. There was no evidence of an increased risk of adverse maternal outcomes in a longer duration of the passive second stage but there were indications of increased adverse neonatal outcomes. Assessment of fetal well-being is important when the duration of the passive phase is prolonged.

Background

Amniotomy is one of the most commonly used interventions in modern obstetric and midwifery practice. The most severe complication to amniotomy is umbilical cord prolapse; a rare obstetric emergency that can cause fetal morbidity and/or mortality. 

Objectives

To identify risk factors for umbilical cord prolapse in labours when amniotomy is performed.

Methods

This retrospective nationwide study included data from the Swedish Pregnancy Register on all births from January 2014 to June 2020. The main outcome, umbilical cord prolapse, was identified in the data by the International Classification of Diseases (ICD-10), diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify risk factors.

Results

During the study period, a total of 614 857 women gave birth, of which 234 756 (38.18%) underwent amniotomy. Umbilical cord prolapse occurred in in 362 (0.15%) of the cases. In the final multiple regression model, twin delivery was the strongest non-modifiable risk factor (OR 10.90). Other risk factors associated with umbilical cord prolapse were higher maternal age (OR 1.02), higher Body Mass Index (OR 1.02), increasing parity (OR 1.06) and maternal country of birth outside of the EU (OR 1.43). Induction of labour was the strongest modifiable risk factor (OR 2.82). Epidural analgesia decreased the probability for umbilical cord prolapse (OR 0.33).

Conclusions

Risk factors for umbilical cord prolapse when amniotomy is used were maternal country of birth outside of the EU, higher maternal age and BMI, increasing parity, induction of labour and twin delivery. 

Key message

Knowledge on risk factors to umbilical cord prolapse, when using amniotomy, can prevent causing significant harm. In the present study; induction of labour was a modifiable risk factor for umbilical cord prolapse.